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Ko YS, Lee HJ, Kim HS, Yoo JJ. Ipsilateral pubic ramus fracture during total hip arthroplasty is not rare: does it matter? Arch Orthop Trauma Surg 2024; 144:2849-2857. [PMID: 38743113 PMCID: PMC11211179 DOI: 10.1007/s00402-024-05368-5] [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: 02/08/2024] [Accepted: 05/05/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Periprosthetic fractures in total hip arthroplasty (THA) have been well described and studied. However, there is a lack of reports on ipsilateral pubic ramus fractures during THA due to the rare occurrence of such fractures and ambiguity of symptoms. With the use of postoperative computed tomography (CT) examinations, we have identified that asymptomatic ipsilateral pubic ramus fractures occur frequently during THA. This study aims to evaluate the incidence, location, clinical outcomes, and risk factors of ipsilateral pubic ramus fractures during THA. METHODS From May 2022 to March 2023, a single surgeon performed 203 THAs in 183 patients at a single institution. All patients underwent postoperative CT scans three days after THA. The patients with ipsilateral pubic ramus fractures were followed up for a minimum of six months. Basic demographics, osteoporosis, general conditions of the operations, and outcomes of THA were investigated in all patients. RESULTS Twenty-two cases (10.8%) of ipsilateral pubic ramus fractures were identified on postoperative CT scans. All fractures were located near the origin of the superior or inferior pubic ramus. Five fractures were detected on simple postoperative radiographs. The fractures did not cause any further complications at a minimum of six-month postoperative follow-up. Univariate and multivariate analyses did not identify any risk factors associated with these fractures. CONCLUSIONS Although the incidence of ipsilateral pubic ramus fractures during THA is high, treatment is not required as they do not cause any significant clinical symptoms or affect the prognosis of THA. However, the possibility of occurrence of these fractures must be explained to the patients before surgery.
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Affiliation(s)
- Young-Seung Ko
- Department of Orthopaedic Surgery, Hallym university Dong-Tan Sacred Heart Hospital, Hwaseong, South Korea
| | - Han Jin Lee
- Department of Orthopaedic Surgery, Hanil Hospital, Seoul, South Korea
| | - Hong Seok Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, South Korea
| | - Jeong Joon Yoo
- Department of Orthopaedic Surgery, Hallym university Dong-Tan Sacred Heart Hospital, Hwaseong, South Korea.
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, South Korea.
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Chun YS, Lee HH, Lim YW, Kim YS, Kwon SY, Kim SC. Incidence and outcomes of intraoperative periprosthetic acetabular fractures during cementless total hip arthroplasty: a prospective three-dimensional computer tomography-based study. INTERNATIONAL ORTHOPAEDICS 2024; 48:667-674. [PMID: 37723316 DOI: 10.1007/s00264-023-05988-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/13/2023] [Indexed: 09/20/2023]
Abstract
PURPOSE Unlike periprosthetic femoral fractures, periprosthetic acetabular fractures during total hip arthroplasty (THA) have not been evaluated in detail. We prospectively evaluated the incidence, patterns, risk factors, and clinical outcomes of intraoperative periprosthetic acetabular fractures using pre- and postoperative computer tomography (CT). METHODS In this prospective single-centre study, we evaluated 234 consecutive patients (250 hips) who underwent THA and three-dimensional CT before and after the surgery. We assessed the incidence, pattern of fractures, outcomes for each fracture pattern, reoperation and revision rates, Harris hip score, and visual analog scale (VAS) for pain. Multivariate regression models were used to identify risk factors for periprosthetic acetabular fractures. RESULTS In total, 43 periprosthetic acetabular fractures (17.2%) were identified via CT. Fractures occurred most frequently at the superolateral wall. Early cup migration occurred in three hips. None of the patients underwent revision surgery for acetabular loosening. Regression modeling showed that rheumatoid arthritis was a significant predictor of periprosthetic acetabular fractures. CONCLUSIONS Periprosthetic acetabular fractures are not infrequent during cementless THA and are more common in patients with rheumatoid arthritis.
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Affiliation(s)
- You-Seung Chun
- Department of Orthopaedic Surgery, College of Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Chunbo-Ro 271, Uijeongbu, Gyeonggi-Do, South Korea
| | - Hwan-Hee Lee
- Department of Orthopaedic Surgery, College of Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daeheung-Ro 64, Daejeon, South Korea
| | - Young-Wook Lim
- Department of Orthopaedic Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Banpodae-Ro 222, Seocho-Gu, Seoul, South Korea
| | - Yong-Sik Kim
- Department of Orthopaedic Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Banpodae-Ro 222, Seocho-Gu, Seoul, South Korea
| | - Soon-Yong Kwon
- Department of Orthopaedic Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Banpodae-Ro 222, Seocho-Gu, Seoul, South Korea
| | - Seung-Chan Kim
- Department of Orthopaedic Surgery, College of Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Tongil-Ro 1021, Eunpyeong-Gu, Seoul, South Korea.
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Stauffer TP, Purcell KF, Pean C, DeBaun M, Bolognesi M, Ryan S, Chun D, Seyler T. Management of Intraoperative Acetabular Fractures During Total Hip Arthroplasty. Orthop Clin North Am 2024; 55:9-17. [PMID: 37980107 DOI: 10.1016/j.ocl.2023.06.009] [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] [Indexed: 11/20/2023]
Abstract
Intraoperative fractures of the acetabulum are a rare but serious complication during total hip arthroplasty. Acute fractures generally require attention with plating, whereas chronic acetabular fractures may be approached with distraction, a Burch-Schneider cage, or a custom implant. It is imperative for arthroplasty surgeons to possess a thorough understanding of how to identify and manage these injuries. Collaborating with an orthopedic traumatologist for assistance with plating the anterior or posterior column, if necessary, can be invaluable. Management options encompass conservative management, revision style acetabular component, screw/plating of anterior/posterior column, and the use of a larger cup with multiple screw augmentation options.
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Affiliation(s)
- Taylor P Stauffer
- School of Medicine, Duke University, Durham, NC, USA; Duke University Hospital, 40 Duke Medicine Circle, Durham, NC 27710, USA.
| | - Kevin F Purcell
- Division of Orthopedic Surgery, Duke University, Durham, NC, USA
| | - Christian Pean
- Division of Orthopedic Surgery, Duke University, Durham, NC, USA
| | - Malcolm DeBaun
- Division of Orthopedic Surgery, Duke University, Durham, NC, USA
| | | | - Sean Ryan
- Division of Orthopedic Surgery, Duke University, Durham, NC, USA
| | - Danielle Chun
- Division of Orthopedic Surgery, Duke University, Durham, NC, USA
| | - Thorsten Seyler
- Division of Orthopedic Surgery, Duke University, Durham, NC, USA
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Wooster BM, Kennedy NI, Dugdale EM, Sierra RJ, Perry KI, Berry DJ, Abdel MP. Contemporary outcomes of primary total hip arthroplasty in patients with inflammatory arthritis. Bone Joint J 2023; 105-B:768-774. [PMID: 37399088 PMCID: PMC10386849 DOI: 10.1302/0301-620x.105b7.bjj-2023-0220.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
Aims Contemporary outcomes of primary total hip arthroplasties (THAs) with highly cross-linked polyethylene (HXLPE) liners in patients with inflammatory arthritis have not been well studied. This study examined the implant survivorship, complications, radiological results, and clinical outcomes of THA in patients with inflammatory arthritis. Methods We identified 418 hips (350 patients) with a primary diagnosis of inflammatory arthritis who underwent primary THA with HXLPE liners from January 2000 to December 2017. Of these hips, 68% had rheumatoid arthritis (n = 286), 13% ankylosing spondylitis (n = 53), 7% juvenile rheumatoid arthritis (n = 29), 6% psoriatic arthritis (n = 24), 5% systemic lupus erythematosus (n = 23), and 1% scleroderma (n = 3). Mean age was 58 years (SD 14.8), 66.3% were female (n = 277), and mean BMI was 29 kg/m2 (SD 7). Uncemented femoral components were used in 77% of cases (n = 320). Uncemented acetabular components were used in all patients. Competing risk analysis was used accounting for death. Mean follow-up was 4.5 years (2 to 18). Results The ten-year cumulative incidence of any revision was 3%, and was highest in psoriatic arthritis patients (16%). The most common indications for the 15 revisions were dislocations (n = 8) and periprosthetic joint infections (PJI; n = 4, all on disease-modifying antirheumatic drugs (DMARDs)). The ten-year cumulative incidence of reoperation was 6.1%, with the most common indications being wound infections (six cases, four on DMARDs) and postoperative periprosthetic femur fractures (two cases, both uncemented femoral components). The ten-year cumulative incidence of complications not requiring reoperation was 13.1%, with the most common being intraoperative periprosthetic femur fracture (15 cases, 14 uncemented femoral components; p = 0.13). Radiological evidence of early femoral component subsidence was observed in six cases (all uncemented). Only one femoral component ultimately developed aseptic loosening. Harris Hip Scores substantially improved (p < 0.001). Conclusion Contemporary primary THAs with HXLPE in patients with inflammatory arthritis had excellent survivorship and good functional outcomes regardless of fixation method. Dislocation, PJI, and periprosthetic fracture were the most common complications in this cohort with inflammatory arthritis.
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Affiliation(s)
- Benjamin M. Wooster
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Nicholas I. Kennedy
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Evan M. Dugdale
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Rafael J. Sierra
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Kevin I. Perry
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Daniel J. Berry
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Matthew P. Abdel
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
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Liu P, Qiao YJ, Lou JP, Cao G, Chang Y, Zhou SH. Cementless total hip arthroplasty for treatment of acetabular protrusion secondary to rheumatoid arthritis. J Orthop Surg Res 2023; 18:282. [PMID: 37024933 PMCID: PMC10080900 DOI: 10.1186/s13018-023-03764-y] [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: 12/25/2022] [Accepted: 03/29/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND To explore the surgical technique and clinical outcomes of cementless total hip arthroplasty (THA) combined with impacted bone grafting for the treatment of moderate and severe acetabular protrusion with rheumatoid arthritis (RA). METHODS From January 2010 to October 2020, 45 patients (56 hips), including 17 men (22 hips) and 28 women (34 hips) with acetabular impingement secondary to RA, were treated with bioprosthetic THA combined with autologous bone grafting at our hospital. According to the Sotello-Garza and Charnley classification criteria, there were 40 cases (49 hips) of type II (protrusio acetabuli 6-15 mm) and 5 cases (7 hips) of type III (protrusio acetabuli > 15 mm). At the postoperative follow-up, the ROM of the hip joint, the VAS score, and the Harris score were evaluated. The healing of the bone graft, the restoration of the hip rotation center, and the prosthesis loosening were assessed by plain anteroposterior radiographs. RESULTS The average operation time was 95.53 ± 22.45 min, and the mean blood loss was 156.16 ± 69.25 mL. There were no neurovascular complications during the operation. The mean follow-up duration was 5.20 ± 1.20 years. The horizontal distance of the hip rotation center increased from preoperative 10.40 ± 2.50 mm to postoperative 24.03 ± 1.77 mm, and the vertical distance increased from preoperative 72.36 ± 3.10 mm to postoperative 92.48 ± 5.31 mm. The range of flexion motion of the hip joint increased from 39.48 ± 8.36° preoperatively to 103.07 ± 7.64° postoperatively, and the range of abduction motion increased from 10.86 ± 4.34° preoperatively to 36.75 ± 3.99° postoperatively. At the last follow-up, the Harris score increased from 37.84 ± 4.74 to 89.55 ± 4.05. All patients were able to move independently without assistance. CONCLUSIONS Cementless THA combined with impacted grafting granule bone of the autogenous femoral head and biological acetabular cup can reconstruct the acetabulum, restore the rotation center of the hip joint, and achieve good medium-term outcomes in the treatment of moderate to severe acetabular herniation secondary to RA.
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Affiliation(s)
- Peng Liu
- Department of Joint Surgery, The 940Th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, South Binhe Road, No. 333, Lanzhou City, 730050, Gansu Province, People's Republic of China
| | - Yong-Jie Qiao
- Department of Joint Surgery, The 940Th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, South Binhe Road, No. 333, Lanzhou City, 730050, Gansu Province, People's Republic of China
| | - Jin-Peng Lou
- Department of Joint Surgery, The 940Th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, South Binhe Road, No. 333, Lanzhou City, 730050, Gansu Province, People's Republic of China
| | - Guoding Cao
- Department of Orthopaedics, Lanzhou University Second Hospital, Cuiying Gate, No. 82, Chengguan District, Lanzhou City, 730030, Gansu Province, People's Republic of China
| | - Yanfeng Chang
- Department of Joint Surgery, The 940Th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, South Binhe Road, No. 333, Lanzhou City, 730050, Gansu Province, People's Republic of China
| | - Sheng-Hu Zhou
- Department of Joint Surgery, The 940Th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, South Binhe Road, No. 333, Lanzhou City, 730050, Gansu Province, People's Republic of China.
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6
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de Ridder VA, Pape HC, Chana-Rodríguez F, Boudissa M, Claudia G, Fabian S, Steven H, Tina H, Konstantinos T, Zoe D. Managing periprosthetic fractures: perspectives on periprosthetic pelvic fractures. OTA Int 2023; 6:e266. [PMID: 37006450 PMCID: PMC10064643 DOI: 10.1097/oi9.0000000000000266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 01/16/2023] [Indexed: 03/30/2023]
Abstract
Periacetabular periprosthetic fractures are rare but potentially disastrous for the longevity of the adjacent implants, leading to multiple revision surgeries. It is of paramount importance to identify and treat intraoperative fractures, which will lead to satisfactory results. Postoperative fractures may be managed operatively or nonoperatively depending on the patient's pain and function, the fracture pattern, and the stability of the acetabular component.
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7
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Ito H, Nishida K, Kojima T, Matsushita I, Kojima M, Hirata S, Kaneko Y, Kishimoto M, Kohno M, Mori M, Morinobu A, Murashima A, Seto Y, Sugihara T, Tanaka E, Nakayama T, Yamanaka H, Kawahito Y, Harigai M. Non-drug and surgical treatment algorithm and recommendations for the 2020 update of the Japan College of Rheumatology clinical practice guidelines for the management of rheumatoid arthritis-secondary publication. Mod Rheumatol 2023; 33:36-45. [PMID: 35294030 DOI: 10.1093/mr/roac019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/03/2022] [Accepted: 02/07/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVES The aim of this study was to update the Japan College of Rheumatology (JCR) clinical practice guidelines (CPGs) for the management of rheumatoid arthritis (RA) and prepare an algorithm for non-drug and surgical treatments. This article is a digest version of the guidelines. METHODS The Japanese Ministry of Health, Labour and Welfare's research group, in collaboration with the JCR, used the Grading of Recommendations, Assessment, Development, and Evaluation method to update the 2014 JCR CPG for RA. The consensus was formed by CPG panel members. RESULTS We raised 19 clinical questions regarding non-drug and surgical treatments for RA and developed recommendations. The treatments included exercise therapy; occupational therapy; joint injection of corticosteroids; and orthopaedic surgeries including cervical spine surgery, wrist and foot arthroplasty, ankle arthrodesis, and replacement arthroplasty of the shoulder, elbow, finger, hip, knee, and ankle. Recommendations regarding the risks of surgery and perioperative discontinuation of medications have also been developed. Based on these recommendations, we created an original algorithm for the non-drug and surgical treatment of RA. CONCLUSIONS These recommendations are expected to serve rheumatologists, health care professionals, and patients with RA as tools for shared decision-making to treat residual limb joint symptoms and functional impairment.
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Affiliation(s)
- Hiromu Ito
- Department of Orthopedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Orthopedic Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Keiichiro Nishida
- Department of Orthopedic Surgery, Okayama University Academic Field of Medicine, Density and Pharmaceutical Sciences, Okayama, Japan
| | - Toshihisa Kojima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Isao Matsushita
- Department of Rehabilitation Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Masayo Kojima
- Department of Frailty Research, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Shintaro Hirata
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan
| | - Yuko Kaneko
- Department of Internal Medicine, Division of Rheumatology, Keio University School of Medicine, Tokyo, Japan
| | - Mitsumasa Kishimoto
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Masataka Kohno
- Inflammation and Immunology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masaaki Mori
- Division of Rheumatology and Allergology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Akio Morinobu
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Atsuko Murashima
- Center for Maternal-Fetal, Neonatal, and Reproductive Medicine/Japan Drug Information Institute in Pregnancy, National Center for Child Health and Development, Tokyo, Japan
| | - Yohei Seto
- Department of Rheumatology, Yachiyo Medical Center, Tokyo Women's Medical University School of Medicine, Yachiyo, Japan
| | - Takahiko Sugihara
- Division of Rheumatology and Allergology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Eiichi Tanaka
- Department of Internal Medicine, Division of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | | | - Yutaka Kawahito
- Inflammation and Immunology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masayoshi Harigai
- Department of Internal Medicine, Division of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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8
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Yamamuro Y, Kabata T, Kajino Y, Inoue D, Hasegawa K, Tsuchiya H. Does intraoperative periprosthetic occult fracture of the acetabulum affect clinical outcomes after primary total hip arthroplasty? Arch Orthop Trauma Surg 2022; 142:3497-3504. [PMID: 34677634 DOI: 10.1007/s00402-021-04226-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/13/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The frequency of intraoperative periprosthetic occult fracture of the acetabulum (IPOA) in primary total hip arthroplasty (THA) is relatively high. However, the effect of this fracture on clinical outcome and survival of primary THA remains unknown. This study aimed to determine the impact of IPOA on the outcomes of primary THA during a minimum follow-up of 5 years. MATERIALS AND METHODS This retrospective case-control study compared the outcomes of primary THA with or without IPOA during a minimum 5-year follow-up. Thirty-eight patients who underwent primary THA with IPOA (O group) were matched to 76 patients without IPOA (C group) between 2004 and 2013 based on age, sex, body mass index, primary diseases, cup diameter, cup design, and additional dome screw. Both groups underwent the same rehabilitation programs after surgery. We evaluated the Japanese Orthopaedic Association clinical outcomes score; postoperative complications, such as nerve injury, dislocation, heterotopic ossification, iliopsoas impingement, or infection; and radiographic outcomes. Additionally, we performed Kaplan-Meier survival analysis with cup aseptic loosening, cup failure revision, and all-cause revision as the endpoints. RESULTS There were no significant differences in the pre- and postoperative clinical scores, postoperative complication rates, and cup sagittal rotation between the two groups. Radiographic evaluations showed no aggravation of cases to overt fractures. Bone ingrowth was observed in all cases, and none of the acetabular cups had a progressive radiolucent line ≥ 2 mm in all the 3 acetabular zones. Ten-year survival rates for cup aseptic loosening and cup failure revision were 100% in both groups; those for all-cause revision were 97.4% (92.0-100%) and 100% in the O and C groups, respectively (p = 0.157). CONCLUSIONS Primary THA with IPOA provides favorable mid- to long-term outcomes. On IPOA diagnosis, although radiographic follow-up is necessary, additional treatments or rehabilitation programs are not required. Furthermore, postoperative computed tomography images for the detection of IPOA may be unnecessary.
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Affiliation(s)
- Yuki Yamamuro
- Department of Orthopedic Surgery Graduate School of Medical Science, Kanazawa University, Takaramachi, 13-1, Kanazawa, Ishikawa, 920-8641, Japan
| | - Tamon Kabata
- Department of Orthopedic Surgery Graduate School of Medical Science, Kanazawa University, Takaramachi, 13-1, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Yoshitomo Kajino
- Department of Orthopedic Surgery Graduate School of Medical Science, Kanazawa University, Takaramachi, 13-1, Kanazawa, Ishikawa, 920-8641, Japan
| | - Daisuke Inoue
- Department of Orthopedic Surgery Graduate School of Medical Science, Kanazawa University, Takaramachi, 13-1, Kanazawa, Ishikawa, 920-8641, Japan
| | - Kazuhiro Hasegawa
- Department of Orthopedic Surgery, Nanto Central Hospital, Nanto, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery Graduate School of Medical Science, Kanazawa University, Takaramachi, 13-1, Kanazawa, Ishikawa, 920-8641, Japan
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9
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Bukowski BR, Clark NJ, Taunton MJ, Freedman BA, Berry DJ, Abdel MP. Primary Total Hip Arthroplasty in Patients With Ankylosing Spondylitis. J Arthroplasty 2021; 36:S282-S289. [PMID: 33602587 DOI: 10.1016/j.arth.2021.01.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/28/2020] [Accepted: 01/19/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Ankylosing spondylitis (AS) is a common inflammatory spondyloarthropathy with hip involvement in 40% of patients. With the renewed interest in the hip-spine interplay, this study aimed to define long-term outcomes of primary total hip arthroplasty (THA) in the setting of AS. METHODS We identified 309 hips (219 patients) with AS treated with primary THA from 1969 to 2018. Mean age was 49 years, 80% were males, and mean body mass index was 28 kg/m2. Cumulative incidences of any revision, reoperation, and dislocation were calculated utilizing a competing risk analysis. Harris Hip Scores and complications were also reported. Mean follow-up was 16 years. RESULTS The cumulative incidence of any revision after primary THA was 2.3% at 5 years and 17.5% at 20 years. The most common reasons for revision (n = 73) were aseptic loosening (41%), osteolysis/polyethylene (PE) wear (30%, all with conventional PE), and femoral component fracture (8%). The cumulative incidence of dislocation was 1.9% at 5 years and 2.9% at 20 years. Younger age was associated with increased risk of revision (hazard ratio (HR) = 1.3, P < .01) and reoperation (HR = 1.2, P < .01), but not dislocation (HR = 0.7, P = .1). Twenty-eight hips (9%) experienced a postoperative complication not requiring reoperation. The mean Harris Hip Score improved from 51 to 76 after THA (P < .001). CONCLUSION In this series of 309 primary THAs in patients with AS, the 20-year cumulative incidence of any revision after primary THA was 17.5%. Aseptic loosening, osteolysis/PE wear, and femoral component fracture were the most common reasons for revision. Notably, the cumulative incidence of dislocation at 20 years was only 2.9%. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
| | | | | | | | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
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10
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Mühlenfeld M, Strahl A, Bechler U, Jandl NM, Hubert J, Rolvien T. Bone mineral density assessment by DXA in rheumatic patients with end-stage osteoarthritis undergoing total joint arthroplasty. BMC Musculoskelet Disord 2021; 22:173. [PMID: 33573628 PMCID: PMC7879515 DOI: 10.1186/s12891-021-04039-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/18/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Patients with rheumatic diseases have a high risk for joint destruction and secondary osteoarthritis (OA) as well as low bone mineral density (BMD, i.e., osteoporosis). While several factors may lead to low BMD in these patients, the value of BMD measurements in rheumatic patients with end-stage OA scheduled for total joint arthroplasty is unknown. METHODS In this retrospective cross-sectional study of 50 adults with secondary OA due to rheumatic diseases, we evaluated dual energy X-ray absorptiometry (DXA) measurements of both hips and the spine performed within 3 months prior to arthroplasty (n = 25 total hip arthroplasty, THA; n = 25 total knee arthroplasty, TKA). We analyzed various demographic and disease-specific characteristics and their effect on DXA results by using group comparisons and multivariate linear regression models. RESULTS Although patients undergoing TKA were younger (63.2 ± 14.2 vs. 71.0 ± 10.8 yr., p = 0.035), osteoporosis was observed more frequently in patients scheduled for TKA than THA (32% vs. 12%). Osteopenia was detected in 13/25 patients (52%) in both the THA and TKA cohort. In the THA cohort, female sex, lower BMI and prednisolone use were associated with lower T-score in the hip. In TKA patients, higher OA grade determined by Kellgren-Lawrence score was associated with lower T-score in the hip of the affected side. CONCLUSIONS Osteoporosis is present in a considerable frequency of rheumatic patients with end-stage OA, and THA and TKA patients show distinct frequencies and risk factors of low BMD. Our findings point to a potential value of DXA regarding preoperative evaluation of bone status.
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Affiliation(s)
- Moritz Mühlenfeld
- Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - André Strahl
- Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Ulrich Bechler
- Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Nico Maximilian Jandl
- Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.,Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestrasse 59, 22529, Hamburg, Germany
| | - Jan Hubert
- Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Tim Rolvien
- Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. .,Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestrasse 59, 22529, Hamburg, Germany.
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11
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Zhen P, Chang Y, Yue H, Chen H, Zhou S, Liu J, He X. Primary total hip arthroplasty using a short bone-conserving stem in young adult osteoporotic patients with Dorr type C femoral bone. J Orthop Surg Res 2021; 16:17. [PMID: 33413495 PMCID: PMC7789779 DOI: 10.1186/s13018-020-01985-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dorr type C femoral bone exhibits a wide, stovepipe-shaped femoral canal, and thin cortices in the proximal femur. Dorr C bone combined with severe osteoporosis is an important challenge in primary hip arthroplasty. In this study, we assessed the effects of short metaphyseal fitting cementless stems on preformatted primary total hip arthroplasties in young adult osteoporotic patients with this femoral presentation. METHODS A total of 42 hip arthroplasties were performed in 35 young patients (range 20 to 36 years) using a short Tri-lock bone preservation metaphyseal-fitting cementless femoral component between 2012 and 2017. The mean age at surgery of the 27 male (33 hips) and 8 female (9 hips) patients was 27.5 years (range 20.3 to 35.8 years). The mean body mass index (BMI) was 20.2 kg/m2 (range, 16.8-23.2 kg/m2). According to Dorr's criteria, all 42 femora were classified as type C bone and all femurs suffered from severe osteoporosis (Singh index ≤ 3). RESULTS The mean follow-up period was 5.5 years (range 3.0 to 8.0 years). The clinical and functional results improved for the Harris hip score, WOMAC, and UCLA activity scores. The Harris Hip score improved from 48.0 ± 8.0 (range 38.0 to 61.0) preoperatively to 87.0 ± 9.0 (range 77.0 to 92.0) at 12 months after surgery and 91.0 ± 8.0 (range 85.0 to 98.0) at final follow-up. The preoperative UCLA activity score was 3.0 ± 0.5 points (range, 1.0-4.0 points), which significantly improved to 7.5 ± 0.7 points (range 6.0 to 8.0 points) at the final follow-up. No patient exhibited thigh pain at the final follow-up. The mean stem-to-canal fill percentages were 97% ± 2.1% (anteroposterior view at midstem). For stem alignment, 40 hips (95.2%) of the femoral stem were positioned neutrally to 3° of varus with reference to the femoral shaft axis. The remaining two were positioned at 4° varus to 4° valgus. Radiographic evaluation showed good osteointegration of the implants in follow-up. CONCLUSIONS Based on the tapered-wedge design and proximal porous coating, the shortened tapered conventional stem can achieve reliable stability through neck filling and metaphyseal fixation, which does not depend on the isthmus hoop stress. This stem was suitable in severe osteoporotic patients with type C bones in young adults who presented with a correspondingly straightened femoral canal with a wide isthmus and thin cortex.
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Affiliation(s)
- Ping Zhen
- Department of Joint Surgery, Institute of Orthopedics, The 940th Hospital of PLA Joint Logistics Support Force, South Binhe Road, No. 333, Lanzhou City, Gansu Province, 730050, PR China
| | - Yanfeng Chang
- Department of Joint Surgery, Institute of Orthopedics, The 940th Hospital of PLA Joint Logistics Support Force, South Binhe Road, No. 333, Lanzhou City, Gansu Province, 730050, PR China
| | - Heng Yue
- Department of Joint Surgery, Institute of Orthopedics, The Dingxi People's Hospital, Anding Road, Anding District, No. 22, Dingxi City, Gansu Province, 730050, PR China
| | - Hui Chen
- Department of Joint Surgery, Institute of Orthopedics, The 940th Hospital of PLA Joint Logistics Support Force, South Binhe Road, No. 333, Lanzhou City, Gansu Province, 730050, PR China
| | - Shenghu Zhou
- Department of Joint Surgery, Institute of Orthopedics, The 940th Hospital of PLA Joint Logistics Support Force, South Binhe Road, No. 333, Lanzhou City, Gansu Province, 730050, PR China
| | - Jun Liu
- Department of Joint Surgery, Institute of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xiwu Road, No. 157, Xi'an City, Shaanxi Province, 730050, PR China.
| | - Xiaole He
- Department of General Practice, Xijing Hospital of Air Force Military Medical University, Xi' an, 710032, China.
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Reliability of stemless shoulder arthroplasty in rheumatoid arthritis: observation of early lysis around the humeral component. Musculoskelet Surg 2019; 105:139-148. [PMID: 31696419 DOI: 10.1007/s12306-019-00629-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/31/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate whether stemless shoulder implants in rheumatoid arthritis (RA) patients provide comparable functional outcomes to patients with osteoarthritis or post-traumatic arthritis. In addition, the study assessed for differences in incidence of radiolucent lines or proximal humeral bone loss during radiographic follow-up. METHODS Consecutive stemless shoulder arthroplasties performed in RA patients and a matched control group were retrospectively identified between February 2012 and 2018. Thirty-five patients were included in each group: 24 total shoulder arthroplasty (TSA) and 11 hemiarthroplasty (HA). Patients were evaluated annually using the Oxford Shoulder Score (OSS) and radiographically. RESULTS The mean OSS significantly improved in all groups until 24 months. The mean improvement for RA TSA and HA patients at 24 months was 19.86 (95% CI 10.66-29.05, p = 0.0004) and 19.71 (95% CI 7.33-32.31, p = 0.0084), respectively. The mean improvement in the control TSA and HA patients at 24 months was 20.86 (95% CI 17-24.71, p = 0.0001) and 17.86 (95% CI 1.36-34.35, p = 0.0381), respectively. During the study period, two patients in the RA TSA group (8%), one patient in the control TSA group (4%) and one patient in the control HA group (9%) required revision. The proportion of progressive proximal humeral bone loss after TSA was 33% in the RA group and 13% in the control group. CONCLUSION Stemless shoulder implants can provide significant improvement in functional scores in RA patients in the short term. However, early bone loss around the humeral implant is a concern and the authors recommend long-term clinical and radiological follow-up.
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Zhen P, Li X, Zhou S, Lu H, Chen H, Liu J. Total hip arthroplasty to treat acetabular protrusions secondary to rheumatoid arthritis. J Orthop Surg Res 2018; 13:92. [PMID: 29673377 PMCID: PMC5907719 DOI: 10.1186/s13018-018-0809-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 04/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The treatment of acetabular protrusions during total hip arthroplasty of patients with rheumatoid arthritis is difficult. A lack of bone stock, deficient medial cup support, and medialization of the joint center in those with protrusio acetabuli must be addressed during acetabular reconstruction. The purpose of this study was to assess the short-term clinical results of total hip arthroplasty in patients with severe acetabular protrusions secondary to rheumatoid arthritis. METHODS From January 2011 to November 2014, 18 patients (20 hips) with severe acetabular protrusions secondary to rheumatoid arthritis underwent total hip arthroplasties using a non-cement impaction and auto-bone-grafting method with resection of the femoral head to treat the acetabular protrusion. The Harris hip scoring system was used to evaluate hip function during follow-up; X-rays were taken to assess the extent of prosthesis loosening and bone graft healing. RESULTS The operation time ranged from 55 to 131 min, averaging 89.5 ± 8.1 min. The blood loss was 165-480 mL (295 ± 10.9 mL). No blood vessel or nerve damage and no acetabular or femoral fracture occurred. The follow-up duration was 4.5 ± 1.7 years. Postoperative X-rays revealed autologous bone graft/acetabular fusion at 4.5 months post-surgery. The Harris hip scores increased significantly, from 55.3 ± 9.5 to 92.2 ± 12.7, after the operation (P < 0.01). The distance from the center of the femoral head to Kohler's line increased from 19.87 ± 3.9 mm to 21.5 ± 3.5 mm after the operation (P < 0.01). During follow-up, no hip acetabular prosthesis loosening was evident. CONCLUSIONS For patients with protrusio acetabuli secondary to rheumatoid arthritis, the use of a cementless, trabecular, metal modular cup allowing peripheral press fitting and restoration of bone stock via impacted autologous bone grafting are both technically straightforward and appear to yield satisfactory short-term results.
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Affiliation(s)
- Ping Zhen
- Department of Orthopedics, The Second Affiliated Hospital of Lanzhou University, Lanzhou, 730030 Gansu People’s Republic of China
- Department of Orthopaedics, Lanzhou General Hospital of PLA, No. 333 South Binhe Road, Lanzhou, 730050 Gansu People’s Republic of China
| | - Xusheng Li
- Department of Orthopaedics, Lanzhou General Hospital of PLA, No. 333 South Binhe Road, Lanzhou, 730050 Gansu People’s Republic of China
| | - Shenghu Zhou
- Department of Orthopaedics, Lanzhou General Hospital of PLA, No. 333 South Binhe Road, Lanzhou, 730050 Gansu People’s Republic of China
| | - Hao Lu
- Department of Orthopaedics, Lanzhou General Hospital of PLA, No. 333 South Binhe Road, Lanzhou, 730050 Gansu People’s Republic of China
| | - Hui Chen
- Department of Orthopaedics, Lanzhou General Hospital of PLA, No. 333 South Binhe Road, Lanzhou, 730050 Gansu People’s Republic of China
| | - Jun Liu
- Department of Orthopaedics, Lanzhou General Hospital of PLA, No. 333 South Binhe Road, Lanzhou, 730050 Gansu People’s Republic of China
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Wacha H, Domsel G, Herrmann E. Long-term follow-up of 1217 consecutive short-stem total hip arthroplasty (THA): a retrospective single-center experience. Eur J Trauma Emerg Surg 2018; 44:457-469. [PMID: 29344706 DOI: 10.1007/s00068-017-0895-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 12/26/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND An arthroplasty registry in Germany has been recently established but long-term results for most short-stem innovations are missing. Short-stem hip arthroplasty is usually indicated in young active patients. Our indication was extended to older age groups, femoral neck fractures (FNF), and dysplasia. We evaluated all total hip arthroplasties (THAs) in this population with a collum femoris preserving stem (CFP) performed from 2003 to 2013. METHODS A consecutive cohort of 1217 CFP THAs with a mean age of 68.7 years was followed retrospectively for a median of 4.8 years (patient follow-up interquartile range from 3.0 to 6.9 years). A questionnaire, which we used in two previous studies, was answered by 89.15% of patients and included information regarding complaints, grade of satisfaction, re-operations, and dislocation. Of the 1217 patients, 77 had died. Survival of the stem and the cup was assessed using a competing risks approach according to an Aalen-Johanson estimator with revision for septic or aseptic loosening or death as a competing endpoint. RESULTS Of the patients who answered the questionnaire, 92.5% had no complaints related to the procedures. In all 1217 patients, there were 43 revisions (4.2%) as follows: stem and cup revisions due to aseptic loosening of the stem (n = 10), infections (n = 6), pain (n = 4), or trauma (n = 3); cup revisions due to aseptic loosening (n = 3), dislocation (n = 5), and offset revisions (n = 12). Survivorship was 96% for the stem and 99% for the cup 9 years postoperatively. Statistical analysis confirmed a higher risk for revision in patients with a younger age (p = 0.033), male sex (p = 0.040), dysplasia (p = 0.032), and undersized or extra-large stems for stem revisions (p = 0.001) and female sex (p = 0.036) for cup revisions. FNF (p > 0.20) and age ≥ 80 years (p = 0.114) had no higher risk for loosening of the stem. Our data is also compared with the current literature, especially with the available CFP studies. CONCLUSION The survival rate of the CFP stem was as high as 96% after 9 years of followup which compares well-to-previously published long-term survival rates. There is no higher risk for revision in patients 80 years old or older and in cases with femoral neck fractures. The CFP preserves also allowed using standard stems in the rare cases of revision.
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Affiliation(s)
- H Wacha
- Department of Surgery, Hospital zum Heiligen Geist, Academic Hospital of the Goethe University, Frankfurt am Main, Germany.
| | - G Domsel
- Department of Surgery, Hospital zum Heiligen Geist, Academic Hospital of the Goethe University, Frankfurt am Main, Germany
| | - E Herrmann
- Institute of Biostatistics and Mathematical Modeling, Goethe University Frankfurt/M, Frankfurt am Main, Germany
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Hasegawa K, Kabata T, Kajino Y, Inoue D, Tsuchiya H. Periprosthetic Occult Fractures of the Acetabulum Occur Frequently During Primary THA. Clin Orthop Relat Res 2017; 475:484-494. [PMID: 27800574 PMCID: PMC5213950 DOI: 10.1007/s11999-016-5138-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 10/19/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Periprosthetic fractures of the acetabulum occurring during primary THA are rare. Periprosthetic occult fractures are defined as those not identified by the surgeon during the procedure which might be missed on a routine postoperative radiograph. However, it is unclear how frequently these fractures occur and whether their presence affects functional recovery. QUESTIONS/PURPOSES In this study, using routine CT scans that were obtained as part of another primary hip arthroplasty study protocol, we retrospectively assessed (1) the prevalence of occult fractures of the acetabulum occurring during primary THA, (2) the location of occult fractures of the acetabulum during THA, and (3) risk factors contributing to such occult fractures. METHODS Between 2004 and 2013, our institute performed 585 primary THAs (cementless or hybrid) in 494 patients with DICOM pre- and postoperative CT; during the period in question, all patients undergoing THA underwent CT before and after surgery. Preoperative CT images were taken as part of a CT-based three-dimensional templating software and navigation system. Postoperative CT images were taken an average of 1 week after surgery as part of a different protocol to evaluate cup position, restoration of leg length and offset, volume of postoperative hematoma to assess anticoagulation effects after THA, and fractures that were not found on routine postoperative radiographs (which we defined as occult fractures). Patients with a history of prior pelvic osteotomy, trauma, and infection were excluded (88 patients/99 hips); 406 patients (102 males and 304 females; 486 hips) form the basis of this report. The mean age of the patients was 60 ± 11 years, with a mean BMI of 23 ± 4 kg/m2. The mean followup of the patients with periprosthetic fracture of the acetabulum was 58 ± 28 months (range, 12-131 months). Potential risk factors for occult acetabular fracture including age, sex, BMI, preoperative diagnosis, additional dome screw fixation, composition and size of each cup, and acetabular design were examined in multivariate analysis. Acetabular component designs were categorized as true hemispheric, peripheral self-locking, and elliptical; during the period in question the indications for each cup design were based on the brand of stem used. Comparison between preoperative and postoperative CT images was done to detect the fractures. Patients with fractures identified during surgery were treated with additional dome screw fixation and a 3-week period of nonweightbearing. Patients with occult fractures in this series did not receive additional treatment as we had confirmed secure fixation of the cup during surgery. RESULTS Occult fractures occurred in 41 hips (8.4%); periprosthetic fractures of the acetabulum were seen during surgery in an additional two hips (0.4%). The superolateral wall was the most frequent location for occult fractures of the acetabulum. After controlling for relevant confounding variables, only the use of peripheral self-locking cups was associated with an increased risk of occult fracture (odds ratio [OR], 2.6 compared with hemispheric cups; 95% CI, 1.2-5.6; p < 0.05). All patients with occult fractures showed bone ingrowth fixation at the final followup, without any additional surgical intervention. CONCLUSIONS Periprosthetic occult fractures of the acetabulum may occur relatively frequently during press-fit impaction. We observed a higher rate of fractures associated with the use of peripheral self-locking components. Occult acetabular fractures not detected on routine postoperative plain films may be ignored if secure fixation of the cup has been confirmed during the operation. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Kazuhiro Hasegawa
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Tamon Kabata
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Yoshitomo Kajino
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Daisuke Inoue
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
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Saglam Y, Ozturk I, Cakmak MF, Ozdemir M, Yazicioglu O. Total hip arthroplasty in patients with ankylosing spondylitis: Midterm radiologic and functional results. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2016; 50:443-7. [PMID: 27492583 PMCID: PMC6197352 DOI: 10.1016/j.aott.2016.06.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 01/10/2016] [Accepted: 01/24/2016] [Indexed: 02/06/2023]
Abstract
Introduction The aim of this study was to evaluate the clinical and radiological outcomes of total hip arthroplasty (THA) in patients with Ankylosing Spondylitis (AS). Patients and methods One hundred five hips of 61 AS patients (mean age: 41.3 ± 10.2 years) who underwent THA between 1997 and 2012 were included into the study. Dorr's classification of proximal femoral geometry, acetabular protrusio, bone ankylosis, acetabular protrusion, Brooker classification of heterotopic ossification (HO), Gruen and Charnley classifications of implant loosening were used in radiographic assessments. Patients were called back to return for an additional long-term follow-up for functional assessment. Results Cementless total hip arthroplasty was used in 83 hips (79%) and cemented TKA was used in 22 hips (21%). The overall rate of aseptic loosening was 7.6% at a mean follow-up of 5.4 years. Femoral loosening was statistically similar in cemented and cementless femoral components (14% vs. 8%, p = 0.089). Acetabular component loosening was statistically higher in patients with any degree of HO (p = 0.04). Regardless of the type of femoral implant (cemented or cementless), femoral component loosening was higher in Dorr's type C patients (p = 0.005). The average pre-operative HSS was 46.6 ± 16.3, and it improved to 80.7 ± 18.7 at last follow-up (p < 0.01). Conclusion Revision incidence was similar in between ankylosed and non-ankylosed hips. While complication rates are high, significant functional improvement can be achieved after THA in patients with AS.
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Affiliation(s)
- Yavuz Saglam
- Biruni University Hospital, Orthopedics and Traumatology Department, Istanbul, Turkey.
| | - Irfan Ozturk
- Istanbul University, Istanbul Faculty of Medicine, Orthopedics and Traumatology Department, Istanbul, Turkey
| | - Mehmet Fevzi Cakmak
- Istanbul University, Istanbul Faculty of Medicine, Orthopedics and Traumatology Department, Istanbul, Turkey
| | - Mustafa Ozdemir
- Istanbul University, Istanbul Faculty of Medicine, Orthopedics and Traumatology Department, Istanbul, Turkey
| | - Onder Yazicioglu
- Istanbul University, Istanbul Faculty of Medicine, Orthopedics and Traumatology Department, Istanbul, Turkey
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Cementless total hip arthroplasty for patients with rheumatoid arthritis: a more than 10-year follow-up. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 26:599-603. [PMID: 27311446 DOI: 10.1007/s00590-016-1804-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 06/09/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND/PURPOSE In this study, cementless THA was performed for RA patients, and its clinical outcomes, as well as radiographic findings and implant survival rates, were examined more than 10 years after surgery in comparison with the outcomes of the same procedure performed for patients with hip osteoarthritis (OA) during the same period. METHOD We studied 28 cases of THA for RA clinically and radiologically at a minimum follow-up duration of 10 years. The patients consisted of 4 males and 22 females, with a mean age at the time of surgery of 53.1. The clinical and radiographic results were compared with an age-matched and sex-matched group of patients who had undergone THA for the diagnosis of primary or secondary OA. RESULTS In the RA group, the mean Harris hip score was 48.3 before surgery, and improved to 76.8 at the time of the final survey. In the control group, the score also improved from 46.8 before to 86.5 after surgery, while revealing significant differences between the groups (p = 0.0002). In the RA group, 2 joints required revision THA on the acetabular side due to aseptic loosening, while such revision was not performed on the femoral side despite the presence of more than 2 mm of subsidence in 2 joints. The implant survival rate was 92.9 and 100 % in the RA and control groups, respectively, without significant differences (p = 0.493). CONCLUSIONS Although its clinical outcomes were significantly different from those for OA, a satisfactory implant survival rate was achieved, at 92.9 % in RA patients.
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Loi F, Córdova LA, Pajarinen J, Lin TH, Yao Z, Goodman SB. Inflammation, fracture and bone repair. Bone 2016; 86:119-30. [PMID: 26946132 PMCID: PMC4833637 DOI: 10.1016/j.bone.2016.02.020] [Citation(s) in RCA: 709] [Impact Index Per Article: 88.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 12/30/2015] [Accepted: 02/29/2016] [Indexed: 12/20/2022]
Abstract
The reconstitution of lost bone is a subject that is germane to many orthopedic conditions including fractures and non-unions, infection, inflammatory arthritis, osteoporosis, osteonecrosis, metabolic bone disease, tumors, and periprosthetic particle-associated osteolysis. In this regard, the processes of acute and chronic inflammation play an integral role. Acute inflammation is initiated by endogenous or exogenous adverse stimuli, and can become chronic in nature if not resolved by normal homeostatic mechanisms. Dysregulated inflammation leads to increased bone resorption and suppressed bone formation. Crosstalk among inflammatory cells (polymorphonuclear leukocytes and cells of the monocyte-macrophage-osteoclast lineage) and cells related to bone healing (cells of the mesenchymal stem cell-osteoblast lineage and vascular lineage) is essential to the formation, repair and remodeling of bone. In this review, the authors provide a comprehensive summary of the literature related to inflammation and bone repair. Special emphasis is placed on the underlying cellular and molecular mechanisms, and potential interventions that can favorably modulate the outcome of clinical conditions that involve bone repair.
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Affiliation(s)
- Florence Loi
- 300 Pasteur Drive, Edwards Building, Room R116, Department of Orthopaedic Surgery, Stanford University, Stanford, CA 94305, USA.
| | - Luis A Córdova
- 300 Pasteur Drive, Edwards Building, Room R116, Department of Orthopaedic Surgery, Stanford University, Stanford, CA 94305, USA; Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Chile, Sergio Livingstone Polhammer 943, Independencia, 8380000 Santiago, Chile.
| | - Jukka Pajarinen
- 300 Pasteur Drive, Edwards Building, Room R116, Department of Orthopaedic Surgery, Stanford University, Stanford, CA 94305, USA.
| | - Tzu-hua Lin
- 300 Pasteur Drive, Edwards Building, Room R116, Department of Orthopaedic Surgery, Stanford University, Stanford, CA 94305, USA.
| | - Zhenyu Yao
- 300 Pasteur Drive, Edwards Building, Room R116, Department of Orthopaedic Surgery, Stanford University, Stanford, CA 94305, USA.
| | - Stuart B Goodman
- 300 Pasteur Drive, Edwards Building, Room R116, Department of Orthopaedic Surgery, Stanford University, Stanford, CA 94305, USA; 300 Pasteur Drive, Edwards Building, Room R114, Department of Bioengineering, Stanford University, Stanford, CA 94305, USA.
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[Juvenile rheumatoid diseases: Endoprosthetic care of destroyed hip joints]. DER ORTHOPADE 2016; 44:531-7. [PMID: 25940873 DOI: 10.1007/s00132-015-3095-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patients with juvenile idiopathic arthritis (JIA) often suffer from involvement of the hip joints, with joint destruction and related functional limitations, making hip replacement necessary. OBJECTIVES To discover what special features are to be expected in patients with JIA and hip arthroplasty and what impact they have on surgical indication, choice of implant, and technique. METHODS Selective literature review and evaluation of our patient population. RESULTS Compared with osteoarthritis patients, JIA patients are on average much younger at the time of hip replacement. Owing to the onset of the disease in childhood or adolescence and the frequent glucocorticoid therapy, growth disorders or abnormal anatomical findings are common in these patients. Bone density is often reduced at an early age. The perioperative management of medication has to be planned. Special implants for patients with rheumatic diseases do not exist, but the above peculiarities of this group of patients should be considered for surgical procedure and choice of implant and material. Overall, the results of hip arthroplasty in juvenile rheumatic diseases, in terms of pain relief and functional improvement, are good. The limited life of the arthroplasty is problematic. CONCLUSIONS By relieving pain, improvement of the range of motion and activity level very high patient satisfaction is usually achieved by hip arthroplasty in JIA patients. In the case of involvement of the contralateral hip or the ipsilateral knee joint it may be useful to perform a simultaneous, single-stage joint replacement of both joints.
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Clarke A, Pulikottil-Jacob R, Grove A, Freeman K, Mistry H, Tsertsvadze A, Connock M, Court R, Kandala NB, Costa M, Suri G, Metcalfe D, Crowther M, Morrow S, Johnson S, Sutcliffe P. Total hip replacement and surface replacement for the treatment of pain and disability resulting from end-stage arthritis of the hip (review of technology appraisal guidance 2 and 44): systematic review and economic evaluation. Health Technol Assess 2015; 19:1-668, vii-viii. [PMID: 25634033 DOI: 10.3310/hta19100] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Total hip replacement (THR) involves the replacement of a damaged hip joint with an artificial hip prosthesis. Resurfacing arthroplasty (RS) involves replacement of the joint surface of the femoral head with a metal surface covering. OBJECTIVES To undertake clinical effectiveness and cost-effectiveness analysis of different types of THR and RS for the treatment of pain and disability in people with end-stage arthritis of the hip, in particular to compare the clinical effectiveness and cost-effectiveness of (1) different types of primary THR and RS for people in whom both procedures are suitable and (2) different types of primary THR for people who are not suitable for hip RS. DATA SOURCES Electronic databases including MEDLINE, EMBASE, The Cochrane Library, Current Controlled Trials and UK Clinical Research Network (UKCRN) Portfolio Database were searched in December 2012, with searches limited to publications from 2008 and sample sizes of ≥ 100 participants. Reference lists and websites of manufacturers and professional organisations were also screened. REVIEW METHODS Systematic reviews of the literature were undertaken to appraise the clinical effectiveness and cost-effectiveness of different types of THR and RS for people with end-stage arthritis of the hip. Included randomised controlled trials (RCTs) and systematic reviews were data extracted and risk of bias and methodological quality were independently assessed by two reviewers using the Cochrane Collaboration risk of bias tool and the Assessment of Multiple Systematic Reviews (AMSTAR) tool. A Markov multistate model was developed for the economic evaluation of the technologies. Sensitivity analyses stratified by sex and controlled for age were carried out to assess the robustness of the results. RESULTS A total of 2469 records were screened of which 37 were included, representing 16 RCTs and eight systematic reviews. The mean post-THR Harris Hip Score measured at different follow-up times (from 6 months to 10 years) did not differ between THR groups, including between cross-linked polyethylene and traditional polyethylene cup liners (pooled mean difference 2.29, 95% confidence interval -0.88 to 5.45). Five systematic reviews reported evidence on different types of THR (cemented vs. cementless cup fixation and implant articulation materials) but these reviews were inconclusive. Eleven cost-effectiveness studies were included; four provided relevant cost and utility data for the model. Thirty registry studies were included, with no studies reporting better implant survival for RS than for all types of THR. For all analyses, mean costs for RS were higher than those for THR and mean quality-adjusted life-years (QALYs) were lower. The incremental cost-effectiveness ratio for RS was dominated by THR, that is, THR was cheaper and more effective than RS (for a lifetime horizon in the base-case analysis, the incremental cost of RS was £11,284 and the incremental QALYs were -0.0879). For all age and sex groups RS remained clearly dominated by THR. Cost-effectiveness acceptability curves showed that, for all patients, THR was almost 100% cost-effective at any willingness-to-pay level. There were age and sex differences in the populations with different types of THR and variations in revision rates (from 1.6% to 3.5% at 9 years). For the base-case analysis, for all age and sex groups and a lifetime horizon, mean costs for category E (cemented components with a polyethylene-on-ceramic articulation) were slightly lower and mean QALYs for category E were slightly higher than those for all other THR categories in both deterministic and probabilistic analyses. Hence, category E dominated the other four categories. Sensitivity analysis using an age- and sex-adjusted log-normal model demonstrated that, over a lifetime horizon and at a willingness-to-pay threshold of £20,000 per QALY, categories A and E were equally likely (50%) to be cost-effective. LIMITATIONS A large proportion of the included studies were inconclusive because of poor reporting, missing data, inconsistent results and/or great uncertainty in the treatment effect estimates. This warrants cautious interpretation of the findings. The evidence on complications was scarce, which may be because of the absence or rarity of these events or because of under-reporting. The poor reporting meant that it was not possible to explore contextual factors that might have influenced study results and also reduced the applicability of the findings to routine clinical practice in the UK. The scope of the review was limited to evidence published in English in 2008 or later, which could be interpreted as a weakness; however, systematic reviews would provide summary evidence for studies published before 2008. CONCLUSIONS Compared with THR, revision rates for RS were higher, mean costs for RS were higher and mean QALYs gained were lower; RS was dominated by THR. Similar results were obtained in the deterministic and probabilistic analyses and for all age and sex groups THR was almost 100% cost-effective at any willingness-to-pay level. Revision rates for all types of THR were low. Category A THR (cemented components with a polyethylene-on-metal articulation) was more cost-effective for older age groups. However, across all age-sex groups combined, the mean cost for category E THR (cemented components with a polyethylene-on-ceramic articulation) was slightly lower and the mean QALYs gained were slightly higher. Category E therefore dominated the other four categories. Certain types of THR appeared to confer some benefit, including larger femoral head sizes, use of a cemented cup, use of a cross-linked polyethylene cup liner and a ceramic-on-ceramic as opposed to a metal-on-polyethylene articulation. Further RCTs with long-term follow-up are needed. STUDY REGISTRATION This study is registered as PROSPERO CRD42013003924. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Aileen Clarke
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Amy Grove
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | - Karoline Freeman
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | - Hema Mistry
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Martin Connock
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | - Rachel Court
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Matthew Costa
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | - Gaurav Suri
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | - David Metcalfe
- Warwick Orthopaedics, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Michael Crowther
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Sarah Morrow
- Oxford Medical School, University of Oxford, Oxford, UK
| | - Samantha Johnson
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | - Paul Sutcliffe
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
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Benazzo F, Formagnana M, Bargagliotti M, Perticarini L. Periprosthetic acetabular fractures. INTERNATIONAL ORTHOPAEDICS 2015; 39:1959-63. [DOI: 10.1007/s00264-015-2971-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 08/07/2015] [Indexed: 11/25/2022]
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An Insight into Methods and Practices in Hip Arthroplasty in Patients with Rheumatoid Arthritis. Int J Rheumatol 2015; 2015:140143. [PMID: 26236339 PMCID: PMC4510111 DOI: 10.1155/2015/140143] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 12/03/2014] [Indexed: 12/31/2022] Open
Abstract
Total hip arthroplasty (THA) has improved the quality of life of patients with hip arthritis. Orthopedic community is striving for excellence to improve surgical techniques and postoperative care. Despite these efforts, patients continue facing postoperative complications. In particular, patients with rheumatoid arthritis display a higher risk of certain complications such as dislocation, periprosthetic infection, and shorter prosthesis durability. In this review we present the current knowledge of hip arthroplasty in patients with rheumatoid arthritis with more insight into common practices and interventions directed at enhancing recovery of these patients and current shortfalls.
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Abstract
Total hip arthroplasty (THA) has proven successful in patients with rheumatoid arthritis (RA). Patients with RA often require multiple revisions, and bone conservation is mandatory. A variety of short stems is currently available with mid-term results for osteoarthritis. This retrospective study evaluated mid-term clinical results of short stem THA in a series of patients with RA. Between 2005 and 2009, a total of 105 cementless short stems were implanted in patients with RA. Average patient age at the time of the index THA was 44.2 years, and average length of follow-up was 5 years. Clinical evaluation included physical examination and documentation of potential adverse events during the postoperative period. No radiographic failures occurred. Femoral and cup components showed some minor radiolucencies with sclerotic lines, but none involved 100% of the bone-prosthesis interface. Complications included femoral component subsidence in 2 hips after initial full weight bearing; 1 case resolved after 3 months, and the other case was revised to a standard shaft. One intraoperative dorsolateral stem tip perforation occurred with revision to a conventional length stem. Migration in 1 cup led to revision without removal of the short stem implant. No infections or joint dislocations were observed. The transfer of the short stem concept to an additional treatment option for patients with RA proved successful in the early to mid-term postoperative period. Complications and revisions were limited to early migration and early loosening of the implants in line with the results reported in the literature of cementless conventional THA in patients with RA.
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Prospective five-year subsidence analysis of a cementless fully hydroxyapatite-coated femoral hip arthroplasty component. Hip Int 2014; 24:91-7. [PMID: 24474406 PMCID: PMC6159840 DOI: 10.5301/hipint.5000082] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2013] [Indexed: 02/04/2023]
Abstract
Early subsidence >1.5 mm is considered to be a predictive factor for later aseptic loosening of the femoral component following total hip arthroplasty (THA). The aim of this study was to assess five-year subsidence rates of the cementless hydroxyapatite-coated twinSys stem (Mathys Ltd., Bettlach, Switzerland).This prospective single-surgeon series examined consecutive patients receiving a twinSys stem at Maria Middelares Hospital, Belgium. Patients aged >85 years or unable to come to follow-up were excluded. Subsidence was assessed using Ein Bild Roentgen Analyse--Femoral Component Analysis (EBRA-FCA). Additional clinical and radiographic assessments were performed. Follow-ups were prospectively scheduled at two, five, 12, 24, and 60 months.In total, 218 THA (211 patients) were included. At five years, mean subsidence was 0.66 mm (95% CI: 0.43-0.90). Of the 211 patients, 95.2% had an excellent or good Harris Hip Score. There were few radiological changes. Kaplan-Meier analysis indicated five-year stem survival to be 98.4% (95% CI: 97.6-100%).Subsidence levels of the twinSys femoral stem throughout the five years of follow-up were substantially lower than the 1.5 mm level predictive of aseptic loosening. This was reflected in the high five-year survival rate.
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Chitre A, Wynn Jones H, Shah N, Clayson A. Complications of total hip arthroplasty: periprosthetic fractures of the acetabulum. Curr Rev Musculoskelet Med 2013; 6:357-63. [PMID: 24222553 PMCID: PMC4094103 DOI: 10.1007/s12178-013-9188-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Periprosthetic fractures of the acetabulum are a rare but potentially disastrous complication of total hip arthroplasty. Such fractures occur either as early perioperative complications or late complications when they are associated with either significant trauma or as a result of the loss of the structural integrity of the bone supporting the prosthesis, such as aseptic osteolysis. The incidence of such fractures appears to be increasing with the increased use of uncemented acetabular components. This article explores the current literature on the epidemiology, etiology, and classification of periprosthetic acetabular fractures as well as offering potential treatment strategies.
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Affiliation(s)
- Amol Chitre
- The Center for Hip Surgery, Wrightington Hospital, Hall Lane, Appley Bridge, West Lancashire, WN6 9EP UK
| | - Henry Wynn Jones
- The Center for Hip Surgery, Wrightington Hospital, Hall Lane, Appley Bridge, West Lancashire, WN6 9EP UK
| | - Nikhil Shah
- The Center for Hip Surgery, Wrightington Hospital, Hall Lane, Appley Bridge, West Lancashire, WN6 9EP UK
| | - Anthony Clayson
- The Center for Hip Surgery, Wrightington Hospital, Hall Lane, Appley Bridge, West Lancashire, WN6 9EP UK
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Bagarić I, Sarac H, Borovac JA, Vlak T, Bekavac J, Hebrang A. Primary total hip arthroplasty: health related quality of life outcomes. INTERNATIONAL ORTHOPAEDICS 2013; 38:495-501. [PMID: 24252971 DOI: 10.1007/s00264-013-2142-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 09/23/2013] [Indexed: 12/27/2022]
Abstract
PURPOSE The health related quality of life (HRQoL) outcomes of total hip arthroplasty (THA) present a pertinent and clinically important problem in modern orthopaedics. Our goal was to report and compare the health-related outcomes after THA in respect to type of fixation in patients with hip osteoarthritis (H-OA) one year after operation. METHODS A total of 145 patients with H-OA who received THA were evaluated. Uncemented and cemented subjects were evaluated using generic measures, i.e. the EQ-5D questionnaire, and the disease-specific measures designed by the authors, i.e. the Total Hip Arthroplasty Questionnaire (THAQ). Obtained data was statistically processed at the level of pain, functionality and general health perception. Patient-reported outcomes were measured differences between pre-operative measures and those at one-year follow-up visit. RESULTS Significant improvement in health outcomes was reached in both groups regardless of the type of fixation (p < 0.001). Uncemented fixation exhibited better results for EQ-5DINDEX, pain (p = 0.004) and self-care on EQ-5D (p = 0.043), as well as increased magnitude of change for functionality on THAQ (p = 0.002). However, additional analysis of the subset did not reveal a significant difference between cemented vs. uncemented groups with regard to function on THAQ, but the significant difference on self-care and pain dimensions of EQ-5D remained. CONCLUSIONS Uncemented endoprosthesis generally achieved better short-term outcomes in some dimensions. However, painless mobility has been restored in most of the patients, regardless of the fixation type. Both methods reached good clinical outcomes in their respective domains; therefore, we would emphasise prevention of osteoarthritis and the quality of care as the more important predictors of good clinical outcomes.
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Affiliation(s)
- Ivan Bagarić
- University of Split School of Medicine (MEFST), Šoltanska 2, HR- 21000, Split, Croatia,
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Schwachmeyer V, Damm P, Bender A, Dymke J, Graichen F, Bergmann G. In vivo hip joint loading during post-operative physiotherapeutic exercises. PLoS One 2013; 8:e77807. [PMID: 24204977 PMCID: PMC3812157 DOI: 10.1371/journal.pone.0077807] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 09/04/2013] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION After hip surgery, it is the orthopedist's decision to allow full weight bearing to prevent complications or to prescribe partial weight bearing for bone ingrowth or fracture consolidation. While most loading conditions in the hip joint during activities of daily living are known, it remains unclear how demanding physiotherapeutic exercises are. Recommendations for clinical rehabilitation have been established, but these guidelines vary and have not been scientifically confirmed. The aim of this study was to provide a basis for practical recommendations by determining the hip joint contact forces and moments that act during physiotherapeutic activities. METHODS Joint contact loads were telemetrically measured in 6 patients using instrumented hip endoprostheses. The resultant hip contact force, the torque around the implant stem, and the bending moment in the neck were determined for 13 common physiotherapeutic exercises, classified as weight bearing, isometric, long lever arm, or dynamic exercises, and compared to the loads during walking. RESULTS With peak values up to 441%BW, weight bearing exercises caused the highest forces among all exercises; in some patients they exceeded those during walking. During voluntary isometric contractions, the peak loads ranged widely and potentially reached high levels, depending on the intensity of the contraction. Long lever arms and dynamic exercises caused loads that were distributed around 50% of those during walking. CONCLUSION Weight bearing exercises should be avoided or handled cautiously within the early post-operative period. The hip joint loads during isometric exercises depend strongly on the contraction intensity. Nonetheless, most physiotherapeutic exercises seem to be non-hazardous when considering the load magnitudes, even though the loads were much higher than expected. When deciding between partial and full weight bearing, physicians should consider the loads relative to those caused by activities of daily living.
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Affiliation(s)
- Verena Schwachmeyer
- Julius Wolff Institute, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Philipp Damm
- Julius Wolff Institute, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Alwina Bender
- Julius Wolff Institute, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Jörn Dymke
- Julius Wolff Institute, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Friedmar Graichen
- Julius Wolff Institute, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Georg Bergmann
- Julius Wolff Institute, Charité – Universitätsmedizin Berlin, Berlin, Germany
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Adelani MA, Keeney JA, Palisch A, Fowler SA, Clohisy JC. Has total hip arthroplasty in patients 30 years or younger improved? A systematic review. Clin Orthop Relat Res 2013; 471:2595-601. [PMID: 23564363 PMCID: PMC3705054 DOI: 10.1007/s11999-013-2975-x] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 03/27/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND The evolution of total hip arthroplasty (THA) generally has led to improved clinical results. However, THA in very young patients historically has been associated with lower survivorship, and it is unclear whether this, or results pertaining to pain and function, has improved with contemporary THA. QUESTIONS/PURPOSES We performed a systematic review of the English literature on THA in patients 30 years of age and younger to assess changes in (1) indications; (2) implant selection; (3) clinical and radiographic outcomes; and (4) survivorship when comparing contemporary and historical reports. METHODS Multiple databases were searched for articles published between 1965 and 2011 that reported clinical and radiographic outcomes of THA in patients 30 years and younger. Sixteen retrospective case series were identified. Surgical indications, implant selection, clinical and radiographic outcomes, and survivorship of patients undergoing THAs before 1988 were compared with those performed in 1988 and after. RESULTS Reported THAs performed more recently were less likely to be performed for juvenile rheumatoid arthritis than earlier procedures. Cementless fixation became more prevalent in later years. Although clinical outcome scores remained constant, aseptic loosening and revision rates decreased substantially with more contemporary procedures. CONCLUSIONS This review of the literature demonstrates an improvement in radiographic outcomes and survivorship of THA, but no significant differences in pain and function scores, in very young patients treated over the past two decades when compared with historical controls.
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Affiliation(s)
- Muyibat A. Adelani
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St Louis, MO 63110 USA
| | - James A. Keeney
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St Louis, MO 63110 USA
| | - Allison Palisch
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St Louis, MO 63110 USA
| | - Susan A. Fowler
- Becker Medical Library, Washington University School of Medicine, St Louis, MO USA
| | - John C. Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St Louis, MO 63110 USA
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Ruosi C, Rossi D, Coppola A, Liccardo S, Granata F, Barbato A, Cimino E, Di Minno MND. Our experience about the particular surgical management of total hip replacement in two patients with severe haemophilic arthropathy: case report. Haemophilia 2013; 19:e184-6. [PMID: 23600909 DOI: 10.1111/hae.12130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2013] [Indexed: 11/28/2022]
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Tan HC, Poh CK, Cai Y, Soe MT, Wang W. Covalently grafted BMP-7 peptide to reduce macrophage/monocyte activity: An in vitro study on cobalt chromium alloy. Biotechnol Bioeng 2012; 110:969-79. [DOI: 10.1002/bit.24756] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 09/11/2012] [Accepted: 10/01/2012] [Indexed: 01/23/2023]
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Perez Alamino R, Casellini C, Baňos A, Schneeberger EE, Gagliardi SA, Maldonado Cocco JA, Citera G. Prevalence of periprosthetic osteolysis after total hip replacement in patients with rheumatic diseases. Open Access Rheumatol 2012; 4:57-62. [PMID: 27790012 PMCID: PMC5045099 DOI: 10.2147/oarrr.s31736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Periprosthetic osteolysis (PO) is a frequent complication in patients with joint implants. There are no data regarding the prevalence of PO in patients with rheumatoid arthritis (RA), juvenile chronic arthritis (JCA), ankylosing spondylitis (AS), and osteoarthritis (OA).
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Affiliation(s)
- Rodolfo Perez Alamino
- Section of Rheumatology, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - Carolina Casellini
- Section of Rheumatology, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - Andrea Baňos
- Section of Rheumatology, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | | | | | | | - Gustavo Citera
- Section of Rheumatology, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
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Bilateral Insufficiency Fracture of the Pelvis Following THA: A Case Report. Case Rep Med 2012; 2012:170736. [PMID: 22536261 PMCID: PMC3318264 DOI: 10.1155/2012/170736] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 01/17/2012] [Accepted: 01/17/2012] [Indexed: 11/17/2022] Open
Abstract
Insufficiency fracture is of the stress fractures and is caused by repetitive stress on fragile bone. Insufficiency fractures of pubic rami are rare occurrences in association with total hip arthroplasty (THA). Postoperative stress fractures occur due to increase of patients activity following years of disability. The physician should consider the possibility of a pelvic insufficiency fracture in patients with RA after THA, if the patients present with groin pain. We demonstrate here the first case of bilateral insufficiency fracture of pubic rami and iliac bone following THA.
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