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Masuda S, Iwakiri K, Ohta Y, Minoda Y, Kobayashi A, Nakamura H. Stem alignment with short tapered-wedge cementless stems affects bone mineral density continuously for at least 5 years after primary total hip arthroplasty. Hip Int 2024; 34:57-65. [PMID: 37293785 DOI: 10.1177/11207000231178984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
AIM This study aimed to assess the relationship between the three-dimensional (3D) alignment of short tapered-wedge cementless stems and bone mineral density (BMD) changes in patients followed up for 5 years after total hip arthroplasty (THA). METHODS We retrospectively analysed the hips of 52 patients who underwent THA using short tapered-wedge cementless stems at our institution from 2013 to 2016 with complete 5-year follow-up data. We evaluated the relationship between stem alignment, measured using a 3D-templating software, and BMD changes in the 7 Gruen zones. RESULTS After 1 year, significant negative correlations between varus insertion and a decrease in BMD in zone 7 and between flexed insertion and decreases in BMD in zones 3 and 4 were noted. After 5 years, significant negative correlations between varus insertion and a decrease in BMD in zone 7 and between flexed insertion and decreases in BMD zones 2, 3, and 4 were observed. With increased amounts of varus/flexion stem alignment, the amount of BMD loss decreased. There was no correlation between anteverted stem insertion and changes in BMD levels. CONCLUSIONS Our data showed that stem alignment affects BMD based on 5-year follow-up data after surgery. Careful observation is necessary, especially when using short tapered-wedge cementless stems, as stem alignment may affect changes in BMD levels more than 5 years after surgery.
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Affiliation(s)
- Sho Masuda
- Department of Orthopaedic Surgery, Shiraniwa Hospital Joint Arthroplasty Centre, Nara, Japan
- Department of Orthopaedic Surgery, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Kentaro Iwakiri
- Department of Orthopaedic Surgery, Shiraniwa Hospital Joint Arthroplasty Centre, Nara, Japan
| | - Yoichi Ohta
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Japan
| | - Yukihide Minoda
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Japan
| | - Akio Kobayashi
- Department of Orthopaedic Surgery, Shiraniwa Hospital Joint Arthroplasty Centre, Nara, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Japan
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Mehta SP, Ellis AP, Meadows S, Lu S, Bullock M, Oliashirazi A. Rasch Analysis of Joint Replacement Version for Hip Disability and Osteoarthritis Outcome in Individuals With Advanced Osteoarthritis of Hip Awaiting Total Hip Arthroplasty Surgery. Arch Phys Med Rehabil 2023; 104:2084-2091. [PMID: 37290491 DOI: 10.1016/j.apmr.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/20/2023] [Accepted: 05/08/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The objective of this study was to examine measurement properties of the Joint replacement version for Hip Disability and Osteoarthritis Outcome Score (HOOS-JR) using Rasch analysis in patients with osteoarthritis of hip (HOA). DESIGN Cross-sectional clinical measurement SETTING: Patient outcomes database at a tertiary care hospital PARTICIPANTS: Convenience sampling of patients with HOA scheduled for total hip arthroplasty (N=327) OUTCOME MEASURES AND ANALYSIS: The data for pre-surgery assessments for patients with HOA were extracted from an existing database. Variables extracted included HOOS-JR scores, demographic information (age, sex), health-related data, and anthropometric variables. The assumptions of Rasch model such as the test of fit, fit residuals, ordering of item thresholds, factor structure, DIF, internal consistency and Pearson separation index were examined for the HOOS-JR scores. RESULTS The HOOS-JR showed adequate overall fit to the Rasch model, logically ordered response thresholds, no floor or ceiling effects, and high internal consistency (Cronbach's alpha of 0.91). The HOOS-JR did not satisfy the assumption of unidimensionality, albeit the violation of this assumption was marginal (6.12% over 5%). Person-item threshold distribution (difference between person and item means were equal to 0.92 which was less than 1 logit unit) confirmed that the HOOS-JR scores were well targeted. CONCLUSIONS Given that the violation of unidimensionality for HOOS-JR was marginal, we recommend further studies to validate this finding. Results broadly support the use of HOOS-JR for assessing hip health in patients with HOA.
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Affiliation(s)
- Saurabh P Mehta
- Physical Therapy Program, East Tennessee State University, Johnson City, TN; Dept. of Orthopedic Surgery, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV.
| | | | | | - Steve Lu
- School of Rehabilitation Science, McMaster University, Hamilton, Canada; Roth McFarlane Hand and Upper Limb Centre, St Joseph's Health Care London, London, Canada
| | - Matthew Bullock
- Dept. of Orthopedic Surgery, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV
| | - Ali Oliashirazi
- Dept. of Orthopedic Surgery, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV
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Lambrey PJ, Bonin N, Thaunat M, Gédouin JE, Flecher X, Wettstein M, Guicherd W, Prevot N, May O. What happens to endoscopic/arthroscopic tenotomies with iliopsoas impingement in the medium term? Review of a prospective cohort of 64 patients with a minimum follow-up of 5 years. Orthop Traumatol Surg Res 2023; 109:103687. [PMID: 37717656 DOI: 10.1016/j.otsr.2023.103687] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/04/2023] [Accepted: 08/22/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION The occurrence of iliopsoas impingement (IPI) after total hip arthroplasty (THA) is a proven risk factor for negative outcomes. Endoscopic or arthroscopic tenotomies of the iliopsoas offer a surgical solution with short-term results that have already been validated in prospective multicenter series. We carried out a review of the patients at more than 5 years of follow-up in order to assess the stability of the results over time. HYPOTHESIS Our main hypothesis was that endoscopic/arthroscopic tenotomies allow stable medium-term resolution of the painful symptoms of IPI. Our secondary hypothesis was that medium-term survival was satisfactory. MATERIAL AND METHOD This study is a continuation of a multicenter prospective series. Patients were contacted through multiple channels in order to: obtain an Oxford score, assess for satisfaction, psoas irritation, and daily pain on a visual analogue scale (VAS). RESULTS Of 64 patients in the original study, 57 were contacted. The Oxford score at the last follow-up was 40.7±7.7 [12-48]. There was a significant difference between the Oxford scores preoperatively, at 8 months and at the last follow-up. The mean satisfaction out of 10 was 8.0±2.1 [1-10]. We found 84% satisfaction at 5 years against 83% at 8 months. The VAS was 2.1±2.3 [0-10]. A straight leg psoas sign was present in 19.6% (10/51) of patients at 5 years, compared to 15.6% (8/51) at 8 months. The sign disappeared in four cases, while it reappeared during the interval in six cases. Survival was 91.2% (95% CI: 80.2-96.3) at 5 years. CONCLUSION Endoscopic/arthroscopic iliopsoas tenotomies represent a permanent medium-term solution to treat IPI after THA. The existence of a force differential or an acetabular overhang does not seem, within a certain limit, to impact the results in the medium term. LEVEL OF EVIDENCE IV; prospective series without control group.
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Affiliation(s)
- Pierre-Jean Lambrey
- Service de chirurgie orthopédique et traumatologique, CHU de Lille, 2, avenue Émile-Laine, 59000 Lille, France; Université Lille-Hauts de France, 59000 Lille, France.
| | - Nicolas Bonin
- Lyon Ortho Clinic, 29B, avenue des Sources, 69009 Lyon, France
| | - Mathieu Thaunat
- Centre orthopédique Santy, avenue Paul-Santy, 69008 Lyon, France
| | | | - Xavier Flecher
- Hôpital Nord, Assistance publique des hôpitaux de Marseille, 13000 Marseille, France
| | - Michael Wettstein
- ITOLS, clinique de Genolier, 3, route du Muids, 1272 Genolier, Switzerland
| | | | - Nicolas Prevot
- Clinique du sport, 4, rue Georges-Negrevergne, 33700 Merignac, France
| | - Olivier May
- Centre de chirurgie de la hanche, Médipole Garonne, 45, rue de Gironis, 31100 Toulouse, France
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Shahbazi P, Jalilvand AH, Ghaseminejad-Raeini A, Ghaderi A, Sheikhvatan M, Fallah Y, Shafiei SH. Risk Factors for Dislocation following Total Hip Arthroplasty in Developmental Dysplasia of the Hip: A Systematic Review and Meta-Analysis. INTERNATIONAL ORTHOPAEDICS 2023; 47:3063-3075. [PMID: 37688602 DOI: 10.1007/s00264-023-05949-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/16/2023] [Indexed: 09/11/2023]
Abstract
PURPOSE This systematic review and meta-analysis aimed to identify risk factors of dislocation after total hip arthroplasty (THA) in patients with developmental dysplasia of the hip (DDH). METHODS A systematic literature review was performed on 18th August 2022 using Medline, Embase, Scopus, Web of Science electronic databases, and a manual search. The study was conducted according to the PRISMA guidelines and registered with PROSPERO. Statistical analysis includes assessment of heterogeneity and data synthesis using RevMan 5.4. RESULTS Review of five studies including 2865 patients and 116 dislocated hips found that lower body mass index (BMI) (SMD = 0.22, p = 0.04, I2 = 0%), Crowe classification type IV versus I, II, and III (OR = 2.70, p = 0.004, I2 = 51%), higher cup inclination (SMD = 0.39 p = 0.0007, I2 = 0%), femoral head size < 28 mm (OR = 5.07, p = 0.003, I2 = 71%), lateral surgical approach (OR = 1.96, p = 0.02, I2 = 0%), and postoperative infection (OR = 6.26, p < 0.0001, I2 = 0%) were significant risk factors. However, age, gender, cup anteversion, femoral osteotomy, vertical (V-COR) centre of rotation, intraoperative fracture, preoperative and postoperative leg length discrepancy (LLD) and previous hip surgery were not found to be significant risk factors. CONCLUSION This study underscores importance of these risk factors in THA planning for DDH patients to reduce dislocation risk. Further research needed to understand mechanisms.
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Affiliation(s)
- Parmida Shahbazi
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Jalilvand
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Ghaseminejad-Raeini
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Ghaderi
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Sheikhvatan
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Heidelberg Medical Hospital, Heidelberg, Germany
| | - Yousef Fallah
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyyed Hossein Shafiei
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Beckers G, Manon J, Cornu O, VAN Cauter M. Unilateral versus simultaneous bilateral total hip arthroplasty. The Belgian experience. Acta Orthop Belg 2023; 89:575-579. [PMID: 38205744 DOI: 10.52628/89.4.12007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Bilateral hip osteoarthritis is frequent. The safety and patient selection for simultaneous bilateral total hip arthroplasty (SBTHA) are still debated. The purpose of this article is to share our experience and assess if performing SBTHA carries more risk than unilateral total hip arthroplasty (UTHA). METHODS A retrospective data analysis was performed on 468 patients who underwent either UTHA (418 patients) or SBTHA (50 patients) using a direct anterior approach between June 2016 and December 2020. Apart from SBTHA patients being significantly younger, there was no significant preoperative difference in demographics, comorbidities, surgical variables and biological values between the two groups. Primary outcomes were 90-days emergency room (ER) visit and readmission, as well as 90-days minor and major complications. Secondary outcomes were length of stay (LOS), operative time and blood loss. RESULTS 90-days ER visit (p=0.244), 90- days readmission (p=0.091), overall complications rate (p=0.376), minor complications (p=0.952) and major complications (p=0.258) were not statistically different between the two groups. Operative time and average LOS were significantly longer in the SBTHA group (p<0.001). Blood loss was significantly higher (p<0.001) in the SBTHA group. However, no difference in the transfusion rate between the two groups was observed (p=0.724). CONCLUSION Complication rate, 90- days hospital readmission and 90-days ER visit were similar between the two groups. This study shows that performing SBTHA is a safe, effective, and doesn't carry additional risks for patients with bilateral symptomatic osteoarthritis.
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Bahadori S, Williams JM, Collard S, Swain I. Can a Purposeful Walk Intervention with a Distance Goal Using an Activity Monitor Improve Individuals' Daily Activity and Function Post Total Hip Replacement Surgery. A Randomized Pilot Trial. CYBORG AND BIONIC SYSTEMS 2023; 4:0069. [PMID: 38435675 PMCID: PMC10907016 DOI: 10.34133/cbsystems.0069] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/17/2023] [Indexed: 03/05/2024] Open
Abstract
Individuals have increasingly high expectations of return to activity following total hip replacement (THR) surgery. The current literature demonstrates marked improvements in pain following THR. However, there is limited evidence showing objective improvement in daily activity. This randomized pilot trial aimed to determine the effect of an intervention where outdoor walking distance is used as a goal to increase daily activity of older adults using a commercial activity monitor at 3 to 6 months post THR. Findings suggested that the participants in the intervention group had higher activity levels after THR, compared to those in the control group. The Cohen's effect sizes were larger for the changes in the gait, Hip Disability and Osteoarthritis Outcome Score, and Psychosocial Impact of Assistive Devices Scale data in the intervention group in contrast to the control group. However, further research with a larger sample size is required to provide tangible evidence on the significance of the effect of the purposeful walk compared to step count.
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Affiliation(s)
- Shayan Bahadori
- Orthopaedic Research Institute,
Bournemouth University, Bournemouth, Dorset, UK
| | | | - Sarah Collard
- Faculty of Science and Technology,
Bournemouth University, Poole, Dorset, UK
| | - Ian Swain
- Orthopaedic Research Institute,
Bournemouth University, Bournemouth, Dorset, UK
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Penfold CM, Blom AW, Redaniel MT, Jones T, Eyles E, Keen T, Elliott A, Judge A. The impact of restricted provision of publicly funded elective hip and knee joints replacement during the COVID-19 pandemic in England. PLoS One 2023; 18:e0294304. [PMID: 38019830 PMCID: PMC10686417 DOI: 10.1371/journal.pone.0294304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
AIMS Elective hip and knee replacement operations were suspended in April 2020 due to the COVID-19 pandemic. The impact of this suspension and continued disruption to the delivery of joint replacement surgery is still emerging. We describe the impact of the pandemic on the provision of publicly funded elective hip and knee replacement surgery at one teaching hospital in England and on which patients had surgery. METHODS We included all elective primary and revision hip and knee replacements performed at one hospital between January 2016 and June 2021. Using data for the years 2016-2019, we estimated the expected number of operations and beds occupied per month in January 2020 to June 2021 using time series linear models (adjusting for season and trend). We compared the predictions with the real data for January 2020 to June 2021 to assess the impact of the pandemic on the provision of elective hip and knee replacements. We compared the length of stay and characteristics (age, gender, number of comorbidities, index of multiple deprivation) of patients who had surgery before the pandemic with those who had surgery during the pandemic. RESULTS We included 6,964 elective primary and revision hip and knee replacements between January 2016 and June 2021. Between January 2020 and June 2021 primary hip replacement volume was 59% of predicted, and 47% for primary knee replacements. Revision hip replacement volume was 77% of predicted, and 42% for revision knee replacement. Median length of stay was one day shorter for primary (4 vs 3 days) and revision (6 vs 5 days) operations during the pandemic compared with before. Patients operated on during the pandemic were younger and had slightly more comorbidities than those operated on before the pandemic. CONCLUSIONS The restricted provision of elective hip and knee replacements during the COVID-19 pandemic changed the patient casemix, but did not introduce new inequalities in access to these operations. Patients were younger, had more comorbidities, and stayed in hospital for less time than those treated before the pandemic. Approximately half the number of operations were performed during the pandemic than would have been expected and the effect was greatest for revision knee replacements.
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Affiliation(s)
- Chris M. Penfold
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, 1st Floor Learning & Research Building, Southmead Hospital, Bristol, United Kingdom
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Ashley W. Blom
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, 1st Floor Learning & Research Building, Southmead Hospital, Bristol, United Kingdom
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
| | - Maria Theresa Redaniel
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Tim Jones
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Emily Eyles
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Tim Keen
- North Bristol NHS Trust, Southmead Hospital, Westbury-on-Trym, Bristol, United Kingdom
| | - Andrew Elliott
- North Bristol NHS Trust, Southmead Hospital, Westbury-on-Trym, Bristol, United Kingdom
| | - Andrew Judge
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, 1st Floor Learning & Research Building, Southmead Hospital, Bristol, United Kingdom
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
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Orfanos G, Nantha Kumar N, Redfern D, Burston B, Banerjee R, Thomas G. The incidence and risk factors for abnormal postoperative blood tests following primary total joint replacement. Bone Jt Open 2023; 4:899-905. [PMID: 37995746 PMCID: PMC10667041 DOI: 10.1302/2633-1462.411.bjo-2023-0137.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2023] Open
Abstract
Aims We aim to evaluate the usefulness of postoperative blood tests by investigating the incidence of abnormal results following total joint replacement (TJR), as well as identifying preoperative risk factors for abnormal blood test results postoperatively, especially pertaining to anaemia and acute kidney injury (AKI). Methods This is a retrospective cohort study of patients who had elective TJR between January and December 2019 at a tertiary centre. Data gathered included age at time of surgery, sex, BMI, American Society of Anesthesiologists (ASA) grade, preoperative and postoperative laboratory test results, haemoglobin (Hgb), white blood count (WBC), haematocrit (Hct), platelets (Plts), sodium (Na+), potassium (K+), creatinine (Cr), estimated glomerular filtration rate (eGFR), and Ferritin (ug/l). Abnormal blood tests, AKI, electrolyte imbalance, anaemia, transfusion, reoperation, and readmission within one year were reported. Results The study included 2,721 patients with a mean age of 69 years, of whom 1,266 (46.6%) were male. Abnormal postoperative bloods were identified in 444 (16.3%) patients. We identified age (≥ 65 years), female sex, and ASA grade ≥ III as risk factors for developing abnormal postoperative blood tests. Preoperative haemoglobin (≤ 127 g/dl) and packed cell volume (≤ 0.395 l/l) were noted to be significant risk factors for postoperative anaemia, and potassium (≤ 3.7 mmol/l) was noted to be a significant risk factor for AKI. Conclusion The costs outweigh the benefits of ordering routine postoperative blood tests in TJR patients. Clinicians should risk-stratify their patients and have a lower threshold for ordering blood tests in patients with abnormal preoperative haemoglobin (≤ 127 g/l), blood loss > 300 ml, chronic kidney disease, ASA grade ≥ III, and clinical concern.
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Affiliation(s)
- Georgios Orfanos
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK
| | - Nakulan Nantha Kumar
- Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
- Keele University, Newcastle, UK
| | - Daniel Redfern
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK
| | - Ben Burston
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK
| | - Robin Banerjee
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK
| | - Geraint Thomas
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK
- Keele University, Newcastle, UK
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Wu L, Li X, Hua L, Sun Q. Effects of technology-assisted rehabilitation for patients with hip arthroplasty: A meta-analysis. Medicine (Baltimore) 2023; 102:e35921. [PMID: 37960720 PMCID: PMC10637488 DOI: 10.1097/md.0000000000035921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 10/12/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND To investigate the efficacy of technology-assisted rehabilitation compared to that of usual care programs after total hip arthroplasty (THA) through randomized controlled trials (RCTs). METHODS The Medline (PubMed), Cochrane Library, Embase and Web of Science databases were searched for RCTs regarding the efficacy of technology-assisted rehabilitation following THA. Data were analyzed using Stata 12.0 software. RESULTS Eleven RCTs involving 1327 patients were included in the meta-analysis. The pooled effect size showed that compared to usual care, telerehabilitation significantly improved the Harris score (standardized mean difference [SMD] 0.74, 95% confidence interval [CI] 0.58 to 0.90) and functional independence measure (FIM) score (SMD 1.26, 95% CI 0.48 to 2.03). In addition, video-based therapy could significantly improve walk test results (SMD 0.43, 95% CI 0.11 to 0.75). CONCLUSION The findings suggest that technology-assisted rehabilitation, especially telerehabilitation, have been shown to improve the physical function of patients following THA compared to conventional rehabilitation. More robust studies are needed to validate the long-term efficacy and safety of innovative technology-assisted training strategies.
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Affiliation(s)
- Lingyun Wu
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiaoyan Li
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
| | - Lijiangshan Hua
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
| | - Qiuhua Sun
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
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Li F, Huang X, Liu W, Huang W, Cheng J, Yin D. Dexamethasone with aggressive warming facilitates pain reduction, reduced blood loss, and quicker recovery after total hip arthroplasty. Sci Rep 2023; 13:19582. [PMID: 37950063 PMCID: PMC10638361 DOI: 10.1038/s41598-023-47050-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 11/08/2023] [Indexed: 11/12/2023] Open
Abstract
This study aimed to evaluate the optimal frequency of dexamethasone (DEX) administration and the efficacy of DEX with aggressive warming in total hip arthroplasty (THA), which remains unclear. A total of 150 patients were treated with DEX (10 mg) once before and once or twice after surgery with or without intraoperative aggressive warming. On postoperative day 3, the dynamic visual analogue scale scores and C-reactive protein (CRP) and interleukin-6 (IL-6) levels in participants administered with DEX twice after surgery were significantly lower than those who did not receive the second dose. The range of motion (ROM), postoperative fatigue based on Identity-Consequence-Fatigue Scale, average temperature at different stages, intraoperative blood loss, and postoperative drainage volume in patients who were subjected to warming were significantly higher than those who were not. The degree of satisfaction was also higher in the patients who received both second dose and warming than those who received neither. No differences in complications were observed based on the treatments. An additional dose of DEX at 48 h post-surgery has short-term advantages in terms of analgesia, anti-inflammatory effects, and accelerated rehabilitation after THA. DEX combined with aggressive warming further optimises short-term ROM and fatigue and improves the degree of satisfaction.Clinical trial was registered in the International Clinical Trial Registry, and the date of registration is 2/12/2020 (ChiCTR2000040560).
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Affiliation(s)
- Fulin Li
- Department of Joint and Sports Medicine Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Xiao Huang
- Department of Joint and Sports Medicine Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Wenhui Liu
- Department of Joint and Sports Medicine Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Wenwen Huang
- Department of Joint and Sports Medicine Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Jinwen Cheng
- Department of Joint and Sports Medicine Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Dong Yin
- Department of Joint and Sports Medicine Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China.
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Erivan R, Bourzat N, Mulliez A, Mougues C, Descamps S, Boisgard S, Villatte G. Single-use versus reusable ancillaries for dual mobility cup in total hip replacement. A prospective randomized short-term safety and feasibility comparison. Orthop Traumatol Surg Res 2023; 109:103658. [PMID: 37451339 DOI: 10.1016/j.otsr.2023.103658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/07/2023] [Accepted: 06/13/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Single-use (SU) ancillaries for cup preparation in total hip arthroplasty (THR) aim to reduce the costs of hip replacement surgery. These devices have been recently introduced, but their safety and feasibility have not been studied. Therefore, we performed a prospective randomized study aiming to assess the impact in our department of using these SU ancillaries versus standard reusable ancillaries for dual mobility THR regarding 1) the cost, 2) operative time, 3) quality of primary fixation. HYPOTHESIS We hypothesized that the use of SU ancillaries for acetabular preparation would reduce maintenance costs, and so optimise the operating procedure, reduce the overall cost of surgery, save time, while maintaining the same quality of prosthesis fitting. METHOD We conducted a randomised, controlled, open-label, two-arm, single-centre, prospective therapeutic trial with a medico-economic objective. Inclusions were made prospectively from patients hospitalised and surgically managed in our department for arthrosis over 18 years old treated with dual mobility THR. RESULTS In the current study, 18/20 (90%) of the cases required the use of one SU reamer when using SU ancillaries. Only two cases (10%) required a second SU reamer (without SU failure regarding the acetabular implant) because there was too much subchondral bone left and not enough cancellous bone allowing correct cup fitting. We also found that the test implant supplied in the SU kit had a less secure press-fit than the reusable metal test implants. There was one of primary press-fit failure in the SU group requiring a different cup with additional screws. The estimated cost to the supplier per procedure was 20,105 euros using single-use reamers versus 26,666 euros using conventional ancillary kits, a saving of 6561 euros (p<0.001). For the healthcare institution, the median price per intervention on the differentiating points was 2648 euros versus 2580 euros, with no significant difference (p=0.297). The results show an average societal cost of 52,199 euros using single-use and 53,572 euros using reusable ancillary equipment, with a significant difference between the two groups (p<0.003). The average cost of Healthcare Risk Waste (HCRW) disposal in the SU group was 5.2 euros per intervention against 5.1 euros in the RU group, without significant difference (p=0.910). We found a similar result for the cost of disposal of non-HCRW waste per procedure: 0.37 euros in the SU group versus 0.34 in the RU group, without significant difference (p=0.345). CONCLUSION SU ancillaries significantly reduce the table set up time and have the potential to facilitate time and cost savings but further research is needed in this direction. Our study shows that the daily workload, operating times, and the number of boxes of instruments to be sterilised are decreased. The associated environmental gain is significant. Nevertheless, the economic promise of these SU ancillaries is only partially supported in this trial owing to the small number of patients. Further work will be needed to obtain a more powerful medico-economic assessment of this promising ancillary product. LEVEL OF EVIDENCE II; prospective randomized study.
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Affiliation(s)
- Roger Erivan
- Université de Clermont Auvergne, CHU de Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France.
| | | | - Aurélien Mulliez
- Délégation à la recherche clinique et aux innovations (DRCI), CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Chalin Mougues
- Délégation à la recherche clinique et aux innovations (DRCI), CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Stéphane Descamps
- Université de Clermont Auvergne, CHU de Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France
| | - Stéphane Boisgard
- Université de Clermont Auvergne, CHU de Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France
| | - Guillaume Villatte
- Université de Clermont Auvergne, CHU de Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France
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Vignesh R, Sharma V, Basu B. Computational nodal displacement analysis of acetabulum fossa for injection molded cemented polyethylene acetabular liner. J Mech Behav Biomed Mater 2023; 147:106109. [PMID: 37742598 DOI: 10.1016/j.jmbbm.2023.106109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 09/05/2023] [Accepted: 09/05/2023] [Indexed: 09/26/2023]
Abstract
The acetabular liner (AL) is one of the key components that determine the functionality and durability of the total hip joint replacement (THR) device. The performance of Ultra high molecular weight polyethylene (UHMWPE)-based AL depends critically on the manufacturing route and its properties, which are evaluated pre-clinically using a host of experimental and computational analyses. The conventional manufacturing of an AL involves multiple stages, including extrusion/compression molding followed by machining, which is time/cost intensive and leads to material loss. In such a scenario, injection molding is a promising alternative, yet its feasbility remains unexplored for the manufacturing of AL for THA applications. Against this backdrop, the two-fold objectives of this work are to report our recent efforts to establish the efficacy of the injection molding of new generation UHMWPE biomaterial; HU (60 wt% HDPE- 40 wt% UHMWPE blend) for manufacturing AL prototype and to present the key biomechanical response analysis of this prototype, in silico. A range of manufacturing relevant material properties, as well as customized mold design to manufacture HU-based AL with external design features, are discussed. Such guidelines are particularly relevant to mold polymeric parts with a higher thickness (>8 mm). As part of the pre-clinical validation of AL with new design features, a less explored in silico approach to assess biomechanical micro-strain in the acetabulum fossa is presented, and the results are analysed in accordance with the mechanostat theory. The outcomes revealed that for a 100 kg subject weight, average micro-strain in the remodelling region was 1132, while it was determined as 723 for a 55 kg subject weight. Such results highlight the influence of subject weight on micro-strain generation and distribution in the acetabulum fossa. The von Mises stress in AL also increased with subject weight from 17 MPa in a subject weight of 55 kg to 28 MPa in a subject weight of 100 kg. Taken together, this work demonstrates the feasibility and competence of this new generation biomaterial in terms of implant manufacturing via injection molding with a clinically desired biomechanical response.
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Affiliation(s)
- R Vignesh
- Laboratory for Biomaterials, Materials Research Centre, Indian Institute of Science, Bangalore 560012, India; Centre of Excellence for Dental and Orthopedic Applications, Material Research Centre, Indian Institute of Science, Bangalore 560012, India
| | - Vidushi Sharma
- Laboratory for Biomaterials, Materials Research Centre, Indian Institute of Science, Bangalore 560012, India; Centre of Excellence for Dental and Orthopedic Applications, Material Research Centre, Indian Institute of Science, Bangalore 560012, India
| | - Bikramjit Basu
- Laboratory for Biomaterials, Materials Research Centre, Indian Institute of Science, Bangalore 560012, India; Centre of Excellence for Dental and Orthopedic Applications, Material Research Centre, Indian Institute of Science, Bangalore 560012, India; Centre for Biosystems Science and Engineering, Indian Institute of Science, Bangalore 560012, India.
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63
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Garcia-Barreiro G, Huespe I, Llano L, Dozo M, Benchimol JA, Rebecchi P, Taype D, Barla J, Sancineto C, Carabelli G. Patients with trochanteric hip fractures and pre-existing osteoarthritis can be treated with nailing osteosynthesis without significant decrease in functional status. Injury 2023; 54 Suppl 6:110735. [PMID: 38143114 DOI: 10.1016/j.injury.2023.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/25/2023] [Accepted: 04/12/2023] [Indexed: 12/26/2023]
Abstract
PURPOSE Functional outcome in patients after trochanteric fracture fixation with pre-existing radiographic osteoarthritis (OA) is unclear. Analyzing their function and independence, before and after fracture, could optimize their treatment and decrease the socioeconomic burden in this particular group. METHODS The influence of pre-existing radiographic hip OA on functional outcome was retrospectively analyzed with a cohort of patients undergoing proximal femoral nailing for trochanteric fracture. OA was graded according to the Tonnis classification. Functional outcome was assessed preoperatively and 12 months after surgery by the Parker Mobility Score (PMS). We consider a meaningful reduction a difference between preoperatively PMS and 12 months after surgery ≥ 2. In order to evaluate if OA is related to PMS reduction ≥ 2, we calculate the SubHazard ratio (SHR) performing a competing risk regression model considering death as a competing risk event, adjusting by confounders. Death, reoperations, readmissions, surgical time, and fracture reduction quality in patients with and without osteoarthritis were recorded. RESULTS 375 trochanteric hip fractures treated with cephalomedullary nails were included, from which 80 (21% CI95% 17%-21%) were classified as Tonnis 2 or 3. This group of patients with pre-existing OA was significantly older (mean age of 88.6 [SD 5.65] vs 85.5 years [SD 6.95]) than the group without OA. The preoperatively PMS score was 6.28 (2.71) in non-OA patients and 5.69 (2.67) in OA patients. The mean PMS reduction 12 months after surgery was 1.3 (SD 2.05) in OA patients and 1.07 (SD 2.2) in non-OA patients (p = 0.43). Competing risks analysis, adjusted by confounders had an SHR of 1.15 (IC95% 0.77 - 1.69). Death, readmission, reoperations, surgical time, and fracture reduction quality did not differ in both groups. CONCLUSIONS Patients with pre-existing radiographic OA treated with femoral nailing have a similar reduction in functional outcomes compared to the non-OA group at one-year follow-up. Further studies will be needed to compare the results of the functional outcome in arthroplasty with those of femoral nailing for the treatment of trochanteric femur fractures in patients with OA.
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Affiliation(s)
- Gonzalo Garcia-Barreiro
- Orthopaedic Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina.
| | - Ivan Huespe
- Orthopaedic Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina.
| | - Lionel Llano
- Orthopaedic Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina.
| | - Marcelo Dozo
- Orthopaedic Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina
| | - Javier Alberto Benchimol
- Orthopaedic Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina
| | - Pilar Rebecchi
- Orthopaedic Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina.
| | - Danilo Taype
- Orthopaedic Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina.
| | - Jorge Barla
- Orthopaedic Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina.
| | - Carlos Sancineto
- Orthopaedic Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina.
| | - Guido Carabelli
- Orthopaedic Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina.
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Venishetty N, Beale J, Martinez J, Mounasamy V, Sambandam S. Understanding factors that impact the length of stay after total hip arthroplasty - A national in-patient sample-based study. J Clin Orthop Trauma 2023; 46:102284. [PMID: 38046927 PMCID: PMC10687332 DOI: 10.1016/j.jcot.2023.102284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 07/15/2023] [Accepted: 11/15/2023] [Indexed: 12/05/2023] Open
Abstract
Background Total hip arthroplasty (THA) is increasingly used every year; however, there is currently limited information on factors that impact the length of stay (LOS) following the procedure. Longer LOS following THA is met with an increase in the cost of care, necessitating studies to identify factors that may impact LOS. Methods In this retrospective study, we used the Nationwide Inpatient Sample (NIS) database from 2016 to 2019 to analyze the preoperative comorbidities and postoperative complications that impact the LOS following THA. We divided our cohort into patients with a LOS greater than two days, and patients with a LOS less than two days. Results A total of 367,890 patients were identified in the NIS database who underwent THA during the study period. Of this cohort, 112,288 (30.52%) patients were identified as having a LOS greater than two days, while the remaining 255,602 (69.48%) patients were patients who had a LOS less than two days. Multivariate analysis demonstrated several pre-operative factors, such as diabetes, systemic lupus erythematosus, organ transplant, dialysis, the human immunodeficiency virus, chronic kidney disease, and Parkinson's disease, were independently associated with a higher risk of a LOS greater than two days. The subsequent multivariate analysis for post-operative variables demonstrated that acute renal failure, myocardial infarction, blood loss anemia, blood transfusion, pulmonary embolism, deep vein thrombosis, periprosthetic fracture, periprosthetic mechanical complications, periprosthetic infections, and wound dehiscence were all independently associated with a higher risk of a LOS greater than two days. Conclusions Several pre-operative comorbidities and postoperative complications were found to increase the likelihood of a LOS greater than two days. In addition, the group with a LOS greater than two days incurred a higher cost of care. This information is useful for providers to make informed decisions regarding patient care and resource utilization for patients undergoing THA, potentially reducing LOS.
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Affiliation(s)
- Nikit Venishetty
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Jack Beale
- University of Texas Southwestern, Dallas, TX, USA
| | | | - Varatharaj Mounasamy
- Department of Orthopedics, University of Texas Southwestern, Dallas VAMC, Dallas, TX, USA
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Perrin T, Bonnomet F, Diemunsch S, Drawin L, Pottecher J, Noll E. Early perioperative quality of recovery after hip and knee arthroplasty: a retrospective comparative cohort study. INTERNATIONAL ORTHOPAEDICS 2023; 47:2637-2643. [PMID: 37542539 DOI: 10.1007/s00264-023-05903-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/15/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE Increasing our knowledge about postoperative global Quality-Of-Recovery (QoR) after THA and TKA is important to improve perioperative medicine, in particular for preoperative patient information and benchmarking of postoperative patient status. METHODS This study is a single centre, retrospective cohort study of prospectively collected data, conducted in Strasbourg University Hospital, Strasbourg, France. The main outcome was the modified French version of the QoR-15 (mQoR-15F) score monitored preoperatively, at postoperative day one, three, 14 and 28. We questioned the hypothesis: would THA and TKA recovery patterns differ and would postoperative health status eventually overreach the preoperative reference? RESULTS The mQoR-15F was statistically higher in the THA group compared to the TKA group in POD 1 and 28 (112 ± 17 vs. 107 ± 17; p < 0.01 and 131 ± 12 vs. 127 ± 15; p = 0.02, respectively). The mean postoperative time delay to reach preoperative mQoR-15F was seven and 16 days for THA and TKA patients, respectively. CONCLUSION Early postoperative health status after THA and TKA differs significantly; TKA being associated with a larger early decrease of global health status compared to THA. Both THA and TKA groups global health status overreached preoperative levels after one and two weeks postoperatively. These surgery-specific recovery profiles may favor improved patient information to steer advised operative decision and set specific recovery goals as part of enhanced recovery pathways.
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Affiliation(s)
- Thomas Perrin
- Department of Anesthesiology, Intensive Care & Perioperative Medicine, Hautepierre Hospital, Strasbourg University Hospital, 1 Avenue Molière 67098, Strasbourg, France
| | - François Bonnomet
- Department of Orthopedic and Trauma Surgery, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France
| | - Sophie Diemunsch
- Department of Anesthesiology, Intensive Care & Perioperative Medicine, Hautepierre Hospital, Strasbourg University Hospital, 1 Avenue Molière 67098, Strasbourg, France
| | - Leopold Drawin
- Department of Anesthesiology, Intensive Care & Perioperative Medicine, Hautepierre Hospital, Strasbourg University Hospital, 1 Avenue Molière 67098, Strasbourg, France
| | - Julien Pottecher
- Department of Anesthesiology, Intensive Care & Perioperative Medicine, Hautepierre Hospital, Strasbourg University Hospital, 1 Avenue Molière 67098, Strasbourg, France
| | - Eric Noll
- Department of Anesthesiology, Intensive Care & Perioperative Medicine, Hautepierre Hospital, Strasbourg University Hospital, 1 Avenue Molière 67098, Strasbourg, France.
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Zampogna B, Papalia GF, Ferrini A, Torre G, Vorini F, Diaz Balzani LA, Farsetti P, Papalia R. Dual-mobility total hip arthroplasty in patients younger than 55 years old: a systematic review. Arch Orthop Trauma Surg 2023; 143:6821-6828. [PMID: 37062001 DOI: 10.1007/s00402-023-04882-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 04/09/2023] [Indexed: 04/17/2023]
Abstract
Total hip arthroplasty (THA) is regarded as one of the most successful and cost-effective orthopedic procedures. However, THA is a surgical procedure with potential intraoperative and postoperative risks. Dislocation is one of the common postoperative complications and remains one of the main indications for THA revision. The purpose of this systematic review was to evaluate the role and the outcomes of dual-mobility implant to prevent dislocation in patients younger than < 55 years in primary THA. In this systematic review, we included observational, prospective, and retrospective studies that evaluated the outcome and the complications of the dual-mobility cup in < 55-year-old patients. After applying exclusion criteria (femoral neck fractures or THA revision, case series, reviews, and meta-analyses), ten articles were included in the study. The overall number of participants in all the studies was 1530. The mean age of the participants was 50 years. The mean follow-up was 11.7 years. A total of 46 patients (2.7%) reported intraprosthetic dislocations, in which the polyethylene liner dissociates from the femoral head, while 4.8% of revision was due to aseptic loosening. The mean revision rate at twelve years was 11%. The mean value of Harris Hip Score increased from 50.9 pre-operatively to 91.6 after surgery. Dual mobility is a valid option for young patients with extended survivorship and low rates of instability and dislocation after primary THA.
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Affiliation(s)
- Biagio Zampogna
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21-00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128, Rome, Italy
| | - Giuseppe Francesco Papalia
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21-00128, Rome, Italy.
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128, Rome, Italy.
| | - Augusto Ferrini
- Department of Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Rome, Italy
| | - Guglielmo Torre
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21-00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128, Rome, Italy
| | - Ferruccio Vorini
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21-00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128, Rome, Italy
| | - Lorenzo Alirio Diaz Balzani
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21-00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128, Rome, Italy
| | - Pasquale Farsetti
- Department of Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Rome, Italy
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21-00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128, Rome, Italy
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Davis TP. Metal-on-Metal Hip Arthroplasty: A Comprehensive Review of the Current Literature. Cureus 2023; 15:e48238. [PMID: 37929272 PMCID: PMC10624517 DOI: 10.7759/cureus.48238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 11/07/2023] Open
Abstract
Metal-on-metal (MoM) total hip arthroplasty has been widely used since the end of the 20th century, although rates have now decreased due to concerns regarding adverse reactions and failure rates. The MoM implant has been replaced with other materials, such as ceramic-on-ceramic (CoC) and metal-on-polyethylene (MoP). This literature review looks at the past and present use of MoM prostheses to assess whether the turn away from MoM use is justified. Online literature searches were performed on PubMed, Ovid Medical Literature Analysis and Retrieval System Online (MEDLINE), and Web of Science online databases using the search terms "MoM and (ARMD and ALVAL)" (ARMD: adverse reaction to metal debris; ALVAL: aseptic lymphocyte-dominant vasculitis-associated lesion). A total of 64 relevant titles were included in the review. Although risk factors for adverse reactions and the causes of ARMD are generally agreed upon, more work is required to further understand the specific thresholds of blood metal ion levels that can be used to consistently identify ARMD and excessive metal wear-debris in patients who have not had their MoM implants revised. Metal-on-metal devices are not an acceptable option for total hip arthroplasties (THAs) in their current formulation due to the high rate and risk of ARMD. Some MoM hip resurfacing operations are appropriate for very carefully selected patients who are fully aware of the risks posed by the implant. It is recommended that device-specific thresholds for metal ion levels be developed to identify patients at risk of ARMD locally and systemically while using auxiliary tools to assist diagnosis, such as metal artefact reduction sequences (MARS)-MRI and hip scoring tools. Further work should investigate device-specific blood metal ion levels, the systemic effects of raised metal ion concentrations secondary to MoM arthroprosthetic wear, and the potential risks of ARMD caused by wear from tapered stems (including the implications this has for patients with CoC and MoP prostheses).
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Affiliation(s)
- Timothy P Davis
- Department of Anatomy, University of Nottingham Medical School, Nottingham, GBR
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Ronconi G, Codazza S, Panunzio M, La Cagnina F, Ariani M, Gatto DM, Coraci D, Ferrara PE. The Effects of Ultrasound-Guided Intra-Articular Injections with Hyaluronic Acid and Corticosteroids in Patients with Hip Osteoarthritis: A Long-Term Real-World Analysis. J Clin Med 2023; 12:6600. [PMID: 37892738 PMCID: PMC10607283 DOI: 10.3390/jcm12206600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/11/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023] Open
Abstract
Intra-articular (IA) ultrasound-guided hip injections are currently considered a cornerstone of the conservative management of symptomatic hip osteoarthritis (HOA), although their effect on clinical outcomes has not been fully elucidated.The purpose of this study is to investigate the effectiveness of ultrasound-guided IA hip injections of hyaluronic acid (HA) with or without corticosteroids (CS) on pain relief and functional improvement in patients with HOA. In total, 167 patients with HOA were assessed at baseline (T0) and 12 months after injection (T1) using the VAS and GLFS scores. The sample consisted mainly of female subjects (58.1%), presenting an average age of 70.6 ± 12.2 years and grade 3 HOA (63.9%) according to the Kellgren-Lawrence classification. Most of the patients (76.2%) underwent unilateral hip injection with a combination of medium-high molecular weight HA (1500-2000 kDa) and CS. At T1, lower use of anti-inflammatory drugs, an increase in the consumption of chondroprotectors, and an overall reduction of instrumental physical therapies and therapeutic exercise were recorded. In addition, a statistically significant intragroup and between-group decrease observed at T1 for both the VAS and GLFS. Study results suggested that intra-articular hip injections with HA alone and with CS could represent a useful therapeutic tool for pain reduction and functional improvement for patients with hip osteoarthritis.
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Affiliation(s)
- Gianpaolo Ronconi
- Department of Rehabilitation, Catholic University of Sacred Heart, 00168 Rome, Italy;
- Department of Ageing, Neurosciences, Head-Neck and Orthopaedics Sciences, University Polyclinic Foundation Agostino Gemelli IRCSS, 00168 Rome, Italy; (M.A.); (D.M.G.); (P.E.F.)
| | - Sefora Codazza
- Department of Ageing, Neurosciences, Head-Neck and Orthopaedics Sciences, University Polyclinic Foundation Agostino Gemelli IRCSS, 00168 Rome, Italy; (M.A.); (D.M.G.); (P.E.F.)
| | | | - Fabiana La Cagnina
- Physical and Rehabilitation Medicine, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Mariantonietta Ariani
- Department of Ageing, Neurosciences, Head-Neck and Orthopaedics Sciences, University Polyclinic Foundation Agostino Gemelli IRCSS, 00168 Rome, Italy; (M.A.); (D.M.G.); (P.E.F.)
| | - Dario Mattia Gatto
- Department of Ageing, Neurosciences, Head-Neck and Orthopaedics Sciences, University Polyclinic Foundation Agostino Gemelli IRCSS, 00168 Rome, Italy; (M.A.); (D.M.G.); (P.E.F.)
| | - Daniele Coraci
- Department of Neuroscience, Section of Rehabilitation, University of Padova, 35122 Padova, Italy;
| | - Paola Emilia Ferrara
- Department of Ageing, Neurosciences, Head-Neck and Orthopaedics Sciences, University Polyclinic Foundation Agostino Gemelli IRCSS, 00168 Rome, Italy; (M.A.); (D.M.G.); (P.E.F.)
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Zhang Z, Zhang F, Yang X, Fan H, Cheng Q, Guo H. The efficacy and safety of direct superior approach (DSA) for total hip arthroplasty: a systematic review and meta-analysis. J Orthop Surg Res 2023; 18:764. [PMID: 37817232 PMCID: PMC10563322 DOI: 10.1186/s13018-023-04233-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/24/2023] [Indexed: 10/12/2023] Open
Abstract
OBJECTIVE To systematically evaluate the clinical safety and efficacy of the direct superior approach and the conventional surgical approach. DATE SOURCES From PubMed, Embase, the Cochrane Library, and China Knowledge Network up to January 30, 2023. MAIN RESULTS A total of 7 case series involving 4306 patients undergoing total hip arthroplasty were included, including 679 patients with direct superior approach. All outcome measures: Oxford Hip Score [MD = 0.30, 95% CI (- 0.87, 1.47), P = 0.62], Hip Harris Score [MD = - 0.18, 95% CI (- 0.86, 0.49), P = 0.59], intraoperative blood loss [MD = - 54.14, 95% CI (- 102.75,-5.52), P = 0.03], transfusion rate [MD = 0.49, 95% CI (0.29, 0.83), P = 0.008], Limb Length Differences [MD = - 0.21, 95% CI (0.02, 0.39), P = 0.03], Length of Stay [MD = - 0.61, 95% CI (- 0.69, - 0.52), P < 0.00001]. CONCLUSIONS The DSA was superior to conventional access in terms of incision length, bleeding, postoperative transfusion rate, and early postoperative HHS. In addition, our study found that because the DSA has less tissue damage, it has the potential advantages of accelerating patient recovery after surgery, shortening hospitalization time, and reducing patient economic pressure, which can significantly improve patient quality of life and satisfaction.
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Affiliation(s)
- Zhuangzhuang Zhang
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, China
| | - Fukang Zhang
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, China
| | - Xin Yang
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, China
| | - Hua Fan
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, China
| | - Qinghao Cheng
- Orthopedics IV, Gansu Provincial Hospital, No. 204 Donggang West Road, Chengguan District, Lanzhou, China
| | - Hongzhang Guo
- Orthopedics IV, Gansu Provincial Hospital, No. 204 Donggang West Road, Chengguan District, Lanzhou, China.
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Sun J, Huang L, Yang Y, Liao H. Risk assessment and clinical prediction model of planned transfer to the ICU after hip arthroplasty in elderly individuals. BMC Surg 2023; 23:305. [PMID: 37805523 PMCID: PMC10559453 DOI: 10.1186/s12893-023-02204-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 09/23/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND With the development of hip arthroplasty technology and rapid rehabilitation theory, the number of hip arthroplasties in elderly individuals is gradually increasing, and their satisfaction with surgery is also gradually improving. However, for elderly individuals, many basic diseases, poor nutritional status, the probability of surgery, anaesthesia and postoperative complications cannot be ignored. How to reduce the incidence of postoperative complications, optimize medical examination for elderly patients, and reasonably allocate medical resources. This study focuses on the construction of a clinical prediction model for planned transfer to the ICU after hip arthroplasty in elderly individuals. METHODS We retrospectively analysed 325 elderly patients who underwent hip arthroplasty. The general data and preoperative laboratory test results of the patients were collected. Univariate and multivariate logistic regression analyses were performed to screen independent influencing factors. The backwards LR method was used to establish the prediction model. Then, we assessed and verified the degree of discrimination, calibration and clinical usefulness of the model. Finally, the prediction model was rendered in the form of a nomogram. RESULTS Age, blood glucose, direct bilirubin, glutamic-pyruvic transaminase, serum albumin, prothrombin time and haemoglobin were independent influencing factors of planned transfer to the ICU after hip arthroplasty. The area under the curve (AUC) of discrimination and the 500 bootstrap internal validation AUC of this prediction model was 0.793. The calibration curve fluctuated around the ideal curve and had no obvious deviation from the ideal curve. When the prediction probability was 12%-80%, the clinical decision curve was above two extreme lines. The discrimination, calibration and clinical applicability of this prediction model were good. The clinical prediction model was compared with the seven factors in the model for discrimination and clinical use. The discrimination and clinical practicability of this prediction model were superior to those of the internal factors. CONCLUSION The prediction model has good clinical prediction ability and clinical practicability. The model is presented in the form of a linear graph, which provides an effective reference for the individual risk assessment of patients.
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Affiliation(s)
| | - Lue Huang
- Meizhou People's Hospital, Meizhou, China
| | - Yali Yang
- Meizhou People's Hospital, Meizhou, China
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71
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Jiawei L, Kai Z, Haiyan W, Chao W, Yunfeng Z, Liangjia D, Qinghua L, Canran L, Feng J, Xiaohe L. Digital measurement and clinical significance of proximal femur in the older people of Inner Mongolia population, China. BMC Geriatr 2023; 23:632. [PMID: 37803256 PMCID: PMC10559419 DOI: 10.1186/s12877-023-04254-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 08/24/2023] [Indexed: 10/08/2023] Open
Abstract
OBJECTIVE This study aimed to measure the parameters of the proximal femur in the older people of Inner Mongolia, China and understand the influence of age and gender so as to provide guidance for the design and improvement of prosthesis for total hip arthroplasty. METHODS A total of 236 patients who underwent CT angiography of lower limbs in the Department of Imaging, Affiliated Hospital of Inner Mongolia Medical University of China were collected. They were divided into 4 groups according to age: < 60 (group A), 60-69 (group B), 70-79 (group C), and > 80 years (group D). Four anatomical parameters, including femoral head diameter (FHD), femoral neck-shaft angle (FNSA), femoral offset (FO), femoral neck anteversion (FNA), were measured by Mimics 21.0. Comparisons were made between age groups of the same gender and between genders in the same age group to analyze the correlation of the 4 parameters of proximal femur with age and gender. In addition, the results of this study were compared with previous studies. RESULTS There were no significant differences in FHD and FO between age groups, indicating no correlation with age. FNSA and FNA were no significantly different between group C and group D in the same gender, whereas there were significant differences between other age groups and were negatively correlated with age. There were significant differences in FHD and FO between genders in the same age group, with the males being larger than the females. FNSA and FNA were no significant differences between genders in the same age group. CONCLUSIONS FNSA and FNA decrease with age. FHD and FO were larger in males than in females in all age groups. Age and gender should be considered in the design of prosthesis.
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Affiliation(s)
- Li Jiawei
- Department of Imaging, The Second Affiliated Hospital of Baotou Medical College, Baotou, 014030, Inner Mongolia Autonomous Region, China
- Department of Anatomy, Inner Mongolia Medical University, Hohhot, 010000, Inner Mongolia Autonomous Region, China
| | - Zhang Kai
- Department of Orthopedics, The Second People's Hospital of Ulanqab, Ulanqab, 012000, Inner Mongolia Autonomous Region, China.
| | - Wang Haiyan
- Department of Anatomy, Inner Mongolia Medical University, Hohhot, 010000, Inner Mongolia Autonomous Region, China
| | - Wu Chao
- Department of Anatomy, Inner Mongolia Medical University, Hohhot, 010000, Inner Mongolia Autonomous Region, China
| | - Zhang Yunfeng
- Department of Imaging, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010000, Inner Mongolia Autonomous Region, China
| | - Ding Liangjia
- Department of Imaging, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010000, Inner Mongolia Autonomous Region, China
| | - Liu Qinghua
- Department of Anatomy, Inner Mongolia Medical University, Hohhot, 010000, Inner Mongolia Autonomous Region, China
| | - Li Canran
- Department of Anatomy, Inner Mongolia Medical University, Hohhot, 010000, Inner Mongolia Autonomous Region, China
| | - Jin Feng
- Department of Imaging, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010000, Inner Mongolia Autonomous Region, China
| | - Li Xiaohe
- Department of Anatomy, Inner Mongolia Medical University, Hohhot, 010000, Inner Mongolia Autonomous Region, China.
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Viswanathan VK, Aggarwal VA, Subramanian S, Mounasamy V, Sambandam S. What enhances the in-hospital mortality following total hip arthroplasty? A national inpatient sample-based study. Arch Orthop Trauma Surg 2023; 143:6423-6430. [PMID: 36976373 DOI: 10.1007/s00402-023-04850-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/18/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE With prolonged life expectancy and advancements in prosthetic designs, the proportion of patients belonging to diverse age groups undergoing total hip arthroplasty (THA) has progressively increased. In this context, the details regarding risk factors associated with mortality after THA, and its prevalence need to be clearly understood. This study sought to identify the possible co-morbidities associated with post-THA mortality. METHODS Based on Nationwide Inpatient Sample (NIS) database, patients undergoing THA from 2016 to 2019 (using ICD-10CMP) were identified. The included cohort was stratified into two groups: "early mortality" and "no mortality" groups. The data regarding patients' demographics, co-morbidities, and associated complications were compared between the groups. RESULTS Overall, 337,249 patients underwent THA, among whom, 332 (0.1%) died during their hospital admission ("early mortality" group). The remaining patients were included under "no mortality" group (336,917 patients). There was significantly higher mortality in the patients, who underwent emergent THA (as compared with elective THA: odd's ratio 0.075; p < 0.001). Based on multivariate analysis, presence of liver cirrhosis, chronic kidney disease (CKD) and previous history of organ transplant increased the odds of mortality {odds ratio [Exp (B)]} after THA by 4.66- (p < 0.001), 2.37-fold (p < 0.001) and 1.91-fold (p = 0.04), respectively. Among post-THA complications, acute renal failure (ARF), pulmonary embolism (PE), pneumonia, myocardial infarction (MI), and prosthetic dislocation increased the odds of post-THA mortality by 20.64-fold (p < 0.001), 19.35-fold (p < 0.001), 8.21-fold (p < 0.001), 2.71-fold (p = 0.05) and 2.54-fold (p < 0.001), respectively. CONCLUSION THA is a safe surgery with low mortality rate during early post-operative period. Cirrhosis, CKD, and previous history of organ transplant were the most common co-morbidities associated with post-THA mortality. Among post-operative complications, ARF, PE, pneumonia, MI, and prosthetic dislocation substantially enhanced the odds of post-THA mortality.
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Affiliation(s)
| | | | - Surabhi Subramanian
- Pediatric Radiology, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Varatharaj Mounasamy
- Department of Orthopedics, University of Texas Southwestern, Dallas VAMC, Dallas, TX, USA
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Mazur M, Steelman K, Sayeed Z, Chen C, Darwiche H, Little B. Total Hip Arthroplasty in the Ultrayoung. Arthroplast Today 2023; 23:101181. [PMID: 37731593 PMCID: PMC10507074 DOI: 10.1016/j.artd.2023.101181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 06/21/2023] [Accepted: 07/01/2023] [Indexed: 09/22/2023] Open
Abstract
Background Total hip arthroplasty (THA) procedures provide a surgical option for "ultrayoung" patients ≤30 years old with end-stage hip arthropathy. This has historically been coupled with concerns over early component failure and challenging surgical technique leading to increased risk of overall morbidity. The purpose of this study is to better elucidate the poorly defined indications and outcomes for THA in ultrayoung patients with end-stage hip disease. Methods A total of 40 THAs in 35 patients ≤30 years old performed at our institution from 2009 to 2016 were retrospectively followed for an average of 2 years (median 11 months, interquartile range 1-31.25). Primary outcome measure was THA revision. Patient demographics were compared against outcomes. The effects on revision rate of hip joint pathology and type of bearing surface were investigated. T-test, chi-square test, and bivariate correlation were performed to determine statistical significance (P < .05). Machine learning was used to determine the normalized important factor leading to THA revision. Results Fifteen male and 25 female patients were included. Median patient age was 23 (interquartile range 19-27) years, with an average body mass index of 27.0 ± 7.9. A majority of THAs were indicated for osteonecrosis (32) and bearing surface type was predominantly metal-on-highly cross-linked polyethylene (36). The overall revision rate was 7.5%, without a correlation between revision and demographic characteristics. Revision surgery was significantly correlated with bearing surface type (P = .028). Important factors for revision were age (100%), bearing surface type (84.7%), and body mass index (52.1%). Conclusions In patients ≤30 years old, THAs performed with the use of modern implants and surgical methods show satisfactory survivorship and functional outcomes with short-term follow-up.
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Affiliation(s)
- Matthew Mazur
- Department of Orthopedic Surgery, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Kevin Steelman
- Department of Orthopedic Surgery, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Zain Sayeed
- Department of Orthopedic Surgery, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Chaoyang Chen
- Department of Orthopedic Surgery, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Hussein Darwiche
- Department of Orthopedic Surgery, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Bryan Little
- Department of Orthopedic Surgery, Detroit Medical Center, Wayne State University, Detroit, MI, USA
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Guo S, Zhang J, Li H, Zhang J, Cheng CK. A multi-branch network to detect post-operative complications following hip arthroplasty on X-ray images. Front Bioeng Biotechnol 2023; 11:1239637. [PMID: 37840662 PMCID: PMC10569301 DOI: 10.3389/fbioe.2023.1239637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/13/2023] [Indexed: 10/17/2023] Open
Abstract
Background: Postoperative complications following total hip arthroplasty (THA) often require revision surgery. X-rays are usually used to detect such complications, but manually identifying the location of the problem and making an accurate assessment can be subjective and time-consuming. Therefore, in this study, we propose a multi-branch network to automatically detect postoperative complications on X-ray images. Methods: We developed a multi-branch network using ResNet as the backbone and two additional branches with a global feature stream and a channel feature stream for extracting features of interest. Additionally, inspired by our domain knowledge, we designed a multi-coefficient class-specific residual attention block to learn the correlations between different complications to improve the performance of the system. Results: Our proposed method achieved state-of-the-art (SOTA) performance in detecting multiple complications, with mean average precision (mAP) and F1 scores of 0.346 and 0.429, respectively. The network also showed excellent performance at identifying aseptic loosening, with recall and precision rates of 0.929 and 0.897, respectively. Ablation experiments were conducted on detecting multiple complications and single complications, as well as internal and external datasets, demonstrating the effectiveness of our proposed modules. Conclusion: Our deep learning method provides an accurate end-to-end solution for detecting postoperative complications following THA.
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Affiliation(s)
- Sijia Guo
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai Jiao Tong University, Shanghai, China
| | - Jiping Zhang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai Jiao Tong University, Shanghai, China
| | - Huiwu Li
- Department of Orthopaedics, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jingwei Zhang
- Department of Orthopaedics, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Cheng-Kung Cheng
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai Jiao Tong University, Shanghai, China
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75
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Hu X, Zhong J, Ao H, Wu X, Chen Y, Peng Z. Iodine-Doped 3D Print Ti Alloy for Antibacterial Therapy on Orthopedic Implants. ACS OMEGA 2023; 8:32990-32997. [PMID: 37720783 PMCID: PMC10500661 DOI: 10.1021/acsomega.3c04721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 08/23/2023] [Indexed: 09/19/2023]
Abstract
This study presents a novel approach to mitigating bacterial infections and antibiotic resistance in medical implants through the integration of iodine-doping and 3D printing techniques. Iodine, with its potent antibacterial properties, and titanium alloy (Ti), a popular metal for implants due to its mechanical and biological properties, were combined via electrodeposition on 3D-printed titanium alloy (3D-Ti) implants. Scanning electron microscopy, energy dispersive spectroscopy, and X-ray photoelectron spectroscopy confirmed the successful creation of iodine-doped titanium implants with improved iodine content due to the rough surface of the 3D-printed material. In vitro studies revealed that these implants significantly inhibited bacterial adhesion and biofilm formation and showed favorable release kinetics for iodine ions. Biocompatibility tests demonstrated no cytotoxic effects and good hemocompatibility. The implants demonstrated enhanced antimicrobial efficacy against Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) bacteria strains. The findings imply that the integration of iodine-doping and 3D printing technologies is a promising strategy for treating postoperative infections associated with medical implants, consequently bettering the prognosis for patients. Future investigations are encouraged to delve into the long-standing impacts and prospective clinical utility of this groundbreaking methodology.
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Affiliation(s)
- Xiaodong Hu
- The
Affiliated Lihuili Hospital, Ningbo University, Ningbo 315040, China
| | - Jiaqi Zhong
- The
Affiliated Lihuili Hospital, Ningbo University, Ningbo 315040, China
| | - Haiyong Ao
- Jiangxi
Key Laboratory of Nanobiomaterials & School of Materials Science
and Engineering, East China Jiaotong University, Nanchang 330000, China
| | - Xinhui Wu
- Xianju
County People’s Hospital, Taizhou 317300, China
| | - Yujiong Chen
- The
Affiliated Lihuili Hospital, Ningbo University, Ningbo 315040, China
| | - Zhaoxiang Peng
- The
Affiliated Lihuili Hospital, Ningbo University, Ningbo 315040, China
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76
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Steinbeck V, Langenberger B, Schöner L, Wittich L, Klauser W, Mayer M, Kuklinski D, Vogel J, Geissler A, Pross C, Busse R. Electronic Patient-Reported Outcome Monitoring to Improve Quality of Life After Joint Replacement: Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2331301. [PMID: 37656459 PMCID: PMC10474554 DOI: 10.1001/jamanetworkopen.2023.31301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/23/2023] [Indexed: 09/02/2023] Open
Abstract
Importance Although remote patient-reported outcome measure (PROM) monitoring has shown promising results in cancer care, there is a lack of research on PROM monitoring in orthopedics. Objective To determine whether PROM monitoring can improve health outcomes for patients with joint replacement compared with the standard of care. Design, Setting, and Participants A 2-group, patient-level randomized clinical trial (PROMoting Quality) across 9 German hospitals recruited patients aged 18 years or older with primary hip or knee replacement from October 1, 2019, to December 31, 2020, with follow-up until March 31, 2022. Interventions Intervention and control groups received the standard of care and PROMs at hospital admission, discharge, and 12 months after surgery. In addition, the intervention group received PROMs at 1, 3, and 6 months after surgery. Based on prespecified PROM score thresholds, at these times, an automated alert signaled critical recovery paths to hospital study nurses. On notification, study nurses contacted patients and referred them to their physicians if necessary. Main Outcomes and Measures The prespecified outcomes were the mean change in PROM scores (European Quality of Life 5-Dimension 5-Level version [EQ-5D-5L; range, -0.661 to 1.0, with higher values indicating higher levels of health-related quality of life (HRQOL)], European Quality of Life Visual Analogue Scale [EQ-VAS; range, 0-100, with higher values indicating higher levels of HRQOL], Hip Disability and Osteoarthritis Outcome Score-Physical Function Shortform [HOOS-PS; range, 0-100, with lower values indicating lower physical impairment] or Knee Injury and Osteoarthritis Outcome Score-Physical Function Shortform [KOOS-PS; range, 0-100, with lower values indicating lower physical impairment], Patient-Reported Outcomes Measurement Information System [PROMIS]-fatigue [range, 33.7-75.8, with lower values indicating lower levels of fatigue], and PROMIS-depression [range, 41-79.4, with lower values indicating lower levels of depression]) from baseline to 12 months after surgery. Analysis was on an intention-to-treat basis. Results The study included 3697 patients with hip replacement (mean [SD] age, 65.8 [10.6] years; 2065 women [55.9%]) and 3110 patients with knee replacement (mean [SD] age, 66.0 [9.2] years; 1669 women [53.7%]). Exploratory analyses showed significantly better health outcomes in the intervention group on all PROMs except the EQ-5D-5L among patients with hip replacement, with a 2.10-point increase on the EQ-VAS in the intervention group compared with the control group (HOOS-PS, -1.86 points; PROMIS-fatigue, -0.69 points; PROMIS-depression, -0.57 points). Patients in the intervention group with knee replacement had a 1.24-point increase on the EQ-VAS, as well as significantly better scores on the KOOS-PS (-0.99 points) and PROMIS-fatigue (-0.84 points) compared with the control group. Mixed-effect models showed a significant difference in improvement on the EQ-VAS (hip replacement: effect estimate [EE], 1.66 [95% CI, 0.58-2.74]; knee replacement: EE, 1.71 [95% CI, 0.53-2.90]) and PROMIS-fatigue (hip replacement: EE, -0.65 [95% CI, -1.12 to -0.18]; knee replacement: EE, -0.71 [95% CI, -1.23 to -0.20]). The PROMIS-depression score was significantly reduced in the hip replacement group (EE, -0.60 [95% CI, -1.01 to -0.18]). Conclusions and Relevance In this randomized clinical trial, the PROM-based monitoring intervention led to a small improvement in HRQOL and fatigue among patients with hip or knee replacement, as well as in depression among patients with hip replacement. Trial registration Deutsches Register Klinischer Studien ID: DRKS00019916.
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Affiliation(s)
- Viktoria Steinbeck
- Department of Healthcare Management, School of Economics and Management, Technical University Berlin, Berlin, Germany
| | - Benedikt Langenberger
- Department of Healthcare Management, School of Economics and Management, Technical University Berlin, Berlin, Germany
| | - Lukas Schöner
- Department of Healthcare Management, School of Economics and Management, Technical University Berlin, Berlin, Germany
| | - Laura Wittich
- Department of Healthcare Management, School of Economics and Management, Technical University Berlin, Berlin, Germany
| | - Wolfgang Klauser
- Department of Orthopedics, VAMED Ostseeklinik Damp, Damp, Germany
| | - Martin Mayer
- Department of Orthopedics, VAMED Ostseeklinik Damp, Damp, Germany
| | - David Kuklinski
- Chair of Healthcare Management, School of Medicine, University of St Gallen, St Gallen, Switzerland
| | - Justus Vogel
- Chair of Healthcare Management, School of Medicine, University of St Gallen, St Gallen, Switzerland
| | - Alexander Geissler
- Chair of Healthcare Management, School of Medicine, University of St Gallen, St Gallen, Switzerland
| | - Christoph Pross
- Department of Healthcare Management, School of Economics and Management, Technical University Berlin, Berlin, Germany
| | - Reinhard Busse
- Department of Healthcare Management, School of Economics and Management, Technical University Berlin, Berlin, Germany
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Deng Q, Feng Q, Jing P, Ma D, Li M, Gong Y, Li Y, Wen F, Leng Y. Metal-Driven Autoantifriction Function of Artificial Hip Joint. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2023; 10:e2301095. [PMID: 37409439 PMCID: PMC10477871 DOI: 10.1002/advs.202301095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 06/01/2023] [Indexed: 07/07/2023]
Abstract
The service life of an artificial hip joint is limited to 10-15 years, which is not ideal for young patients. To extend the lifespan of these prostheses, the coefficient of friction and wear resistance of metallic femoral heads must be improved. In this study, a Cu-doped titanium nitride (TiNX -Cu) film with "autoantifriction" properties is deposited on a CoCrMo alloy via magnetron sputtering. When delivered in a protein-containing lubricating medium, the Cu in TiNX -Cu quickly and consistently binds to the protein molecules in the microenvironment, resulting in the formation of a stable protein layer. The proteins adsorbed on the TiNX -Cu surface decompose into hydrocarbon fragments owing to the shear stress between the Al2 O3 /TiNX -Cu tribopair. The synergistic effect of the catalysis of Cu and shear stress between the Al2 O3 /TiNX -Cu tribopair transforms these fragments into graphite-like carbon tribofilms with an antifriction property. These tribofilms can simultaneously reduce the friction coefficient of the Al2 O3 /TiNX -Cu tribopair and enhance the wear resistance of the TiNX -Cu film. Based on these findings, it is believed that the autoantifriction film can drive the generation of antifriction tribofilms for lubricating and increasing the wear resistance of prosthetic devices, thereby prolonging their lifespan.
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Affiliation(s)
- Qiaoyuan Deng
- Institute of Biomedical EngineeringKey Laboratory of Advanced Technologies of MaterialsMinistry of EducationCollege of MedicineSouthwest Jiaotong UniversityChengduSichuan610031China
- Key Laboratory of Advanced Material of Tropical Island Resources of Educational MinistrySchool of Materials Science and EngineeringHainan UniversityHaikouHainan570228China
| | - Qingguo Feng
- Institute of Biomedical EngineeringKey Laboratory of Advanced Technologies of MaterialsMinistry of EducationCollege of MedicineSouthwest Jiaotong UniversityChengduSichuan610031China
| | - Peipei Jing
- Institute of Biomedical EngineeringKey Laboratory of Advanced Technologies of MaterialsMinistry of EducationCollege of MedicineSouthwest Jiaotong UniversityChengduSichuan610031China
| | - Donglin Ma
- College of Physics and EngineeringChengdu Normal UniversityChengduSichuan611130China
| | - Mengting Li
- Hainan Provincial Fine Chemical Engineering Research Center, School of Chemical Engineering and TechnologyHainan UniversityHaikouHainan570228P. R. China
| | - Yanli Gong
- Institute of Biomedical EngineeringKey Laboratory of Advanced Technologies of MaterialsMinistry of EducationCollege of MedicineSouthwest Jiaotong UniversityChengduSichuan610031China
| | - Yantao Li
- Institute of Biomedical EngineeringKey Laboratory of Advanced Technologies of MaterialsMinistry of EducationCollege of MedicineSouthwest Jiaotong UniversityChengduSichuan610031China
| | - Feng Wen
- Key Laboratory of Advanced Material of Tropical Island Resources of Educational MinistrySchool of Materials Science and EngineeringHainan UniversityHaikouHainan570228China
| | - Yongxiang Leng
- Institute of Biomedical EngineeringKey Laboratory of Advanced Technologies of MaterialsMinistry of EducationCollege of MedicineSouthwest Jiaotong UniversityChengduSichuan610031China
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Heinz K, Nowack D, von Eisenhart-Rothe R, Wassilew G, Matziolis G, Brodt S. "Koehlers teardrop is not a reliable landmark for assessing the centre of rotation after Total hip arthroplasty" - a retrospective radiological study. Arch Orthop Trauma Surg 2023; 143:5671-5676. [PMID: 37099164 PMCID: PMC10449955 DOI: 10.1007/s00402-023-04859-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/25/2023] [Indexed: 04/27/2023]
Abstract
PURPOSE Various anatomical landmarks have become established in radiography for the assessment of cup positioning after total hip arthroplasty (THA). The most important one is Koehler's teardrop figure (KTF). However, there is a lack of data on the validity of this landmark, which is widely used clinically for assessing the centre of rotation of the hip. METHOD A retrospective measurement of the lateral and cranial distance of the KTF to the centre of hip rotation was performed on the basis of 250 X-ray images of patients who had undergone THA. In addition, the dependence of these distances on pelvic tilt was determined in 16 patients by means of virtual X-ray projections based on pelvic CTs. RESULTS It was shown that the distance of the KTF from the centre of hip rotation in the horizontal plane is gender-dependent (men: 42.8 ± 6.0 mm vs. women: 37.4 ± 4.7 mm; p < 0.001) and age-dependent (Pearson correlation - 0.114; p < 0.05). Furthermore, the vertical and horizontal distances are subject to variation depending on height (Pearson correlation 0.14; p < 0.05 and 0.40; p < 0.001, respectively) and weight (Pearson correlation 0.158; p < 0.05). The distance between the KTF and the centre of hip rotation varies slightly depending on pelvic tilt. CONCLUSION The KTF is not a sufficiently valid landmark for assessing the centre of rotation after THA. It is influenced by many different disturbance variables. However, it is largely robust against changes in pelvic tilt, so that it can be used as a reference point when comparing different intraindividual radiographs to assess the change in the centre of rotation due to implantation or to detect cup migration.
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Affiliation(s)
- Kristian Heinz
- Orthopaedic Department, Jena Universitiy Hospital, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany.
| | - Dimitri Nowack
- Orthopaedic Department, Jena Universitiy Hospital, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | | | - Georgi Wassilew
- Orthopaedic Department, Greifswald Universitiy, Greifswald, Germany
| | - Georg Matziolis
- Orthopaedic Department, Jena Universitiy Hospital, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Steffen Brodt
- Orthopaedic Department, Jena Universitiy Hospital, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
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Carella M, Beck F, Piette N, Denys S, Lecoq JP, Bonhomme VL. Comparison between supra-inguinal fascia iliaca and pericapsular nerve group blocks on postoperative pain and functional recovery after total hip arthroplasty: A noninferiority randomised clinical trial. Eur J Anaesthesiol 2023; 40:660-671. [PMID: 37395511 DOI: 10.1097/eja.0000000000001875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
BACKGROUND Pain after a posterolateral approach for total hip arthroplasty (THA) may affect early functional recovery. Supra-inguinal fascia iliaca (SFIB) and pericapsular nerve group (PENG) blocks have been proposed as promising analgesia techniques. OBJECTIVES This trial was conducted to compare a PENG with a SFIB for controlling postoperative pain and for providing functional recovery. DESIGN Noninferiority monocentric randomised controlled study. SETTING One hundred and two patients scheduled for a total hip arthroplasty via the posterolateral approach under spinal anaesthesia were prospectively allocated to two groups. Data acquisition occurred between October 2021 and July 2022 at the University Hospital of Liege. PATIENTS One hundred and two patients completed the trial. INTERVENTIONS Group SFIB received supra-inguinal fascia iliaca block (SFIB) (40 ml ropivacaine 0.375%), whereas group PENG received a PENG block (20 ml ropivacaine 0.75%). MAIN OUTCOME MEASURES Rest and mobilisation pain on a 0 to 10 numeric rating scale at fixed time points: 1 and 6 h after surgery, on day-1 and day-2 at 8 a.m.,1 p.m. and 6 p.m. On day-1 and day-2, evolution of quality-of-recovery-15 score was assessed, and timed-up-and-go, 2 and 6 min-walking tests. The noninferiority margin was set as 1 numeric rating scale point 6 h after surgery. RESULTS Six hours after surgery, pain scores in group PENG were noninferior to those of group SFIB, with a difference between medians at 0 (95% CI -0.93 to 0.93). There were no significant differences between the groups regarding rest and dynamic pain trajectories during the first 48 postoperative hours, with no significant effects of group (rest P = 0.800; dynamic P = 0.708) or interaction between group and time (rest P = 0.803; dynamic P = 0.187). Similarly, no significant differences were observed regarding motor and functional recovery as assessed by timed-up-and-go ( P = 0.197), 2 min ( P = 0.364), and 6 min walking ( P = 0.347) tests and quality-of-recovery-15 ( P = 0.417) score. CONCLUSION Following a total hip arthroplasty via the posterolateral approach, a PENG block is noninferior to SFIB regarding postoperative pain control 6 h after surgery, and functional recovery. TRIAL REGISTRATION European Clinical Trial Register under EudraCT-number 2020-005126-28 ( https://www.clinicaltrialsregister.eu/ctr-search/trial/2020-005126-28/BE ).
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Affiliation(s)
- Michele Carella
- From the Department of Anaesthesia and Intensive Care Medicine, Liege University Hospital (MC, FB, NP, J-PL, VLB), Inflammation and Enhanced Rehabilitation Laboratory (Regional Anaesthesia and Analgesia), GIGA-I3 Thematic Unit, GIGA-Research (MC, NP, J-PL), Anaesthesia and Perioperative Neuroscience Laboratory, GIGA-Consciousness Thematic Unit, GIGA-Research (FB, VLB) and Department of Physical Medicine, Rehabilitation and Sports Traumatology, Liege University Hospital, Liege, Belgium (SD)
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80
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Jennison T, MacGregor A, Goldberg A. Hip arthroplasty practice across the Organisation for Economic Co-operation and Development (OECD) over the last decade. Ann R Coll Surg Engl 2023; 105:645-652. [PMID: 37652085 PMCID: PMC10471436 DOI: 10.1308/rcsann.2022.0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION There are large variations in the number of hip replacements performed between countries, demonstrating large health inequalities; however, there has been limited research on this variation. The aims of this paper were to compare rates of hip replacements using Organisation for Economic Co-operation and Development (OECD) data for the period 2008-2018. The study also compared changes in the number of hip replacements in the total population and in only those aged over 65, and looked for a correlation of health expenditure and gross domestic product (GDP) with rates of hip replacements. METHODS The OECD collects annual data from all member countries on the numbers of hip replacements, healthcare expenditure and GDP. Data analysis was undertaken using STATA. Descriptive statistics and Pearson's correlation coefficient were performed. RESULTS The mean number of hip replacements performed in OECD countries in 2018 was 191.5 per 100,000 population per year. The largest number was 310.6 in Germany and the lowest was 8.6 in Mexico. There has been a 21.7% increase in the mean number of hip replacements across OECD countries. There was a moderate and significant Pearson coefficient of 0.468 (p = 0.009) between the number of hip replacements performed per 100,000 population in 2018 and GDP per person, and a strong and significant correlation with health expenditure (R = 0.784, p < 0.001). There was a moderate correlation (R = 0.645, p = 0.003) between the percentage change in the number of hip replacements performed per 100,000 population and the percentage change in healthcare expenditure per person between 2008 and 2018. CONCLUSIONS There is 36-fold variation in the practice of hip replacements across the OECD and the number of hip replacements has increased by more than 20% over the past decade. The number of hip replacements performed appears to be correlated with health expenditure in each country and may indicate a need that can only be met by increasing health expenditure.
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Affiliation(s)
- T Jennison
- Cardiff and Vale University Health Board, UK
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81
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Venishetty N, Nguyen I, Sohn G, Bhalla S, Mounasamy V, Sambandam S. The effect of cocaine on patients undergoing total hip arthroplasty. J Orthop 2023; 43:64-68. [PMID: 37555205 PMCID: PMC10404604 DOI: 10.1016/j.jor.2023.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Cocaine use has surged in the past decade, with 4.8 million Americans (1.7% of the population greater than 12) reporting use in 2021, leading to a healthcare burden of 1.3 billion dollars. Cocaine users experience prolonged hospital stays, higher costs, worse surgical outcomes, increased risk of medical conditions, and inflammation-related osteoarthritis. The study aims to identify factors influencing length of stay, costs, and perioperative complications in cocaine users undergoing total hip arthroplasty (THA) to reduce these risks. METHODS This study utilized the NIS database, providing comprehensive information on patient demographics, length of stay, hospital costs, and complications. Statistical analyses were conducted using SPSS software, including propensity matching and significance testing, to compare outcomes between cocaine users (CU) and non-cocaine users (NCU) undergoing total hip arthroplasty. RESULTS After propensity matching, cocaine users had a significantly longer LOS (4.8 days) in comparison to non-cocaine users (2.6 days) (p < 0.001). Similarly, the CU group had a larger of care (87984.9) than the NCU group (69149.2) (p < 0.001). Cocaine users had significantly higher rates of blood loss anemia (OR: 3.24, 95% CI: 2.21, 4.73), blood loss anemia (OR: 1.59, 95% CI: 1.12, 2.24), blood transfusion (OR: 2.23, 95% CI: 1.04, 4.78), periprosthetic dislocation (OR: 6.57, 95% CI: 1.47, 29.32), and periprosthetic infection (OR: 4.59, 95% CI: 1.54, 13.68) than patients in the non-cocaine user's group. CONCLUSION Cocaine users had a significantly longer length of stay, higher costs of care, and an increased number of post-operative complications compared to non-cocaine users. These data contribute to understanding the potential ramifications of cocaine users undergoing THA.
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Affiliation(s)
- Nikit Venishetty
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, 5001 El Paso Dr, El Paso, TX, USA
| | - Ivy Nguyen
- University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX, USA
| | - Garrett Sohn
- University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX, USA
| | - Shubhang Bhalla
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, 5001 El Paso Dr, El Paso, TX, USA
| | - Varatharaj Mounasamy
- Department of Orthopedics, University of Texas Southwestern, Chief of Orthopedics, Dallas VAMC, 4500 South Lancaster Road, Dallas, TX, USA
| | - Senthil Sambandam
- University of Texas Southwestern, Staff Orthopedic Surgeon, Dallas VAMC, 4500 South Lancaster Road, Dallas, TX, USA
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82
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Lu H, Xiao Q, Xu H, Yan T, Zhou Z. Robotic arm-assisted total hip arthroplasty for preoperative planning and intraoperative decision-making. J Orthop Surg Res 2023; 18:608. [PMID: 37605281 PMCID: PMC10440908 DOI: 10.1186/s13018-023-04095-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/11/2023] [Indexed: 08/23/2023] Open
Abstract
AIMS This article aimed to explore the efficacy of robotic arm-assisted total hip arthroplasty (THA) in improving preoperative planning and intraoperative decision-making. METHODS In this single-center, prospective, randomized clinical controlled trial, 60 patients were randomly divided into two groups: conventional THA (cTHA) and robotic arm-assisted THA (rTHA). The rTHA underwent procedures using a robot-assisted surgical system, which generated three-dimensional models to determine the most appropriate prosthesis size and position. The standard process of replacement was executed in cTHA planned preoperatively via X-ray by experienced surgeons. Differences between predicted and actual prosthetic size, prosthetic position, and leg length were evaluated. RESULTS Sixty patients were included in the study, but one patient was not allocated due to anemia. No significant preoperative baseline data difference was found between the two groups. The actual versus predicted implantation size of both groups revealed that 27/30 (90.0%) in the rTHA group and 25/29 (86.2%) in the cTHA group experienced complete coincidence. The coincidence rate for the femoral stem was higher in the rTHA group (83.3%) than that in the cTHA group (62.7%). Between the actual and predicted rTHA, the difference in anteversion/inclination degree (< 6°) was largely dispersed, while cTHA was more evenly distributed in degree (< 9°). The differences in leg length between the surgical side and contralateral side showed a significant deviation when comparing the two groups (P = 0.003), with 0.281 (- 4.17 to 3.32) mm in rTHA and 3.79 (1.45-6.42) mm in cTHA. CONCLUSION Robotic arm-assisted total hip arthroplasty can be valuable for preoperative planning and intraoperative decision-making.
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Affiliation(s)
- Hanpeng Lu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Road, Wuhou District, Chengdu, 610041, Si Chuan, People's Republic of China
| | - Qiang Xiao
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Road, Wuhou District, Chengdu, 610041, Si Chuan, People's Republic of China
| | - Hong Xu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Road, Wuhou District, Chengdu, 610041, Si Chuan, People's Republic of China
| | - Tingfang Yan
- Yuanhua Intelligent Technology Co., Ltd, Shenzhen, People's Republic of China
| | - Zongke Zhou
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Road, Wuhou District, Chengdu, 610041, Si Chuan, People's Republic of China.
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83
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Pan B, Zhang Z, Wu X, Xian G, Hu X, Gu M, Zheng L, Li X, Long L, Chen W, Sheng P. Macrophages-derived exosomes modulates wear particle-induced osteolysis via miR-3470b targeting TAB3/NF-κB signaling. Bioact Mater 2023; 26:181-193. [PMID: 36911207 PMCID: PMC9999169 DOI: 10.1016/j.bioactmat.2023.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/25/2023] [Accepted: 02/25/2023] [Indexed: 03/07/2023] Open
Abstract
Image 1.
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Key Words
- APL, Aseptic prothesis loosening
- Aseptic prothesis loosening
- Bglap, Osteocalcin
- CTSK, Cathepsin K
- Exosome
- Inflammatory osteolysis
- Macrophage
- NF-κB, nuclear factor kappa-light-chain-enhancer of activated B cells
- NFATc-1, Nuclear factor of activated T-cells, cytoplasmic 1
- Non-coding RNA
- OB, Osteoblast
- OC, Osteoclast
- P-P65, phospho-P65
- P65, NF-κB signaling
- Runx2, Runt-related transcription factor 2
- TAB3, TGF-β-activated kinase 1 (MAP3K7) binding protein 3
- ncRNA, non-coding RNA
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Affiliation(s)
- Baiqi Pan
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, The First Affiliated Hospital of Sun Yat-Sen University, China
| | - Ziji Zhang
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, The First Affiliated Hospital of Sun Yat-Sen University, China
| | - Xiaoyu Wu
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, The First Affiliated Hospital of Sun Yat-Sen University, China
| | - Guoyan Xian
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, The First Affiliated Hospital of Sun Yat-Sen University, China.,Université de Paris, CNRS, INSERM, B3OA, Paris, France
| | - Xuantao Hu
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, The First Affiliated Hospital of Sun Yat-Sen University, China
| | - Minghui Gu
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, The First Affiliated Hospital of Sun Yat-Sen University, China
| | - Linli Zheng
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, The First Affiliated Hospital of Sun Yat-Sen University, China
| | - Xiang Li
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, The First Affiliated Hospital of Sun Yat-Sen University, China.,Department of Spine Surgery, The first affiliated hospital of Sun Yat-sen University, China
| | - Lingli Long
- Research Center of Translational Medicine, The First Affiliated Hospital of Sun Yat-sen University, China
| | - Weishen Chen
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, The First Affiliated Hospital of Sun Yat-Sen University, China
| | - Puyi Sheng
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, The First Affiliated Hospital of Sun Yat-Sen University, China
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84
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Baba K, Mori Y, Chiba D, Kuwahara Y, Kurishima H, Tanaka H, Kogure A, Kamimura M, Yamada N, Ohtsu S, Oyama M, Masahashi N, Hanada S, Itoi E, Aizawa T. TiNbSn stems with gradient changes of Young's modulus and stiffness reduce stress shielding compared to the standard fit-and-fill stems. Eur J Med Res 2023; 28:214. [PMID: 37400903 DOI: 10.1186/s40001-023-01199-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 06/26/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND The difference between Young's moduli of the femur and the stem causes stress shielding (SS). TiNbSn (TNS) stem has a low Young's modulus and strength with gradient functional properties during the change in elastic modulus with heat treatment. The aim of this study was to investigate the inhibitory effect of TNS stems on SS and their clinical outcomes compared to conventional stems. METHODS This study was a clinical trial. Primary THA was performed using a TNS stem from April 2016 to September 2017 for patients in the TNS group. Unilateral THA was performed using a Ti6Al4V alloy stem from January 2007 to February 2011 for patients in the control group. The TNS and Ti6Al4V stems were matched in shape. Radiographs were obtained at the 1- and 3-year follow-ups. Two surgeons independently checked the SS grade and appearance of cortical hypertrophy (CH). The Japanese Orthopaedic Association (JOA) scores before and 1 year after surgery were assessed as clinical scores. RESULTS None of the patients in the TNS group had grade 3 or 4 SS. In contrast, in the control group, 24% and 40% of patients had grade 3 and 4 SS at the 1- and 3-year follow-ups, respectively. The SS grade was lower in the TNS group than in the control group at the 1- and 3-year follow-ups (p < 0.001). The frequencies of CH in both groups were no significant difference at the 1- and 3-year follow-ups. The JOA scores of the TNS group significantly improved at 1 year after surgery and were comparable to control group. CONCLUSION The TNS stem reduced SS at 1 and 3 years after THA compared to the proximal-engaging cementless stem, although the shapes of the stems matched. The TNS stem could reduce SS, stem loosening, and periprosthetic fractures. TRIAL REGISTRATION Current Controlled Trials. ISRCTN21241251. https://www.isrctn.com/search?q=21241251 . The date of registration was October 26, 2021. Retrospectively registered.
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Affiliation(s)
- Kazuyoshi Baba
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Yu Mori
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
| | - Daisuke Chiba
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Yoshiyuki Kuwahara
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Hiroaki Kurishima
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Hidetatsu Tanaka
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Atsushi Kogure
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Masayuki Kamimura
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Norikazu Yamada
- Department of Orthopaedic Surgery, Sendai Red Cross Hospital, 2‑43‑3 Yagiyamahoncho, Taihaku‑ku, Sendai, Miyagi, 982-8501, Japan
| | - Susumu Ohtsu
- Department of Orthopaedic Surgery, Osaki Citizen Hospital, 3-8-1 Furukawahonami, Osaki, Miyagi, 989-6183, Japan
| | - Masamizu Oyama
- Department of Orthopaedic Surgery, Sendai Red Cross Hospital, 2‑43‑3 Yagiyamahoncho, Taihaku‑ku, Sendai, Miyagi, 982-8501, Japan
| | - Naoya Masahashi
- Institute for Materials Research, Tohoku University, 2-1-1 Katahira, Aoba-ku, Sendai, Miyagi, 980-8577, Japan
| | - Shuji Hanada
- Institute for Materials Research, Tohoku University, 2-1-1 Katahira, Aoba-ku, Sendai, Miyagi, 980-8577, Japan
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku Rosai Hospital, 4-3-21 Dainohara, Aoba-ku, Sendai, Miyagi, 981-0911, Japan
| | - Toshimi Aizawa
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
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Fenske F, Krause L, Meyer S, Kujat B, Repmann J, Neuhaus M, Zimmerer R, Roth A, Lethaus B, Ziebolz D, Schmalz G. Oral Health Screening for Risk Reduction for Early Periprosthetic Joint Infections of Hip and Knee Endoprostheses-Results of a Prospective Cohort Study. J Clin Med 2023; 12:4451. [PMID: 37445486 DOI: 10.3390/jcm12134451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/29/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
This prospective observational study had two aims: (I) to assess whether a preoperative dental screening before endoprosthesis (EP) implantation with need-based dental intervention would decrease the prevalence of periprosthetic joint infection (PJI) and (II) to evaluate whether instructed orthopedic surgeons would achieve similar results in oral screening as dentists. The preoperative oral health statuses of the patients, prior to EP insertion, were either evaluated by the patients' general dentists (Ia) or, if the patient had not visited a general dentist, by an instructed orthopedic surgeon (Ib). Both the dentist and orthopedic surgeon used standardized risk estimation (low risk, moderate risk, and high risk) for an oral-health-related infectious complication after EP insertion, including a recommendation for further management of the patient. If required, a need-based dental rehabilitation was performed. In addition, retrospective data evaluation of a comparison group (II) was performed, which had not been screened orally preoperatively. A total of 777 patients (screening group (I): n = 402, of which 229 were screened by a dentist (Ia), 173 were screened by an orthopedic surgeon (Ib); comparison group (II): n = 375) were included. No general association between early infection rate and preoperative oral screening in general was found (1% PJI in screening group (I), 1.6% PJI in comparison group (II); p = 0.455). However, screening performance (dentist vs. orthopedic surgeon) had a significant impact on the prevalence of developed PJIs (p = 0.021). Thereby, 100% of observed infections in the screening group (I) occurred in the group with previous oral screening by an orthopedic surgeon (Ib). Furthermore, the C-reactive protein (CRP) value at discharge was significantly lower when general preoperative oral screening had been performed (group I vs. group II, p = 0.03). Only preoperative oral screening by a dentist had the potential to reduce oral-focus-associated EP infections; therefore, increased attention should be paid to the further promotion of interdisciplinary work between dentists and orthopedic surgeons. Dental screenings, using objectifiable criteria, as applied in this study, seem reasonable but require further validation in larger cohorts.
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Affiliation(s)
- Fabian Fenske
- Department of Oral and Maxillofacial Surgery, University of Leipzig, 04103 Leipzig, Germany
| | - Leah Krause
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany
| | - Stephan Meyer
- Department of Oral and Maxillofacial Surgery, University of Leipzig, 04103 Leipzig, Germany
| | - Benjamin Kujat
- Specialised Clinic for Orthopedics, Mediclin Waldkrankenhaus Bad Düben, 04848 Bad Düben, Germany
| | - Jacqueline Repmann
- Specialised Clinic for Orthopedics, Mediclin Waldkrankenhaus Bad Düben, 04848 Bad Düben, Germany
| | - Michael Neuhaus
- Department of Oral and Maxillofacial Surgery, University of Leipzig, 04103 Leipzig, Germany
| | - Rüdiger Zimmerer
- Department of Oral and Maxillofacial Surgery, University of Leipzig, 04103 Leipzig, Germany
| | - Andreas Roth
- Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Bernd Lethaus
- Department of Oral and Maxillofacial Surgery, University of Leipzig, 04103 Leipzig, Germany
| | - Dirk Ziebolz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany
| | - Gerhard Schmalz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany
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Moissenet F, Beauseroy V, Gasparutto X, Armand S, Hannouche D, Dumas R. Estimation of two wear factors for total hip arthroplasty: A simulation study based on musculoskeletal modelling. Clin Biomech (Bristol, Avon) 2023; 107:106035. [PMID: 37413813 DOI: 10.1016/j.clinbiomech.2023.106035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/31/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Primary causes of surgical revision after total hip arthroplasty are polyethylene wear and implant loosening. These factors are particularly related to joint friction and thus patients' physical activity. Assessing implant wear over time according to patients' morphology and physical activity level is key to improve follow-up and patients' quality of life. METHODS An approach initially proposed for tibiofemoral prosthetic wear estimation was adapted to compute two wear factors (force-velocity, directional wear intensity) using a musculoskeletal model. It was applied on 17 participants with total hip arthroplasty to compute joint angular velocity, contact force, sliding velocity, and wear factors during common daily living activities. FINDINGS Differences were observed between gait, sitting down, and standing up tasks. An incremental increase of both global wear factors (time-integral) was observed during gait from slow to fast speeds (p ≤ 0.01). Interestingly, these two wear factors did not result in same trend for sitting down and standing up tasks. Compared to gait, one cycle of sitting down or standing up tends to induce higher friction-related wear but lower cross-shear-related wear. Depending on the wear factor, significant differences can be found between sitting down and gait at slow speed (p ≤ 0.05), and between sitting down (p ≤ 0.05) or standing up (p ≤ 0.05) and gait at fast speed. Furthermore, depending on the activity, wear can be fostered by joint contact force and/or sliding velocity. INTERPRETATION This study demonstrated the potential of wear estimation to highlight activities inducing a higher risk of implant wear after total hip arthroplasty from motion capture data.
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Affiliation(s)
- Florent Moissenet
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland; Biomechanics Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
| | - Victor Beauseroy
- Univ Lyon, Univ Gustave Eiffel, Univ Claude Bernard Lyon 1, LBMC UMR T_9406, F-69622 Lyon, France
| | - Xavier Gasparutto
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Stéphane Armand
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Didier Hannouche
- Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Raphaël Dumas
- Univ Lyon, Univ Gustave Eiffel, Univ Claude Bernard Lyon 1, LBMC UMR T_9406, F-69622 Lyon, France
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Poulsen AG, Gravesen JD, Madsen MN, Mikkelsen LR, Bandholm T, Rossen CB. Patient perspectives on home-based rehabilitation exercise and general physical activity after total hip arthroplasty: A qualitative study (PHETHAS-2). F1000Res 2023; 10:382. [PMID: 37359253 PMCID: PMC10285331 DOI: 10.12688/f1000research.51684.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 07/20/2023] Open
Abstract
Background: Home-based rehabilitation exercise following Total Hip Arthroplasty (THA) shows similar outcomes compared to supervised outpatient rehabilitation exercise. Little is known about patients' experiences with home-based rehabilitation, and this study aimed to investigate how patients perceived home-based rehabilitation exercise and general physical activity after THA, focusing on facilitators and barriers. Methods: Semi-structured interviews of qualitative design were conducted with 22 patients who had undergone THA and who had performed home-based rehabilitation exercise. The study took place in a regional hospital in Denmark between January 2018 and May 2019. Data were analyzed using an interpretive thematic analysis approach, with theoretical underpinning from the concept 'conduct of everyday life'. The study is embedded within the Pragmatic Home-Based Exercise Therapy after Total Hip Arthroplasty-Silkeborg trial (PHETHAS-1). Results: The main theme, 'wishing to return to the well-known everyday life', and four subthemes were identified. Generally, participants found the home-based rehabilitation exercise boring but were motivated by the goal of returning to their well-known everyday life and performing their usual general physical activities, though some lacked contact to physiotherapist. Participants enrolled in the PHETHAS-1 study used the enrollment as part of their motivation for doing the exercises. Both pain and the absence of pain were identified as barriers for doing home-based rehabilitation exercise. Pain could cause insecurity about possible medical complications, while the absence of pain could lead to the rehabilitation exercise being perceived as pointless. Conclusions: The overall goal of returning to the well-known everyday life served as a facilitator for undertaking home-based rehabilitation exercise after THA along with the flexibility regarding time and place for performing exercises. Boring exercises as well as both pain and no pain were identified as barriers to the performance of home-based rehabilitation exercise. Participants were motivated towards performing general physical activities which were part of their everyday life.
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Affiliation(s)
- Anne Grøndahl Poulsen
- Research Unit, Elective Surgery Center, Silkeborg Regional Hospital, Silkeborg, 8600, Denmark
| | | | - Merete Nørgaard Madsen
- Research Unit, Elective Surgery Center, Silkeborg Regional Hospital, Silkeborg, 8600, Denmark
| | - Lone Ramer Mikkelsen
- Research Unit, Elective Surgery Center, Silkeborg Regional Hospital, Silkeborg, 8600, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, 8000, Denmark
| | - Thomas Bandholm
- Physical Medicine & Rehabilitation Research – Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Clinical Research Center and Department of Orthopedic Surgery, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, 2650, Denmark
| | - Camilla Blach Rossen
- Research Unit, Elective Surgery Center, Silkeborg Regional Hospital, Silkeborg, 8600, Denmark
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88
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Poulsen AG, Gravesen JD, Madsen MN, Mikkelsen LR, Bandholm T, Rossen CB. Patient perspectives on home-based rehabilitation exercise and general physical activity after total hip arthroplasty: A qualitative study (PHETHAS-2). F1000Res 2023; 10:382. [PMID: 37359253 PMCID: PMC10285331 DOI: 10.12688/f1000research.51684.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 01/04/2024] Open
Abstract
Background: Home-based rehabilitation exercise following Total Hip Arthroplasty (THA) shows similar outcomes compared to supervised outpatient rehabilitation exercise. Little is known about patients' experiences with home-based rehabilitation, and this study aimed to investigate how patients perceived home-based rehabilitation exercise and general physical activity after THA, focusing on facilitators and barriers. Methods: Semi-structured interviews of qualitative design were conducted with 22 patients who had undergone THA and who had performed home-based rehabilitation exercise. The study took place in a regional hospital in Denmark between January 2018 and May 2019. Data were analyzed using an interpretive thematic analysis approach, with theoretical underpinning from the concept 'conduct of everyday life'. The study is embedded within the Pragmatic Home-Based Exercise Therapy after Total Hip Arthroplasty-Silkeborg trial (PHETHAS-1). Results: The main theme, 'wishing to return to the well-known everyday life', and four subthemes were identified. Generally, participants found the home-based rehabilitation exercise boring but were motivated by the goal of returning to their well-known everyday life and performing their usual general physical activities, though some lacked contact to physiotherapist. Participants enrolled in the PHETHAS-1 study used the enrollment as part of their motivation for doing the exercises. Both pain and the absence of pain were identified as barriers for doing home-based rehabilitation exercise. Pain could cause insecurity about possible medical complications, while the absence of pain could lead to the rehabilitation exercise being perceived as pointless. Conclusions: The overall goal of returning to the well-known everyday life served as a facilitator for undertaking home-based rehabilitation exercise after THA along with the flexibility regarding time and place for performing exercises. Boring exercises as well as both pain and no pain were identified as barriers to the performance of home-based rehabilitation exercise. Participants were motivated towards performing general physical activities which were part of their everyday life.
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Affiliation(s)
- Anne Grøndahl Poulsen
- Research Unit, Elective Surgery Center, Silkeborg Regional Hospital, Silkeborg, 8600, Denmark
| | | | - Merete Nørgaard Madsen
- Research Unit, Elective Surgery Center, Silkeborg Regional Hospital, Silkeborg, 8600, Denmark
| | - Lone Ramer Mikkelsen
- Research Unit, Elective Surgery Center, Silkeborg Regional Hospital, Silkeborg, 8600, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, 8000, Denmark
| | - Thomas Bandholm
- Physical Medicine & Rehabilitation Research – Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Clinical Research Center and Department of Orthopedic Surgery, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, 2650, Denmark
| | - Camilla Blach Rossen
- Research Unit, Elective Surgery Center, Silkeborg Regional Hospital, Silkeborg, 8600, Denmark
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89
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McLaughlin J, Kipping R, Owen-Smith A, McLeod H, Hawley S, Wilkinson JM, Judge A. What effect have commissioners' policies for body mass index had on hip replacement surgery?: an interrupted time series analysis from the National Joint Registry for England. BMC Med 2023; 21:202. [PMID: 37308999 DOI: 10.1186/s12916-023-02899-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 05/10/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Despite their widespread use, the impact of commissioners' policies for body mass index (BMI) for access to elective surgery is not clear. Policy use varies by locality, and there are concerns that these policies may worsen health inequalities. The aim of this study was to assess the impact of policies for BMI on access to hip replacement surgery in England. METHODS A natural experimental study using interrupted time series and difference-in-differences analysis. We used National Joint Registry data for 480,364 patients who had primary hip replacement surgery in England between January 2009 and December 2019. Clinical commissioning group policies introduced before June 2018 to alter access to hip replacement for patients with overweight or obesity were considered the intervention. The main outcome measures were rate of surgery and patient demographics (BMI, index of multiple deprivation, independently funded surgery) over time. RESULTS Commissioning localities which introduced a policy had higher surgery rates at baseline than those which did not. Rates of surgery fell after policy introduction, whereas rates rose in localities with no policy. 'Strict' policies mandating a BMI threshold for access to surgery were associated with the sharpest fall in rates (trend change of - 1.39 operations per 100,000 population aged 40 + per quarter-year, 95% confidence interval - 1.81 to - 0.97, P < 0.001). Localities with BMI policies have higher proportions of independently funded surgery and more affluent patients receiving surgery, indicating increasing health inequalities. Policies enforcing extra waiting time before surgery were associated with worsening mean pre-operative symptom scores and rising obesity. CONCLUSIONS Commissioners and policymakers should be aware of the counterproductive effects of BMI policies on patient outcomes and inequalities. We recommend that BMI policies involving extra waiting time or mandatory BMI thresholds are no longer used to reduce access to hip replacement surgery.
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Affiliation(s)
- Joanna McLaughlin
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, UK.
| | - Ruth Kipping
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - Amanda Owen-Smith
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - Hugh McLeod
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
- National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, Bristol, BS1 2NT, UK
| | - Samuel Hawley
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, UK
| | - J Mark Wilkinson
- Department of Oncology and Metabolism, The Mellanby Centre for Musculoskeletal Research, University of Sheffield, Metabolic Bone Unit, Sorby Wing, Northern General Hospital, Sheffield, UK
| | - Andrew Judge
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, UK
- National Institute for Health and Care Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
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90
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Zhang K, Miao X, Jiang L, Cui S, Liu Z, Wang Z. Postoperative analgesic efficacy and safety of imrecoxib versus celecoxib in hip osteoarthritis patients undergoing total hip arthroplasty: a multi-center, randomized, controlled, non-inferiority study. Inflammopharmacology 2023:10.1007/s10787-023-01260-7. [PMID: 37306938 DOI: 10.1007/s10787-023-01260-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/26/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Imrecoxib, a novel cyclooxygenase-2 inhibitor, possesses a certain postoperative analgesic effect for several orthopedic surgeries. This multi-center, randomized, controlled, non-inferiority study intended to investigate the postoperative analgesic efficacy and safety profile of imrecoxib (versus celecoxib) in hip osteoarthritis patients undergoing total hip arthroplasty (THA). METHODS 156 hip osteoarthritis patients planned for THA were randomized into imrecoxib (N = 78) and celecoxib (N = 78) groups. Patients were orally administrated with imrecoxib or celecoxib 200 mg at 2 h (h) after THA, 200 mg every 12 h to day (D)3, and 200 mg every 24 h to D7; additionally, each patient received patient-controlled analgesia (PCA) for 2 days. RESULTS Resting pain visual analogue scale (VAS) score at 6 h, 12 h, D1, D2, D3, and D7 post THA was not varied between imrecoxib and celecoxib groups (all P > 0.050), neither was moving pain VAS score (all P > 0.050). Importantly, the upper of 95% confidence interval of pain VAS score margin between imrecoxib and celecoxib groups was within the non-inferiority threshold (Δ = 1.0), indicating the fact that non-inferiority was established. The additional and total consumption of PCA was not varied between imrecoxib and celecoxib groups (both P > 0.050). Also, no difference was seen in Harris hip score, European Quality of Life 5-Dimensions (EQ-5D) total and VAS scores at month (M)1, M3 between the two groups (all P > 0.050). Besides, the incidences of all adverse events were not different between imrecoxib and celecoxib groups (all P > 0.050). CONCLUSION Imrecoxib is non-inferior to celecoxib for postoperative analgesia in hip osteoarthritis patients undergoing THA.
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Affiliation(s)
- Kai Zhang
- Department of Orthopedics, Handan Central Hospital, No. 59 Congtai North Road, Handan, 056000, China
| | - Xiaoyan Miao
- Department of General Surgery, Affiliated Hospital of Hebei Engineering University, Handan, 056002, China
| | - Liqiang Jiang
- Department of Orthopedics, Handan Central Hospital, No. 59 Congtai North Road, Handan, 056000, China
| | - Shubei Cui
- Department of Orthopedics, Handan Central Hospital, No. 59 Congtai North Road, Handan, 056000, China
| | - Zhenwu Liu
- Department of Orthopedics, Handan Central Hospital, No. 59 Congtai North Road, Handan, 056000, China
| | - Zhiyun Wang
- Department of Orthopedics, Handan Central Hospital, No. 59 Congtai North Road, Handan, 056000, China.
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91
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Wolf MA, Goebel L, Winter P, Landgraeber S, Orth P. Subgroup analysis of scientific performance in the field of arthroplasty. Front Surg 2023; 10:1187223. [PMID: 37377669 PMCID: PMC10291130 DOI: 10.3389/fsurg.2023.1187223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/12/2023] [Indexed: 06/29/2023] Open
Abstract
Introduction Arthroplasty is the final treatment option for maintaining mobility and quality of life in many primary degenerative and (post-) traumatic joint diseases. Identification of research output and potential deficits for specific subspecialties may be an important measure to achieve long-term improvement of patient care in this field. Methods Using specific search terms and Boolean operators, all studies published since 1945 to the subgroups of arthroplasty listed in the Web of Science Core Collection were included. All identified publications were analysed according to bibliometric standards, and comparative conclusions were drawn regarding the scientific merit of each subgroup. Results Most publications investigated the subgroups of septic surgery and materials followed by approach, navigation, aseptic loosening, robotic and enhanced recovery after surgery (ERAS). In the last 5 years, research in the fields of robotic and ERAS achieved the highest relative increase in publications In contrast, research on aseptic loosening has continued to lose interest over the last 5 years. Publications on robotics and materials received the most funding on average while those on aseptic loosening received the least. Most publications originated from USA, Germany, and England, except for research on ERAS in which Denmark stood out. Relatively, publications on aseptic loosening received the most citations, whereas the absolute scientific interest was highest for the topic infection. Discussion In this bibliometric subgroup analysis, the primary scientific outputs focused on septic complications and materials research in the field of arthroplasty. With decreasing publication output and the least financial support, intensification of research on aseptic loosening is urgently recommended.
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92
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Holzer LA. Total Hip Arthroplasty: So Hip It Hurts. J Clin Med 2023; 12:jcm12113849. [PMID: 37298044 DOI: 10.3390/jcm12113849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/15/2023] [Indexed: 06/12/2023] Open
Abstract
Total hip arthroplasty (THA) has become a standard surgical intervention for patients with hip joint disorders [...].
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Affiliation(s)
- Lukas A Holzer
- Department of Orthopaedics, Fiona Stanley Fremantle Hospitals Group, Murdoch, WA 6150, Australia
- Perth Orthopaedic and Sports Medicine Centre, West Perth, WA 6005, Australia
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93
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Layer YC, Mesropyan N, Kupczyk PA, Luetkens JA, Isaak A, Dell T, Attenberger UI, Kuetting D. Combining iterative metal artifact reduction and virtual monoenergetic images severely reduces hip prosthesis-associated artifacts in photon-counting detector CT. Sci Rep 2023; 13:8955. [PMID: 37268675 DOI: 10.1038/s41598-023-35989-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/26/2023] [Indexed: 06/04/2023] Open
Abstract
Aim of this study was to assess the impact of virtual monoenergetic images (VMI) in combination and comparison with iterative metal artifact reduction (IMAR) on hip prosthesis-associated artifacts in photon-counting detector CT (PCD-CT). Retrospectively, 33 scans with hip prosthesis-associated artifacts acquired during clinical routine on a PCD-CT between 08/2022 and 09/2022 were analyzed. VMI were reconstructed for 100-190 keV with and without IMAR, and compared to polychromatic images. Qualitatively, artifact extent and assessment of adjacent soft tissue were rated by two radiologists using 5-point Likert items. Quantitative assessment was performed measuring attenuation and standard deviation in most pronounced hypodense and hyperdense artifacts, artifact-impaired bone, muscle, vessels, bladder and artifact-free corresponding tissue. To quantify artifacts, an adjusted attenuation was calculated as the difference between artifact-impaired tissue and corresponding tissue without artifacts. Qualitative assessment improved for all investigated image reconstructions compared to polychromatic images (PI). VMI100keV in combination with IMAR achieved best results (e.g. diagnostic quality of the bladder: median PI: 1.5 (range 1-4); VMI100keV+IMAR: 5 (3-5); p < 0.0001). In quantitative assessment VMI100keV with IMAR provided best artifact reduction with an adjusted attenuation closest to 0 (e.g. bone: PI: 302.78; VMI100keV+IMAR: 51.18; p < 0.0001). The combination of VMI and IMAR significantly reduces hip prosthesis-associated artifacts in PCD-CT and improves the diagnostic quality of surrounding tissue.
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Affiliation(s)
- Yannik C Layer
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Narine Mesropyan
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Patrick A Kupczyk
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Alexander Isaak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Tatjana Dell
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Ulrike I Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Daniel Kuetting
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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94
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Venishetty N, Sohn G, Nguyen I, Trivedi M, Mounasamy V, Sambandam S. Perioperative complications of legally blind patients undergoing total hip arthroplasty - A national in-patient sample database study. J Orthop 2023; 40:47-51. [PMID: 37188145 PMCID: PMC10172850 DOI: 10.1016/j.jor.2023.04.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 04/21/2023] [Indexed: 05/17/2023] Open
Abstract
Background Legally blind patients are more prone to injury-related falls, which may lead to hip fractures, often necessitating total hip arthroplasty (THA), as a corrective procedure. Many of these patients have unique medical needs and have increased rates of perioperative complications following surgical procedures. However, there is limited information on the hospitalization data and perioperative complications in this population following guidelines such as THA. The purpose of this study was to evaluate the patient characteristics, demographics, and prevalence of perioperative issues among THA patients who were legally blind. Methods Using 2016-2019 data from the Nationwide Inpatient Sample (NIS), the incidence of perioperative complications, length of stay (LOS), and the cost of care (COC) among patients undergoing THA who were categorized as legally blind patients, compared to those who were not were analyzed. Propensity matching was conducted to consider associated factors that may influence perioperative complications. Results From 2016 to 2019, 367,856 patients underwent THA, according to the NIS. Of those, 322 (0.1%) patients were categorized as legally blind, and the remaining 367,534 (99.9%) patients were not identified as legally blind (control). Legally blind patients were significantly younger than the control group (65.4 years vs. 66.7 years, p < 0.001). After propensity matching, legally blind patients had longer LOS (3.9 days vs. 2.8, p = 0.04), increased discharges to another facility (45.9% vs. 29.3%, p < 0.001), and fewer discharges to home (21.4% vs. 32.2%, p = 0.02) than control patients. Conclusions The legally blind group had significantly longer LOS, higher rates of discharge to another facility, and lower rates of discharge to home compared to the control group. This data will help providers make informed decisions about patient care and resource allocation for legally blind patients undergoing THA.
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Affiliation(s)
- Nikit Venishetty
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, 5001 El Paso Dr, El Paso, TX, USA
| | - Garrett Sohn
- University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX, USA
| | - Ivy Nguyen
- University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX, USA
| | - Meesha Trivedi
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, 5001 El Paso Dr, El Paso, TX, USA
| | - Varatharaj Mounasamy
- Department of Orthopedics, University of Texas Southwestern, Chief of Orthopedics, Dallas VAMC, 4500 South Lancaster Road, Dallas, TX, USA
| | - Senthil Sambandam
- University of Texas Southwestern, Staff Orthopedic Surgeon, Dallas VAMC, 4500 South Lancaster Road, Dallas, TX, USA
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95
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Postler AE, Lützner C, Goronzy J, Lange T, Deckert S, Günther KP, Lützner J. When are patients with osteoarthritis referred for surgery? Best Pract Res Clin Rheumatol 2023; 37:101835. [PMID: 37263807 DOI: 10.1016/j.berh.2023.101835] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 04/21/2023] [Indexed: 06/03/2023]
Abstract
Current treatment strategies in hip and knee osteoarthritis (OA) involve a combined approach that includes not only modification of risk factors and conservative treatment but also joint-preserving surgical therapy in the early stages, or joint replacement in late OA. With the recent development of new etiological concepts (i.e. hip dysplasia and femoroacetabular impingement as major risk factors for hip OA), treatment alternatives for joint preservation could be extended significantly. Satisfactory results of osteotomies and other reconstructive procedures around hip and knee joints can only be expected in early OA (Kellgren/Lawrence grade 0-II). If patients with advanced radiographic OA grades III-IV do not respond to conservative treatment over at least 3 months and express a relevant burden of disease, joint replacement might be considered. Prior to surgery, potential contraindications must be excluded, patient expectations need to be discussed, and modifiable risk factors, which may negatively influence the outcome, should be optimized.
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Affiliation(s)
- A E Postler
- Department for Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Germany.
| | - C Lützner
- Department for Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Germany; Center for Evidence-based Healthcare, University Hospital Carl Gustav Carus and Faculty of Medicine Carl Gustav Carus, Technical University Dresden, Germany.
| | - J Goronzy
- Department for Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Germany.
| | - T Lange
- Center for Evidence-based Healthcare, University Hospital Carl Gustav Carus and Faculty of Medicine Carl Gustav Carus, Technical University Dresden, Germany.
| | - S Deckert
- Center for Evidence-based Healthcare, University Hospital Carl Gustav Carus and Faculty of Medicine Carl Gustav Carus, Technical University Dresden, Germany.
| | - K P Günther
- Department for Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Germany.
| | - J Lützner
- Department for Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Germany.
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96
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Venishetty N, Toutoungy M, Beale J, Martinez J, Wukich DK, Mounasamy V, Huo MH, Sambandam S. Total Hip Arthroplasty in Nonagenarians - A National In-Patient Sample-Based Study of Perioperative Complications. Geriatr Orthop Surg Rehabil 2023; 14:21514593231178624. [PMID: 37250017 PMCID: PMC10214100 DOI: 10.1177/21514593231178624] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 05/31/2023] Open
Abstract
Background Nonagenarians are a rapidly expanding population in the United States. These patients are met with increasing rates of hip arthritis, necessitating the need for total hip arthroplasty (THA). However, there is currently limited information on hospitalization information and perioperative complications in this population. Methods: In this retrospective study, we used the Nationwide Inpatient Sample (NIS) database from 2016-2019 to analyze the incidence of perioperative complications, length of stay (LOS), and the cost of care (COC) among patients undergoing THAs who were categorized as nonagenarians, and those who were not. Results The NIS database identified 309 100 patients who underwent THAs from 2016-2019. Of those, 1864 patients (.6%) were nonagenarian, while the remaining 307 236 patients were included under the non-nonagenarian category (control). The mean age in the nonagenarian group was 90 years compared to the control group which had a mean age of 65.8 years. There was an increased incidence of mortality rate (nonagenarian group .2%, control group .03%, P < .001), myocardial infarction (MI) (nonagenarian group .1%, control group .02%, P = .01), acute renal failure (ARF) (nonagenarian group 5.4%, control group 1.6%, P < .001), blood anemia post-operatively (nonagenarian group 28.9%, control group 17.2%, P < .001), and deep vein thrombosis (DVT) (nonagenarian group .48%, control group .07%, P < .001) in the nonagenarian group. The COC for the nonagenarian group was higher than that in the control group (P < .001). The mean LOS was longer in the nonagenarian group (3.1 days) in comparison to the control group (1.96 days) (P < .001). Conclusions Nonagenarians had significantly higher rates of both orthopedics and medical complications than the younger patients undergoing THAs. In addition, the nonagenarian group incurred higher COC. This information is useful for the providers to make informed decisions regarding patient care and resource utilization for nonagenarian patients undergoing THAs.
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Affiliation(s)
- Nikit Venishetty
- Paul L. Foster School of Medicine,
Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Michel Toutoungy
- Paul L. Foster School of Medicine,
Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Jack Beale
- University of Texas
Southwestern, Dallas, TX, USA
| | | | - Dane K. Wukich
- Department of Orthopedics, University of Texas
Southwestern, Dallas, TX, USA
| | | | - Michael H. Huo
- Department of Orthopedics, University of Texas
Southwestern, Dallas, TX, USA
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97
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Dudoniene V, Adomaitytė A, Žlibinaitė L. Randomized controlled trial to compare conventional physiotherapy with task-oriented exercises after total hip replacement. J Back Musculoskelet Rehabil 2023:BMR220340. [PMID: 37248880 DOI: 10.3233/bmr-220340] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Different interventions are used during rehabilitation after hip replacement surgery, but it is unclear if task-oriented exercise is more effective than conventional physiotherapy. OBJECTIVE This study compared the effectiveness of conventional physiotherapy (CPT) programme with task-oriented exercise (TOE) on hip pain, function, static and dynamic balance during the early rehabilitation stage after total hip replacement. METHODS This randomized controlled parallel-group trial was executed in an inpatient physical medicine and rehabilitation centre. The study included 40 patients who were randomly classified into CPT and TOE groups (n= 20 in each). Hip pain (assessed by visual analogue scale), function in the operated leg (assessed by modified Harris Hip Score, mHHS), static balance (assessed by Abili Balance analyser system) and dynamic balance (assessed by Berg Balance Scale) were evaluated at baseline and after 18 days of rehabilitation. Cohen's effect size (d) was calculated. RESULTS Greater pain reduction (p< 0.05; d= 0.08) was observed after TOE (1.6 ± 0.68 scores) compared with the CPT programme (2.2 ± 0.83 scores). Hip function assessed by the modified mHHS improved more (p< 0.05; d= 0.30) in the TOE group (73.45 ± 6.23 scores) than in the CPT group (54.90 ± 6.28 scores). Static balance improved significantly in both groups after the interventions but did not differ significantly between the groups. The improvement in dynamic balance was significantly greater (p< 0.05; d= 0.45) after TOE (50.55 ± 1.57 scores) than after CPT (38.55 ± 3.43 scores). CONCLUSION Both interventions reduced pain and improved function of the operated leg and static and dynamic balance. The effect on hip function was superior for TOE compared with CPT.
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Jones T, Penfold C, Redaniel MT, Eyles E, Keen T, Elliott A, Blom AW, Judge A. Impact of pausing elective hip and knee replacement surgery during winter 2017 on subsequent service provision at a major NHS Trust: a descriptive observational study using interrupted time series. BMJ Open 2023; 13:e066398. [PMID: 37192798 DOI: 10.1136/bmjopen-2022-066398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
OBJECTIVES To explore the impact of a temporary cancellation of elective surgery in winter 2017 on trends in primary hip and knee replacement at a major National Health Service (NHS) Trust, and whether lessons can be learnt about efficient surgery provision. DESIGN AND SETTING Observational descriptive study using interrupted time series analysis of hospital records to explore trends in primary hip and knee replacement surgery at a major NHS Trust, as well as patient characteristics, 2016-2019. INTERVENTION A temporary cancellation of elective services for 2 months in winter 2017. OUTCOMES NHS-funded hospital admissions for primary hip or knee replacement, length of stay and bed occupancy. Additionally, we explored the ratio of elective to emergency admissions at the Trust as a measure of elective capacity, and the ratio of public to private provision of NHS-funded hip and knee surgery. RESULTS After winter 2017, there was a sustained reduction in the number of knee replacements, a decrease in the proportion of most deprived people having knee replacements and an increase in average age for knee replacement and comorbidity for both types of surgery. The ratio of public to private provision dropped after winter 2017, and elective capacity generally has reduced over time. There was clear seasonality in provision of elective surgery, with less complex patients admitted during winter. CONCLUSIONS Declining elective capacity and seasonality has a marked effect on the provision of joint replacement, despite efficiency improvements in hospital treatment. The Trust has outsourced less complex patients to independent providers, and/or treated them during winter when capacity is most limited. There is a need to explore whether these are strategies that could be used explicitly to maximise the use of limited elective capacity, provide benefit to patients and value for money for taxpayers.
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Affiliation(s)
- Tim Jones
- NIHR ARC West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Chris Penfold
- NIHR ARC West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Maria Theresa Redaniel
- NIHR ARC West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emily Eyles
- NIHR ARC West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tim Keen
- North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | | | - Ashley W Blom
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Andrew Judge
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
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Huang Y, Yang Q, Wang Z, Pan Z, Zhang Y, Shi Z, Yang S. Comparisons of in-hospital complications between total hip arthroplasty and hip resurfacing arthroplasty. BMC Musculoskelet Disord 2023; 24:375. [PMID: 37170240 PMCID: PMC10173641 DOI: 10.1186/s12891-023-06487-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 05/03/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Hip resurfacing arthroplasty (HRA) is a less common but effective alternative method to total hip arthroplasty (THA) for hip reconstruction. In this study, we investigated the incidences of in-hospital complications between patients who had been subjected to THA and HRA. METHODS The National Inpatient Sample data that had been recorded from 2005 to 2014 was used in this study. Based on the International Classification of Disease, Ninth Revision, Clinical Modification, patients who underwent THA or HRA were included. Data on demographics, preoperative comorbidities, length of hospital stay, total charges, and in-hospital mortality and complications were compared. Multiple logistic regression analysis was used to determine whether different surgical options are independent risk factors for postoperative complications. RESULTS A total of 537,506 THAs and 9,744 HRAs were obtained from the NIS database. Patients who had been subjected to HRA exhibited less preoperative comorbidity rates, shorter length of stay and extra hospital charges. Moreover, HRA was associated with more in-hospital prosthesis loosening. Notably, patients who underwent HRA were younger and presented less preoperative comorbidities but did not show lower incidences in most complications. CONCLUSIONS The popularity of HRA gradually reduced from the year 2005 to 2014. Patients who underwent HRA were more likely to be younger, male, have less comorbidities and spend more money on medical costs. The risk of in-hospital prosthesis loosening after HRA was higher. The HRA-associated advantages with regards to most in-hospital complications were not markedly different from those of THA. In-hospital complications of HRA deserve more attention from surgeons.
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Affiliation(s)
- Yuanyuan Huang
- School of Health, Dongguan Polytechnic, Dongguan, Guangdong, 523000, China
| | - Qinfeng Yang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue, Guangzhou, Guangdong, 510515, China
| | - Ziqi Wang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue, Guangzhou, Guangdong, 510515, China
| | - Zhijie Pan
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue, Guangzhou, Guangdong, 510515, China
| | - Yang Zhang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue, Guangzhou, Guangdong, 510515, China.
| | - Zhanjun Shi
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue, Guangzhou, Guangdong, 510515, China.
| | - Sheng Yang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue, Guangzhou, Guangdong, 510515, China.
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, 510515, China.
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Lu H, Zhu N, Ling T, Cao J, Xu H, Zhou K, Zhao E, Zhou Z. Total hip arthroplasty for failed internal fixation of femoral neck fracture: a retrospective study with 2-14 years' follow-up of 345 patients. J Orthop Surg Res 2023; 18:341. [PMID: 37161494 PMCID: PMC10169472 DOI: 10.1186/s13018-023-03827-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/04/2023] [Indexed: 05/11/2023] Open
Abstract
OBJECTIVES The purpose of this study was to analyze mid- to long-term outcomes of total hip arthroplasty (THA) following failed internal fixation of femoral neck fracture. METHODS This study retrospectively analyzed 345 patients with femoral neck fracture who underwent THA after failure of internal fixation at our hospital between January, 2003 and December, 2019. Patients older than 55 years (n = 175) and patients no older than 55 years (n = 170) were compared in terms of complications and survival rates during follow-up, which lasted a mean of 6 years. RESULTS The two age groups showed similarly low incidence of complications and similarly long periods of survival without revision surgery. Only three younger patients and two older patients underwent revision surgery during follow-up. The two groups showed similarly high survival rates at the end of follow-up (> 93%). Younger patients showed significantly bettter Harris hip score at last follow-up (90.2 vs. 88.1 points, p < 0.001) without clinically significant difference, but they required THA significantly earlier after internal fixation (4.4 vs. 6.8 years, p < 0.001). CONCLUSIONS THA after failed internal fixation of femoral neck fracture is a well tolerated and effective procedure in older and younger patients.
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Affiliation(s)
- Hanpeng Lu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Niu Zhu
- Precision Medicine Center, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Tingxian Ling
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jian Cao
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Hong Xu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Kai Zhou
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Enze Zhao
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Zongke Zhou
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China.
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