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Horwood C, Carvajal JL, Pozzi A, Kim SE. Complications and outcomes of total hip arthroplasty in dogs with luxoid hip dysplasia: 18 cases (2010-2022). Vet Surg 2024; 53:620-629. [PMID: 38563528 DOI: 10.1111/vsu.14087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 02/26/2024] [Accepted: 03/03/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To describe the complications and outcomes in dogs with luxoid hip dysplasia (LH) undergoing total hip arthroplasty (THA) and compare complication rates with THA in non-LH dogs. STUDY DESIGN Retrospective study. SAMPLE POPULATION Client-owned dogs (n = 217) undergoing primary THA (n = 238). METHODS Medical records (2010-2022) of dogs undergoing THA were reviewed, and LH was defined as complete dorsal displacement of the femoral head from the acetabulum on lateral projection radiographs. Major or catastrophic complications, revisions, and outcomes were recorded for all dogs and they were compared between LH and non-LH groups. RESULTS Eighteen cases met the subcriterion for the LH group and 220 cases met the subcriterion for inclusion in the non-LH group. There were 14 complications in 13/18 dogs with LH; seven were intraoperative (femoral fissure/fracture) and seven were postoperative (dorsal luxation, n = 5; femoral fracture, n = 1; acetabular cup septic loosening, n = 1). Revisions were performed for all LH dogs that encountered complications; satisfactory outcomes were achieved in 12/13 dogs. Overall, LH dogs had a higher risk of developing complications (p < .001), including intraoperative fracture (p < .001) and postoperative dorsal luxation (p = .019) when compared with non-LH dogs. CONCLUSION Luxoid hip dysplasia was associated with a higher risk of major complications following THA in dogs, specifically intraoperative fissure/fracture and postoperative dorsal luxation. Despite the increased risk, revisions typically yielded satisfactory outcomes. CLINICAL SIGNIFICANCE Luxoid hip dysplasia is an important risk factor for the development of major complications in dogs undergoing THA.
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Affiliation(s)
- Carma Horwood
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Jose Luis Carvajal
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Antonio Pozzi
- Department of Small Animal Surgery, College of Veterinary Medicine, University of Zurich, Zurich, Switzerland
| | - Stanley Eunwoo Kim
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
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Ye X, Zeng J, Liu Y, Wang J. Clinical evaluation of total hip arthroplasty for osteoarthropathy secondary to septic hip arthritis. Medicine (Baltimore) 2023; 102:e33227. [PMID: 36930118 PMCID: PMC10019132 DOI: 10.1097/md.0000000000033227] [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: 12/02/2022] [Accepted: 02/16/2023] [Indexed: 03/18/2023] Open
Abstract
To investigate the clinical efficacy and prognosis of total hip arthroplasty (THA) in patients with osteoarthropathy secondary to septic hip arthritis. A total of 100 patients with osteoarthropathy secondary to septic hip arthritis who underwent surgery in our hospital from December 2010 to December 2021 were selected. Operative data were summarized. Moreover, preoperative and postoperative differences in Harris score, Western Ontario and McMaster Universities Osteoarthritis Index score, Visual Analogue Scale score, hip mobility were compared. Due to hospital transfer, the epidemic of COVID-2019 and other reasons, 10 patients were lost to follow-up and finally 90 patients were recorded. According to the results, the mean operation time (OT) was 1.78 ± 0.32 (hour), the mean intraoperative blood loss (BL) was 586.62 ± 31.66 (mL), the mean red blood cell (RBC) transfusion was 3.84 ± 0.75 (U), and 2 cases were positive, and 88 cases were negative for Trendelenburg sign. Postoperatively, the unequal length of the lower limbs and the Visual Analogue Scale score were significantly lower than that of the preoperative, while the Western Ontario and McMaster Universities Osteoarthritis Index score, Harris score, and hip joint range of motion were significantly higher than those of the preoperative (P < .05). At the last follow-up, all the incisions healed with no deep infections, 1 case suffered from transient sciatic nerve palsy, 2 cases had intermuscular venous thrombosis, and 2 cases who occurred hip dislocation recovered after treatment. THA surgery for osteoarthropathy secondary to septic hip arthritis has a good effect, relieving the patient's pain effectively, improving prognosis and joint mobility. For osteoarthropathy secondary to septic hip arthritis, THA may be meaningful in terms of prognosis.
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Affiliation(s)
- Xiguang Ye
- Department of Orthopedics, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, Hubei, China
| | - Jing Zeng
- Department of Joint Surgery, Wuhan No.1 Hospital, Wuhan, Hubei, China
| | - Yongguo Liu
- Department of Pain, Huangpi District People’s Hospital Affiliated to Jianghan University, Wuhan, China
| | - Jie Wang
- Department of Pain, Huangpi District People’s Hospital Affiliated to Jianghan University, Wuhan, China
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Tinga S, Tuyn DD, Kopp RJ, Kim SE. Biomechanical comparison of canine femurs implanted with either cemented (CFX ®) or cementless (with lateral bolt) (BFX ®+lb) total hip replacement under 4-point bending or torsional loads. Front Bioeng Biotechnol 2023; 11:999271. [PMID: 36970631 PMCID: PMC10030729 DOI: 10.3389/fbioe.2023.999271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 02/27/2023] [Indexed: 03/29/2023] Open
Abstract
Objective: Compare biomechanical properties of femurs implanted with either BioMedtrix™ biological fixation with interlocking lateral bolt (BFX®+lb) or cemented (CFX®) stems when subjected to 4-point bending or axial torsional forces. Study Design: Twelve pairs of normal medium to large cadaveric canine femora were implanted with a BFX + lb (n = 12) and a CFX (n = 12) stem-one in the right and one in the left femora of the pair. Pre- and post-operative radiographs were made. Femora were tested to failure in either 4-point bending (n = 6 pairs) or axial torsion (n = 6 pairs), and stiffness, load or torque at failure, linear or angular displacement, and fracture configuration were noted. Results: Implant position was acceptable in all included femora, but CFX stems were placed in less anteversion than BFX + lb stems in the 4-point bending group (median (range) 5.8 (-1.9-16.3) vs. 15.9 (8.4-27.9) anteversion, respectively (p = 0.04)). CFX implanted femora were more stiff than BFX + lb implanted femora in axial torsion (median (range) 2,387 (1,659-3,068) vs. 1,192 (795-2,150) N*mm/o, respectively (p = 0.03)). One of each stem type, from different pairs, did not fail in axial torsion. There was no difference in stiffness or load to failure in 4-point bending, or in fracture configuration for either test, between implant groups. Conclusion: Increased stiffness of CFX implanted femurs under axial torsional forces may not be clinically relevant as both groups withstood expected in vivo forces. Based on this acute post-operative model using isolated forces, BFX + lb stems may be a suitable replacement for CFX stems in femurs with normal morphology (stovepipe and champagne flute morphology were not tested).
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Affiliation(s)
- Selena Tinga
- Comparative Orthopaedics and Biomechanics Laboratory, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States
- *Correspondence: Selena Tinga,
| | - David D. Tuyn
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, United States
| | - Rosalind J. Kopp
- Comparative Orthopaedics and Biomechanics Laboratory, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States
| | - Stanley E. Kim
- Comparative Orthopaedics and Biomechanics Laboratory, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States
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Israel SK, Jaramillo E, Liska WD. Preclosure povidone-iodine lavage in total hip replacement surgery: Infection outcomes and cost-benefit analysis. Vet Surg 2023; 52:33-41. [PMID: 36411945 DOI: 10.1111/vsu.13910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/16/2022] [Accepted: 10/25/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To report the outcomes and cost-benefit analysis of preclosure povidone-iodine lavage (PrePIL) used to reduce the risk of infection following total hip replacement (THR) surgery. STUDY DESIGN Retrospective study. ANIMALS One thousand six hundred ninety-nine dogs, 17 cats. METHODS The medical records of 2213 consecutive THR cases were reviewed to determine the incidence of infection. The last 102 were treated with PrePIL using a commercially sourced 0.035% povidone-iodine solution. Postoperative infection rates were compared. A cost-benefit analysis was used to calculate if a PrePIL protocol is economically feasible. RESULTS Twenty-one THRs out of 2111 (0.99%) that did not have PrePIL developed infection. Infection occurred in none of the 102 PrePIL cases. Cost analysis revealed a PrePIL break-even cost at $49.74 and a break-even infection rate of 0.949%. No complications were identified related to the use of PrePIL. CONCLUSION Preclosure povidone-iodine lavage appeared to be efficacious in lowering THR infection rates, and it appeared to be safe for this use based on our 102 consecutive cases. The cost of the PrePIL was minimal compared to the overall cost to resolve THR infection and the potential effect on hip function prognosis. The math formulas developed can be used by surgeons to calculate cost effectiveness and break-even cost based on their THR infection rate, and to compare to the cost of a THR revision and infection resolution. CLINICAL SIGNIFICANCE At current costs, PrePIL can be used in 2415 THR cases at a similar cost of a single revision surgery and resolution of a periprosthetic infection.
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Kwok JY, Wendelburg KL. Clinical outcomes of canine total hip replacement utilizing a BFX lateral bolt femoral stem: 195 consecutive cases (2013-2019). Vet Surg 2023; 52:51-61. [PMID: 36181274 DOI: 10.1111/vsu.13871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 06/23/2022] [Accepted: 07/14/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To evaluate the clinical outcomes of total hip replacements (THR) utilizing a BFX lateral bolt stem in dogs with coxofemoral joint disease. STUDY DESIGN Retrospective study. SAMPLE POPULATION A total of 149 dogs representing 195 THR. METHODS Consecutive THRs utilizing a BFX lateral bolt stem were studied. Preoperative, immediate postoperative, 1-, 2-, 3-, 4-, and 12-month postoperative radiographs were performed. All major and minor complications, revisions, outcomes, subsidence, canal flare index (CFI) were recorded. RESULTS An intraoperative complication rate of 11.8% was observed. The postoperative complication rate was 13.6%, with 9.2% major and 4.4% minor complications. Complications included: postoperative femur fractures (3.6%), coxofemoral luxation (3.6%), stem failure (0.5%), septic loosening (0.5%), aseptic loosening (0.5%), and acetabular fracture (0.5%). Three dogs underwent prophylactic plating after subjective assessment of cortical thickness. Five of 195 (2.6%) cases underwent explant of their prostheses (median = 3 months). Mean stem subsidence at 1 month postoperatively was 1.22 ± 0.16 mm. An increased CFI was associated with postoperative femur fractures (p < .05). A total of 190 of 195 (97.4%) cases returned to normal function in the long-term follow-up period. CONCLUSION Use of the BFX lateral bolt stem resulted in minimal postoperative subsidence, a low femoral stem complication rate, and a high rate of achieving normal limb function. CLINICAL SIGNIFICANCE The BFX lateral bolt stem should be considered in canine THR as the femoral failure rate is low and the long-term success rate is high.
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Affiliation(s)
- Jenny Y Kwok
- VCA Animal Specialty Group, Los Angeles, California, USA
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Wang X, Li Z, Wang Z, Liu H, Cui Y, Liu Y, Ren M, Zhan H, Li Z, Wu M, Wang J. Incorporation of Bone Morphogenetic Protein-2 and Osteoprotegerin in 3D-Printed Ti6Al4V Scaffolds Enhances Osseointegration Under Osteoporotic Conditions. Front Bioeng Biotechnol 2021; 9:754205. [PMID: 34805113 PMCID: PMC8600075 DOI: 10.3389/fbioe.2021.754205] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/12/2021] [Indexed: 01/23/2023] Open
Abstract
Osteoporosis is an age-related metabolic disease that results in limited bone regeneration capacity and excessive osteoclast activity. After arthroplasty in patients with osteoporosis, poor interface osseointegration resulting from insufficient bone regeneration ability often leads to catastrophic complications such as prosthesis displacement and loosening and periprosthetic fractures. In this study, we prepared a thermosensitive hydrogel loaded with bone morphogenetic protein-2 (BMP-2) to promote osteogenesis and osteoprotegerin (OPG) to inhibit excessive osteoclast activity. To construct three-dimensional (3D)-printed composite scaffolds for implantation, a hydrogel loaded with drugs was injected into porous Ti6Al4V scaffolds. The 3D-printed composite scaffolds showed good biocompatibility and sustained release of BMP-2 and OPG for more than 20 days. In vitro experiments indicated that composite scaffolds promoted osteogenic differentiation and reduced the osteoclastic activation simultaneously. Remarkably, immunofluorescence staining, micro-CT, histological, and biomechanical tests demonstrated that the sustained release of both BMP-2 and OPG from composite scaffolds significantly improved bone ingrowth and osseointegration in osteoporotic defects. In conclusion, this study demonstrated that the BMP-2- and OPG-loaded 3D-printed composite scaffolds can potentially promote osseointegration for osteoporotic patients after joint replacement.
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Affiliation(s)
- Xianggang Wang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
- Orthopaedic Research Institute of Jilin Province, Changchun, China
| | - Zhengyan Li
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of TCM, Shanghai, China
- Institute of Traumatology, Shanghai Academy of TCM, Shanghai, China
| | - Zhonghan Wang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
- Orthopaedic Research Institute of Jilin Province, Changchun, China
| | - He Liu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
- Orthopaedic Research Institute of Jilin Province, Changchun, China
| | - Yutao Cui
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
- Orthopaedic Research Institute of Jilin Province, Changchun, China
| | - Yuzhe Liu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
- Orthopaedic Research Institute of Jilin Province, Changchun, China
| | - Ming Ren
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
- Orthopaedic Research Institute of Jilin Province, Changchun, China
| | - Hongsheng Zhan
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of TCM, Shanghai, China
- Institute of Traumatology, Shanghai Academy of TCM, Shanghai, China
| | - Zuhao Li
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
- Orthopaedic Research Institute of Jilin Province, Changchun, China
| | - Minfei Wu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
- Orthopaedic Research Institute of Jilin Province, Changchun, China
| | - Jincheng Wang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
- Orthopaedic Research Institute of Jilin Province, Changchun, China
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