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Favreau H, Raynier JL, Rousseau T, Lustig S, Bonnomet F, Trojani C. Hip and knee arthroplasty in one surgical session: early morbi-mortality study. Orthop Traumatol Surg Res 2024:103955. [PMID: 39038514 DOI: 10.1016/j.otsr.2024.103955] [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: 03/11/2024] [Revised: 06/04/2024] [Accepted: 06/26/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION Bilateral prosthetic hip or knee replacement in one surgical session is a procedure that has been widely validated in the literature, whereas hip and knee replacement in one surgical session remains poorly documented. This study reports on the results of these procedures by analyzing early post-operative complications in a retrospective multicenter study. MATERIAL AND METHODS Between 2009 and 2023, 51 patients underwent hip and knee replacement surgery in a single surgical session at 4 French centers. They were 24 men and 27 women, with a mean age of 68.8 years (36 - 87); 7 patients were ASA 1, 30 were ASA 2 and 14 ASA 3. Prosthetic hip replacement was always performed first, associated 33 times with the ipsi-lateral knee and 18 times with the contralateral knee. All early complications, within the first 90 days post-operatively, were recorded: death, phlebitis, pulmonary embolism, myocardial infarction, surgical site infection (SSI), knee stiffness treated by mobilization under general anesthesia, urinary tract infection, acute urine retention or any other adverse event related to care. Transfusion rates were also reported. RESULTS The rate of early complications was 9.8% (5/51). No deaths, no phlebitis, no pulmonary embolism and no SSI were observed. Complications included one myocardial infarction, one urinary tract infection, one superficial infection, one haematoma treated by surgical evacuation and one recurrent instability requiring revision surgery (hip arthroplasty). The transfusion rate was 17.6% (9/51). The complication rate of ASA 3 patients was higher than that of ASA 1 and 2 patients, while there was no difference related to age or BMI. DISCUSSION Our results confirm the feasibility of single-stage hip and knee replacement, with a low complication rate in ASA 1 and 2 patients. This study adds to the few published works on the subject and reports comparable results. The small sample size and the heterogeneity of patients and centers limit the scope of the results, these limitations being relative to the volume expected for a rare procedure. CONCLUSION Single-session hip and knee arthroplasty should be reserved for patients selected according to comorbidities: ASA score, age and body mass index. ASA 3 patients have a higher risk of complications. LEVEL OF EVIDENCE IV; retrospective.
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Affiliation(s)
- Henri Favreau
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre 2, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098 Strasbourg cedex, France; Laboratory INSERM UMR 1260, Regenerative Nanomedicine Centre de recherche en biomédecine de Strasbourg (CRBS), 1 rue Eugène Boeckel, 67084 Strasbourg Cedex, France; ICube Laboratory, CNRS UMR 7357, 30 Bd Sébastien Brant, 67400 Illkirch, France.
| | - Jean-Luc Raynier
- ICR, Institut de Chirurgie Réparatrice Locomoteur et du Sport, 7 avenue Durante, 06000 Nice, France
| | - Thomas Rousseau
- Clinique Mutualiste Catalane, 60 rue Louis Mouillard 66000 Perpignan, France
| | - Sébastien Lustig
- Orthopaedic Department, Lyon North University Hospital, Hopital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
| | - François Bonnomet
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre 2, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098 Strasbourg cedex, France; Laboratory INSERM UMR 1260, Regenerative Nanomedicine Centre de recherche en biomédecine de Strasbourg (CRBS), 1 rue Eugène Boeckel, 67084 Strasbourg Cedex, France; ICube Laboratory, CNRS UMR 7357, 30 Bd Sébastien Brant, 67400 Illkirch, France
| | - Christophe Trojani
- ICR, Institut de Chirurgie Réparatrice Locomoteur et du Sport, 7 avenue Durante, 06000 Nice, France
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Yakkanti RR, Syros A, Reddy GB, D’Apuzzo MR. In-Hospital Complications and Costs of Simultaneous Bilateral Total Hip Arthroplasty: The Case for Selection and Potential Cost Savings. Arthroplast Today 2024; 25:101294. [PMID: 38313189 PMCID: PMC10834459 DOI: 10.1016/j.artd.2023.101294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 10/19/2023] [Accepted: 11/03/2023] [Indexed: 02/06/2024] Open
Abstract
Background Published comparisons between bilateral and unilateral total hip arthroplasty (THA) remain controversial regarding the potential risks and benefits. Our objectives were to compare (1) postoperative complications and (2) resource utilization of patients having simultaneous bilateral THA with patients having unilateral procedures. Methods The Nationwide Inpatient Sample was used to identify patients undergoing primary elective THA from January 2016 to December 2019. Complications and costs were compared between unilateral and simultaneous bilateral patients. Binary logistic regression analysis controlling demographics, comorbidities, and the primary diagnosis was performed to compare the cohorts of unilateral and bilateral patients. Results Nine thousand nine hundred fifty-five Bilateral procedures and 785,609 unilateral procedures were identified. Patients with bilateral procedures were at increased risk for many medical complications including gastrointestinal complications (OR: 4.1; 95% CI: 2.4-6.9, P < .01), postoperative blood transfusions (OR: 3.6; 95% CI: 3.3-3.9, P < .01), and pulmonary embolisms (OR: 3.2; 95% CI: 2.0-5.1, P < .01). Patients with bilateral procedures were also at increased risk for joint complications, including periprosthetic fractures (OR: 7.4; 95% CI: 5.2-10.5, P < .01) and other mechanical complications (OR: 27.0; 95% CI: 23-30, P < .01). These patients also incurred higher index hospitalization costs ($25,347 vs $16,757, P < .001) and were discharged more commonly to a rehabilitation facility (17.8% vs 13.4%, P < .001). Conclusions Bilateral THA are at increased risk of developing postoperative complications despite being younger and having fewer comorbidities on average when compared with unilateral patients. While bilateral patients had a higher index hospitalization cost, the overall cost of one episode of care is lower than two separate hospitalizations.
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Affiliation(s)
- Ramakanth R. Yakkanti
- Department of Orthopaedics and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Alina Syros
- Department of Orthopaedics and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Gireesh B. Reddy
- Department of Orthopaedics and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michele R. D’Apuzzo
- Department of Orthopaedics and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA
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Tyrpenou E, Megaloikonomos PD, Epure L, Huk-Papanastassiou O, Zukor D, Antoniou J. Similar complication and readmission rates following simultaneous versus staged bilateral total hip arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:863-867. [PMID: 37743391 DOI: 10.1007/s00590-023-03734-4] [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: 08/03/2023] [Accepted: 09/10/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE To compare short-term complications and readmission rates, in patients treated with simultaneous versus staged bilateral total hip arthroplasty (THA) within a year from the index procedure. METHODS We reviewed the charts of patients that underwent simultaneous and staged-within a year-bilateral THA, between 2016 and 2020. Preoperative baseline characteristics were evaluated, while differences in terms of 30-day major and 30-day minor complications and readmission rates were compared between the groups. RESULTS One-hundred-sixty patients (mean age, 64.3 years; SD, ± 11.7) were identified. Seventy-nine patients were treated with simultaneous (Group A) and eighty-one patients with staged (Group B) THA. There were no differences in baseline characteristic between the two groups (p > 0.050). Group A was more likely to receive general anesthesia (43% vs. 9.9%, p < 0.001) and had longer total operative time (182.8 vs. 128.0 min, p < 0.001). Group A had an overall shorter total length of hospital stay (5.8 vs. 8.6 days, p < 0.001). No differences in transfusion rates (p = 0.229) and no differences in major and minor complications (p > 0.05) were identified. Postoperative visits at the emergency department or readmissions were similar between the two groups (p > 0.050). CONCLUSION This study shows that similar complication and readmission rates are expected after simultaneous and staged THA. Simultaneous bilateral THA is a safe and effective procedure, that should be considered for patients that present with radiologic and clinical bilateral hip disease.
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Affiliation(s)
- Evangelos Tyrpenou
- Department of Orthopaedic Surgery, SMBD-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | | | - Laura Epure
- Department of Orthopaedic Surgery, SMBD-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Olga Huk-Papanastassiou
- Department of Orthopaedic Surgery, SMBD-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - David Zukor
- Department of Orthopaedic Surgery, SMBD-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - John Antoniou
- Department of Orthopaedic Surgery, SMBD-Jewish General Hospital, McGill University, Montreal, QC, Canada
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Kirschbaum S, Hube R, Perka C, Ley C, Rosaria S, Najfeld M. Bilateral simultaneous hip arthroplasty shows comparable early outcome and complication rate as staged bilateral hip arthroplasty for patients scored ASA 1-3 if performed by a high-volume surgeon. INTERNATIONAL ORTHOPAEDICS 2023; 47:2571-2578. [PMID: 37355529 PMCID: PMC10522735 DOI: 10.1007/s00264-023-05871-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 06/13/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE The aim of this study was to compare early outcomes after simultaneous and staged hip arthroplasty (THA) in patients with bilateral symptomatic pathology. METHODS We conducted a retrospective cohort study including all patients scheduled for primary THA for bilateral hip osteoarthritis (OA, n = 290). Patients either received simultaneous (n = 152, 52.4%) or staged (n = 138, 47.6%) bilateral THA based on individual preference. All operations (n = 428) were performed by one single, high-volume surgeon. Demographic data (e.g., age, ASA score) as well as perioperative parameters (haemoglobin drop (Hb), red blood cell transfusion, length of stay (LOS), operation time, six week complication rate and achievement of inpatient rehabilitation key points) were evaluated. RESULTS Patients in the simultaneous bilateral THA group were younger (62.8 ± 8.9 vs. 65 ± 9.7 years, p = 0.022) and had lower ASA scores (1.8, (34.2% ASA 1, 55.3% ASA 2, 37.2% ASA 3) vs. 2.0 (18.8% ASA 1, 61.6% ASA 2, 19.6% ASA 3)) than the staged group. While the average LOS was 7.1 ± 1.7 days for simultaneous bilateral THA, the combined LOS for the staged group was 12.9 ± 2.4 days (p < 0.001). The cumulative operation time in the simultaneous bilateral THA group was 61.1 ± 11.5 min and 57.6 ± 7.3 min in the staged group (p < 0.015). Cumulative Hb loss was significantly higher in the staged group (2.1 ± 7.2 g/dl vs. 3.7 ± 1.3 g/dl, p < 0.001). No significant differences were found concerning the complication rate or early inpatient rehabilitation. CONCLUSION Simultaneous bilateral hip arthroplasty in patients with symptomatic bilateral hip osteoarthritis is as safe and successful as a staged procedure if performed by a high-volume surgeon.
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Affiliation(s)
- Stephanie Kirschbaum
- Centre for Musculoskeletal Surgery, Charité-University Hospital Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Robert Hube
- OCM Orthopädische Chirurgie München, Steinerstraße 6, 81369, Munich, Germany
| | - Carsten Perka
- Centre for Musculoskeletal Surgery, Charité-University Hospital Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Christophe Ley
- University of Luxembourg, 2 Av. de l'Universite, 4365, Esch-sur-Alzette, Luxembourg
| | - Simone Rosaria
- University of Napoli Federico II, Corso Umberto I 40, 80138, Naples, Italy
| | - Michael Najfeld
- OCM Orthopädische Chirurgie München, Steinerstraße 6, 81369, Munich, Germany
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Jungwirth-Weinberger A, Do HT, Krell EC, Valle AGD, Chalmers BP, Boettner F. Blood management in direct anterior versus posterior primary total hip arthroplasty using tranexamic acid: a matched cohort study. Arch Orthop Trauma Surg 2023; 143:91-95. [PMID: 34152489 DOI: 10.1007/s00402-021-03965-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 05/18/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Proponents of the direct anterior approach (DAA) for THA claim patients recover faster compared to primary THA through the posterior approach (PA). Blood loss and transfusion have substantially declined with the use of tranexamic acid (TXA). However, it is still controversial if hemoglobin drops and transfusion rates are affected by the surgical approach when TXA is routinely used. MATERIALS AND METHODS 2418 patients undergoing DAA THA were matched 1:1 with patients undergoing PA THA according to preoperative hemoglobin (± 1 g/dl), age (± 5 years), sex, BMI (± 5 kg/m2) and year of surgery (± 2 years). All patients received perioperative TXA. None of the patients donated autologous blood. Hemoglobin levels, drain placement and output, blood transfusion rates and volume as well as length of stay were recorded. RESULTS A closed suction drain was used in 121 (5.0%) DAA and in 135 (5.6%) PA THAs (p = 0.369). Mean drain output was higher in the DAA compared to the PA group (134 ml (0-520 ml) versus 92.3 ml (0-600 ml), p = 0.004). There was no difference in hemoglobin drop [2.6 g/dl versus 2.6 g/dl (p = 0.143)] and transfusion rate [n = 31 (1.3%) versus n = 29 (1.2%), p = 0.793)] between DAA and PA THA. Mean transfusion amounts were 421.8 ml (250-1120.8 ml) in the DAA and 353.9 ml (250-560 ml) in the PA group (p = 0.801). The length of stay was shorter in the DAA group with a mean 1.6 days versus 2.1 days in the PA group (p ≤ 0.001). CONCLUSION In this large matched cohort study, there was no difference in the perioperative hemoglobin drop, the transfusion rate and the transfusion amount between DAA and PA THA.
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Affiliation(s)
- Anna Jungwirth-Weinberger
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopedics and Traumatology, Cantonal Hospital Baden, Im Ergel 1, 5404, Baden, Switzerland
| | - Huong T Do
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Ethan C Krell
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | | | - Brian P Chalmers
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Friedrich Boettner
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
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Martinez L, Noé N, Beldame J, Matsoukis J, Poirier T, Brunel H, Van Driessche S, Lalevée M, Billuart F. Quantitative gait analysis after total hip arthroplasty through a minimally invasive direct anterior approach: A case control study. Orthop Traumatol Surg Res 2022; 108:103214. [PMID: 35092851 DOI: 10.1016/j.otsr.2022.103214] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/20/2021] [Accepted: 11/04/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Total Hip Arthroplasty (THA) leads to excellent clinical and functional results. The Minimally Invasive Anterior Approach (MIAA) theoretically allows rapid recovery and a reduction in the need for rehabilitation, but alterations in muscle and static balance have previously been demonstrated. Kinetic, kinematic and muscular alterations have been shown to persist up to 1year postoperatively but data beyond 1year postoperatively is lacking. Thus, the objective of this study was to compare the data from Quantitative Gait Analysis (QGA) coupled with electromyography (EMG), of patients one year postoperatively with THA through MIAA, compared to an asymptomatic control group. HYPOTHESIS We hypothesized that QGA and EMG parameters would not normalize beyond one year postoperatively. PATIENTS AND METHODS Twenty-seven patients were recruited, including 15 subjects (64.6±6.6years) operated on by MIAA, who at 15.9±3.1months postoperatively, along with 12 asymptomatic control subjects (68.9±9.7years), who underwent QGA and maximal isometric muscle strength tests, coupled with EMG on the gluteus medius and maximus, Tensor Fascia Lata (TFL) and Sartorius muscles. The spatiotemporal parameters of walking (step length, walking speed, cadence, single leg support time), kinetics (vertical ground reaction forces, hip moments in the 3 planes) and kinematics (coxofemoral and pelvic amplitudes) were analyzed. RESULTS The walking speed was lower on the non-operated side of the experimental subjects (0.96ms-1 compared to 1.13ms-1 for asymptomatic [p=0.018]), as was the step length on the operated side (0.53m compared to 0.60m for asymptomatic [p=0.042]). Maximal isometric muscle strength was lower in subjects operated on for the gluteus maximus and medius (p=0.004), compared to asymptomatic subjects. Moments were lower in the subjects operated on in extension (0.72Nm on the operated side, 0.75Nm on the non-operated side compared to 1.06Nm for asymptomatic [p=0.007 and p=0.024]) and lateral rotation (0.09Nm on the operated side, 0.05Nm on the non-operated side compared to 0.16Nm for asymptomatic subjects [p=0.009 and p=0.0005]). Hip adduction amplitudes were lower on the operated side compared to asymptomatic subjects (3.93° versus 9.14° for asymptomatic [p=0.005]). Pelvic amplitudes in the frontal plane were lower amongst operated subjects (0.44° against 1.97° for asymptomatic [p=0.041]). Pelvic amplitudes in the sagittal plane were higher in the operated subjects (15.74° on the operated side, 15.43° on the non-operated side compared to 9.65° for asymptomatic [p=0.041 and p=0.032]). DISCUSSION Our initial hypothesis was validated, since walking deficits persisted beyond one year postoperatively after THA through MIAA. A decrease in maximal isometric muscle strength of the gluteus medius and gluteus maximus was observed, as well as an alteration of kinetic and kinematic parameters in the sagittal and frontal planes. The results were in agreement with the literature and reflected the establishment of compensatory mechanisms to overcome alterations in joint strength and range more than one year postoperatively. These results would allow rehabilitation programs to be more specific and would justify a study on the other approaches for THA. LEVEL OF EVIDENCE III; non-randomized control trial.
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Affiliation(s)
- Lucas Martinez
- Laboratoire d'analyse du mouvement, Institut de formation en masso-kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France; Unité de recherche ERPHAN, UR 20201, UVSQ, Versailles, France
| | - Nathalie Noé
- Laboratoire d'analyse du mouvement, Institut de formation en masso-kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France
| | - Julien Beldame
- Clinique Mégival, 1328, avenue de la Maison-Blanche, 76550 Saint-Aubin-sur-Scie, France
| | - Jean Matsoukis
- Département de chirurgie orthopédique, Groupe hospitalier du Havre, BP24, 76083, Le Havre cedex, France
| | - Thomas Poirier
- Laboratoire d'analyse du mouvement, Institut de formation en masso-kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France
| | - Helena Brunel
- Laboratoire d'analyse du mouvement, Institut de formation en masso-kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France
| | | | - Matthieu Lalevée
- Laboratoire d'analyse du mouvement, Institut de formation en masso-kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France; Service de chirurgie orthopédique et traumatologique, Centre hospitalier universitaire de Rouen, 76000 Rouen, France
| | - Fabien Billuart
- Laboratoire d'analyse du mouvement, Institut de formation en masso-kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France; Unité de recherche ERPHAN, UR 20201, UVSQ, Versailles, France.
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Micicoi G, Bernard de Dompsure R, Boileau P, Trojani C. Comparative study of bilateral total hip arthroplasty in one or two stages. Orthop Traumatol Surg Res 2022; 108:103359. [PMID: 35781050 DOI: 10.1016/j.otsr.2022.103359] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/09/2022] [Accepted: 03/28/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Bilateral total hip arthroplasty (Bi THA) for disabling bilateral hip osteoarthritis can be performed in one or two operative sessions. The objective of this study was to compare the complication rates of a group of patients who had bilateral THA in one operating session (Bi-1S THA) to a matched group of patients who had bilateral THA in two separate operating sessions (Bi-2S THA). MATERIALS AND METHODS This retrospective case-control study compared 84 Bi-1S THA matched to 84 Bi-2S THA by age, gender, diagnosis, ASA score (1-2) and surgical approach. The minimum follow-up was 12 months. Complication rates, total blood loss, number of blood transfusion units, and functional outcomes were assessed. RESULTS Twelve patients (14.3%) in the Bi-1S THA group had minor or major complications, compared to twenty-one (25%) in the Bi-2S THA group (p=0.08): there were fewer minor complications in the Bi-1S THA group and a similar rate of major complications amongst the two groups. Total blood loss estimated using the OSTHEO formula was significantly lower in patients operated on by Bi-1S THA (1853±753mL versus 2804±1012mL, p <0.0001). The number of blood transfusion units was similar between the groups (0.5±0.8 versus 0.3±1.4 respectively, p=0.55). No significant difference was found regarding the functional results. CONCLUSION Under the conditions of this study, bilateral total hip arthroplasty in one operative session leads to fewer minor complications, and a similar rate of major complications, when compared to bilateral total hip arthroplasty in two separate sessions. This strategy can therefore be recommended for ASA 1 and 2 patients, under the age of 80 with disabling bilateral osteoarthritis. LEVEL OF EVIDENCE III, retrospective comparative study.
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Affiliation(s)
- Grégoire Micicoi
- Institut Universitaire Locomoteur et du Sport (IULS), Hôpital Pasteur 2, CHU de Nice, 30, avenue Voie Romaine, 06000 Nice, France
| | - Régis Bernard de Dompsure
- Institut Universitaire Locomoteur et du Sport (IULS), Hôpital Pasteur 2, CHU de Nice, 30, avenue Voie Romaine, 06000 Nice, France
| | - Pascal Boileau
- Institut de Chirurgie Réparatrice Locomoteur et du Sport (ICR), Clinique Kantys Centre, Groupe Kantys, 7, avenue Durante, 06000 Nice, France
| | - Christophe Trojani
- Institut de Chirurgie Réparatrice Locomoteur et du Sport (ICR), Clinique Kantys Centre, Groupe Kantys, 7, avenue Durante, 06000 Nice, France.
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Martinez L, Noé N, Simon H, Beldame J, Matsoukis J, Brunel H, Van Driessche S, Billuart F. Stabilometric assessments of two rehabilitation protocols on postural parameters after posterior total hip arthroplasty: A prospective randomized comparative study. Orthop Traumatol Surg Res 2022; 108:103174. [PMID: 34896580 DOI: 10.1016/j.otsr.2021.103174] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/21/2021] [Accepted: 09/28/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION After total hip arthroplasty (THA), patients continue to have muscular, functional and postural deficits. The literature seems to support the use of postoperative rehabilitation, especially self-directed programs. However, there is no set protocol for the management of postural disorders. Therefore, the purpose of this study was to compare postural parameters of a group of patients who underwent posterior THA followed by 2 different types of rehabilitation (stabilometric platform (SP) and home-based self-directed protocols) with a control group of operated patients who did not undergo rehabilitation and a control group of age-matched asymptomatic subjects. HYPOTHESIS We hypothesized that rehabilitation would normalize the stabilometric parameters. PATIENTS AND METHODS A total of 67 subjects were enrolled in this study (mean age 67.85±1.22years) and divided into 4 groups. Forty-one of these subjects had undergone a posterior THA were randomly assigned between D10 and D21 to one of the following 3 groups: no rehabilitation control group (THACG=14), supervised rehabilitation with a stabilometric platform group (RSPG=16), and a self-directed home-based rehabilitation group (SDHRG=11). The 4th group was a control group made up of 26 age-matched asymptomatic nonoperated subjects (CG55-80). These rehabilitation protocols lasted 3weeks. At the end of the 3weeks, the groups performed the same stabilometric single leg and double leg stance tests (considering lower limb dominance) on an SP. RESULTS No significant differences were observed between groups in the bipedal stance, except between the CG55-80 and the THACG, where a higher energy expenditure was observed in the THACG during the static stance with eyes open (EO) and eyes closed (EC): increase in the path length (Plength) covered by the center of pressure (COP) (EO: p=01; EC: p=03) and the average velocity (Vavg) of the COP (EO: p=01; EC: p=03). These differences were not observed in the SDHRG and RSPG whether they were compared with one another or with both control groups. In the unipedal stance, subjects in the RSPG and SDHRG showed greater muscle activity in the anterior and posterior chains and hip abductors, and used less energy to maintain the stance than those in the CG55-80, regardless of lower limb dominance: decrease in the mediolateral range of COP displacement (Xrange) (hip abductor muscles) (p=02) and anteroposterior range of COP displacement (Yrange) (anterior and posterior chains) (p=3.49.10-3), 95% confidence ellipse area (Earea) of COP data (p=1.47.10-3), Plength (p=04) and Vavg (p=04). The RSPG had a smaller Earea than the SDHRG (p=04), demonstrating a better postural stability during the unipedal stance performed on the dominant operated leg. DISCUSSION Our results were consistent with the literature on the benefits of rehabilitation after THA, thus confirming our hypothesis that rehabilitation normalized stabilometric parameters between D31-D45, depending on the subjects. These results provide new information regarding rehabilitation techniques to be implemented postoperatively after a THA. A home-based self-directed rehabilitation program is just as effective as an SP program in managing postural disorders. LEVEL OF EVIDENCE II; randomized controlled trial with low statistical power.
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Affiliation(s)
- Lucas Martinez
- Laboratoire d'analyse du mouvement, institut de formation en Masso-Kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France
| | - Nathalie Noé
- Laboratoire d'analyse du mouvement, institut de formation en Masso-Kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France
| | - Hermann Simon
- Laboratoire d'analyse du mouvement, institut de formation en Masso-Kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France
| | - Julien Beldame
- Clinique Mégival, 1328, avenue de la Maison-Blanche, 76550 Saint-Aubin-sur-Scie, France
| | - Jean Matsoukis
- Département de chirurgie orthopédique, groupe hospitalier du Havre, BP24, 76083 Le Havre cedex, France
| | - Helena Brunel
- Laboratoire d'analyse du mouvement, institut de formation en Masso-Kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France
| | | | - Fabien Billuart
- Laboratoire d'analyse du mouvement, institut de formation en Masso-Kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France; Unité de recherche ERPHAN, UR 20201, UVSQ, France.
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Afghanyar Y, Klug A, Rehbein P, Dargel J, Drees P, Kutzner KP. One-stage bilateral versus unilateral short-stem total hip arthroplasty: A matched-pair analysis of 216 hips. J Orthop 2021; 27:130-136. [PMID: 34616117 PMCID: PMC8476895 DOI: 10.1016/j.jor.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 09/19/2021] [Indexed: 12/01/2022] Open
Abstract
Background One-stage, bilateral, short-stem total hip arthroplasty (1B-ssTHA) represents an alternative to staged, unilateral, short-stem total hip arthroplasty (U-ssTHA); however, the safety and reliability of 1B-ssTHA remain unknown. The objective of the present study was to compare the functional outcomes, complications, and mortality rates between 1B-ssTHA and U-ssTHA at mid-term. Methods A retrospective, matched-pair study was performed, including 216 short stems implanted in 162 patients. Among the study population, 54 patients were treated with 1B-ssTHA. Patients were matched by gender, age, body mass index (BMI), and American Society of Anesthesiologists (ASA) classification. A total of 46 full matches could be accomplished. The mean follow-up time for the 1B-ssTHA group was 61.7 months (standard deviation [SD] 6.2 months), compared with was 63.4 months (SD 8.0 months) for the U-ssTHA group. Mortality, complication, and revision rates were documented. For clinical examinations, the visual analogue scale (VAS) was used to evaluate satisfaction, rest pain, and load pain, and the Harris Hip Score (HHS) was determined. Results No surgery-related deaths were observed. At mid-term, none of the 1B-ssTHA patients required stem revision. The rate of complications for both groups was low. The mean drop in haemoglobin measured in the 1B-ssTHA group was 4.42 mg/dl, compared with 3.18 mg/dl in the U-ssTHA group. The mean HHS in the 1B-ssTHA group was 98.3 points (SD 2.80), whereas, in the U-ssTHA group, the mean HHS was 97.9 points (SD 3.44) (p = 0.478). Satisfaction rates were significantly higher in the 1B-ssTHA group (p = 0.04) than in the U-ssTHA group, whereas no significant differences were found for pain at rest and pain at load (p = 0.56 and p = 0.26, respectively). Conclusion Our findings indicate that 1B-ssTHA is an effective and beneficial procedure for a select population. Mortality, complications, implant survival, and clinical outcomes were comparable to those for a matched group with unilateral osteoarthritis treated with U-ssTHA. However, an increase in blood loss must be acknowledged for the 1B-ssTHA procedure.
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Affiliation(s)
- Yama Afghanyar
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Alexander Klug
- Department of Orthopaedics and Traumatology, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Philipp Rehbein
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Jens Dargel
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Philipp Drees
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Karl Philipp Kutzner
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany.,Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
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Micicoi G, de Dompsure RB, Micicoi L, Tran L, Carles M, Boileau P, Trojani C. One-stage bilateral total hip arthroplasty versus unilateral total hip arthroplasty: A retrospective case-matched study. Orthop Traumatol Surg Res 2020; 106:577-581. [PMID: 32265170 DOI: 10.1016/j.otsr.2020.02.003] [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: 10/28/2019] [Revised: 02/03/2020] [Accepted: 02/04/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND One-stage bilateral hip replacement has the advantage of involving a single anesthesia, single hospital admission and single rehabilitation program. The theoretic drawback is increased surgical risk. Few French series have been reported, and none with comparison versus unilateral arthroplasty. We therefore conducted a comparative case-control study between 1-stage bilateral (1B-THA) and unilateral total hip arthroplasty (U-THA), assessing (1) morbidity/mortality, (2) survival, and (3) functional scores and forgotten hip rates. HYPOTHESIS In a selected ASA 1 or 2 population, 1B-THA shows complications rates and implant survival comparable to U-THA. MATERIAL AND METHOD Between 2004 and 2018, 327 patients were included: 109 with 1B-THA, 218 with U-THA. One 1B-THA patient was matched to 2 U-THA patients on age, gender, diagnosis, ASA score 1 or 2, and anterior or posterior approach. Minimum follow-up was 12 months. Complications were collected for all patients in both groups. Early (≤90 days) or late (>90 days) morbidity/mortality and implant survival were recorded for both groups. Secondary endpoints concerned blood-sparing strategy and blood loss, functional scores, and patient satisfaction. RESULTS Mortality was zero in both groups. There was no significant difference in complications rates (1B-THA 38.5%, U-THA 40.8%) (p=0.69), whether early (8.3% [9/109] and 7.8% [17/218] respectively [p=0.89]) or late (30.3% [33/109] and 33.0% [72/218] respectively [p=0.61]). Limb-length discrepancy was significantly less frequent in 1B-THA (5.5% [6/109] versus 13.3% [29/218] [p=0.03]). Forgotten hip rate was significantly more frequent in 1B-THA (86% [94/109] versus 70% [152/218] [p=0.01]). Five-year Kaplan-Meier implant survival was 97.2% (95% CI [91.9-99.1]) in 1B-THA and 96.6% (95% CI [93.0-98.4]) in U-THA (p=0.08). DISCUSSION One-stage bilateral total hip arthroplasty gave acceptable results in disabling bilateral osteoarthritis of the hip with low surgical risk in selected patients (ASA 1 or 2). Mortality, complications and implant survival were unaffected, but the 1-stage bilateral procedure allowed better control of limb-length and provided a higher rate of forgotten hip. LEVEL OF EVIDENCE III, matched case-control study.
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Affiliation(s)
- Grégoire Micicoi
- Service de chirurgie orthopédique et chirurgie du sport, Institut universitaire locomoteur et du sport (IULS), hôpital Pasteur 2, 30, voie Romaine, 06000 Nice, France
| | - Régis Bernard de Dompsure
- Service de chirurgie orthopédique et chirurgie du sport, Institut universitaire locomoteur et du sport (IULS), hôpital Pasteur 2, 30, voie Romaine, 06000 Nice, France
| | - Lolita Micicoi
- Service de chirurgie orthopédique et chirurgie du sport, Institut universitaire locomoteur et du sport (IULS), hôpital Pasteur 2, 30, voie Romaine, 06000 Nice, France
| | - Laurie Tran
- Service d'anesthésie-réanimation, institut Arnault Tzanck, 171, rue du Commandant Gaston Cahuzac, 06700 Saint-Laurent-du-Var, France
| | - Michel Carles
- Service d'anesthésie-réanimation, CHU de la Guadeloupe, route Chauvel, 97110 Pointe-à-Pitre, France
| | - Pascal Boileau
- Service de chirurgie orthopédique et chirurgie du sport, Institut universitaire locomoteur et du sport (IULS), hôpital Pasteur 2, 30, voie Romaine, 06000 Nice, France
| | - Christophe Trojani
- Service de chirurgie orthopédique et chirurgie du sport, Institut universitaire locomoteur et du sport (IULS), hôpital Pasteur 2, 30, voie Romaine, 06000 Nice, France.
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