1
|
Ugland SH, Ugland TO, Haugeberg G, Pripp AH, Nordsletten L. Periprosthetic bone mineral density, assessed using dual energy x-ray absorptiometry, following arthroplasty in patients with femoral neck fracture: 5-year outcomes of a randomized controlled trial. J Int Med Res 2024; 52:3000605241276491. [PMID: 39268760 PMCID: PMC11403699 DOI: 10.1177/03000605241276491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2024] Open
Abstract
OBJECTIVE The relationship between the surgical approach used for hemiarthroplasty and periprosthetic bone mineral density (BMD) is not well understood. We have previously described a decrease in BMD 1 year postoperatively. Here, we assessed the medium-term changes in periprosthetic BMD. METHODS We performed a follow-up study of patients with femoral neck fracture (FNF) who underwent uncemented hemiarthoplasty using a direct lateral or anterolateral approach. Dual-energy X-ray absorptiometry (DXA) was used to evaluate the changes in BMD in 23 patients over 5 years. RESULTS A mean 6% loss of total BMD occurred over 1 year, but between 1 and 5 years, BMD was restored to the baseline value. The mean total BMD in the anterolateral group had decreased by 2% after 3 months and 3% after 12 months, and increased by 2% after 5 years, vs. decreases of 7%, 8%, and 3% for the direct lateral group. Between 1 and 5 years, BMD increased in Gruen zones 2, 3, 4, 5, and 6 in both groups. There was a significantly larger increase in zone 4 in the lateral group (4%) than the anterolateral group. CONCLUSION The surgical approach affects periprosthetic BMD in patients with FNF. Furthermore, BMD is restored to the baseline value 5 years postoperatively.ClinicalTrials.gov registration number: NCT03753100.
Collapse
Affiliation(s)
- Stein H Ugland
- Department of Orthopedics, Sorlandet Hospital Kristiansand, Norway
- University of Oslo, Olso, Norway
| | - Terje O Ugland
- Department of Orthopedics, Sorlandet Hospital Kristiansand, Norway
| | - Glenn Haugeberg
- Department of Rheumatology, Sorlandet Hospital Kristiansand, Norway
- Department of Neurosciences, Rheumatology Division, Norwegian University of Science and Technology, Trondheim, Norway
| | - Are H Pripp
- Oslo Centre of Biostatistics and Epidemiology, Oslo, Norway
| | - Lars Nordsletten
- Department of Orthopedics, Oslo University Hospital, Ullevål, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
2
|
Leino OK, Forsbacka N, Laaksonen IE, Mäkelä KT, Matilainen M, Ekman EM. Changing treatment of hip fractures in Finland. Arch Orthop Trauma Surg 2024; 144:3469-3478. [PMID: 39196404 PMCID: PMC11417085 DOI: 10.1007/s00402-024-05462-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 07/11/2024] [Indexed: 08/29/2024]
Abstract
INTRODUCTION Hip fracture treatment should be as standardized and effective as possible, with emphasis on fast recovery and avoidance of complications, especially those leading to reoperations. There is accumulating evidence regarding the optimal treatment of hip fractures but reports of whether this has influenced treatment in the clinical setting are sparse. The objective of this study was to determine the trends of hip fracture incidence and treatment in Finland, with special regard to how we treat older patients compared to younger ones. MATERIALS AND METHODS All operatively treated hip fractures in Finland between 1997 and 2018 were identified from a national administrative register. The incidence of these fractures and operations performed to treat them were calculated based on the adult population size. RESULTS Apart from a decline in the elderly age groups during the first half of the study period, the incidence of hip fractures remained relatively constant. However, the incidences of different operations changed significantly. In treatment of femoral neck fractures from 1997 to 2018, the incidence of cemented hemiarthroplasty (HA) increased from 41.1 to 59.9 per 100,000 person-years (105) and hybrid total hip arthroplasty (THA) from 0.56 to 5.93 per 105, while the incidence of internal fixation (IF) decreased, for instance screw fixation from 12.5 to 2.7 per 105. The incidence of cementless HA decreased from 13.3 to 1.2 per 105. These changes were much more pronounced in the elderly population and there was a statistically significant difference in the proportion of patients aged > 59 treated with cemented HA and IF in 1997 compared to 2018. For trochanteric and subtrochanteric fractures, treatment with intramedullary nails replaced extramedullary devices as the most common treatment method. CONCLUSIONS The changes in treatment methods in Finland correspond to the increasing knowledge available about the optimal treatment of hip fractures and global treatment trends.
Collapse
Affiliation(s)
- Oskari K Leino
- Department of Orthopaedics and Traumatology, Turku University Hospital, University of Turku, Turku, Finland.
| | - Nora Forsbacka
- Department of Orthopaedics and Traumatology, Turku University Hospital, University of Turku, Turku, Finland
| | - Inari E Laaksonen
- Department of Orthopaedics and Traumatology, Turku University Hospital, University of Turku, Turku, Finland
| | - Keijo T Mäkelä
- Department of Orthopaedics and Traumatology, Turku University Hospital, University of Turku, Turku, Finland
| | - Markus Matilainen
- Department of Biostatistics, Faculty of Medicine, University of Turku, Turku, Finland
| | - Elina M Ekman
- Department of Orthopaedics and Traumatology, Turku University Hospital, University of Turku, Turku, Finland
| |
Collapse
|
3
|
Humez M, Kötter K, Skripitz R, Kühn KD. Evidence for cemented TKA and THA based on a comparison of international register data. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:597-607. [PMID: 38568216 PMCID: PMC11329679 DOI: 10.1007/s00132-024-04489-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Hip and knee implants can either be fixed without cement, press-fit, or with bone cement. Real-world data from arthroplasty registers, as well as studies provide a broad database for the discussion of cemented versus uncemented arthroplasty procedures. OBJECTIVE What does current evidence from international arthroplasty registries and meta-analyses recommend regarding cemented or cementless fixation of hip and knee implants? METHODS A recommendation is generated by means of direct data comparison from the arthroplasty registries of eight countries (USA, Germany, Australia, UK, Sweden, Norway, New Zealand, Netherlands), the comparison of 22 review studies and meta-analyses based on registry data, as well as an evaluation of recommendations of healthcare systems from different nations. For this purpose, reviews and meta-analyses were selected where the results were statistically significant, as were the annual reports of the arthroplasty registries that were current at the time of writing. RESULTS For knee arthroplasties, long survival time as well as lower risk of revision can be achieved with the support of cemented fixation with antibiotic-loaded bone cement. In patients aged 70 years and older, cemented fixation of hip stem implants significantly reduces risk of intraoperative or postoperative periprosthetic fracture (quadruple). This applies both to elective total hip arthroplasties and to hemiarthroplasty after femoral neck fractures. Antibiotic-loaded bone cement significantly (p = 0.041) reduces the risk of periprosthetic infection, especially in patients with femoral neck fractures. CONCLUSION Total knee replacement with antibiotic-loaded bone cement is well established internationally and is evidence-based. Registry data and meta-analyses recommend cemented fixation of the hip stem in older patients. In Germany, USA and Australia these evidence-based recommendations still must be transferred to daily practice.
Collapse
Affiliation(s)
- Martina Humez
- Institute of Hygiene and Environmental Medicine, Justus-Liebig-Universität Giessen, Schubertstraße 81, 35392, Giessen, Germany.
| | | | - Ralf Skripitz
- Centre for Endoprosthetics, Foot Surgery, Paediatric and General Orthopaedics, Roland-Klinik Bremen, Bremen, Germany
| | - Klaus-Dieter Kühn
- Department of Orthopaedics and Orthopaedic Surgery, Medical University of Graz, Graz, Germany
| |
Collapse
|
4
|
Kweon SH, Park JS, Baek SJ. Outcomes of Hybrid Total Hip Arthroplasty for Subchondral Insufficiency Fracture of the Femoral Head. Clin Orthop Surg 2024; 16:390-396. [PMID: 38827754 PMCID: PMC11130634 DOI: 10.4055/cios23189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 01/18/2024] [Accepted: 01/18/2024] [Indexed: 06/04/2024] Open
Abstract
Background The purpose of this study was to evaluate functional outcomes, radiologic results, and complications after hybrid total hip arthroplasty (THA) in patients with subchondral insufficiency fractures (SIFs) of the femoral head. Methods From June 2009 to December 2020, among 985 patients who underwent hybrid THA at our hospital, 19 patients diagnosed with SIF through a retrospective chart review were included. Those under 50 years of age, with radiographic findings of osteonecrosis on the contralateral side of surgery, a history of organ transplantation, and alcohol abuse, were excluded. Functional evaluation was performed using a modified Harris Hip Score (HHS). After surgery, inclination and anteversion of the acetabular cup and version of the femoral system were measured using postoperative x-ray. The outpatient follow-up was performed at 6 weeks, 3 months, 9 months, and 12 months after surgery and every year thereafter. Complications including dislocation, implant loosening, stem subsidence, and periprosthetic infection were observed on follow-up radiographs. Results The average follow-up time was 29.3 ± 9.1 months (range, 24-64 months) with no loss to follow-up. The mean modified HHS was 83.4 ± 9.6 (range, 65-100) at the last outpatient clinic follow-up. The average inclination of the acetabular cup was 41.9° ± 3.4° (range, 37°-48°), and the anteversion was 27.5° ± 6.7° (range, 18°-39°). The version of the femoral stem was 19° ± 5.7° (range, 12°-29°). There was no case of intraoperative fracture. There were no cases of dislocation, loosening of the cup, subsidence of the femoral stem, intraoperative or periprosthetic fracture, or periprosthetic infection on the follow-up radiographs. Conclusions In our study, hybrid THA showed favorable outcomes in patients diagnosed with SIF, and there were no further special considerations as for THA performed due to other diseases or fractures.
Collapse
Affiliation(s)
- Suc-Hyun Kweon
- Department of Orthopedic Surgery, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
| | - Jin Sung Park
- Department of Orthopedic Surgery, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
| | - Seung Jeong Baek
- Department of Orthopedic Surgery, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
| |
Collapse
|
5
|
Kuyl EV, Agarwal AR, Patel PK, Harris AB, Gu A, Rao S, Thakkar SC, Golladay GJ. Osteoporotic Patients Undergoing Total Hip Arthroplasty Have a Similar 5-Year Cumulative Incidence Rate of Periprosthetic Fracture Regardless of Cemented Versus Cementless Femoral Stem Fixation. J Arthroplasty 2024; 39:1285-1290.e1. [PMID: 37952741 DOI: 10.1016/j.arth.2023.11.001] [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: 08/22/2023] [Revised: 10/30/2023] [Accepted: 11/04/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND In osteoporotic patients, surgeons may utilize cemented femoral fixation to minimize risk of fracture. The purpose of this study was to compare 5-year implant survivability in patients who have osteoporosis who underwent elective total hip arthroplasty (THA) with cementless versus cemented fixation. METHODS A retrospective analysis of patients who have osteoporosis undergoing THA with either cemented or cementless femoral fixation was conducted using a national administrative claims database. Of the 18,431 identified THA patients who have osteoporosis, 15,867 (86.1%) underwent cementless fixation. The primary outcome was a comparison of the 5-year cumulative incidences of aseptic revision, mechanical loosening, and periprosthetic fracture (PPF). Kaplan-Meier and Multivariable Cox Proportional Hazard Ratio analyses were used, controlling for femoral fixation method, age, sex, a comorbidity scale, use of osteoporosis medication, and important comorbidity. RESULTS There was no difference in aseptic revision (Hazard's Ratio (HR): 1.13; 95% Confidence Interval (CI): 0.79 to 1.62; P value: .500) and PPF (HR: 0.96; 95% CI: 0.64 to 1.44; P value: .858) within 5 years of THA between fixation cohorts. However, patients who had cemented fixation were more likely to suffer mechanical loosening with 5 years post-THA (HR: 1.79; 95% CI: 1.17 to 2.71; P-value: .007). CONCLUSIONS We found a similar 5-year rate of PPF when comparing patients who underwent cementless versus cemented femoral fixation for elective THA regardless of preoperative diagnosis of osteoporosis. While existing registry data support the use of cemented fixation in elderly patients, a more thorough understanding of the interplay between age, osteoporosis, and implant design is needed to delineate in whom cemented fixation is most warranted for PPF prevention.
Collapse
Affiliation(s)
- Emile-Victor Kuyl
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Amil R Agarwal
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Parth K Patel
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Andrew B Harris
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, Maryland
| | - Alex Gu
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Sandesh Rao
- Washington Orthopaedics and Sports Medicine, Washington, District of Columbia
| | | | - Gregory J Golladay
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia
| |
Collapse
|
6
|
Rossi N, Nannini A, Ulivi M, Sirtori P, Banfi G, Tomaiuolo R, de Girolamo L, Mangiavini L, Peretti GM. Men and women undergoing total hip arthroplasty have different clinical presentations before surgery and different outcomes at 1-year follow-up. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38461374 DOI: 10.1002/ksa.12124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/09/2024] [Accepted: 02/15/2024] [Indexed: 03/11/2024]
Abstract
PURPOSE The purpose of this study was to investigate the influence of sex on patients undergoing total hip arthroplasty (THA) for hip osteoarthritis (HOA), aiming to assess the clinical and functional outcomes using patient-reported outcome measures (PROMs). METHODS A retrospective analysis of patients undergoing THA at Ospedale Galeazzi-Sant'Ambrogio between 2016 and 2022 was conducted. Inclusion criteria encompassed Kellgren-Lawrence grade III or IV HOA, with preoperative and 12-month postoperative PROMs. Enroled patients have been selected from a larger cohort without matching design for confounders. The analyses were performed using R software v4.0.3 (R Core Team) and data distributions were assessed using the Shapiro-Wilk normality test. RESULTS One hundred ninety patients (72 male and 118 female) who had both preoperative and postoperative PROMs have been analysed from our institutional prosthesis registry (Datareg). Baseline and 12-month post-THA PROMs showed significant improvements overall. VAS score dropped notably from baseline to 3 months postsurgery (7.1 ± 2.1 vs. 0.9 ± 1.7). Functional and mental PROMs, including Harris Hip Score-functional (HHS-F), Harris Hip Score-total (HHS-t), SF-12PS and SF-12MS, exhibited substantial improvements post-THA. Stratifying by sex, males had lower baseline VAS, higher HHS-F, SF-12MS and hip disability and osteoarthritis outcome score-physical function short form (HOOS-PS). At 12 months, males displayed significantly better VAS, HHS-F, SF-12PS and HOOS-PS scores. Complication rates were minimal (1.5%), with stable rates across genders, mostly involving dislocation and periprosthetic fractures. Implant survival at 12 months reached an impressive 99%. CONCLUSION THA remains an effective treatment for severe HOA. However, females presented with worse baseline conditions and showed relatively less improvement at 1-year postsurgery compared to males. This difference could be attributed to physiological and psychosocial factors associated with sex, including hormonal changes, muscle mass decline and perception of pain. Longer follow-ups and prospective studies are necessary to validate these findings and facilitate personalised approaches in HOA treatment, emphasising the need for careful consideration of sex-related variables in clinical decision-making for THA patients. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Nicolò Rossi
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Alessandra Nannini
- Residency Program in Orthopaedics and Traumatology, University of Milan, Milan, Italy
| | | | | | | | - Rossella Tomaiuolo
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
- Faculty of Medicine, Università Vita-Salute San Raffaele, Milano, Italy
| | | | - Laura Mangiavini
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Giuseppe M Peretti
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| |
Collapse
|
7
|
Humez M, Kötter K, Skripitz R, Kühn KD. [Register data on cemented arthroplasty : A proof for cementless fixation?]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:163-175. [PMID: 37889315 PMCID: PMC10896946 DOI: 10.1007/s00132-023-04451-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Hip and knee implants can be either fixated without cement, press-fit, or with bone cement. Real-world data from arthroplasty registers, as well as studies, provide a broad database for the discussion of cemented versus uncemented arthroplasty procedures. OBJECTIVES What is the recommendation for cemented or cementless anchorage of hip and knee implants based on the current evidence from international arthroplasty registries and meta-analyses? METHODS A recommendation is generated by means of a direct comparison of data from the arthroplasty registries of eight different countries (USA, Germany, Australia, UK, Sweden, Norway, New Zealand, and The Netherlands), the comparison of 22 review studies and meta-analyses based on registry data, as well as the evaluation of the recommendation of healthcare systems of different nations. For this purpose, reviews and meta-analyses whose results were statistically significant were selected, as were the annual reports of the arthroplasty registries that were current at the time of writing. RESULTS For knee endoprostheses, a long survival time, as well as a lower risk of revision can be achieved with the help of cemented anchorage with antibiotic-laden bone cement. In patients aged 70 years and older, cemented anchorage of the hip stem implant significantly reduces the risk of intraoperative or postoperative periprosthetic fracture (times four), this applies both to elective total hip arthroplasties (TEPs) and to hemiarthroplasty after femoral neck fractures. Antibiotic-loaded bone cement significantly (p = 0.041) reduces the risk of periprosthetic infection, especially in patients with femoral neck fractures. CONCLUSIONS Total knee replacement with antibiotic-loaded bone cement is well established in Germany and evidence based. Registry data and meta-analyses recommend cemented fixation of the hip stem in older patients-in Germany the evidence-based recommendations must still be transferred to daily practice.
Collapse
Affiliation(s)
- Martina Humez
- Heraeus Medical GmbH, Philipp-Reis-Str. 8/13, 61273, Wehrheim, Deutschland.
| | - Katharina Kötter
- Heraeus Medical GmbH, Philipp-Reis-Str. 8/13, 61273, Wehrheim, Deutschland
| | - Ralf Skripitz
- Zentrum für Endoprothetik, Fußchirurgie, Kinder- und Allgemeine Orthopädie, Roland-Klinik Bremen, Bremen, Deutschland
| | - Klaus-Dieter Kühn
- Department of Orthopaedics and Trauma, Medizinische Universität Graz, Graz, Österreich
| |
Collapse
|
8
|
Gjertsen JE, Nilsen D, Furnes O, Hallan G, Kroken G, Dybvik E, Fenstad AM. Promoting cemented fixation of the femoral stem in elderly female hip arthroplasty patients and elderly hip fracture patients: a retrospective cohort study from the Norwegian Arthroplasty Register and the Norwegian Hip Fracture Register. Acta Orthop 2024; 95:130-137. [PMID: 38391278 PMCID: PMC10885817 DOI: 10.2340/17453674.2024.40073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND AND PURPOSE Uncemented stems increase the risk of revision in elderly patients. In 2018, we initiated a national quality improvement project aiming to increase the proportion of cemented stems in elderly female total hip arthroplasty (THA) and hip fracture hemiarthroplasty (HA) patients. We aimed to evaluate the association of this project on the frequency of cemented stems and the risk of secondary procedures in the targeted population. METHODS 10,815 THAs in female patients ≥ 75 years in the Norwegian Arthroplasty Register and 19,017 HAs in hip fracture patients ≥ 70 years in the Norwegian Hip Fracture Register performed in 2015-2017 and 2019-2021 at all Norwegian hospitals were included in this retrospective cohort study. The quality improvement project was implemented at 19 hospitals (8,443 patients). 1-year revision risk (THAs) and reoperation risk (HAs) were calculated for uncemented and cemented stems by Kaplan-Meier and Cox adjusted hazard rate ratios (aHRRs) with all-cause revision/reoperation as main endpoint. RESULTS The use of cemented stem fixation in the targeted population increased from 26% to 80% for THAs and from 27% to 91% for HAs. For THAs, the 1-year revision rate decreased from 3.7% in 2015-2017 to 2.1% in 2019-2021 (aHRR 0.7, 95% confidence interval [CI] 0.5-0.9) at the intervention hospitals. For HAs, the reoperation rate decreased from 5.9% in 2015-2017 to 3.3% in 2019-2021 (aHRR 0.6, CI 0.4-0.8) at the intervention hospitals. CONCLUSION The quality improvement project resulted in a significant increase in the proportion of cemented stems and reduced risk of secondary procedures for both THAs and HAs.
Collapse
Affiliation(s)
- Jan-Erik Gjertsen
- The Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; Department of Clinical Medicine, University of Bergen, Bergen.
| | - Daniel Nilsen
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
| | - Ove Furnes
- Department of Clinical Medicine, University of Bergen, Bergen; The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
| | - Geir Hallan
- Department of Clinical Medicine, University of Bergen, Bergen; The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
| | - Gard Kroken
- Directorate of Fisheries, Section for Analysis and Risk Assessment, Bergen, Norway
| | - Eva Dybvik
- The Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
| | - Anne Marie Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
| |
Collapse
|
9
|
Giovanoulis V, Kenanidis E, Aïm F, Gamie Z, Marmor S, Potoupnis M, Lustig S, Tsiridis E. Collared versus collarless hydroxyapatite-coated stems for primary cementless total hip arthroplasty; a systematic review of comparative studies. Is there any difference in survival, functional, and radiographic outcomes? SICOT J 2024; 10:8. [PMID: 38358293 PMCID: PMC10868518 DOI: 10.1051/sicotj/2024003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/10/2024] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION This systematic review aims to critically assess the literature comparative studies investigating collared and collarless Corail stem in primary total hip arthroplasty (THA) to find differences in revision rates, radiographic and clinical outcomes, and postoperative complications between these two types of the same stem. METHODS Eligible studies were found by searching PubMed, Science Direct/Scopus, and the Cochrane Database of Systematic Reviews from conception till May 2023. The PRISMA guidelines were followed. The investigation encompassed randomized controlled trials, case series, comparative, cohort, and observational studies that assessed at least one comparative outcome or complication between collared and collarless Corail stems. RESULTS Twelve comparative studies with 90,626 patients undergoing primary THA were included. There were 40,441 collared and 58,543 collarless stems. The follow-up ranged from 12 to 360 months. Our study demonstrated no significant difference in stem revision relative risk (RR = 0.68; 95% confidence interval (CI), 0.23, 2.02; p = 0.49), number of radiolucent lines (RR = 0.3; 95% CI, 0.06, 2.28; p = 0.29) and overall complication risk (RR = 0.62; 95% CI, 0.22, 1.76; p = 0.37) between collared and collarless stems. The collared stems demonstrated significantly lesser subsidence (mean difference: 1.01 mm; 95% CI, -1.77, -0.25; p = 0.009) and risk of periprosthetic fractures (RR = 0.52; 95% CI, 0.29, 0.92; p = 0.03). CONCLUSION The comparative studies between collared and collarless stem groups showed similar survival and overall complication rates and functional outcomes. The similar revision rates between groups make the impact of higher subsidence for collarless stems uncertain. The lower risk of periprosthetic fractures in the collared stems group must be clarified further but could be related to increased rotational stability.
Collapse
Affiliation(s)
- Vasileios Giovanoulis
- Orthopedic Surgery Department, Groupe Hospitalier Diaconnesses Croix Saint-Simon 125 Rue d’Avron 75020 Paris France
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou Ring Road Efkarpia Thessaloniki 56403 Greece
- Center of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation(CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd PO Box 8318 GR 57001 Greece
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Hospices Civils de Lyon 103 Grande Rue de La Croix Rousse 69004 Lyon France
| | - Eustathios Kenanidis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou Ring Road Efkarpia Thessaloniki 56403 Greece
- Center of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation(CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd PO Box 8318 GR 57001 Greece
| | - Florence Aïm
- Orthopedic Surgery Department, Groupe Hospitalier Diaconnesses Croix Saint-Simon 125 Rue d’Avron 75020 Paris France
| | - Zakareya Gamie
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou Ring Road Efkarpia Thessaloniki 56403 Greece
- Center of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation(CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd PO Box 8318 GR 57001 Greece
| | - Simon Marmor
- Orthopedic Surgery Department, Groupe Hospitalier Diaconnesses Croix Saint-Simon 125 Rue d’Avron 75020 Paris France
| | - Michael Potoupnis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou Ring Road Efkarpia Thessaloniki 56403 Greece
- Center of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation(CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd PO Box 8318 GR 57001 Greece
| | - Sébastien Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Hospices Civils de Lyon 103 Grande Rue de La Croix Rousse 69004 Lyon France
| | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou Ring Road Efkarpia Thessaloniki 56403 Greece
- Center of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation(CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd PO Box 8318 GR 57001 Greece
| |
Collapse
|
10
|
Ladurner A, Zdravkovic V, Giesinger K. Sex-Specific Implant Fixation Can Reduce Revision Rates in Total Hip Arthroplasty: Evidence From the Swiss National Joint Registry. J Arthroplasty 2024; 39:421-426. [PMID: 37595764 DOI: 10.1016/j.arth.2023.08.035] [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: 04/07/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Patient's sex is considered a risk factor for revision following primary total hip arthroplasty (THA), but sex-specific treatment guidelines are lacking. The purpose was to assess sex-specificity of risk factors for periprosthetic femoral fractures (PFFs) and aseptic stem loosening (ASL) in a nationwide register study. METHODS All uncemented and hybrid THAs for hip osteoarthritis registered in the Swiss National Joint Registry were considered. 86,423 THAs were analyzed. Comparable THA subsets for both sexes were obtained through propensity score matching (1:1). A sex-specific analysis of risk factors for early PFF or ASL was performed using recursive partitioning analyses. RESULTS In women, PFFs were most significantly associated with uncemented THA fixation (P < .0001) and age (P < .01, threshold: 70.5 years). The ASLs were solely associated with patient age of <65 years (P = .023). In men, PFFs were associated exclusively with an American Society of Anesthesiologists (ASA) score >2 (P = .026). The ASLs were not correlated to any of the potential risk factors analyzed. A mathematical simulation indicated that avoiding uncemented THA fixation in women ≥70.5 years of age decreased the number of revisions within the observational period by 21% in this subset and by 4.9% in the entire patient population. CONCLUSION Uncemented THA should be avoided in women >70.5 years due to the increased risk of early PFF, while the mode of stem fixation did not influence revision risk in men. A sex-specific regimen for THA fixation has the potential to markedly reduce early THA revision rates.
Collapse
Affiliation(s)
- Andreas Ladurner
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Vilijam Zdravkovic
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Karlmeinrad Giesinger
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| |
Collapse
|
11
|
Kelly M, Chen AF, Ryan SP, Working ZM, Porter KR, De A, Mullen K, Kagan R. Cemented Femoral Fixation in Total Hip Arthroplasty Reduces the Risk of Periprosthetic Femur Fracture in Patients 65 Years and Older: An Analysis from the American Joint Replacement Registry. J Arthroplasty 2023:S0883-5403(23)00395-9. [PMID: 37105331 DOI: 10.1016/j.arth.2023.04.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Periprosthetic femur fracture (PPFx) is a devastating complication after total hip arthroplasty (THA). Despite concerns for increased PPFx, cementless fixation predominates in the United States (US). This study utilized the American Joint Replacement Registry (AJRR) to compare PPFx risk between cemented and cementless femoral fixation for THA. METHODS An analysis of primary THA cases in patients aged 65 years and older was performed with AJRR data linked to Centers for Medicare and Medicaid Services (CMS) data from 2012 to 2020. Analyses compared cemented to cementless femoral fixation. We identified 279,052 primary THAs, 266,040 (95.3%) with cementless and 13,012 (4.7%) with cemented femoral fixation. Cox proportional hazard regression analyses evaluated the association of fixation and PPFx risk, while adjusting for sex, age and competing risk of mortality. Cumulative incidence function (CIF) survival curves evaluated time to PPFx. RESULTS Age ≥ 80 years (P<0.0001) and women (P<0.0001) were associated with PPFx. Compared to cemented stems, cementless stems had an elevated risk of PPFx (Hazards Ratio 7.70, [95% Confidence interval 3.2-18.6], P<0.0001). The CIF curves demonstrated an increased risk for PPFx across all time points for cementless stems, with equal magnitude of risk to eight years. CONCLUSION Cementless femoral fixation in THA continues to predominate in the US, with cementless femoral fixation demonstrating increased risk of PPFx in patients 65 years or older. Surgeons should consider greater use of cemented femoral fixation in this population to decrease the risk of PPFx.
Collapse
Affiliation(s)
- Mackenzie Kelly
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Antonia F Chen
- Department of Orthopaedics, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sean P Ryan
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, North Carolina
| | - Zachary M Working
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Kimberly R Porter
- American Academy of Orthopaedic Surgeons, Registries and Data Science Department, Rosemont, Illinois
| | - Ayushmita De
- American Academy of Orthopaedic Surgeons, Registries and Data Science Department, Rosemont, Illinois
| | - Kyle Mullen
- American Academy of Orthopaedic Surgeons, Registries and Data Science Department, Rosemont, Illinois
| | - Ryland Kagan
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon.
| |
Collapse
|
12
|
van Loon J, Sierevelt IN, Spekenbrink-Spooren A, Opdam KTM, Poolman RW, Kerkhoffs GMMJ, Haverkamp D. Higher risk of 2-year cup revision of ceramic-on-ceramic versus ceramic-on-polyethylene bearing: analysis of 33,454 primary press-fit total hip arthroplasties registered in the Dutch Arthroplasty Register (LROI). Hip Int 2023; 33:280-287. [PMID: 34974763 PMCID: PMC9978866 DOI: 10.1177/11207000211064975] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE The influence of bearing on short-term revision in press-fit total hip arthroplasty (THA) remains under-reported. The aim of this study was to describe 2-year cup revision rates of ceramic-on-ceramic (CoC) and ceramic-on-polyethylene (CoPE). PATIENTS AND METHODS Primary press-fit THAs with one of the three most used cups available with both CoC or CoPE bearing recorded in the Dutch Arthroplasty Register (LROI) were included (2007-2019). Primary outcome was 2-year cup revision for all reasons. Secondary outcomes were: reasons for revision, incidence of different revision procedures and use of both bearings over time. RESULTS 2-year Kaplan-Meier cup revision rate in 33,454 THAs (12,535 CoC; 20,919 CoPE) showed a higher rate in CoC (0.67% [95% CI, 0.54-0.81]) compared to CoPE (0.44% [95% CI, 0.34-0.54]) (p = 0.004). Correction for confounders (age, gender, cup type, head size) resulted in a hazard ratio (HR) of 0.64 [95%CI, 0.48-0.87] (p = 0.019). Reasons for cup revision differed only by more cup revision due to loosening in CoC (26.2% vs.1 3.2%) (p = 0.030). For aseptic loosening a revision rate of 0.153% [95% CI, 0.075-0.231] was seen in CoC and 0.058% [95%CI 0.019-0.097] in CoPE (p = 0.007). Correction for head size resulted in a HR of 0.475 [95% CI, 0.197-1.141] (p = 0.096). Incidence of different revision procedures did not differ between bearings. Over time the use of CoPE has increased and CoC decreased. CONCLUSIONS A higher 2-year cup revision rate in press-fit THA was observed in CoC compared to CoPE. Cup loosening was the only significantly different reason for revision and seen more often in CoC and mostly aseptic. Future randomised controlled trials need to confirm causality, since the early cup revision data provided has the potential to be useful when choosing the bearing in press-fit THA, when combined with other factors like bone quality and patient and implant characteristics.
Collapse
Affiliation(s)
- Justin van Loon
- Xpert Clinics Orthopedie Amsterdam, The
Netherlands,Department of Orthopaedic Surgery,
Amsterdam Movement Sciences, Amsterdam UMC, Academic Medical Centre, University of
Amsterdam, Amsterdam, The Netherlands,Department of Orthopaedic Surgery,
Tergooi, Hilversum, The Netherlands
| | - Inger N Sierevelt
- Xpert Clinics Orthopedie Amsterdam, The
Netherlands,Department of Orthopaedic Surgery,
Spaarne Gasthuis Academy, TM Hoofddorp, The Netherlands
| | | | - Kim TM Opdam
- Department of Orthopaedic Surgery,
Amsterdam Movement Sciences, Amsterdam UMC, Academic Medical Centre, University of
Amsterdam, Amsterdam, The Netherlands
| | - Rudolf W Poolman
- Department of Orthopaedic Surgery,
Leiden University Medical Centre, Leiden, The Netherlands,Department of Orthopaedic Surgery,
OLVG, Amsterdam, The Netherlands
| | - Gino MMJ Kerkhoffs
- Department of Orthopaedic Surgery,
Amsterdam Movement Sciences, Amsterdam UMC, Academic Medical Centre, University of
Amsterdam, Amsterdam, The Netherlands
| | - Daniël Haverkamp
- Xpert Clinics Orthopedie Amsterdam, The
Netherlands,Daniël Haverkamp, Xpert Clinics Orthopedie
Amsterdam, Laarderhoogtweg 12, Amsterdam, North-Holland, 1101EA, The
Netherlands.
| |
Collapse
|
13
|
Allaith S, Tucker LJ, Innes JF, Arthurs G, Vezzoni A, Morrison S, Onyett J, Stork CK, Witte P, Denny H, Pettitt R, Moores AP, Maddox T, Comerford EJ. Outcomes and complications reported from a multiuser canine hip replacement registry over a 10-year period. Vet Surg 2023; 52:196-208. [PMID: 36062338 PMCID: PMC10087566 DOI: 10.1111/vsu.13885] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 07/24/2022] [Accepted: 08/07/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To report outcomes and complications associated with total hip replacements (THR) using a multiuser canine hip registry (CHR) and owner-administered questionnaire. STUDY DESIGN Prospective longitudinal clinical study. ANIMALS Dogs (n = 1852). METHODS Total hip replacement cases submitted to a CHR were reviewed. An online questionnaire including an adapted "Liverpool Osteoarthritis in Dogs" (LOAD) score was e-mailed to owners. Data were analyzed to determine associations between clinical variables and the agreement by veterinary surgeons and owners for complications. RESULTS A group of 1329 (72%) dogs had unilateral THRs and another group of 523 (28%) dogs had bilateral THRs, resulting in 2375 THRs. Indications included hip dysplasia and osteoarthritis (n = 2028/2375, 85%). Implants were manufactured by Kyon (n = 1087, 46%), BioMedtrix CFX (n = 514, 22%), BioMedtrix hybrid (n = 264, 11%), BioMedtrix BFX (n = 221, 9%), and Helica (n = 107, 4.5%). Median veterinary surgeon and owner follow up were 1328 and 900 days respectively. Postoperative LOAD scores (21 ± 9) reported by 461 owners improved compared to preoperative scores (11 ± 9) (P < .001). Veterinary surgeons reported complications in 201/2375 (8.5%) THRs and owners in 107/461 (23%) THRs, with moderate agreement (weighted kappa = 0.44). No associations were identified between complications and weight, age, sex, or breed. BioMedtrix BFX and Helica implants were associated with increased complications (P = .031) when used for revisions of femoral head and neck excisions. CONCLUSION Excellent outcomes, including improved canine mobility, were reported after THRs. Complications were underreported by veterinary surgeons compared to owners in this first multiuser CHR. CLINICAL SIGNIFICANCE Canine THRs are safe, effective procedures but THR implants should be carefully selected when revising femoral head and neck excisions.
Collapse
Affiliation(s)
- Sumaya Allaith
- Department of Musculoskeletal and Ageing Sciences, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Lydia J Tucker
- Department of Musculoskeletal and Ageing Sciences, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - John F Innes
- ChesterGates Veterinary Specialists, Units E & F, Cheshire, UK
| | - Gareth Arthurs
- Arthurs Orthopaedics, Towcester Veterinary Centre, Towcester, UK
| | | | | | - Jeremy Onyett
- Abington Park Referrals, The Holcot Centre, Northampton, UK
| | | | - Philip Witte
- Cornwall Veterinary Referrals, Penmellyn Veterinary Group, Cornwall, UK
| | - Hamish Denny
- Denny Veterinary Orthopaedic Referrals, Cedar House, Bristol, UK
| | - Rob Pettitt
- Small Animal Teaching Hospital, Leahurst Campus, School of Veterinary Science, University of Liverpool, Neston, UK
| | - Andy P Moores
- Anderson Moores Veterinary Specialists, Bunstead Barns, Poles Lane, Hursley, Hampshire, UK
| | - Thomas Maddox
- Department of Musculoskeletal and Ageing Sciences, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.,Small Animal Teaching Hospital, Leahurst Campus, School of Veterinary Science, University of Liverpool, Neston, UK
| | - Eithne J Comerford
- Department of Musculoskeletal and Ageing Sciences, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.,Small Animal Teaching Hospital, Leahurst Campus, School of Veterinary Science, University of Liverpool, Neston, UK
| |
Collapse
|
14
|
Satalich JR, Lombardo DJ, Newman S, Golladay GJ, Patel NK. Cementation in total hip arthroplasty: history, principles, and technique. EFORT Open Rev 2022; 7:747-757. [PMID: 36475555 PMCID: PMC9780613 DOI: 10.1530/eor-22-0002] [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] [Indexed: 12/12/2022] Open
Abstract
Total hip arthroplasty (THA) is a remarkably successful operation that has grown rapidly its utilization. Early modern THA constructs as developed by Sir John Charnley featured cemented femoral stems and acetabular components. The technique of cementing components for THA has evolved over time. Modern acetabular preparation requires exposure of the subchondral bone with appropriate cement penetration into the trabecular bone, whereas femoral preparation requires cleaning of the canal, cement restrictor placement, retrograde filling, and pressurization of the cement. When used appropriately, these techniques result in excellent long-term survivorship of implants and are also widely considered to be the ideal method of fixation for hip fractures. The purpose of this article to review the history, properties, techniques, and outcomes of bone cement utilization in THA.
Collapse
Affiliation(s)
- James R Satalich
- VCU Health Department of Orthopaedic Surgery, Richmond, Virginia, USA,Correspondence should be addressed to James R Satalich;
| | - Daniel J Lombardo
- VCU Health Department of Orthopaedic Surgery, Richmond, Virginia, USA
| | - Simon Newman
- Nuffield Orthopaedic Center, University of Oxford, Oxford, UK
| | | | - Nirav K Patel
- VCU Health Department of Orthopaedic Surgery, Richmond, Virginia, USA
| |
Collapse
|
15
|
Solarino G, Bizzoca D, Moretti AM, D’Apolito R, Moretti B, Zagra L. Sex and Gender-Related Differences in the Outcome of Total Hip Arthroplasty: A Current Concepts Review. Medicina (B Aires) 2022; 58:medicina58121702. [PMID: 36556904 PMCID: PMC9788147 DOI: 10.3390/medicina58121702] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 10/31/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022] Open
Abstract
Background and Objectives: Sex and gender-related differences may influence the outcome of patients undergoing total hip arthroplasty (THA). The present paper aims to depict the importance of sex and gender-related issues in the perioperative management of patients undergoing THA to improve clinical outcomes and prevent postoperative complications. Materials and Methods: From January 2002 to August 2022, OVID-MEDLINE, EMBASE, SCOPU S, Web of Science, Google Scholar, and PubMed were searched to identify relevant studies for further analysis. The search strategy included the following terms: (("gender-related differences" [MeSH Terms] OR "sex-related differences" [All Fields]) OR ("gender indicators" [MeSH Terms] OR "sex" [All Fields])) AND ("total hip arthroplasty" [MeSH Terms] OR (total hip replacement [All Fields])). Results: Twenty-eight papers were included in this current concepts review. Sex and gender-related differences were analyzed with regard to the following points: (1) surgical approach, robotic surgery, scar cosmesis, and implant choice; (2) postoperative clinical outcome and complications; (3) sexual activity after THA; and (4) psychological status and daily functional requirements. The data analysis showed that female patients need more specific attention in the preoperative, intraoperative, and postoperative phases to improve clinical and functional outcomes, reduce complications risk, and manage patient satisfaction. Conclusions: THA outcomes may be influenced by sex and gender-related factors which should be carefully assessed and addressed in patients undergoing surgery to improve the postoperative outcomes of patients' satisfaction and reduce postoperative complications that can differ between the two sexes.
Collapse
Affiliation(s)
- Giuseppe Solarino
- Orthopaedics Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, School of Medicine, University of Bari “Aldo Moro”, AOU Consorziale Policlinico, 70124 Bari, Italy
| | - Davide Bizzoca
- Orthopaedics Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, School of Medicine, University of Bari “Aldo Moro”, AOU Consorziale Policlinico, 70124 Bari, Italy
- Ph.D. Course in Public Health, Clinical Medicine and Oncology, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Anna Maria Moretti
- Department of Pneumology, Santa Maria Hospital, Via De Ferrariis 18/D, 70124 Bari, Italy
| | - Rocco D’Apolito
- IRCCS Istituto Ortopedico Galeazzi, Hip Department, 20161 Milan, Italy
| | - Biagio Moretti
- Orthopaedics Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, School of Medicine, University of Bari “Aldo Moro”, AOU Consorziale Policlinico, 70124 Bari, Italy
- Gruppo Italiano Salute e Genere (GISEG), 70126 Bari, Italy
| | - Luigi Zagra
- IRCCS Istituto Ortopedico Galeazzi, Hip Department, 20161 Milan, Italy
- Correspondence:
| |
Collapse
|
16
|
Pomeroy E, McGoldrick NP, Moody PW, Vasarhelyi EM, McCalden RW, Lanting BA. Cement Mantle Quality and Stem Alignment in Cemented Collarless Polished Tapered Stems Implanted via the Direct Anterior and Direct Lateral Approaches: A Single Institution Experience. J Arthroplasty 2022; 37:2208-2213. [PMID: 35580767 DOI: 10.1016/j.arth.2022.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 05/05/2022] [Accepted: 05/10/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The aim of this study was to compare the stem alignment and the quality of cement mantle of collarless polished tapered cemented stems inserted through the direct anterior approach (DAA) and the direct lateral approach (DLA). METHODS A comparative retrospective study of 232 hybrid total hip arthroplasties using a cemented collarless polished tapered stem through either the DAA (n = 147) or DLA (n = 85) was performed. Radiographic evaluation included stem alignment, cement mantle quality, and cement mantle thickness. RESULTS On anteroposterior radiographs, stems implanted through the DLA were more likely to be in neutral alignment, than those implanted through the DAA (83.5%[n = 71] versus 71.4% [n = 105]; P = <.001). No difference between approaches was noted for stem alignment on lateral radiographs or cement mantle quality. Multivariate analysis revealed factors associated with suboptimal cement mantle and included Dorr type B or C femur as well as male gender. A mean cement mantle thickness ≥2mm was achieved in all Gruen zones for both approaches. CONCLUSION In our series, the DAA was associated with a higher incidence of coronal plane stem malalignment compared to the DLA when using cemented tapered polished femoral components for total hip arthroplasty. No difference in lateral stem alignment or cement mantle quality was found.
Collapse
Affiliation(s)
- Eoghan Pomeroy
- London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | | | - Patrick W Moody
- London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | | | - Richard W McCalden
- London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | - Brent A Lanting
- London Health Sciences Centre, University Hospital, London, Ontario, Canada
| |
Collapse
|
17
|
The Effect of Femoral Fixation on Revision and Mortality Following Elective Total Hip Arthroplasty in Patients Over the Age of 65 years. An Analysis of the American Joint Replacement Registry. J Arthroplasty 2022; 37:1105-1110. [PMID: 35131391 DOI: 10.1016/j.arth.2022.01.088] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/22/2022] [Accepted: 01/30/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND With the overwhelming use of cementless femoral fixation for primary total hip arthroplasty in the United States, the associations of stem fixation on the risk of revision and mortality are poorly understood. We evaluated the relationship between femoral fixation and risk of revision and mortality in patients included in the American Joint Replacement Registry. METHODS Elective, primary, unilateral total hip arthroplasties in the American Joint Replacement Registry, in patients over the age of 65 years were considered. In total, 9,612 patients with a cemented stem were exact matched 1:1 with patients who received a cementless stem based on age, gender, and the Charlson Comorbidity Index. Outcomes compared between the groups included need and reason for revision at 90 days and 1 year; in-hospital, 90-day, and 1-year mortality; and mortality after early revision. Covariates were used in linear regression analyses. RESULTS Cemented fixation was associated with a 37% reduction in the risk of 90-day revision, and a reduction in the risk of revision for periprosthetic fracture of 87% at 90 days and 81% at 1 year. Cemented fixation was associated with increased 90-day and 1-year mortality (odds ratio [OR] 3.15, confidence interval [CI] 2.24-4.43 and OR 2.36, CI 1.86-3.01, respectively). Patients who underwent subsequent revision surgery within the first year exhibited the highest mortality risk (OR 3.23, CI 1.05-9.97). CONCLUSION In this representative sample of the United States, 90-day revision for any reason and for periprosthetic fracture was significantly reduced in patients with a cemented stem. This benefit must be weighed against the association with increased mortality and with the high risk of mortality associated with early revision, which was more prevalent with cementless fixation.
Collapse
|
18
|
Khanuja HS, Mekkawy KL, MacMahon A, McDaniel CM, Allen DA, Moskal JT. Revisiting Cemented Femoral Fixation in Hip Arthroplasty. J Bone Joint Surg Am 2022; 104:1024-1033. [PMID: 35298444 PMCID: PMC9969348 DOI: 10.2106/jbjs.21.00853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ The primary means of femoral fixation in North America is cementless, and its use is increasing worldwide, despite registry data and recent studies showing a higher risk of periprosthetic fracture and early revision in elderly patients managed with such fixation than in those who have cemented femoral fixation. ➤ Cemented femoral stems have excellent long-term outcomes and a continued role, particularly in elderly patients. ➤ Contrary to historical concerns, recent studies have not shown an increased risk of death with cemented femoral fixation. ➤ The choice of femoral fixation method should be determined by the patient's age, comorbidities, and bone quality. ➤ We recommend considering cemented femoral fixation in patients who are >70 years old (particularly women), in those with Dorr type-C bone or a history of osteoporosis or fragility fractures, or when intraoperative broach stability cannot be obtained.
Collapse
Affiliation(s)
- Harpal S. Khanuja
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Kevin L. Mekkawy
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Aoife MacMahon
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Claire M. McDaniel
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Donald A. Allen
- Department of Orthopaedic Surgery, Carilion Clinic, Roanoke, Virginia
| | - Joseph T. Moskal
- Department of Orthopaedic Surgery, Carilion Clinic, Roanoke, Virginia
| |
Collapse
|
19
|
BLOEMHEUVEL EM, VAN STEENBERGEN LN, SWIERSTRA BA. Comparable mortality but higher revision rate after uncemented compared with cemented total hip arthroplasties in patients 80 years and older: report of 43,053 cases of the Dutch Arthroplasty Register. Acta Orthop 2022; 93:151-157. [PMID: 34984473 PMCID: PMC8815327 DOI: 10.2340/17453674.2021.886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - Mortality and revision risks are important issues during shared decision-making for total hip arthroplasty (THA) especially in elderly patients. We examined mortality and revision rates as well as associated patient and prosthesis factors in primary THA for osteoarthritis (OA) in patients ≥ 80 years in the Netherlands. Patients and methods - We included all primary THAs for OA in patients ≥ 80 years in the period 2007-2019. Patient mortality and prosthesis revision rates were calculated using Kaplan-Meier survival analyses. Risk factors for patient mortality and prosthesis revision were analyzed using multivariable Cox regression analysis adjusted for age, sex, ASA class, fixation method, head size, and approach. Results - Mortality was 0.2% at 7 days, 0.4% at 30 days, 2.7% at 1 year, and 20% at 5 years. Mortality was higher in males and higher ASA class, but did not differ between fixation methods. The 1-year revision rate was 1.6% (95% CI 1.5-1.7) and 2.6% (CI 2.5-2.7) after 5 years. Multivariable Cox regression analysis showed a higher risk of revision for uncemented (hazard ratio [HR] 1.6; CI 1.4-1.8) and reverse hybrid THAs (HR 2.9; CI 2.1-3.8) compared with cemented THAs. Periprosthetic fracture was the most frequently registered reason for revision in uncemented THAs. Interpretation - Mortality is comparable but revision rate is higher after uncemented compared with cemented THA in patients 80 years and older, indicating that cemented THA might be a safer option in this patient group.
Collapse
Affiliation(s)
| | | | - Bart A SWIERSTRA
- Dutch Arthroplasty Register (LROI), ‘s-Hertogenbosch, the Netherlands
| |
Collapse
|
20
|
Kelly MP, Chan PH, Prentice HA, Paxton EW, Hinman AD, Khatod M. Cause-Specific Stem Revision Risk in Primary Total Hip Arthroplasty Using Cemented vs Cementless Femoral Stem Fixation in a US Cohort. J Arthroplasty 2022; 37:89-96.e1. [PMID: 34619308 DOI: 10.1016/j.arth.2021.09.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/21/2021] [Accepted: 09/27/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND We sought to evaluate the cause-specific revision risk following hybrid (cemented stem mated to a cementless acetabular implant) vs cementless total hip arthroplasty (THA) in a US cohort. METHODS Primary elective THA for osteoarthritis was identified using Kaiser Permanente's Total Joint Replacement Registry (2001-2018). Multivariable Cox regression was used to evaluate cause-specific revision, including aseptic loosening, infection, instability, and periprosthetic fracture (PPF), for hybrid vs cementless THA. Analysis was stratified by age (<65, 65-74, and ≥75 years) and gender. RESULTS The study cohort comprised 88,830 THAs, including 4539 (5.1%) hybrid THAs. In stratified analysis, hybrid THA had a higher revision risk for loosening in females in all 3 age subgroups. A lower risk of revision for PPF was observed following hybrid THA in females aged ≥75 years. For females ≥75 years, cementless THA had an excess PPF risk of 0.9% while hybrid THA had an excess loosening risk of 0.2%, translating to a theoretical prevention of 10 PPF revisions but a price of 3 loosening revisions per 1000 hybrid THAs. No difference in revision risk was observed in males. CONCLUSION We observed differences in cause-specific revision risks by method of stem fixation which depended upon patient age and gender. Although the trend toward all cementless fixation continue, there may be a role for hybrid fixation in females ≥75 years to mitigate risk for revision due to PPF at the potential cost of a slight increase in longer term aseptic loosening. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Matthew P Kelly
- Department of Orthopaedics, Southern California Permanente Medical Group, Harbor City, CA
| | - Priscilla H Chan
- Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, CA
| | | | | | - Adrian D Hinman
- Department of Orthopaedics, The Permanente Medical Group, San Leandro, CA
| | - Monti Khatod
- Department of Orthopaedics, Southern California Permanente Medical Group, West Los Angeles, CA
| |
Collapse
|
21
|
Wagner M, Schönthaler H, Endstrasser F, Dammerer D, Nardelli P, Brunner A. Mid-Term Results After 517 Primary Total Hip Arthroplasties With a Shortened and Shoulderless Double-Taper Press-Fit Stem: High Rates of Aseptic Loosening. J Arthroplasty 2022; 37:97-102. [PMID: 34625308 DOI: 10.1016/j.arth.2021.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Shorter double-taper stems with reduced lateral shoulders facilitate implantation via the muscle-sparing direct anterior approach and are becoming increasingly popular. We observed an unusually high number of cases of aseptic loosening with the use of a modified stem. Therefore, the aim of this prospective single-center study was to assess safety and efficacy of this cementless stem. METHODS A total of 486 consecutive patients receiving 517 primary total hip arthroplasties using the MonoconMIS stem were prospectively followed up for a mean period of 5.29 years (standard deviation [SD], 1.47). Surgical and clinical data, complications, and revision surgeries were analyzed. The Western Ontario and McMaster Universities Arthritis Index (WOMAC) score was recorded before surgery and at one year and five years after surgery. RESULTS The overall 5-year implant survival rate was 95.2%. The individual component survival rates were 96.1% for the stem, 99.4% for the acetabular cup, and 99.0% for the isolated mobile component exchange. The most common reasons for revision were periprosthetic fracture (1.5%), aseptic stem loosening (1.4%), and infection (1.0%). The WOMAC score improved significantly from 49.57 (SD, 21.42) at baseline to 13.33 (SD, 16.47) at one year and 9.84 (SD, 14.45) at five years after surgery. Aseptic stem loosening occurred only in patients with Dorr type A proximal femur morphology. CONCLUSION The evaluated femoral stem is associated with revision rates higher than what has been reported for other implants. The WOMAC scores suggest adequate efficacy. Our data do not support the use of the MonoconMIS for primary total hip arthroplasty in patients with Dorr type A proximal femur morphology.
Collapse
Affiliation(s)
- Moritz Wagner
- Department of Orthopaedics and Traumatology, Bezirkskrankenhaus, St. Johann, Tyrol, Austria
| | - Hannes Schönthaler
- Department of Orthopaedics and Traumatology, Bezirkskrankenhaus, St. Johann, Tyrol, Austria
| | - Franz Endstrasser
- Department of Orthopaedics and Traumatology, Bezirkskrankenhaus, St. Johann, Tyrol, Austria
| | - Dietmar Dammerer
- Department of Orthopaedics and Traumatology, Medical University Innsbruck, Innsbruck, Tyrol, Austria
| | - Paul Nardelli
- Department of Orthopaedics and Traumatology, Medical University Innsbruck, Innsbruck, Tyrol, Austria
| | - Alexander Brunner
- Department of Orthopaedics and Traumatology, Bezirkskrankenhaus, St. Johann, Tyrol, Austria
| |
Collapse
|
22
|
A Comparison of Risks and Benefits Regarding Hip Arthroplasty Fixation. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202111000-00001. [PMID: 34726640 PMCID: PMC8565793 DOI: 10.5435/jaaosglobal-d-21-00014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 10/05/2021] [Indexed: 11/18/2022]
Abstract
Since the field-changing invention of noncemented hip arthroplasty fixation in the 1980s, noncemented fixation has been progressively replacing cemented fixation. However, analyses of fixation frequencies reveal new patterns in cement versus noncemented preferences. Although cementation is again gaining ground in the United States, noncemented models remain the dominant fixation mode, seen in more than 90% of all hip arthroplasties. This stark preference is likely driven by concerns regarding implant durability and patient safety. Although advances in surgical techniques, intensive perioperative care, and improved instrument have evolved in both methods, data from large arthroplasty registries reveal shifting risks in contemporary hip arthroplasty, calling the use of noncemented fixation into question. Varying risk profiles regarding sex, age, or health comorbidities and morphological and functional differences necessitate personalized risk assessments. Furthermore, certain patient populations, based on the literature and data from large registries, have superior outcomes from cemented hip arthroplasty techniques. Therefore, we wanted to critically evaluate the method of arthroplasty fixation in primary hip arthroplasties for unique patient populations.
Collapse
|
23
|
Melbye SM, Haug SCD, Fenstad AM, Furnes O, Gjertsen JE, Hallan G. How Does Implant Survivorship Vary with Different Corail Femoral Stem Variants? Results of 51,212 Cases with Up to 30 Years Of Follow-up from the Norwegian Arthroplasty Register. Clin Orthop Relat Res 2021; 479:2169-2180. [PMID: 34427568 PMCID: PMC8445552 DOI: 10.1097/corr.0000000000001940] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 07/20/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Corail® cementless stem (DePuy Synthes) has been used in Norway since 1987 and is one of the most frequently used stems in THA worldwide. Although the published survival results of the standard Corail stem have been good, little is known about the long-term (more than 20 years) survival of other stem design variants. Further, some changes were made to the extramedullary part of the stem in 2003, and the effect of these changes on survival is unknown. QUESTIONS/PURPOSES (1) What is the survival up to 30 years of the standard collarless Corail femoral stem, and were extramedullary changes (slimmer, polished and rectangular neck, shorter taper) associated with differences in survivorship? (2) How does the 10-year survival and the risk of revision of other Corail stem variants, including the standard collared stem, coxa vara collared stem, and high offset collarless stem, compare with those of the standard collarless stem? (3) Which factors are associated with an increased risk of revision of the Corail stem, and are there any differences in those factors among the four stem variants? METHODS Data for this study were drawn from the Norwegian Arthroplasty Register. Since 1987, THAs have been registered in the Norwegian Arthroplasty Register with completeness of data greater than 97% for primary THAs and 93% for revisions. To study survivorship with up to 30 years of follow-up (1987 to 2018; median 7.7-year follow-up), and to compare the original stem with stems with extramedullary modifications, we included 28,928 standard collarless Corail stems in 24,893 patients (mean age at time of implantation 62 years; 66% [16,525 of 24,893] were women). To compare the newer stem variants with the standard collarless stem (2008 to 2018), we included 20,871 standard collarless, 10,335 standard collared, 6760 coxa vara collared, and 4801 high offset collarless stems. Survival probabilities were estimated using the Kaplan-Meier method with endpoints of stem revision, revision due to aseptic stem loosening, and periprosthetic fracture. The endpoint of all noninfectious causes of THA revision (including cup revision) was additionally analyzed for the long-term comparison. The proportion of patients who died was limited, and there was no difference in death rate between the groups compared. Therefore, we believe that competing events were not likely to influence survivorship estimates to a large degree. To compare different stem variants and evaluate factors that could be associated with the risk of revision, we calculated hazard ratios using Cox regression analyses with adjustments for gender, age group, surgical approach, diagnosis, and stem size. RESULTS The 30-year Kaplan-Meier survival of the standard collarless stem was 88.4% (95% confidence interval 85.4% to 91.4%), 93.3% (95% CI 91.1% to 95.5%), and 94.4% (95% CI 92.0% to 96.8%) using stem revision for any noninfectious cause, aseptic loosening, and periprosthetic fracture of the femur as endpoints, respectively. There was no difference in survival between the original stem and the modified stem. The 10-year Kaplan-Meier survivorship free of stem revision (all causes including infection) was 97.6% (95% CI 97.2% to 98.0%) for the standard collarless stem, 99.0% (95% CI 98.8% to 99.2%) for the standard collared stem, 97.3% (95% CI 96.3% to 98.3%) for the coxa vara collared stem, and 95.0% (95% CI 93.6% to 96.4%) for the high offset collarless stem. Compared with the standard collarless stem, the standard collared stem performed better (HR 0.4 [95% CI 0.3 to 0.6]; p < 0.001) and the high offset collarless stem performed more poorly (HR 1.4 [95% CI 1.1 to 1.7]; p = 0.006) with any stem revision as the endpoint, and similar results were found with revision for aseptic stem loosening and periprosthetic fracture as endpoints. Controlling for the noted confounders, the standard collared stem had a lower revision risk. The high offset collarless stem had an increased stem revision risk for any reason (HR 1.4 [95% CI 1.1 to 1.7]; p = 0.006) and aseptic loosening (HR 1.6 [95% CI 1.1 to 2.3]; p = 0.022). Other factors associated with an increased risk of stem revision for all stem variants were being a man (HR 1.7 [95% CI 1.4 to 2.0]; p < 0.001), age 70 to 79 years and 80 years and older compared with the age group of 50 to 59 years (HR 1.6 [95% CI 1.2 to 2.0]; p < 0.001 and HR 1.9 [95% CI 1.4 to 2.6]; p < 0.001, respectively), the anterior approaches (direct anterior Smith-Petersen and anterolateral Watson-Jones combined) compared with the posterior approach (HR 1.4 [95% CI 1.1 to 1.7]; p = 0.005), as well as a preoperative nonosteoarthritis diagnosis (HR 1.3 [95% CI 1.0 to 1.6]; p = 0.02) and small stem sizes (sizes 8-11) compared with the medium sizes (sizes 12-15) (HR 1.4 [95% CI 1.1 to 1.6]; p = 0.001). The very small sizes (8 and 9) were associated with a 2.0 times higher risk of revision (95%. CI 1.4 to 2.6; p < 0.01) compared with all other sizes combined. CONCLUSION When using the uncemented Corail stem, surgeons can expect good results with up to 30 years of follow-up. Our results should be generalizable to the typical surgeon at the average hospital in a comparable setting. From our results, using a collared variant would be preferable to a collarless one. Due to an increased risk of periprosthetic fracture, caution with the use of the uncemented Corail stem in patients older than 70 years, especially in women, is warranted. Poorer stem survival should also be expected with the use of small stem sizes. The risk of periprosthetic fractures for the Corail uncemented stem versus cemented stems in different age categories has not been extensively examined, nor has the use of a collar for different age groups and genders, and both should be subjects for further investigation. LEVEL OF EVIDENCE Level III, therapeutic study.
Collapse
Affiliation(s)
| | | | - Anne Marie Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Ove Furnes
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jan-Erik Gjertsen
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Geir Hallan
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| |
Collapse
|
24
|
Affiliation(s)
- Patrick Morgan
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
| |
Collapse
|
25
|
Lee SW, Kim WY, Song JH, Kim JH, Lee HH. Factors Affecting Periprosthetic Bone Loss after Hip Arthroplasty. Hip Pelvis 2021; 33:53-61. [PMID: 34141691 PMCID: PMC8190495 DOI: 10.5371/hp.2021.33.2.53] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/16/2021] [Accepted: 03/29/2021] [Indexed: 12/22/2022] Open
Abstract
Periprosthetic bone loss may lead to major complications in hip arthroplasty, including aseptic loosening, implant migration, and even periprosthetic fracture. Such a complication leads to revision surgeries, which are expensive, technically demanding, and result in a low satisfaction rate. Therefore, a study was conducted of the factors affecting the periprosthetic bone loss around the stem that caused these complications. Factors influencing periprosthetic bone loss include demographic factors such as age, sex, obesity, smoking, and comorbidity including diabetes and osteoporosis. The implant design and fixation method are also factors that are determined before surgery. In addition, there are surgical factors, such as surgical approach and surgical technique, and we wish to investigate the factors affecting periprosthetic bone loss around the stem by comparing the effects of postoperative rehabilitation protocols and osteoporosis drugs.
Collapse
Affiliation(s)
- Se-Won Lee
- Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Weon-Yoo Kim
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Joo-Hyoun Song
- Department of Orthopedic Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Jae-Hoon Kim
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Hwan-Hee Lee
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| |
Collapse
|
26
|
Chen A, Paxton L, Zheng X, Peat R, Mao J, Liebeskind A, Gressler LE, Marinac-Dabic D, Devlin V, Cornelison T, Sedrakyan A. Association of Sex With Risk of 2-Year Revision Among Patients Undergoing Total Hip Arthroplasty. JAMA Netw Open 2021; 4:e2110687. [PMID: 34076699 PMCID: PMC8173374 DOI: 10.1001/jamanetworkopen.2021.10687] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
IMPORTANCE The worldwide population is aging and includes more female individuals than male individuals, with higher rates of total hip arthroplasty (THA) among female individuals. Although research on this topic has been limited to date, several studies are currently under way. OBJECTIVES To evaluate the association between sex and 2-year revision after THA. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from statewide databases in New York and California between October 1, 2015, and December 31, 2018. Patients 18 years or older with osteoarthritis who underwent THA and had sex recorded in the database were included in the analysis. EXPOSURE Total hip arthroplasty. MAIN OUTCOMES AND MEASURES The outcome of interest was the difference in early, all-cause revision surgery rates after primary THA between women and men. The association of sex with the revision rate was examined using Cox proportional hazards regression analysis. RESULTS Of 132 826 patients included in the study, 74 002 (55.7%) were women; the mean (SD) age was 65.9 (11.0) years, and the median follow-up time was 1.3 years (range, 0.0-3.0 years). The 2-year revision rate was 2.5% (95% CI, 2.4%-2.6%) among women and 2.1% (95% CI, 2.0%-2.2%) among men. After adjusting for demographic characteristics, comorbidities, and facility volume, a minimal clinically meaningful difference was observed in revision rates despite women having a higher risk of all-cause revision compared with men (hazard ratio, 1.16; 95% CI, 1.07-1.26; P < .001). The risk of revision was increased among women compared with men in the subgroup of patients who were younger than 55 years (hazard ratio, 1.47; 95% CI, 1.20-1.81; P < .001). CONCLUSIONS AND RELEVANCE In this cohort study, no clinically meaningful difference in all-cause revision rates after primary THA was found between men and women at 2-year follow-up. The modest difference in the risk of revision between men and women in a small subgroup of patients younger than 55 years suggests that the risk of revision in this population should be studied further.
Collapse
Affiliation(s)
- Amanda Chen
- Department of Population Health Sciences, Weill Cornell College of Medicine, New York, New York
| | - Liz Paxton
- Kaiser Permanente, San Diego, California
| | - Xinyan Zheng
- Department of Population Health Sciences, Weill Cornell College of Medicine, New York, New York
| | - Raquel Peat
- Office of Orthopedic Devices, Office of Product Evaluation and Quality, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | - Jialin Mao
- Department of Population Health Sciences, Weill Cornell College of Medicine, New York, New York
| | - Alexander Liebeskind
- Department of Population Health Sciences, Weill Cornell College of Medicine, New York, New York
| | - Laura E. Gressler
- Office of Clinical Evidence and Analysis, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | - Danica Marinac-Dabic
- Office of Clinical Evidence and Analysis, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | - Vincent Devlin
- Office of Orthopedic Devices, Office of Product Evaluation and Quality, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | - Terri Cornelison
- Health of Women Program, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | - Art Sedrakyan
- Department of Population Health Sciences, Weill Cornell College of Medicine, New York, New York
| |
Collapse
|
27
|
Liu Z, Liu B, Zhang B, Ma W, Wu T, Huo J, Liu S, Han Y. Short uncemented femoral component for hip revision: prognosis and risk factors associated with failure. BMC Surg 2021; 21:192. [PMID: 33849491 PMCID: PMC8045178 DOI: 10.1186/s12893-021-01196-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 04/08/2021] [Indexed: 11/30/2022] Open
Abstract
Background The application of short femoral stems is partially restricted in revision surgery. This study will demonstrate the therapeutic effect and unsuitable situation for short stem revision. Methods Demographic characteristics of all patients were recorded in detail (Table 1). Anteroposterior view radiographic examinations of proximal femur are necessary before and after the operation for patients. The primary outcome of interest was the survival rate of the femoral stem at the final follow-up. Risk factors for failure were also investigated. The secondary outcomes of interest included the Harris hip score, excellent to good rate and incidence of complications. The Mann–Whitney U test was performed for comparisons between continuous variables. The chi-square test was performed for comparisons between categorical variables. Cox regression analysis was used to assess the association between potential risk factors and the failure of revision surgery.
Results A total of 381 patients with short stems were retrospectively reviewed. There were 188 males and 193 females. The average age and body mass index before revision surgery were 58.85 ± 13.46 years and 23.72 ± 3.40 kg/m2, respectively. The mid-term survival rate of the short femoral component was 94.23%. The prognosis and complications of patients between the two groups were compared. There was no significant difference between the two groups in the Harris score, complication incidence or survival rate of the femoral component. The strongest risk factor in this study was intraoperative periprosthetic femoral fracture during revision surgery (HR = 5.477, 95% CI = 2.156–13.913). Conclusion Three risk factors for failure were identified: ageing, osteoporosis and intraoperative periprosthetic femoral fracture during revision surgery. Therefore, a short femoral stem should be implanted in patients with these risk factors with additional caution.
Collapse
Affiliation(s)
- Zeming Liu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, Hebei, People's Republic of China
| | - Bo Liu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, Hebei, People's Republic of China
| | - Bingshi Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, Hebei, People's Republic of China
| | - Wenhui Ma
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, Hebei, People's Republic of China
| | - Tao Wu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, Hebei, People's Republic of China
| | - Jia Huo
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, Hebei, People's Republic of China
| | - Sikai Liu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, Hebei, People's Republic of China
| | - Yongtai Han
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, Hebei, People's Republic of China.
| |
Collapse
|
28
|
Hopman SR, de Windt TS, van Erp JHJ, Bekkers JEJ, de Gast A. Uncemented total hip arthroplasty; increased risk of early periprosthetic fracture requiring revision surgery in elderly females. J Orthop 2021; 25:40-44. [PMID: 33867753 DOI: 10.1016/j.jor.2021.03.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/12/2021] [Accepted: 03/28/2021] [Indexed: 10/21/2022] Open
Abstract
Purpose The preferred method of stem fixation in total hip arthroplasty (THA) remains debatable. Uncemented THA favors a lower rate of aseptic loosening but has an increased risk of early periprosthetic fractures (EPF). We hypothesize that routine placement of uncemented THA by experienced surgeons diminishes this EPF-risk. The purpose of this study is to investigate the effect of age, gender, ASA classification and BMI of THA performed by experienced surgeons on the risk of EPF. Methods A retrospective cohort study including all primary THAs and revision surgeries performed between 2012 and 2018. Possible predictive factors included are age, gender, BMI, ASA classification, presence of osteoporosis, Dorr classification, revision surgery type and clinical outcome. A number needed to treat (NNT) analysis was conducted assuming that cementing THA prevents EPF. Results 2635 primary THAs were performed. Indications for 70 revisions included 18 EPF in uncemented THA female patients. Periprosthetic fractures without a relevant trauma occurred within six weeks in 16 patients. There was a statistically significant correlation between EPF-risk and age (P = 0.032), female gender (P = 0.001) and ASA classification (P = 0.015). For age ≥75, there was an increase in EPF (P = 0.047). With the assumption that cementing would prevent EPF, the NNT is 48. No statistically significant correlation was found between EPF and BMI, osteoporosis or Dorr classification. Conclusion Female patients aged ≥75 have an increased EPF-risk after uncemented THA and would therefore benefit from treatment with a cemented stem. An ASA score of III-IV is an independent risk factor for EPF after uncemented THA.
Collapse
Affiliation(s)
- S R Hopman
- Department of Orthopedic Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - T S de Windt
- Department of Orthopedic Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - J H J van Erp
- Clinical Orthopedic Research Center - mN, Zeist, Jagersingel 1, 3707, HL, Zeist, the Netherlands.,Department of Orthopedic Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - J E J Bekkers
- Clinical Orthopedic Research Center - mN, Zeist, Jagersingel 1, 3707, HL, Zeist, the Netherlands.,Department of Orthopedic Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - A de Gast
- Clinical Orthopedic Research Center - mN, Zeist, Jagersingel 1, 3707, HL, Zeist, the Netherlands.,Department of Orthopedic Surgery, Diakonessenhuis, Utrecht, the Netherlands
| |
Collapse
|
29
|
Ukaj S, Veslko M, Krasniqi S, Podvorica V, Ukaj F, Ahmeti A, Hernigou P, Cimerman M. Cemented stems in healthy elderly patients result in higher hypoxia despite a paradoxical lower femoral increase of intramedullary pressure. INTERNATIONAL ORTHOPAEDICS 2021; 45:915-922. [PMID: 33528632 DOI: 10.1007/s00264-021-04955-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/22/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Hypoxia is a well-known complication in cemented arthroplasty; however, it is not known whether the level of hypoxia is related to the intramedullary pressure or to the age of the patient; therefore, we studied the intramedullary pressure and level of hypoxia in patients undergoing cemented arthroplasty. METHODS A prospective study was performed during cemented arthroplasties in 25 patients with an average age of 66.2 ± 12.1 years old. The intramedullary pressure (IMP) was measured by placing a pressure transducer within the bone while simultaneously measuring the pulse oximetry arterial oxygen saturation (SpO2), pulse, and blood pressure. These variables were obtained immediately after spinal anaesthesia, five minutes after cementation, and 15 minutes after prosthesis insertion. RESULTS One hundred percent of patients had hypoxia at some level, but 83% of elderly patients (older than 66.5 years) had hypoxia (SpO2 <94%) as compared to only 23% of younger patients (p = 0.006). In the group of young patients, IMP was roughly increased 32 times as compared with baseline level, with as consequences a decrease of 4% of SpO2 (from 98.3 to 94.15%); in the elderly group, the IMP was only increased 20 times, but a decrease of 6% of SpO2 (from 97.25 to 91%) was observed. CONCLUSIONS This series demonstrated higher hypoxia in elderly healthy patients despite a paradoxical lower femoral increase of intramedullary pressure as compared with younger patients. This hypoxia is probably not only related to the cement but also to the patient's age with decline of maximum oxygen uptake capacity and increase bone porosity. CLINICAL TRIALS ClinicalTrials.gov Identifier: NCT03930537 https://clinicaltrials.gov/ct2/show/NCT03930537.
Collapse
Affiliation(s)
- Skender Ukaj
- University of Ljubljana, Ljubljana, Slovenia.,Orthopaedic and Traumatology Department, University Clinical Center of Prishtina, Prishtina, Kosovo.,Faculty of Medicine "Fehmi Agani", University of Gjakova, Gjakova, Kosovo
| | | | - Shaip Krasniqi
- Faculty of Medicine, University of Prishtina, Prishtina, Kosovo
| | - Vlora Podvorica
- Orthopaedic and Traumatology Department, University Clinical Center of Prishtina, Prishtina, Kosovo
| | - Fatime Ukaj
- National Institute of Public Health, Prishtina, Kosovo
| | - Arben Ahmeti
- Orthopaedic and Traumatology Department, University Clinical Center of Prishtina, Prishtina, Kosovo
| | | | | |
Collapse
|
30
|
Yu W, Han X, Chen W, Mao S, Zhao M, Zhang X, Han G, Ye J, Chen M, Zhuang J. Conversion from a failed proximal femoral nail anti-rotation to a cemented or uncemented total hip arthroplasty device: a retrospective review of 198 hips with previous intertrochanteric femur fractures. BMC Musculoskelet Disord 2020; 21:791. [PMID: 33256693 PMCID: PMC7702693 DOI: 10.1186/s12891-020-03806-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 11/19/2020] [Indexed: 11/12/2022] Open
Abstract
Background At present, it is unclear which device (uncemented or cemented total hip arthroplasty [UTA or CTA, respectively]) is more suitable for the conversion of a failed proximal femoral nail anti-rotation (PFNA). The aim of this review was to assess the outcomes of failed PFNAs converted to a UTA or CTA device in elderly individuals with intertrochanteric femoral fractures (IFFs). Methods Two hundred fifty-eight elderly individuals (258 hips) with IFFs who underwent a conversion to a UTA or CTA device following failed PFNAs during 2007–2017 were retrospectively identified from the China Southern Medical Centre (CSMC) database. The primary endpoint was the Harris Hip Score (HHS); secondary endpoint was the key orthopaedic complication rate. Results The median follow-up was 65 months (60–69 months). Significant distinctions were observed (87.26 ± 16.62 for UTA vs. 89.32 ± 16.08 for CTA, p = 0.021; 86.61 ± 12.24 for symptomatic UTA vs. 88.68 ± 13.30 for symptomatic CTA, p = 0.026). A significant difference in the overall key orthopaedic complication rate was detected (40.8% [40/98] vs. 19.0% [19/100], p = 0.001). Apparent distinctions were detected in terms of the rate of revision, loosening, and periprosthetic fracture (11.2% for UTA vs 3.0% for CTA, p = 0.025; 13.2% for UTA vs 5.0% for CTA, p = 0.043; 10.2% for UTA vs 3.0% for CTA, p = 0.041, respectively). Conclusion For elderly individuals with IFFs who suffered a failed PFNA, CTA devices may have a noteworthy advantage in regard to the revision rate and the rate of key orthopaedic complications compared with UTA devices, and CTA revision should be performed as soon as possible, regardless of whether these individuals have symptoms.
Collapse
Affiliation(s)
- Weiguang Yu
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Xiulan Han
- Department of Rehabilitation, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Wenli Chen
- Department of Neurosurgery, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Shuai Mao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Mingdong Zhao
- Department of Orthopaedics, Jinshan Hospital, Fudan University, Longhang Road No. 1508, Jinshan District, Shanghai, 201508, China
| | - Xinchao Zhang
- Department of Orthopaedics, Jinshan Hospital, Fudan University, Longhang Road No. 1508, Jinshan District, Shanghai, 201508, China.
| | - Guowei Han
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Junxing Ye
- Department of Orthopaedics, The Affiliated Hospital of Jiangnan University, No. 1000, Hefeng Road, Wuxi, 214000, Jiangsu, China.
| | - Meiji Chen
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China.
| | - Jintao Zhuang
- Department of Urology, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China.
| |
Collapse
|
31
|
Affiliation(s)
- Mengnai Li
- The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | |
Collapse
|
32
|
Lübbeke A. Uncemented science at its best! Acta Orthop 2020; 91:228-229. [PMID: 32406288 PMCID: PMC8023948 DOI: 10.1080/17453674.2020.1763566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Anne Lübbeke
- Division of Orthopaedic Surgery and Traumatology, Geneva University Hospitals, Switzerland; ,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK,E-mail:
| |
Collapse
|
33
|
Duijnisveld BJ, van den Hout JAAM, Wagenmakers R, Koenraadt KLM, Bolder SBT. No Learning Curve of the Direct Superior Approach in Total Hip Arthroplasty. Orthop Surg 2020; 12:852-860. [PMID: 32424969 PMCID: PMC7307249 DOI: 10.1111/os.12689] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/11/2020] [Accepted: 03/27/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To assess the learning curve of the direct superior approach (DSA) for total hip arthroplasty (THA) and to compare surgical, clinical, and radiological results with a matched control group using the mini posterior approach (MPA). METHODS A prospective cohort study was performed from October 2016 to May 2017 including our first 52 patients undergoing THA using the DSA. Patients with primary osteoarthritis or osteonecrosis and a body mass index (BMI) < 35 who were eligible for surgery were included. As a control group, 52 patients who underwent the MPA were included, matched based on age, BMI, and ASA classification. In the DSA group, damage to the iliotibial tract and the distal external rotators, including the external obturator and quadriceps femoris muscles, was avoided. Outcome measures were collected, including surgical time, blood loss, postoperative pain, length of stay, implant position, use of walking aids, patient reported outcome measures (PROM), and complications. Unpaired t-tests were used to analyze differences between the DSA and the MPA group in surgical time, blood loss, length of stay, and acetabular and femoral component position. χ2 -tests were used to analyze mobility and the number of complications. Two-way repeated measures ANOVA was used to analyze pain scores and PROM between the DSA and the MPA groups. RESULTS The mean surgical time of 61 min (SD 8) in the DSA group was longer (P < 0.001) compared to that in the MPA group, 46 min (SD 12). No differences were found in blood loss, postoperative pain, or mean length of stay in the hospital. After 6 weeks, 94% of the patients in the DSA group were able to walk inside their home without walking aids compared to 90% in the MPA group. The mobility scores were not different after follow up of 6 weeks and 1 year (P = 0.12 and P = 0.36 respectively). All PROM improved postoperatively in both the DSA and the MPA group (P < 0.01). Acetabular cup and femoral stem position were not compromised by the DSA. Complications included two Vancouver B2 periprosthetic fractures in the DSA group, of which there was one surgical-related fracture and one fracture after a traffic accident. Complications in the MPA group included one periprosthetic fracture, two hip dislocations, and one ischial neuropathy. No infections or thromboembolic events were observed. The 1-year complication rate was not different between the MPA and DSA groups (P = 0.40). CONCLUSION The DSA can be safely introduced as no learning curve in the prosthesis position or the complication rate was found.
Collapse
Affiliation(s)
- Bouke J Duijnisveld
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | | | - Robert Wagenmakers
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Koen L M Koenraadt
- Foundation for Orthopaedic Research, Care and Education, Amphia Hospital, Breda, The Netherlands
| | - Stefan B T Bolder
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands
| |
Collapse
|
34
|
Dale H, Børsheim S, Kristensen TB, Fenstad AM, Gjertsen JE, Hallan G, Lie SA, Furnes O. Perioperative, short-, and long-term mortality related to fixation in primary total hip arthroplasty: a study on 79,557 patients in the -Norwegian Arthroplasty Register. Acta Orthop 2019; 91:152-158. [PMID: 31833434 PMCID: PMC7155214 DOI: 10.1080/17453674.2019.1701312] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - There are reports on perioperative deaths in cemented total hip arthroplasty (THA), and THA revisions are associated with increased mortality. We compared perioperative (intraoperatively or within 3 days of surgery), short-term and long-term mortality after all-cemented, all-uncemented, reverse hybrid (cemented cup and uncemented stem), and hybrid (uncemented cup and cemented stem) THAs.Patients and methods - We studied THA patients in the Norwegian Arthroplasty Register from 2005 to 2018, and performed Kaplan-Meier and Cox survival analyses with time of death as end-point. Mortality was calculated for all patients, and in 3 defined risk groups: high-risk patients (age ≥ 75 years and ASA > 2), intermediate-risk patients (age ≥ 75 years or ASA > 2), low-risk patients (age < 75 years and ASA ≤ 2). We also calculated mortality in patients with THA due to a hip fracture, and in patients with commonly used, contemporary, well-documented THAs. Adjustement was made for age, sex, ASA class, indication, and year of surgery.Results - Among the 79,557 included primary THA patients, 11,693 (15%) died after 5.8 (0-14) years' follow-up. Perioperative deaths were rare (30/105) and found in all fixation groups. Perioperative mortality after THA was 4/105 in low-risk patients, 34/105 in intermediate-risk patients, and 190/105 in high-risk patients. High-risk patients had 9 (CI 1.3-58) times adjusted risk of perioperative death compared with low-risk patients. All 4 modes of fixation had similar adjusted 3-day, 30-day, 90-day, 3-30 day, 30-90 day, 90-day-10-year, and 10-year mortality risk.Interpretation - Perioperative, short-term, and long-term mortality after primary THA were similar, regardless of fixation type. Perioperative deaths were rare and associated with age and comorbidity, and not type of fixation.
Collapse
Affiliation(s)
- Håvard Dale
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; ,Department Clinical Medicine, University of Bergen, Bergen; ,Correspondence:
| | | | - Torbjørn Berge Kristensen
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen;
| | - Anne Marie Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen;
| | - Jan-Erik Gjertsen
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; ,Department Clinical Medicine, University of Bergen, Bergen;
| | - Geir Hallan
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; ,Department Clinical Medicine, University of Bergen, Bergen;
| | - Stein Atle Lie
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; ,Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Ove Furnes
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; ,Department Clinical Medicine, University of Bergen, Bergen;
| |
Collapse
|