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Mutschler M, Massazza A, Antoniadis A, Palazzuolo M, Wegrzyn J. Conversion of hip resurfacing to total hip arthroplasty: is the outcome closer to primary or revision total hip arthroplasty? Orthop Traumatol Surg Res 2024:103950. [PMID: 39029794 DOI: 10.1016/j.otsr.2024.103950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 06/23/2024] [Accepted: 07/09/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND Along with the advent of newer bearings, hip resurfacing (HR) is gaining renewed interest as a bone sparing alternative to conventional total hip arthroplasty (THA) in young patients. However, the outcome of conversion of failed HR to THA (HRc) remains sparsely described. This study aimed to compare the outcomes and complication rates of HRc to those of primary (pTHA) and revision THA (rTHA) to find out to which group HRc is most comparable. HYPOTHESIS The study hypothesis was that the outcomes and complications rates of HRc were closer to those of pTHA than rTHA. MATERIALS AND METHODS Between 2001 and 2011, a continuous series of 207 HR were prospectively included in our institutional registry and retrospectively analyzed. Out of them, 17 HR (8%) were converted to THA. Propensity scores were used to match patients in the HRc group to the pTHA and the rTHA groups using a greedy 1:3 matching procedure (51 pTHA and 51 rTHA). Clinical and radiographic outcomes, perioperative data and complications were analyzed and compared between the three groups. RESULTS No significant difference between HRc and pTHA was observed in terms of clinical and functional outcomes, duration of surgery, acetabular component diameter and length of hospital stay (p = 0.13 to 0.94). Perioperative blood loss was significantly lower for pTHA than for HRc (p = 0.01). HRc demonstrated significantly higher HHS and HOOS scores than for rTHA at one year (p = 0.03 and p < 0.01, respectively). Duration of surgery was significantly lower in HRc compared to rTHA (p = 0.02) while length of hospital stay was similar (p = 0.84). Complication rate was significantly higher in the rTHA group, compared to HRc and pTHA groups (37.3 vs. 29.4 vs. 11.8%, p = 0.01). CONCLUSION This study demonstrated that the clinical and functional outcomes of HRc were closer to those of pTHA than those of rTHA, though complication rate was higher than for pTHA. LEVEL OF EVIDENCE III; Retrospective comparative study.
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Affiliation(s)
- Marion Mutschler
- Department of Orthopaedic Surgery, Lausanne University Hospital and University of Lausanne, Avenue Pierre-Decker, 4, CH-1011 Lausanne, Switzerland
| | - Allegra Massazza
- Department of Orthopaedic Surgery, Lausanne University Hospital and University of Lausanne, Avenue Pierre-Decker, 4, CH-1011 Lausanne, Switzerland
| | - Alexander Antoniadis
- Department of Orthopaedic Surgery, Lausanne University Hospital and University of Lausanne, Avenue Pierre-Decker, 4, CH-1011 Lausanne, Switzerland.
| | - Michele Palazzuolo
- Department of Orthopaedic Surgery, Lausanne University Hospital and University of Lausanne, Avenue Pierre-Decker, 4, CH-1011 Lausanne, Switzerland
| | - Julien Wegrzyn
- Department of Orthopaedic Surgery, Lausanne University Hospital and University of Lausanne, Avenue Pierre-Decker, 4, CH-1011 Lausanne, Switzerland
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Girard J. What role for short stems in 2023? Orthop Traumatol Surg Res 2024; 110:103779. [PMID: 38040113 DOI: 10.1016/j.otsr.2023.103779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 03/23/2023] [Indexed: 12/03/2023]
Abstract
Current trends in total hip replacement aim at soft tissue and bone stock conservation. At the same time, mean patient age has been decreasing from decade to decade, raising the issue of iterative revision. Short stems seek to resolve the problem on the femoral side. Hopefully, revision of a short stem will be easier and bone stock depletion will be less than with a standard stem. Short stems also seem to have other advantages: automatically personalized biomechanical reconstruction, easier minimally invasive strategies, very low rate of hip pain, more harmonious distribution of bone stress, etc. Despite these advantages, however, use of short stems since their introduction in the late 1980s has varied from country to country, and is not widespread in France. The present study addressed several questions concerning these implants. Firstly, what is a "short" stem? Then, what are the indications and contraindications? Shortened standard stems do not come under the concept of short stem and will not be dealt with here. Furthermore, the learning curve and specificities of short stems need to be acquired. Implantation technique differs greatly from standard stems, and short stem implantation requires particular rigor. Results also need to be assessed, and especially the rate of complications as compared to standard stems. And lastly, it needs to be determined whether the advantages are real or only theoretical: this will determine their usefulness and role in the armamentarium, in which short stems are a new paradigm. LEVEL OF EVIDENCE: Expert opinion.
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Affiliation(s)
- Julien Girard
- Université Lille Nord de France, 59000 Lille, France; Service d'Orthopédie II, Hôpital Salengro, CHU de Lille, place de Verdun, 59000 Lille, France; Université Lille, Université Artois, Université Littoral Côte d'Opale, EA 7369, Unité de Recherche Pluridisciplinaire Sport Santé Société (URePSS), 59000 Lille, France.
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Zgouridou A, Kenanidis E, Potoupnis M, Tsiridis E. Global mapping of institutional and hospital-based (Level II-IV) arthroplasty registries: a scoping review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1219-1251. [PMID: 37768398 PMCID: PMC10858160 DOI: 10.1007/s00590-023-03691-y] [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: 07/04/2023] [Accepted: 08/13/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Four joint arthroplasty registries (JARs) levels exist based on the recorded data type. Level I JARs are national registries that record primary data. Hospital or institutional JARs (Level II-IV) document further data (patient-reported outcomes, demographic, radiographic). A worldwide list of Level II-IV JARs must be created to effectively assess and categorize these data. METHODS Our study is a systematic scoping review that followed the PRISMA guidelines and included 648 studies. Based on their publications, the study aimed to map the existing Level II-IV JARs worldwide. The secondary aim was to record their lifetime, publications' number and frequency and recognise differences with national JARs. RESULTS One hundred five Level II-IV JARs were identified. Forty-eight hospital-based, 45 institutional, and 12 regional JARs. Fifty JARs were found in America, 39 in Europe, nine in Asia, six in Oceania and one in Africa. They have published 485 cohorts, 91 case-series, 49 case-control, nine cross-sectional studies, eight registry protocols and six randomized trials. Most cohort studies were retrospective. Twenty-three per cent of papers studied patient-reported outcomes, 21.45% surgical complications, 13.73% postoperative clinical and 5.25% radiographic outcomes, and 11.88% were survival analyses. Forty-four JARs have published only one paper. Level I JARs primarily publish implant revision risk annual reports, while Level IV JARs collect comprehensive data to conduct retrospective cohort studies. CONCLUSIONS This is the first study mapping all Level II-IV JARs worldwide. Most JARs are found in Europe and America, reporting on retrospective cohorts, but only a few report on studies systematically.
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Affiliation(s)
- Aikaterini Zgouridou
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Eustathios Kenanidis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece.
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece.
| | - Michael Potoupnis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
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Palazzuolo M, Bensa A, Bauer S, Blakeney WG, Filardo G, Riegger M. Resurfacing Hip Arthroplasty Is a Safe and Effective Alternative to Total Hip Arthroplasty in Young Patients: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12062093. [PMID: 36983096 PMCID: PMC10052473 DOI: 10.3390/jcm12062093] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/02/2023] [Accepted: 03/04/2023] [Indexed: 03/30/2023] Open
Abstract
This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed at comparing resurfacing hip arthroplasty (RHA) and total hip arthroplasty (THA) in terms of rate of complications, revisions, functional outcomes, blood loss, operative time and metal ions levels. The search was conducted on three databases (PubMed, Cochrane and Web of Science) updated until 13 October 2022. The inclusion criteria were RCTs) written in the English language, with no time limitation, comparing RHA and THA. Among the retrieved 4748 articles, 18 RCTs were eligible for a total of 776 patients (mean age 53.1 ± 5.0). A meta-analysis was performed. RHA reported significantly lower blood loss compared to THA (p < 0.001) but with longer operative time (p < 0.001). No statistically significant difference was found between RHA and THA in terms of complications (12.08% and 16.24%, respectively) and revisions (6.32% and 6.14%, respectively). Both RHA and THA provide excellent clinical results in a population of young and active patients. Functional outcomes were not significantly different between the groups. Moreover, no significant difference in metal ion levels was found. These findings provide evidence concerning the safety and clinical effectiveness of RHA. Because of its bone-preserving properties, the lack of drawbacks and good outcomes, RHA appears to be a valid alternative to THA in young and active patients.
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Affiliation(s)
- Michele Palazzuolo
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6600 Locarno, Switzerland
| | - Alessandro Bensa
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6900 Lugano, Switzerland
| | - Stefan Bauer
- Service d'Orthopédie et de Traumatologie, Chirurgie de l'Épaule, Ensemble Hospitalier de la Côte, 1110 Morges, Switzerland
- Department of Orthopedic Surgery, Royal Perth Hospital, Perth, WA 6000, Australia
| | - William G Blakeney
- Department of Orthopedic Surgery, Royal Perth Hospital, Perth, WA 6000, Australia
| | - Giuseppe Filardo
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Martin Riegger
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
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Bouguennec N, Thaunat M, Barth J, Cavaignac E, Gunepin FX, Letartre R, Netten A, Pujol N, Rousseau T, Sbihi J, Mouton C, Sfa TFAS. Consensus statement on data to be entered in the ACL tear registry: SFA-DataLake. Orthop Traumatol Surg Res 2022; 108:103392. [PMID: 36064107 DOI: 10.1016/j.otsr.2022.103392] [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: 05/26/2022] [Revised: 07/11/2022] [Accepted: 07/15/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) reconstruction is a frequent procedure, with room for improvement by rehabilitation measures and associated peripheral and meniscal surgeries that are currently under assessment, requiring follow-up. Outside France, there have been ACL registries for 20 years now. The French Arthroscopy Society (SFA) decided to set up an ACL tear registry within its SFA DataLake registry platform. MATERIAL AND METHOD This article presents the methodology underlying the ACL Tear Registry: i.e., identification, definition and coding of essential and relevant data. A test phase comprised an initial assessment to improve data quality and overall coherence, to optimize data-entry time for patients and practitioners, who are the guarantors of the registry's use and efficacy. RESULTS The SFA DataLake ACL Tear Registry was made available to SFA members in December 2021. It aims to enable a review of practices for surgeons, early detection of failure of procedures and implants, with rates of failure and abnormal complications, and identification of prognostic factors for outcome, especially regarding original items that do not figure in previous registries. CONCLUSION SFA DataLake strikes a balance between "indispensable" and "original" items. The choice of contents and data quality is founded on a robust methodology with overall coherence, enabling analysis of large cohorts and comparisons with the literature and other registries. However, it remains to assess rates of data entry and item relevance as the Registry progresses. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - Mathieu Thaunat
- Ramsay santé, centre orthopédique Santy, hôpital privé Jean-Mermoz, 24, avenue Paul-Santy, 69008 Lyon, France
| | - Johannes Barth
- Clinique des Cèdres, 21, avenue Albert-Londres, 38130 Échirolles, France
| | - Etienne Cavaignac
- Clinique universitaire du sport, 1, place du Docteur Joseph-Baylac, 31300 Toulouse, France
| | - François-Xavier Gunepin
- Clinique mutualiste de la porte de l'Orient, 3 rue Robert-de-La-Croix, 56100 Lorient, France
| | - Romain Letartre
- Ramsay santé, hôpital privé la Louvière, 126, rue de la Louvière, 59800 Lille, France
| | | | - Nicolas Pujol
- Centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France
| | - Thomas Rousseau
- Clinique mutualiste catalane, 60, rue Louis-Mouillard, 66000 Perpignan, France
| | - Jaafar Sbihi
- Clinique Juge, 116, rue J.-Mermoz, 13008 Marseille, France
| | - Caroline Mouton
- Department of Orthopaedic Surgery, Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, centre hospitalier Luxembourg, clinique d'Eich, Luxembourg, Luxembourg
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Debridement, antibiotics and implant retention for prosthetic joint infection: comparison of outcomes between total hip arthroplasty and hip resurfacing. INTERNATIONAL ORTHOPAEDICS 2022; 46:2799-2806. [PMID: 35960343 DOI: 10.1007/s00264-022-05522-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/17/2022] [Indexed: 01/22/2023]
Abstract
INTRODUCTION The management of prosthetic joint infection (PJI) has been widely studied in the context of total hip arthroplasty (THA). However, the outcomes of debridement, antibiotics and implant retention (DAIR) for PJI have never been compared between hip resurfacing arthroplasty (HRA) and THA. This led us to carry out a retrospective case-control study comparing the surgical treatment of post-operative infections between HRA and THA to determine the infection remission rate and the medium-term functional outcomes. METHODS This single-centre case-control study analysed 3056 HRA cases of which 13 patients had a PJI treated by DAIR. These patients were age-matched with 15 infected THA hips treated by DAIR and modular component exchange (controls). Their survival (no recurrence of the infection) was compared and factors that could affect the success of the DAIR were explored: sex, body mass index, age at surgery, presence of haematoma, type of bacteria present and antibiotic therapy. RESULTS At a mean follow-up of five years (2-7), the infection control rate was significantly higher in the HRA group (100% [13/13]) than in the THA group (67% [10/15]) (p = 0.044). More patients in the THA group had undergone early DAIR (< 30 days) (73% [11/15]) than in the HRA group (54% [7/13]). There was no significant difference between the two groups in the ASA score, presence of comorbidities, body mass index and duration of the initial arthroplasty procedure. At the review, the Oxford-12 score of 17/60 (12-28) was better in the HRA group than the score of 25/60 (12-40) in the THA group (p = 0.004). CONCLUSION DAIR, no matter the time frame, is a viable therapeutic option for infection control after HRA.
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