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Goh EL, Boughton OR, Donnelly T, Murphy CG, Cashman J, Green C. Do joint-preserving hip procedures compromise subsequent total hip arthroplasty? A meta-analysis of complications, functional outcome and survivorship. SICOT J 2024; 10:25. [PMID: 38847649 PMCID: PMC11160402 DOI: 10.1051/sicotj/2024018] [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: 02/15/2024] [Accepted: 05/04/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Joint-preserving hip operations can help relieve pain and delay the need for long-term joint arthroplasty. Previous research has not identified procedures that can compromise outcomes following total hip arthroplasty (THA). This meta-analysis aims to evaluate the effect of joint-preserving hip operations on outcomes following subsequent THA. METHODS MEDLINE, EMBASE and Scopus databases were searched from the date of inception until February 2024. All studies comparing outcomes following THA in individuals with (PS) and without prior surgery (NPS) of the femur or pelvis were included. Data on operative time, blood loss, intra- and post-operative complications, functional outcomes, and implant survivorship were extracted. RESULTS 16 studies, comprising 2576 patients were included (PS = 939, NPS = 1637). The PS group was associated with significantly longer operative time [MD: 8.1, 95% CI: 4.6-11.6], significantly greater blood loss [MD: 167.8, 95% CI: 135.6-200.0], and a higher risk of intra-operative peri-prosthetic fracture [RR: 1.9, 95% CI: 1.2-3.0], specifically, with prior femoral osteotomy. There were no differences in terms of risks of dislocation [RR: 1.8, 95% CI: 1.0-3.2], implant loosening [RR: 1.0, 95% CI: 0.7-1.5], or revision surgery [RR: 1.3, 95% CI: 1.0-1.7] between the two groups. The PS group was associated with significantly poorer improvements in functional outcome [MD: -5.6, 95% CI: -7.6-(-3.5)], specifically, with prior acetabular osteotomy. Implant survivorship in the two groups was comparable after one year [HR: 1.9, 95% CI: 0.6-6.2] but significantly inferior in the PS group after five years [HR: 2.5, 95% CI: 1.4-4.7], specifically, with prior femoral osteotomy. CONCLUSION Joint-preserving hip operations are associated with greater intra-operative challenges and complications. In subsequent joint arthroplasty, prior acetabular procedures affect functional outcomes while prior femoral procedures influence implant survivorship. Hip pain due to the morphological sequelae of pediatric hip pathology can be debilitating at a young age. Surgical decision-making at that time needs to consider the survivorship of a THA implanted at that young age against the consequences of hip preservation surgery on further THA.
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Affiliation(s)
- En Lin Goh
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopedics Rheumatology and Musculoskeletal Sciences, Kadoorie Centre, University of Oxford Oxford OX3 9DU United Kingdom
| | - Oliver R. Boughton
- National Orthopedic Hospital Cappagh Cappagh Road, Cappoge Dublin 11 D11 EV29 Ireland
| | - Thomas Donnelly
- National Orthopedic Hospital Cappagh Cappagh Road, Cappoge Dublin 11 D11 EV29 Ireland
| | - Colin G. Murphy
- Department of Trauma and Orthopedics, Merlin Park Hospital EC5, Old Dublin Road Galway Ireland
| | - James Cashman
- National Orthopedic Hospital Cappagh Cappagh Road, Cappoge Dublin 11 D11 EV29 Ireland
| | - Connor Green
- National Orthopedic Hospital Cappagh Cappagh Road, Cappoge Dublin 11 D11 EV29 Ireland
- University College Dublin, School of Medicine Belfield Dublin 4 Ireland
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Szapary HJ, Desai V, Farid A, Franco H, Chen AF, Lange JK, Ready JE. Predictors of Reoperation and Survival Experience (Minimum 1 Year) for Primary Versus Conversion Total Hip Arthroplasty in Young Patients. J Arthroplasty 2024:S0883-5403(24)00529-1. [PMID: 38797454 DOI: 10.1016/j.arth.2024.05.057] [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: 01/06/2024] [Revised: 05/17/2024] [Accepted: 05/19/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Total hip arthroplasty (THA), including primary and conversion procedures, is commonly used for many types of joint disease in patients aged below 65 years, though few studies have evaluated THA outcomes in young patients (≤ 40 years old). This study examined a large cohort of patients who underwent THA at a young (≤ 40 years old) age to identify predictors of reoperation and compare survivorship between primary and conversion THAs. METHODS A retrospective study was conducted on 497 patients who underwent 612 primary and conversion THAs at 40 years old or younger between 1990 and 2020. Medical records were reviewed to collect patient/surgical data. A multivariable logistic regression model identified independent predictors of reoperation, and Kaplan-Meier analysis with log-rank tests was used to compare survival curves by THA type. RESULTS The median age at surgery (interquartile range) was 31 years (25 to 36). The median follow-up time was 6.6 years (range, 3.8 to 10.5). Conversion THAs had an increased rate of both revisions (12.3 versus 5.6%, P = 0.02) and nonrevision reoperations (8.9 versus 3.2%, P = 0.03) compared to primary THAs. A ceramic-on-ceramic articulation (odds ratio: 5.17; P = 0.03) and a higher estimated blood loss (odds ratio: 1.0007; P = 0.03) were independent predictors of reoperation for primary and conversion THA, respectively. Conversion THAs had a lower 15-year survival (77.8 versus 90.8%, P = 0.009) compared to primary THAs. CONCLUSIONS Patients ≤ 40 years old who underwent primary and conversion THAs demonstrated an impressive 15-year survival comparable to that of older populations (74 to 93%), while conversion procedures had a higher reoperation rate. Although primary THA may be more ideal, there are promising outcomes for patients who need THA at a younger age than typically implemented, especially for those who are very young (≤ 30 years old).
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Affiliation(s)
- Hannah J Szapary
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Vineet Desai
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Alexander Farid
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Helena Franco
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey K Lange
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - John E Ready
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Zeng Y, Yang J, Wang G, Zhang R, Si H, Wu Y, Shen B. [Effectiveness of total hip arthroplasty in patients with a history of hip preservation surgery with secondary osteoarthritis for developmental dysplasia of the hip]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1537-1542. [PMID: 34913309 DOI: 10.7507/1002-1892.202108062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To evaluate early to medium-term effectiveness of total hip arthroplasty (THA) in patients with a history of hip preservation surgery with secondary severe osteoarthritis for developmental dysplasia of the hip (DDH). Methods The clinical data of 25 DDH patients (31 hips) who had severe osteoarthritis after hip preservation surgery and received THA between September 2009 and March 2021 were retrospectively analyzed. There were 1 male and 24 females; the age ranged from 18 to 65 years, with an average age of 43 years; 8 hips were classified into Crowe type Ⅰ, 9 hips were type Ⅱ, 3 hips were type Ⅲ, and 11 hips were type Ⅳ. The time between osteotomy and THA ranged from 31 to 51 years, with an average of 31.96 years. Preoperative hip flexion range of motion was (69.31±29.72)°, abduction range of motion was (24.00±14.79)°; and Harris hip score was 45.3±15.5. Postoperative Harris hip score, hip range of motion, complications, radiographic findings, and implant survival rate were analyzed. Results Patients in both groups were followed up 2-132 months, with an average of 51 months. During the follow-up, periprosthetic fracture occurred in 1 case; there was no complication such as dislocation, periprosthetic infection, nerve palsy, or deep vein thrombosis. At last follow-up, the hip flexion range of motion was (109.52±11.17)°, abduction range of motion was (41.25±5.59)°, showing significant differences when compared with preoperative values ( t=8.260, P=0.000; t=6.524, P=0.000). The Harris hip score was 91.5±4.1, and the difference was significant when compared with preoperative score ( t=11.696, P=0.000); among them, 13 cases were excellent and 12 cases were good. Radiographic evaluation showed that the center of acetabular rotation moved up 0-18 mm (mean, 6.35 mm). The cup abductor angle was 28°-49° (mean, 37.74°) and the coverage rate was 69.44%-98.33% (mean, 81.04%). All femoral stems were fixed in neutral position without varus or valgus. No osteolysis, radiolucent line, or implant migration was observed. By the end of follow-up, none of the patients underwent revision and the survival rate of prothesis was 100%. Conclusion THA is still the gold standard for the treatment of DDH patients with secondary osteoarthritis after hip preservation surgery. The postoperative joint function can be rapidly restored, the patients' quality of life can significantly improve, and the early to medium-term survival rate of the prosthesis is satisfactory.
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Affiliation(s)
- Yi Zeng
- National Clinical Research Center for Geriatrics, Chengdu Sichuan, 610041, P.R.China.,Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Jing Yang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Gang Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Rongying Zhang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Haibo Si
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Yuangang Wu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Bin Shen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
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Yacovelli S, Abdelaal M, Fillingham Y, Sutton R, Madding R, Parvizi J. Prior Pelvic Osteotomy Affects the Outcome of Subsequent Total Hip Arthroplasty. J Arthroplasty 2021; 36:600-604. [PMID: 32917462 DOI: 10.1016/j.arth.2020.07.080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/20/2020] [Accepted: 07/29/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Although pelvic osteotomy (PO) is an important surgical procedure that can alleviate symptoms and potentially slow progression of osteoarthritis in patients with development dysplasia of the hip, some patients eventually require conversion to total hip arthroplasty (THA). This study aimed to determine the outcome of conversion THA in patients with prior PO. METHODS Forty nine patients with a history of prior PO who underwent conversion THA at a single institution were matched at a 1:3 ratio based on the date of surgery, age, gender, and body mass index with 147 developmental dysplasia of the hip patients who underwent primary THA without prior PO. A retrospective chart review was performed to compare outcomes at a minimum follow-up of 2 years. RESULTS Patients with prior PO required more supplemental screw fixation for the acetabular component (59.2% vs 38.1%, P = .016), more autologous bone grafting (24.5% vs 11.6%, P = .048), had a longer mean operative time (106.0 vs 79.8 minutes, P < .001), and greater estimated blood loss (350.0 vs 206.8 mL, P = .015). Patients with prior PO had smaller cup version angle (26.0° vs 29.0°, P = .012) and greater discrepancy in the limb length (10.3 vs 7.26 mm, P = .041). Eight hips (16.3%) with prior PO and 6 (4.1%) without osteotomy required reoperation (P = .008). There was no difference in outcome scores at the latest follow-up. CONCLUSION THA after prior PO is technically demanding, leading to longer operative times, greater blood loss, and variation in implant placement. Although functional outcomes are similar, THA after a prior PO is more likely to require reoperation. CONCLUSION THA after prior PO is technically demanding, leading to longer operative times, greater blood loss, and variation in implant placement. Although functional outcomes are similar, THA after a prior PO is more likely to require reoperation.
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Affiliation(s)
- Steven Yacovelli
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Mohammad Abdelaal
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Yale Fillingham
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Ryan Sutton
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Rachel Madding
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Javad Parvizi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
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Rahm S, Hoch A, Tondelli T, Fuchs J, Zingg PO. Revision rate of THA in patients younger than 40 years depends on primary diagnosis - a retrospective analysis with a minimum follow-up of 10 years. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:1335-1344. [PMID: 33495905 PMCID: PMC8448705 DOI: 10.1007/s00590-021-02881-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/15/2021] [Indexed: 01/12/2023]
Abstract
Background Treating osteoarthritis in elderly patients with THA is very successful. However, surgeons hesitate to recommend THA in younger patients. The spectrum of etiologies for end stage hip disease in the younger population is diverse and therefore different courses may be assumed. Our objective was to evaluate THA revision rate within a minimum follow-up period of 10 years in young patients and to analyze the difference between different primary diagnoses. Methods We included 144 consecutive hips in 127 patients younger than 40 years, who received a primary THA from 01/1996 to 12/2007. Operative reports, clinical and radiographic documentation were reviewed to determine primary diagnosis, prior hip surgery, component specifications and revision surgery. 111 hips in 97 patients were available for outcome analysis with a minimum follow-up of 10 years. Results The mean age was 33 years (range 15–40 years) at the time of the index THA, 68 patients were female and 59 were male. Ten years revision rate on the prosthetic components was 13%. The most common primary diagnosis was DDH. DDH was associated with a risk of 17% for requiring a reoperation on the prosthetic components because of mechanical fatigue and therefore, significantly higher than for any other primary diagnosis (p = 0.005). Conclusion THA in young patients is associated with a high revision rate of 13% in 10 years. 17% of patients with DDH required revision surgery for mechanical fatigue within 10 years, which was significantly higher than for any other primary diagnosis (1.2%, OR 16.8).
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Affiliation(s)
- Stefan Rahm
- Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Armando Hoch
- Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Timo Tondelli
- Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Johannes Fuchs
- Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
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Guo J, Dou D. Influence of prior hip arthroscopy on outcomes after hip arthroplasty: A meta-analysis of matched control studies. Medicine (Baltimore) 2020; 99:e21246. [PMID: 32702905 PMCID: PMC7373566 DOI: 10.1097/md.0000000000021246] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND No meta-analysis exists elucidate the impact of prior hip arthroscopy on the outcomes of subsequent hip arthroplasty. The purpose of this study was to systematically review the current evidence in the literature to ascertain if prior hip arthroscopy leads to inferior outcomes after hip arthroplasty. METHODS PUBMED, Scopus, EMBASE, and Cochrane Library databases were searched on May 20, 2019. Only English publications were included. The primary outcomes were postoperative complication, revision, and reoperation. Secondary outcomes included Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), operative time, and estimated blood loss. RESULTS Eleven studies with a total of 1227 patients were included. The pooled data revealed that patients with prior hip arthroscopy were associated with higher risks for any postoperative complication (P < .00001), dislocation (P = .03), revision (P = .03), and reoperation (P = .02) following subsequent hip arthroplasty. However, there were no significant differences in infection rate (P = .22), HHS (P = .09), WOMAC (P = .19), operative time (P = .52), and estimated blood loss (P = .17) between the groups. CONCLUSIONS Patients with prior hip arthroscopy are at increased risks for any postoperative complication, dislocation, revision, and reoperation following subsequent hip arthroplasty. However, prior hip arthroscopy does not appear to have an impact on the functional outcomes and intraoperative outcomes.
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Affiliation(s)
- Jiankuo Guo
- Department of Orthopedics, Huaihe Hospital, Henan University
| | - Dongmei Dou
- Institute of Chronic Disease Risks Assessment, Henan University, Henan, China
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Aalirezaie A, Anoushiravani A, Cashman J, Choon D, Danoff J, Dietz M, Gold P, Schwarzkopf R, Sheehan E, Vigante D. General Assembly, Prevention, Host Risk Mitigation - Local Factors: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S37-S41. [PMID: 30343966 DOI: 10.1016/j.arth.2018.09.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Affiliation(s)
- Mengnai Li
- The Ohio State University, Columbus, Ohio
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