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Katzman JL, Manjunath A, Brandstetter AS, Ben-Ari E, Schwarzkopf R, Snir N. Mid-term outcomes of total hip arthroplasty in patients younger than 30 years. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05473-5. [PMID: 39096326 DOI: 10.1007/s00402-024-05473-5] [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: 01/02/2024] [Accepted: 07/23/2024] [Indexed: 08/05/2024]
Abstract
INTRODUCTION Total hip arthroplasty (THA) has predominantly been utilized to treat older patients with primary osteoarthritis. However, recent improvements in surgical technique and implant materials have increased implant longevity, making THA a viable option for younger patients (< 30 years old). While trend analyses indicate an expanding utilization of THA in younger patients with non-OA diagnoses, current data on mid- and long-term THA outcomes in this population are limited. This study aims to describe the demographics, perioperative data, and implant survivorship of patients younger than 30 years undergoing THA. METHODS A retrospective study across two large urban academic medical institutions identified 135 patients aged < 30 years who underwent 155 primary THAs between 2012 and 2017, with up to 10-year clinical follow-up. Baseline demographics, surgical indications, intraoperative details, and postoperative outcomes were analyzed. RESULTS The mean age at surgery was 24.9 years (range 18-29). Osteonecrosis of the femoral head (55.5%), developmental hip dysplasia (28.3%), and arthritis (15.5%) were the primary indications. Most surgeries utilized the posterior approach (64.5%), manual technique (65.8%), and Ceramic-on-Polyethylene articulation (71.6%). Seven patients (4.5%) were readmitted within 90-days of surgery, including three non-orthopedic-related readmissions (1.9%) and four orthopedic-related readmissions (2.6%). Dislocations were reported in two patients (1.3%). There were six all-cause revisions (3.9%), four aseptic (2.6%) and two septic (1.3%). Kaplan-Meier analysis showed 10-year survival from implant retaining reoperation was 98.7%, 10-year survival from all-cause revision was 96.1%, and 10-year survival from aseptic revision was 97.4%. CONCLUSION With a 10-year aseptic implant survivorship rate of 97.4%, THA is a reliable surgical intervention for patients younger than 30 years of age who have severe hip pathology. Further studies are warranted for a more comprehensive understanding of mid- and long-term survivorship risk factors in this demanding population, facilitating improved risk assessment and informed surgical decisions.
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Affiliation(s)
- Jonathan L Katzman
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 East 17 Street, New York, NY, 10003, USA
| | - Amit Manjunath
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 East 17 Street, New York, NY, 10003, USA
| | - Addy S Brandstetter
- Division of Orthopedic Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Erel Ben-Ari
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 East 17 Street, New York, NY, 10003, USA
- Division of Orthopedic Surgery, Tel-Hashomer "Sheba" Medical Center, Ramat Gan, Israel
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 East 17 Street, New York, NY, 10003, USA.
| | - Nimrod Snir
- Division of Orthopedic Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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Sakamoto K, Motomura G, Hamai S, Kawahara S, Sato T, Yamaguchi R, Utsunomiya T, Nakashima Y. Radiological factors associated with posterior dislocation after total hip arthroplasty for osteonecrosis of the femoral head - A retrospective study. J Orthop 2024; 48:38-41. [PMID: 38059215 PMCID: PMC10696299 DOI: 10.1016/j.jor.2023.11.015] [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: 08/30/2023] [Revised: 11/04/2023] [Accepted: 11/07/2023] [Indexed: 12/08/2023] Open
Abstract
Purpose The dislocation rate after total hip arthroplasty for osteonecrosis of the femoral head is higher than that after total hip arthroplasty for osteoarthritis. However, few reports have investigated the factors contributing to dislocation after total hip arthroplasty for osteonecrosis of the femoral head. The aim of this study was to assess radiological factors associated with posterior dislocation after total hip arthroplasty for osteonecrosis of the femoral head. Methods We retrospectively reviewed 179 cementless total hip arthroplasties for osteonecrosis of the femoral head using a posterolateral approach between 2002 and 2020 with a minimum follow-up period of 24 months. The following radiological factors were examined for a possible association with posterior dislocation after total hip arthroplasty: cup anteversion angle, cup inclination angle, femoral offset, and stem anteversion angle. Results Posterior dislocation occurred in seven hips (3.9 %). Compared to hips without posterior dislocation, those with posterior dislocation exhibited a significantly smaller cup anteversion angle (p = 0.045) and a nonsignificantly greater decrease in femoral offset (p = 0.089). Based on receiver operating characteristic curve analyses, the cutoff values for predicting posterior dislocation were 9.9° for the cup anteversion angle and 8.1 mm for the decrease in femoral offset. Logistic regression analysis showed a significantly higher risk of posterior dislocation among hips with a cup anteversion angle less than 9.9° (odds ratio = 7.1, p = 0.022) or with a decrease in femoral offset over 8.1 mm (odds ratio = 5.0, p = 0.040). Conclusions A small cup anteversion angle and a decreased femoral offset are suggested to be associated with posterior dislocation after total hip arthroplasty in patients with osteonecrosis of the femoral head.
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Affiliation(s)
- Kosei Sakamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Goro Motomura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shinya Kawahara
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Taishi Sato
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Ryosuke Yamaguchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Takeshi Utsunomiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Reddy GB, Tremblay JO, Yakkanti RR, Hernandez VH, D'Apuzzo MR. Increased Risk of In-Hospital Complications and Costs After Total Hip Arthroplasty for Primary and Secondary Osteonecrosis. J Arthroplasty 2023; 38:2398-2403. [PMID: 37271238 DOI: 10.1016/j.arth.2023.05.042] [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: 01/30/2023] [Revised: 05/15/2023] [Accepted: 05/20/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND An increasing proportion of patients are undergoing total hip arthroplasty (THA) for osteonecrosis (ON). Comorbid conditions and surgical risk factors are known to be greater in ON patients compared with patients who have osteoarthritis (OA) alone. The purpose of our study was to quantify the specific in-hospital complications and resource utilization associated with patients undergoing THA for ON versus OA. METHODS A large national database was queried to identify patients undergoing primary THA from January 1, 2016 to December 31, 2019. A total of 1,383,880 OA, 21,080 primary ON, and 54,335 secondary ON patients were identified. Demographics, in-hospital complications, costs, lengths of stay, and discharge dispositions for primary and secondary ON cohorts were compared to OA only. Age, race, ethnicity, comorbidities, Medicaid, and income status were controlled with binary logistic regression analyses. RESULTS The ON patients were often younger, African American or Hispanic, and had more comorbidities. Those undergoing THA for primary and secondary ON had a significantly higher risk of perioperative complications, including myocardial infarction, postoperative blood transfusion, and intraoperative bleeding. Total hospital costs and lengths of stay were significantly higher for both primary ON and secondary ON and both cohorts were less likely to be discharged home. CONCLUSION While rates of most complications have decreased over recent decades in ON patients undergoing THA, the ON patients still have worse outcomes even when controlling for comorbidity differences. Bundled payment systems and perioperative management strategies for these different patient cohorts should be considered separately.
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Affiliation(s)
- Gireesh B Reddy
- Department of Orthopaedics and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
| | - Julien O Tremblay
- Department of Orthopaedics and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
| | - Ramakanth R Yakkanti
- Department of Orthopaedics and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
| | - Victor H Hernandez
- Department of Orthopaedics and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
| | - Michele R D'Apuzzo
- Department of Orthopaedics and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
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Wang T, Gao C, Wu D, Li C, Cheng X, Yang Z, Zhang Y, Zhu Y. One-year unplanned readmission after total hip arthroplasty in patients with osteonecrosis of the femoral head: rate, causes, and risk factors. BMC Musculoskelet Disord 2023; 24:845. [PMID: 37884992 PMCID: PMC10605627 DOI: 10.1186/s12891-023-06968-9] [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: 08/07/2023] [Accepted: 10/15/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND The primary objectives of this study were to focus on one - year unplanned readmissions after THA in ONFH patients and to investigate rates, causes, and independent risk factors. METHODS Between October 2014 and April 2019, eligible patients undergoing THA were enrolled and divided into unplanned readmission within one year and no readmission in this study. All unplanned readmissions within 1 year of discharge were reviewed for causes and the rate of unplanned readmissions was calculated. Demographic information, ONFH characteristics, and treatment-related variables of both groups were compared and analysed. RESULTS Finally, 41 out of 876 patients experienced unplanned readmission. The readmission rate was 1.83% in 30 days 2.63% in 90 days, and 4.68% in 1 year. Prosthesis dislocation was always the most common cause at all time points studied within a year. The final logistic regression model revealed that higher risks of unplanned readmission were associated with age > 60 years (P = 0.001), urban residence (P = 0.001), ARCO stage IV (P = 0.025), and smoking (P = 0.033). CONCLUSIONS We recommend the introduction of a strict smoking cessation program prior to surgery and the development of comprehensive management strategies, especially for the elderly and end-stage ONFH patients, and pay more attention to preventing prosthesis dislocation in the early days after surgery.
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Affiliation(s)
- Tianyu Wang
- Department of Orthopaedics, the 3rd Hospital, Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, P.R. China
| | - Congliang Gao
- Department of Orthopaedic Surgery, Huai'an Hospital of Huai'an City, Huai'an, Jiangsu, 223200, P.R. China
| | - Dongwei Wu
- Department of Orthopaedics, the 3rd Hospital, Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, P.R. China
| | - Chengsi Li
- Department of Orthopaedics, the 3rd Hospital, Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, P.R. China
| | - Xinqun Cheng
- Department of Orthopaedics, the 3rd Hospital, Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, P.R. China
| | - Zhenbang Yang
- Department of Orthopaedics, the 3rd Hospital, Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, P.R. China
| | - Yingze Zhang
- Department of Orthopaedics, the 3rd Hospital, Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, P.R. China.
| | - Yanbin Zhu
- Department of Orthopaedics, the 3rd Hospital, Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, P.R. China.
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Moharrami A, Mirghaderi SP, Marzban S, Moazen-Jamshidi SMM, Shakoor D, Mortazavi SMJ. Total Hip Arthroplasty via direct anterior approach for osteonecrosis; comparison with primary hip osteoarthritis in a mid term follow up. J Clin Orthop Trauma 2022; 34:102042. [PMID: 36263249 PMCID: PMC9574779 DOI: 10.1016/j.jcot.2022.102042] [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: 04/28/2022] [Revised: 09/03/2022] [Accepted: 09/27/2022] [Indexed: 10/31/2022] Open
Abstract
Background To determine the mid-term outcomes of conventional cementless Total Hip Arthroplasty (THA) in patients with avascular necrosis (AVN) of the femoral head and compare to patients with primary hip osteoarthritis (OA). Method A total of 330 consecutive primary THA procedures (AVN and OA) performed between 2010 and 2013 by a single surgeon and in a single center using the direct anterior approach (DAA) were included. Assessments including SF-36, WOMAC, and Harris Hip Scores (HHS) were retrieved from patients before the surgery and at the latest follow-up. Clinical and functional outcomes were compared between the AVN and OA groups. Results A total of 294 consecutive THA (AVN = 107, OA = 187) with 104.4 ± 6.2 months follow-up were analyzed, which AVN patients were significantly younger (32.0 vs. 59.6 y/o). Corticosteroid 34 (31.8%), idiopathic AVN 31 (29.0%) and use of unapproved weight gain supplements (UWGS) 23 (21.5%) were the main reasons for AVN. Despite that preoperative scores were comparable (P > 0.05), the HHS, SF-36, and WOMAC scores are significantly higher in the AVN group after THA surgery (P < 0.05). Moreover, flexion and abduction ROM were significantly higher in the AVN group (P < 0.05). Regarding each complication, no significant difference was observed between groups. In the whole sample, there were 5 (1.7%) revisions due to loosening of acetabular components, all the OA group (P > 0.05). Conclusion Conventional cementless THA with highly cross-linked polyethylene provides satisfactory mid-term results in patients with AVN with a low rate of postoperative complications. Compared to primary OA patients, this group reaches superior postoperative scores.
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Affiliation(s)
- Alireza Moharrami
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Peyman Mirghaderi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Shahin Marzban
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Delaram Shakoor
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Osteonecrosis of the Femoral Head. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202205000-00002. [PMID: 35511598 PMCID: PMC9076447 DOI: 10.5435/jaaosglobal-d-21-00176] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 01/23/2022] [Indexed: 11/18/2022]
Abstract
Osteonecrosis of the femoral head is a progressive and debilitating condition with a wide variety of etiologies including trauma, steroid use, and alcohol intake. Diagnosis and staging are based on imaging including MRI at any stage and plain radiography in more advanced lesions. The only definitive treatment is total hip arthroplasty, although numerous treatments including disphosphonates and core decompression are used to delay the progression. Lack of satisfactory conservative measures suggests the need for additional research of osteonecrosis including large patient registries to further understand this condition.
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Kim HS, Park JW, Ha JH, Lee YK, Ha YC, Koo KH. Third-Generation Ceramic-on-Ceramic Total Hip Arthroplasty in Patients with Osteonecrosis of the Femoral Head: A 10- to 16-year Follow-up Study. J Bone Joint Surg Am 2022; 104:68-75. [PMID: 34780390 DOI: 10.2106/jbjs.20.00720] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Long-term follow-up results of ceramic-on-ceramic (COC) total hip arthroplasty (THA), specifically, in patients with osteonecrosis of the femoral head (ONFH) are unknown. We evaluated (1) clinical results and radiological outcomes, (2) ceramic-related complications: noise and ceramic fracture, (3) osteolysis, and (4) survivorship after alumina COC THA in ONFH patients with longer than 10-year follow-up. METHODS From May 2003 to June 2009, 325 ONFH patients (403 hips) underwent primary THAs at our department. Among them, 231 patients (293 THAs) were followed for 10 to 16 (mean, 12.9) years. There were 148 men and 83 women, their mean age at the time of THA was 47.2 years, and their mean body index was 24.0 kg/m2. The postoperative CT scans were done in 160 hips. RESULTS Grinding sensation or squeak was noted in 6.8% (20/293), ceramic head fracture occurred in 2.4% (7/293) and acetabular osteolysis developed in 0.7% (2/293). All 7 ceramic fractures occurred in 28-mm short-neck heads. There was no detectable wear or prosthetic loosening, and the 16-year survivorship was 96.0% (95% confidence interval; 93.8% to 98.2%). The mean Harris hip score was 91.7 (range, 84 to 100) points at the final follow-up. CONCLUSIONS The 10- to 16-year results of alumina COC THAs were encouraging with an excellent survivorship. However, ceramic fracture and noise still remain matters of concern. We recommend not to use 28-mm short-neck ceramic head to avoid ceramic head fractures. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hong Seok Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jung Wee Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Joo Hyung Ha
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Orthopedic Surgery, Seoul National University College of Medicine, 166 Gumi-ro, Bundang-gu, Seongnam-si, 463-707, Republic of Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Orthopedic Surgery, Seoul National University College of Medicine, 166 Gumi-ro, Bundang-gu, Seongnam-si, 463-707, Republic of Korea
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Survival and complications of total hip arthroplasty using third-generation dual-mobility cups with non-cross-linked polyethylene liners in patients younger than 55years. Orthop Traumatol Surg Res 2022; 108:103208. [PMID: 35081455 DOI: 10.1016/j.otsr.2022.103208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 07/01/2021] [Accepted: 07/21/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND In younger patients, total hip prostheses are subjected to wide motion ranges and wear-inducing forces. Dual-mobility cups (DMCs) are effective in decreasing the risk of dislocation. However, wear and osteolysis have been reported with first-generation DMCs. These complications have not been assessed in younger patients managed with third-generation DMCs associated with a lower risk of intra-prosthetic dislocation (IPD). We therefore designed a retrospective study of patients younger than 55years at THA with third-generation DMCs. Our objectives were to evaluate (1) the complication rate, and (2) the survival rate. HYPOTHESIS The rate of complications of THA with third-generation DMCs in patients younger than 55years of age is comparable to that in the general population of THA patients. MATERIAL AND METHODS This retrospective study included 79 consecutive patients (91 hips) who had total hip arthroplasty (THA) between 2007 and 2012. We included all patients younger than 55years who underwent primary THA with a third-generation DMC and a liner made of non-cross-linked polyethylene. The patients were evaluated clinically and radiologically. RESULTS Mean follow-up was 9.8years (range: 2-13years). At last follow-up, no patient had experienced prosthetic dislocation or IPD. Aseptic and septic cup loosening each occurred in 1 patient. In all, 7 (7.7%) patients required revision surgery with exchange of at least one component (cup loosening, n=2; neck fracture with a short stem fixed to the neck, n=1; peri-prosthetic femoral fracture, n=1; infection, n=1; and femoral-stem loosening, n=2). Peri-acetabular osteolysis developed in 2 (2.2%) hips. Cup survival to aseptic loosening was 98.9% (95% confidence interval, 97%-100%) and survival to revision for any reason except infection was 95.6% (95% confidence interval, 82%-100%). DISCUSSION In patients younger than 55years, third-generation DMCs were associated with absence of prosthetic dislocation, absence of IPD, and a low revision rate for cup loosening, in the medium term. These implants therefore constitute a viable treatment option in younger patients requiring THA. LEVEL OF EVIDENCE IV, retrospective study.
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Shakya H, Zhou K, Yao SY, Dahal S, Zhou ZK. Short to mid-term outcome of total hip arthroplasty with cementless implants in patients younger than 25 years old. DER ORTHOPADE 2020; 50:742-749. [PMID: 32821952 DOI: 10.1007/s00132-020-03966-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Total hip arthroplasty (THA) was once reserved for old patients with hip arthritis but has become more common in very young patients (≤25 years old) diagnosed with various joint disease that were not relieved with conservative treatment. The purpose of this study was to evaluate short to mid-term outcome of THA in patients younger than 25 years old. METHOD This retrospective study included 45 patients younger than 25 years (mean age 21.8 ± 2.14 years) who underwent THA. The surgical indications, implant selection, leg length discrepancy, medication history, radiographic outcome, survival and clinical results including the modified Harris hip score (mHHS) and SF-36 score were assessed. RESULT The mean follow-up period recorded for patients was 7.82 years (range 5-12 years). The most common diagnosis was avascular necrosis (37.7%) followed by ankylosing spondylitis (24.4%), developmental dysplasia of the hip (17.7%) and rheumatoid arthritis (8.8%). The preoperative leg length discrepancy (LLD), which ranged from 0.5-7 cm significantly improved after surgery ranging from 0-1 cm. The mean preoperative mHHS was 32.44 ± 18.90 compared with the postoperative score of 94.54 ± 5.81 (p < 0.001). The preoperative p-value of SF-36 was lower compared to the postoperative value in all subgroups of SF-36 (p < 0.001). At the latest follow-up there were no radiological signs of loosening and all the implants were classified as well-integrated. CONCLUSION At present total hip arthroplasty is considered to be safe and a good solution for young patients below 25 years suffering from end-stage joint disease; however, longer follow-up is required to evaluate the long-term function and outcome of the prosthesis in order to restore the normal lifestyle of the patients.
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Affiliation(s)
- Hirose Shakya
- Department of Orthopedics, West China Hospital, Sichuan University, 37# Wuhou Guoxue Road, 610041, Chengdu, China
| | - Kai Zhou
- Department of Orthopedics, West China Hospital, Sichuan University, 37# Wuhou Guoxue Road, 610041, Chengdu, China
| | - Shun-Yu Yao
- Department of Orthopedics, West China Hospital, Sichuan University, 37# Wuhou Guoxue Road, 610041, Chengdu, China
| | - Suraj Dahal
- Department of Orthopedics, West China Hospital, Sichuan University, 37# Wuhou Guoxue Road, 610041, Chengdu, China
| | - Zong-Ke Zhou
- Department of Orthopedics, West China Hospital, Sichuan University, 37# Wuhou Guoxue Road, 610041, Chengdu, China.
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Sodhi N, Anis HK, Coste M, Piuzzi NS, Jones LC, Mont MA. Thirty-Day Complications in Osteonecrosis Patients Following Total Hip Arthroplasty. J Arthroplasty 2020; 35:2136-2143. [PMID: 32209288 DOI: 10.1016/j.arth.2020.02.067] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/16/2020] [Accepted: 02/29/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Thirty-day complications in osteonecrosis (ON) patients undergoing total hip arthroplasty (THA) are inconsistently reported. Therefore, the purpose of this study is to evaluate (1) the incidence of THA, (2) operative times, (2) length of stay, (3) reoperation rates, (4) readmission rates, and (5) complication rates, in the general vs ON THA populations. We also substratified and compared these cohorts based on ON-specific risk factors. METHODS Using the National Surgical Quality Improvement Program database, Current Procedural Terminology code 27130, International Classification of Disease, Ninth Edition code 733.42, and a 1:1 propensity score match, a total of 8344 matched ON and non-ON THA patients were identified. ON patients were also substratified based on key risk factors. The above variables were compared between the matched ON and non-ON cohorts as well as for patients with each risk factor using Pearson's chi-square and Student t-tests. RESULTS The proportion of THAs performed on ON patients decreased by 35% from 2008 to 2015. Mean operative times were constant between the ON and non-ON patients (102 minutes). ON patients had shorter mean length of stay (3.1 vs 3.4 days, P = .002). Of the 17 different 30-day complications evaluated, superficial surgical site infection (1.2% vs 0.6%, P = .004), pneumonia (0.8% vs 0.2%, P = .001), transfusion (15.6% vs 5.4%, P < .001), and readmission (5.1% vs 2.3%, P = .012) were higher among ON patients. ON patients with a history of corticosteroid use, higher American Society of Anesthesiologists score, and smoking were also found to have higher complication rates compared to non-ON patients with the same risk factors. CONCLUSION This is one of the first studies to compare postoperative THA outcomes between matched ON vs non-ON patients, while also taking into consideration specific risk factors between the cohorts.
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Affiliation(s)
- Nipun Sodhi
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Hiba K Anis
- Department of Orthopaedic Surgery, Cleveland Clinic Cleveland, OH
| | - Marine Coste
- Department of Orthopaedic Surgery, SUNY Downstate Brooklyn, New York, NY
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic Cleveland, OH
| | - Lynne C Jones
- Department of Orthopaedic Surgery, Johns Hopkins Medical Center Baltimore, MD
| | - Michael A Mont
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY; Department of Orthopaedic Surgery, Cleveland Clinic Cleveland, OH
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Fassihi SC, Lee R, Quan T, Tran AA, Stake SN, Unger AS. Total Hip Arthroplasty in Patients With Sickle Cell Disease: A Comprehensive Systematic Review. J Arthroplasty 2020; 35:2286-2295. [PMID: 32376165 DOI: 10.1016/j.arth.2020.04.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/18/2020] [Accepted: 04/05/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) is a common treatment for end-stage osteonecrosis of the hip in patients with sickle cell disease (SCD). This patient population presents unique challenges in the perioperative period. This systematic review aims to investigate the existing literature on the outcomes, complications, and survivorship of primary THA in SCD patients. METHODS A systematic search using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed of PubMed, MEDLINE, EMBASE, and Cochrane databases for clinical studies on THA in SCD patients. Studies on primary THA in SCD patients with a mean follow-up greater than 90 days were included. RESULTS Sixteen studies containing 5193 SCD patients met criteria for inclusion. The Coleman Quality of Evidence score ranged from poor to moderate. SCD patients had a significant increase in Harris Hip Scores and Merle d'Aubigne Scores after undergoing THA. Compared to non-SCD patients, SCD patients had increased hospital length-of-stay, 30-day and 90-day readmission rates, and rates of medical complications, including pain crises, acute chest syndrome, cardiac complications, sepsis, and mortality. SCD patients also had increased rates of surgical complications, including wound complications, infection, periprosthetic fracture, and aseptic loosening. Overall, THA revision rates were higher in SCD patients relative to those with primary osteoarthritis. CONCLUSION THA remains an effective treatment modality for osteonecrosis of the hip in SCD patients. However, these patients are at increased risk of medical and surgical complications. Surgeons should be aware of the unique challenges in this patient population when counseling and managing these patients in the perioperative period.
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Affiliation(s)
- Safa C Fassihi
- Department of Orthopaedic Surgery, George Washington University, Washington, District of Columbia
| | - Ryan Lee
- School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia
| | - Theodore Quan
- School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia
| | - Andrew A Tran
- Department of Orthopaedic Surgery, George Washington University, Washington, District of Columbia
| | - Seth N Stake
- Department of Orthopaedic Surgery, George Washington University, Washington, District of Columbia
| | - Anthony S Unger
- Department of Orthopaedic Surgery, Sibley Gildenhorn Institute, Johns Hopkins University, Washington, District of Columbia
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Who Cares for Total Hip Arthroplasty Complications? Rates of Readmission to a Hospital Different From the Location of the Index Procedure. J Am Acad Orthop Surg 2019; 27:e669-e675. [PMID: 30379760 DOI: 10.5435/jaaos-d-18-00464] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION While the number of total hip arthroplasties (THAs) performed increases, so is the number of postoperative readmissions, resulting in costly episodes of care that may disproportionately affect certain hospitals. This study examines the rates of readmission of patients to the same hospital at which they underwent index THA, compared with readmission to a different hospital. METHODS Data for all hospital discharges from 1995 to 2010 were obtained from the California Office of Statewide Health Planning and Development database. Patient outcomes, readmission data, demographic information, hospital teaching status, and location were analyzed. Regression modeling was used to evaluate the effect of hospital teaching status, location, and individual complications on the risk of readmission to the same hospital as opposed to a different hospital following the index procedure. RESULTS The overall postoperative readmission rate for specific defined complications or all-cause 30-day readmissions was 3.92%, with 75.17% readmitted to the same hospital. Following index THA at a nonacademic or academic hospital, 95.9% and 84.6% of patients were readmitted to the same type of hospital, respectively. Patients who had their index procedure at an academic hospital had lower odds for readmission to the same hospital (odds ratio, 0.734; P < 0.0001) compared with nonacademic centers. Hospitals in midsize towns had higher odds of readmission to the same hospital (odds ratio, 1.735; P = 0.0012) compared with those in large metropolitan areas. DISCUSSION Although more than 75% of patients with unplanned readmissions went to the same hospital as their index THA, academic and larger metropolitan hospitals had higher odds of postoperative readmissions to a different hospital.
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Internal Validation of a Predictive Model for Complications After Total Hip Arthroplasty. J Arthroplasty 2018; 33:3759-3767. [PMID: 30193881 DOI: 10.1016/j.arth.2018.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/21/2018] [Accepted: 08/08/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) is projected to increase in prevalence and associated complications will impose significant cost on the US healthcare system. The purpose of this study is to validate a predictive model for postoperative complications utilizing a novel 11-component hip-specific questionnaire encompassing preoperatively available clinical and radiographic data. METHODS Consecutive primary THA patients between January 2014 and January 2016 were included. Exclusion criteria included patients without questionnaire scoring variables and less than 1-year follow-up. Patients were stratified into 4 tiers based on their questionnaire score: low risk (>74), mild risk (57-73), moderate risk (41-56), and high risk (<40). A binary logistic regression was performed to determine if the questionnaire predicted complications. Receiver-operator curves were constructed to determine the threshold score below which there was a high likelihood of experiencing a complication. RESULTS Four hundred fifty patients were included in the final analysis with a mean (range) follow-up of 2.1 years (1.0-5.9), age of 63.1 years (25.7-9.17), and body mass index of 31.7 kg/m2 (17.8-64.5). The complication rate was 13.6%. A hip questionnaire score of 73.8 conferred a 98.5% sensitivity and 98.5% negative predictive value for complications. The questionnaire score was the strongest predictor of a decreased complication likelihood (odds ratio 0.94, 95% confidence interval 0.90-0.97, P < .001). Risk tier was significantly associated with complications (low risk: 0; mild risk: 12; moderate risk: 25; and high risk: 24; P < .001). CONCLUSION This novel hip questionnaire demonstrated a high sensitivity and negative predictive value to identify patients at risk for postoperative complications. Future studies should attempt to prospectively validate the use of this questionnaire.
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Malahias MA, Chulsomlee K, Thorey F. Simultaneous bilateral minimally invasive total hip arthroplasty: A comprehensive review of the literature. Orthop Rev (Pavia) 2018; 10:7677. [PMID: 30370034 PMCID: PMC6187005 DOI: 10.4081/or.2018.7677] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/06/2018] [Accepted: 06/14/2018] [Indexed: 01/10/2023] Open
Abstract
Several studies have reported that minimally- invasive total hip arthroplasty (MISTHA) may significantly reduce postoperative pain and results in faster postoperative rehabilitation when compared with the traditional lateral or posterior approach. Regarding bilateral hip osteoarthritis, there is still no consensus whether simultaneous bilateral MIS-THA can be established as the treatment of choice. Therefore, we searched the international databases of Pubmed, Medline, and Cochrane Database of Systematic Reviews using the key words minimally invasive bilateral total hip arthroplasty. From the initial 23 articles we found five clinical studies which met our inclusion criteria. From the perspective of possible intra- and postoperative complications, one-stage bilateral MIS THA was equally safe or safer than two-stage interventions. In addition, from a clinical outcome perspective, the one-stage procedure can be considered to be preferable. Higher blood transfusion requirements, which were expected following the standard bilateral simultaneous THA, seemed to be minimized with the simultaneous bilateral MIS THA. The supine position of the patient minimized the mean operation time. Approaches using the lateral decubitus position of the patient should be avoided in simultaneous bilateral THA due to the increased operation time. There is a lack of randomized, controlled clinical trials, comparing simultaneous bilateral MIS THA with staged bilateral MIS THA. Although simultaneous bilateral MIS THA seems to be efficacious, cost-effective and safe, more clinical trials are required to establish its superiority over the sequential MIS THA.
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Affiliation(s)
| | - Kulapat Chulsomlee
- Orthopedic Department, Faculty of Medicine, Chakri Naruebodindra Medical Institute, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Fritz Thorey
- International Center for Hip, Knee and Foot Surgery, ATOS Hospital Heidelberg, Germany
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Ponzio DY, Pitta M, Carroll KM, Alexiades M. Hip arthroplasty for osteonecrosis of the femoral head secondary to alcohol abuse. Arthroplast Today 2018; 5:172-175. [PMID: 31286039 PMCID: PMC6588658 DOI: 10.1016/j.artd.2018.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 07/06/2018] [Accepted: 07/06/2018] [Indexed: 11/26/2022] Open
Abstract
Although the challenges of hip arthroplasty for avascular necrosis (AVN) are known, limited data exist to describe patient demographics and outcomes in the setting of AVN attributed to alcoholism. We retrospectively identified 43 patients (62 hips) who underwent primary hip arthroplasty between 1999 and 2016 for a diagnosis of AVN of the femoral head with a concomitant diagnosis of alcohol abuse and minimum follow-up of 2 years (mean, 8.6 years). The mean age was 51 years, predominantly male (88%), with a high rate of comorbidities. History of cigarette smoking was prevalent (65%). Mean length of stay was 5.3 days, which is prolonged due to a high prevalence of acute postoperative alcohol withdrawal (14.5% of cases). There were 5 early (≤2 years) reoperations (8% of hips) for instability, periprosthetic acetabular fracture and component loosening, heterotopic ossification, superficial infection, and acute periprosthetic infection. There were no additional radiographic failures. The mean postoperative Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement was 97.8 ± 7.8, indicative of excellent outcomes at final follow-up of 2 to 18 years. Early risks associated with hip replacement surgery must be communicated to the predominantly young male subgroup of patients with AVN attributed to alcoholism, but these patients may achieve excellent mid- to long-term outcomes.
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Affiliation(s)
| | - Michael Pitta
- Hospital for Special Surgery, New York City, NY, USA
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Schnurr C, Loucif A, Patzer T, Schellen B, Beckmann J, Eysel P. Short stem survival after osteonecrosis of the femoral head. Arch Orthop Trauma Surg 2018; 138:573-579. [PMID: 29396635 DOI: 10.1007/s00402-018-2892-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Short stems were developed as a bone-conserving alternative especially for the young hip arthroplasty patient. Patients suffering from osteonecrosis of the femoral head are frequently younger than primary arthritis patients. The outcome of short stems in these patients remains unclear. The aim of our study was to compare mid-term survival of short stems after osteonecrosis of the femoral head (ONFH) and primary arthritis. MATERIALS AND METHODS Data on short stem implantations over a 10-year period were collected. Demographic data and X-ray measurements before and after surgery were recorded. Indication for operation was determined from medical records and X-rays. Patients were asked by post about any revision. Reason for revision was identified by analysis of operation protocols. Short stem revision rates were analyzed using Kaplan-Meier charts, comparing 212 ONFH patients (231 operations) and 1284 primary arthritis patients (1455 operations). RESULTS Follow-up time averaged 5.3 and 6 years and was complete for 92% (ONFH) and 94% (primary arthritis) of the patients. ONFH patients were significantly younger (53 years vs. 59 years, p < 0.001) and more frequently male (55 vs. 42%, p < 0.001). The total revision rate did not differ between the two groups (8 years: 4.2 vs. 5.6%, p = ns). A trend towards more stem revisions was detected for ONFH patients (3 vs. 1.8%, p = ns). The aseptic stem loosening rate was significantly elevated for osteonecrosis patients (8 years: 2.6 vs. 0.7%, p = 0.013). CONCLUSIONS Our study showed elevated short stem loosening rates after ONFH. Similar results are published for classic cementless stems. The question of which stem is best for the young osteonecrosis patient cannot be answered yet. Consecutive studies directly comparing loosening rates of short and classic cementless stems in young osteonecrosis patients are required.
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Affiliation(s)
- Christoph Schnurr
- Clinic of Orthopedic Surgery, St. Vinzenz Hospital Düsseldorf, Schloßstr. 85, 40477, Düsseldorf, Germany.
| | - Anissa Loucif
- Clinic of Orthopedic Surgery, St. Vinzenz Hospital Düsseldorf, Schloßstr. 85, 40477, Düsseldorf, Germany
| | - Theresa Patzer
- Clinic of Orthopedic Surgery, St. Vinzenz Hospital Düsseldorf, Schloßstr. 85, 40477, Düsseldorf, Germany
| | - Bernd Schellen
- Clinic of Orthopedic Surgery, St. Vinzenz Hospital Düsseldorf, Schloßstr. 85, 40477, Düsseldorf, Germany
| | - Johannes Beckmann
- Department for Endoprosthetics Lower extremity, Sportklinik Stuttgart, Taubenheimstr. 8, 70372, Stuttgart, Germany
| | - Peer Eysel
- Clinic for Orthopedic Surgery and Traumatology, University of Cologne, Joseph-Stelzmann-Str. 9, 50924, Cologne, Germany
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Lovecchio FC, Manalo JP, Demzik A, Sahota S, Beal M, Manning D. Avascular Necrosis Is Associated With Increased Transfusions and Readmission Following Primary Total Hip Arthroplasty. Orthopedics 2017; 40:171-176. [PMID: 28112786 DOI: 10.3928/01477447-20170117-03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 12/05/2016] [Indexed: 02/03/2023]
Abstract
Avascular necrosis (AVN) may confer an increased risk of complications and readmission following total hip arthroplasty (THA). However, current risk-adjustment models do not account for AVN. A total of 1706 patients who underwent THA for AVN from 2011 to 2013 were selected from the American College of Surgeon's National Surgical Quality Improvement Program database and matched 1:1 to controls using a predetermined propensity score algorithm. Rates of 30-day medical and surgical complications, readmissions, and reoperations were compared between cohorts. Propensity-score logistic regression was used to determine independent associations between AVN and outcomes of interest. Patients with AVN had a higher rate of medical complications than those without AVN (20.3% vs 15.3%, respectively; P<.001). Bleeding transfusion was the most common medical complication, occurring at a significantly higher rate in patients with AVN than those without AVN (19.6% vs 13.9%, respectively; P<.001). Patients with AVN were also twice as likely to experience a readmission after THA (odds ratio, 2.093; 95% confidence interval, 1.385-3.164). Avascular necrosis of the femoral head is an independent risk factor for transfusion up to 72 hours postoperatively and readmission up to 30 days following total hip replacement. [Orthopedics. 2017; 40(3):171-176.].
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Martz P, Maczynski A, Elsair S, Labattut L, Viard B, Baulot E. Total hip arthroplasty with dual mobility cup in osteonecrosis of the femoral head in young patients: over ten years of follow-up. INTERNATIONAL ORTHOPAEDICS 2016; 41:605-610. [PMID: 27888294 DOI: 10.1007/s00264-016-3344-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 11/09/2016] [Indexed: 12/18/2022]
Abstract
Osteonecrosis of the femoral head affects mainly young patients with high functional needs this increases the risk of dislocation. Dual mobility cups known for low rate of dislocation and high mobility range seems indicated. We evaluate functional efficiency, survival and dislocation rate of dual mobility cup for total hip arthroplasty for osteonecrosis in young patients. Monocentric retrospective clinical study, from 2000 to 2008. With a clinical analysis in pre-operative and over ten years of follow-up of one cohort of patients under 55 years old with an indication of THA for ONFH. The judgement criteria was: clinical scores at the maximal follow-up, the dislocation rate, and the cumulate survival rate over ten years follow-up. Forty THA in 31 patients, nine bilateral cases, 23 males and eight females with average age of 44 (±4) years old. In pre-operative: PMA 11 (±3.3), HHS 50,8 (±15.5). At the final follow-up of 129.8 (±33.8) months: PMA (17.4 ± 1.12), HHS (95.7 ± 6.9), no dislocation. We had 11 deaths on average at 95.2 ± 47.3 months. The cumulate survival rate over ten years follow-up is 100% without revisions or long-term dislocation. Analysis concludes to very significant functional improvement without any dislocation despite the young population with high level of activity. Thus, dual mobility cups is a reliable choice preventing dislocation with a very good survival rate without premature wear, preserving mobility and activity.
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Affiliation(s)
- Pierre Martz
- Department of Orthopaedic Surgery, Dijon University Hospital, CHU Dijon, 14 rue Paul Gaffarel, 21079, Dijon, Cedex, France.
- INSERM, U1093, Burgundy University, Dijon, France.
| | - Alexandre Maczynski
- Department of Orthopaedic Surgery, Dijon University Hospital, CHU Dijon, 14 rue Paul Gaffarel, 21079, Dijon, Cedex, France
| | - Sebastien Elsair
- Department of Orthopaedic Surgery, Dijon University Hospital, CHU Dijon, 14 rue Paul Gaffarel, 21079, Dijon, Cedex, France
| | - Ludovic Labattut
- Department of Orthopaedic Surgery, Dijon University Hospital, CHU Dijon, 14 rue Paul Gaffarel, 21079, Dijon, Cedex, France
| | - Brice Viard
- Department of Orthopaedic Surgery, Dijon University Hospital, CHU Dijon, 14 rue Paul Gaffarel, 21079, Dijon, Cedex, France
- INSERM, U1093, Burgundy University, Dijon, France
| | - Emmanuel Baulot
- Department of Orthopaedic Surgery, Dijon University Hospital, CHU Dijon, 14 rue Paul Gaffarel, 21079, Dijon, Cedex, France
- INSERM, U1093, Burgundy University, Dijon, France
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Meloni MC, Hoedemaeker WR, Fornasier V. Failed vascularized fibular graft in treatment of osteonecrosis of the femoral head. A histopathological analysis. JOINTS 2016; 4:24-30. [PMID: 27386444 DOI: 10.11138/jts/2016.4.1.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE vascularized fibular grafting has been used to treat osteonecrosis of the femoral head in younger patients. Although the results described in the literature are promising, the failure rate is still significant, especially in steroid users. This study was undertaken to learn more, on a histopathological level, about the mechanism of vascularized fibular graft failure. METHODS fifteen femoral heads removed at conversion to total hip arthroplasty were analyzed. The case load comprised 10 men and 5 women. They ranged in age from 28 to 39 years and had a median age of 35 years. The interval between the vascularized fibular implant procedure and the conversion to total hip arthroplasty ranged from 22 months to 30 months; the median interval was 26 months. All the patients were steroid users. The heads were sectioned and axial and coronal sections were taken and stained using the WHO method (hematoxylin, phloxine, saffron and Alcian green). A quantitative and qualitative analysis of graft-host interaction at the head (zone 1), neck (zone 2) and epiphysis (zone 3) was performed. RESULTS all the specimens showed recognizable collapse of the articular surface over the area of necrosis. Thirteen femoral heads showed the presence of an osteochondral flap attached only at the margins of the area of avascular necrosis, and 10 of these 13 femoral heads also showed loss of the articulating surface with an ulcer crater corresponding to the exposed area of avascular necrosis. CONCLUSIONS vascularized fibular graft failure seems to be related to a negative effect of creeping substitution: the revascularization becomes a negative force as it supports unbalanced bone resorption, which, as is well known, is enhanced by corticosteroids. CLINICAL RELEVANCE creeping substitution is an undermining force in the repair and revascularization of the necrotic area in the femoral head.
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Mayers W, Schwartz B, Schwartz A, Moretti V, Goldstein W, Shah R. National trends and in hospital outcomes for total hip arthroplasty in avascular necrosis in the United States. INTERNATIONAL ORTHOPAEDICS 2016; 40:1787-92. [DOI: 10.1007/s00264-015-3089-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 12/21/2015] [Indexed: 01/07/2023]
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Lavernia CJ, Villa JM. Total hip arthroplasty in the treatment of osteonecrosis of the femoral head: then and now. Curr Rev Musculoskelet Med 2015; 8:260-4. [PMID: 26088797 DOI: 10.1007/s12178-015-9290-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The objective of this review is to summarize and analyze the survivorship and the reported results of the use of total hip arthroplasty (THA) in patients with osteonecrosis of the femoral head. In the past, THA was thought to have poor survivorship and poor clinical and radiological results in patients with this diagnosis. However, more recent reports have suggested an improvement in the survivorship, radiological results, and outcomes of THAs when performed for this condition. Surgeons have incorporated THA into their practice patterns to the point that an increasing percentage of patients with this particular diagnosis are currently being treated with it. When collapse and/or arthrosis of the necrotic femoral head are present, THA seems to be the most reliable and proven option for its treatment.
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Affiliation(s)
- Carlos J Lavernia
- The Center for Advanced Orthopedics at Larkin Hospital, 7000 SW 62nd Ave, Suite 600 South, Miami, FL, 33143, USA,
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Lamo-Espinosa J, Pascual-Roquet Jalmar E. Hospital readmission rates following primary total hip arthroplasty: present and future in sight. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:S38. [PMID: 26046085 PMCID: PMC4437938 DOI: 10.3978/j.issn.2305-5839.2015.03.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 03/04/2015] [Indexed: 11/14/2022]
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