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Carender CN, Bothun CE, Sierra RJ, Trousdale RT, Abdel MP, Bedard NA. Contemporary Aseptic Revision Total Hip Arthroplasty in Patients ≤50 Years of Age: Results of >500 Cases. J Bone Joint Surg Am 2024; 106:1108-1116. [PMID: 38687829 DOI: 10.2106/jbjs.23.01467] [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] [Indexed: 05/02/2024]
Abstract
BACKGROUND There has been a paucity of long-term outcomes data on aseptic revision total hip arthroplasties (THAs) in the young adult population. The purpose of this study was to evaluate implant survivorship, complications, and clinical outcomes in a large cohort of contemporary aseptic revision THAs in patients ≤50 years of age at the time of the surgical procedure. METHODS We identified 545 aseptic revision THAs performed at a single academic institution from 2000 to 2020 in patients who were 18 to 50 years of age. Patients who underwent conversion THAs and patients with a history of any ipsilateral hip infection were excluded. The mean age was 43 years, the mean body mass index (BMI) was 29 kg/m 2 , and 63% were female. The index indication for revision THA was aseptic loosening in 46% of cases, polyethylene wear or osteolysis in 28% of cases (all revisions of conventional polyethylene), and dislocation in 11% of cases. There were 126 hips (23%) that had undergone at least 1 previous revision (median, 1 revision [range, 1 to 5 revisions]). The mean follow-up was 10 years. RESULTS In the entire cohort, the 20-year survivorship free of any re-revision was 76% (95% confidence interval [95% CI], 69% to 82%). There were 87 re-revisions, with 31 dislocations, 18 cases of aseptic loosening of the femoral component, and 16 periprosthetic joint infections (PJIs) being the most common reasons for re-revision. Dislocation as the indication for the index revision was associated with an increased risk of re-revision (hazard ratio, 2.9; p < 0.001). The 20-year survivorship free of any reoperation was 73% (95% CI, 66% to 78%). There were 75 nonoperative complications (14%), including 32 dislocations. The mean Harris hip score significantly improved (p < 0.001) from 65 preoperatively to 81 at 10 years postoperatively. CONCLUSIONS Contemporary aseptic revision THAs in patients ≤50 years of age demonstrated a re-revision risk of approximately 1 in 4 at 20 years. Dislocation, aseptic loosening of the femoral component, and PJI were the most common reasons for re-revision. Index revision THAs for dislocation had a 3 times higher risk of re-revision. LEVEL OF EVIDENCE Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Szapary HJ, Desai V, Farid A, Franco H, Chen AF, Lange JK, Ready JE. Predictors of Reoperation and Survival Experience (Minimum 1 Year) for Primary Versus Conversion Total Hip Arthroplasty in Young Patients. J Arthroplasty 2024:S0883-5403(24)00529-1. [PMID: 38797454 DOI: 10.1016/j.arth.2024.05.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 05/17/2024] [Accepted: 05/19/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Total hip arthroplasty (THA), including primary and conversion procedures, is commonly used for many types of joint disease in patients aged below 65 years, though few studies have evaluated THA outcomes in young patients (≤ 40 years old). This study examined a large cohort of patients who underwent THA at a young (≤ 40 years old) age to identify predictors of reoperation and compare survivorship between primary and conversion THAs. METHODS A retrospective study was conducted on 497 patients who underwent 612 primary and conversion THAs at 40 years old or younger between 1990 and 2020. Medical records were reviewed to collect patient/surgical data. A multivariable logistic regression model identified independent predictors of reoperation, and Kaplan-Meier analysis with log-rank tests was used to compare survival curves by THA type. RESULTS The median age at surgery (interquartile range) was 31 years (25 to 36). The median follow-up time was 6.6 years (range, 3.8 to 10.5). Conversion THAs had an increased rate of both revisions (12.3 versus 5.6%, P = 0.02) and nonrevision reoperations (8.9 versus 3.2%, P = 0.03) compared to primary THAs. A ceramic-on-ceramic articulation (odds ratio: 5.17; P = 0.03) and a higher estimated blood loss (odds ratio: 1.0007; P = 0.03) were independent predictors of reoperation for primary and conversion THA, respectively. Conversion THAs had a lower 15-year survival (77.8 versus 90.8%, P = 0.009) compared to primary THAs. CONCLUSIONS Patients ≤ 40 years old who underwent primary and conversion THAs demonstrated an impressive 15-year survival comparable to that of older populations (74 to 93%), while conversion procedures had a higher reoperation rate. Although primary THA may be more ideal, there are promising outcomes for patients who need THA at a younger age than typically implemented, especially for those who are very young (≤ 30 years old).
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Affiliation(s)
- Hannah J Szapary
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Vineet Desai
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Alexander Farid
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Helena Franco
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey K Lange
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - John E Ready
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Oosterhoff JHF, de Hond AAH, Peters RM, van Steenbergen LN, Sorel JC, Zijlstra WP, Poolman RW, Ring D, Jutte PC, Kerkhoffs GMMJ, Putter H, Steyerberg EW, Doornberg JN. Machine Learning Did Not Outperform Conventional Competing Risk Modeling to Predict Revision Arthroplasty. Clin Orthop Relat Res 2024:00003086-990000000-01528. [PMID: 38470976 DOI: 10.1097/corr.0000000000003018] [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] [Received: 07/11/2023] [Accepted: 02/01/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Estimating the risk of revision after arthroplasty could inform patient and surgeon decision-making. However, there is a lack of well-performing prediction models assisting in this task, which may be due to current conventional modeling approaches such as traditional survivorship estimators (such as Kaplan-Meier) or competing risk estimators. Recent advances in machine learning survival analysis might improve decision support tools in this setting. Therefore, this study aimed to assess the performance of machine learning compared with that of conventional modeling to predict revision after arthroplasty. QUESTION/PURPOSE Does machine learning perform better than traditional regression models for estimating the risk of revision for patients undergoing hip or knee arthroplasty? METHODS Eleven datasets from published studies from the Dutch Arthroplasty Register reporting on factors associated with revision or survival after partial or total knee and hip arthroplasty between 2018 and 2022 were included in our study. The 11 datasets were observational registry studies, with a sample size ranging from 3038 to 218,214 procedures. We developed a set of time-to-event models for each dataset, leading to 11 comparisons. A set of predictors (factors associated with revision surgery) was identified based on the variables that were selected in the included studies. We assessed the predictive performance of two state-of-the-art statistical time-to-event models for 1-, 2-, and 3-year follow-up: a Fine and Gray model (which models the cumulative incidence of revision) and a cause-specific Cox model (which models the hazard of revision). These were compared with a machine-learning approach (a random survival forest model, which is a decision tree-based machine-learning algorithm for time-to-event analysis). Performance was assessed according to discriminative ability (time-dependent area under the receiver operating curve), calibration (slope and intercept), and overall prediction error (scaled Brier score). Discrimination, known as the area under the receiver operating characteristic curve, measures the model's ability to distinguish patients who achieved the outcomes from those who did not and ranges from 0.5 to 1.0, with 1.0 indicating the highest discrimination score and 0.50 the lowest. Calibration plots the predicted versus the observed probabilities; a perfect plot has an intercept of 0 and a slope of 1. The Brier score calculates a composite of discrimination and calibration, with 0 indicating perfect prediction and 1 the poorest. A scaled version of the Brier score, 1 - (model Brier score/null model Brier score), can be interpreted as the amount of overall prediction error. RESULTS Using machine learning survivorship analysis, we found no differences between the competing risks estimator and traditional regression models for patients undergoing arthroplasty in terms of discriminative ability (patients who received a revision compared with those who did not). We found no consistent differences between the validated performance (time-dependent area under the receiver operating characteristic curve) of different modeling approaches because these values ranged between -0.04 and 0.03 across the 11 datasets (the time-dependent area under the receiver operating characteristic curve of the models across 11 datasets ranged between 0.52 to 0.68). In addition, the calibration metrics and scaled Brier scores produced comparable estimates, showing no advantage of machine learning over traditional regression models. CONCLUSION Machine learning did not outperform traditional regression models. CLINICAL RELEVANCE Neither machine learning modeling nor traditional regression methods were sufficiently accurate in order to offer prognostic information when predicting revision arthroplasty. The benefit of these modeling approaches may be limited in this context.
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Affiliation(s)
- Jacobien H F Oosterhoff
- Amsterdam UMC, University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam, the Netherlands
- Department of Engineering Systems and Services, Faculty of Technology Policy and Management, Delft University of Technology, Delft, the Netherlands
| | - Anne A H de Hond
- Clinical AI Implementation and Research Lab, Leiden University Medical Center, Leiden, the Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Rinne M Peters
- Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | | | - Juliette C Sorel
- Department of Orthopaedic Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Wierd P Zijlstra
- Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Rudolf W Poolman
- Department of Orthopaedic Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas, Austin, TX, USA
| | - Paul C Jutte
- Department of Orthopaedic and Trauma Surgery, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Gino M M J Kerkhoffs
- Amsterdam UMC, University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam, the Netherlands
| | - Hein Putter
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Ewout W Steyerberg
- Clinical AI Implementation and Research Lab, Leiden University Medical Center, Leiden, the Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Job N Doornberg
- Department of Orthopaedic and Trauma Surgery, University Medical Center Groningen, University of Groningen, the Netherlands
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van Steenbergen LN, de Reus IM, Hannink G, Vehmeijer SB, Schreurs BW, Zijlstra WP. Femoral head size and surgical approach affect dislocation and overall revision rates in total hip arthroplasty: up to 9-year follow-up data of 269,280 procedures in the Dutch Arthroplasty Register (LROI). Hip Int 2023; 33:1056-1062. [PMID: 36935558 DOI: 10.1177/11207000231160223] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
BACKGROUND Femoral head size and surgical approach might affect the revision rate for dislocation and for any other reason after total hip arthroplasty (THA). We penetrated this question based on registry data with up to 9-year follow-up. METHODS 269,280 primary THAs documented in the Dutch Arthroplasty Registry (LROI) between 2007 and 2019 were included. Revision rates were calculated by competing risk analyses. Multivariable Cox proportional hazard regression ratios (HR) were used for comparison. RESULTS Revisions for dislocation were rare. They were more frequent after posterolateral (1.4% [95% CI, 1.3-1.5]), compared to straight lateral (0.6% [95% CI, 0.5-0.7]), anterolateral (0.6% [95% CI, 0.5-0.7]) and anterior (0.4% [95% CI, 0.3-0.5]) approach. Larger femoral head size decreased the dislocation revision risk: 1.4% [95% CI, 1.3-1.5) for 22-28-mm heads; 0.9% (95% CI, 0.8-1.0) for 32-mm heads; 0.6% (95% CI, 0.6-0.7) for 36-mm heads. For the anterior approach, the HR for both revision for dislocation (0.3, 95% CI, 0.3-0.4) and any other reason (0.8, 95% CI, 0.8-0.9) were lowest compared to other approaches including posterolateral (HR 1). Revision risk for any other reason was highest with anterolateral (HR 1.3 (95% CI, 1.2-1.4)) and straight lateral approach (1.1 [95% CI, 1.0-1.2]). CONCLUSIONS The anterior approach might reduce revision rates for both dislocation and all cause revision. Posterolateral approach is associated with a higher risk of dislocation revision but has a lower risk of any other revision. Increasing femoral head size up to 36 mm reduces revision for dislocation and improves overall revision rates for all approaches.
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Affiliation(s)
| | - Ilse Ma de Reus
- Dutch Arthroplasty Register (LROI), 's Hertogenbosch, The Netherlands
| | - Gerjon Hannink
- Department of Operating Rooms, Radboudumc, Nijmegen, The Netherlands
| | - Stephan Bw Vehmeijer
- Department of Orthopaedics, Reinier Haga Orthopaedic Clinic, Zoetermeer, The Netherlands
| | - Berend W Schreurs
- Dutch Arthroplasty Register (LROI), 's Hertogenbosch, The Netherlands
- Department of Orthopaedics, Radboudumc, Nijmegen, The Netherlands
| | - Wierd P Zijlstra
- Department of Orthopaedics, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
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Rullán PJ, Orr MN, Emara AK, Klika AK, Molloy RM, Piuzzi NS. Understanding the 30-day mortality burden after revision total hip arthroplasty. Hip Int 2023; 33:727-735. [PMID: 35578410 DOI: 10.1177/11207000221094543] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Revision total hip arthroplasty (THA) is a challenging procedure that burdens the healthcare system. Despite being associated with worse outcomes relative to its primary counterpart, postoperative mortality after revision THA remains ill-defined. The present study aimed to (1) establish the overall 30-day mortality rate after revision THA and (2) explore the mortality rate stratified by age, comorbidity burden, and aseptic versus septic failure. METHODS The American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) database was retrospectively reviewed for all patients who underwent revision THA from 2011 to 2019. A total of 23,501 patients were identified and grouped into mortality (n = 161) and mortality-free (n = 23,340) cohorts. Patient demographics, comorbidities, and aseptic/septic failure were evaluated. RESULTS The overall 30-day mortality was 0.69%. The mortality rate by age group (normalised per 1000 patients) was 0 (18-39 years [Y]), 0.67 (40-49 Y), 1.10 (50-59 Y), 2.58 (60-69 Y), 6.15 (70-79 Y) 19.32 (80-89 Y), and 58.22 (90+Y) (p < 0.001). The mortality rate by ASA classification (normalised per 1000 patients) was 0 (ASA I), 1.47 (ASA II), 6.94 (ASA III), 45.42 (ASA IV), and 200 (ASA V) (p < 0.001). The 30-day mortality rate for the septic and aseptic cohorts was 1.03% and 0.65%, respectively (p = 0.038). CCI scores (p < 0.001), diabetes (p < 0.001), systematic sepsis (p < 0.001), poor functional status (p < 0.001), BMI < 24.9 kg/m2 (p < 0.001), and dirty/infected wounds (p < 0.001) were all associated with increased mortality risk. CONCLUSIONS 1 in 145 patients will suffer mortality during the 30 days after revision THA. PJI-related revision THA was associated with 1.5-fold increase in 30-day mortality rate compared to its aseptic counterpart. Certain patient determinants and baseline comorbidities, as measured by ASA and CCI scores, were associated with higher 30-day mortality rates. Therefore, it is imperative to identify such risk factors and implement perioperative patient optimisation pathways to mitigate the risk among vulnerable patients.
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Affiliation(s)
- Pedro J Rullán
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Melissa N Orr
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Ahmed K Emara
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Alison K Klika
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Robert M Molloy
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
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Van Dooren B, Peters RM, Ettema HB, Schreurs BW, Van Steenbergen LN, Bolder SBT, Zijlstra WP. Revision risk by using the direct superior approach (DSA) for total hip arthroplasty compared with postero-lateral approach: early nationwide results from the Dutch Arthroplasty Register (LROI). Acta Orthop 2023; 94:158-164. [PMID: 37066786 PMCID: PMC10108617 DOI: 10.2340/17453674.2023.11959] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/13/2023] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND AND PURPOSE The direct superior approach (DSA) is a modification of the classic posterolateral approach (PLA) for total hip arthroplasty (THA), in which the iliotibial band and short external rotators are spared. The revision rate of the DSA has not been investigated previously using arthroplasty registry data. We examined the reasons and risk of revision of the DSA, compared with the direct anterior approach (DAA) and PLA. PATIENTS AND METHODS In this population-based cohort study we included 175,543 primary THAs performed between 2014 and 2020 (PLA, n = 117,576; DAA, n = 56,626; DSA, n = 1,341). Competing risk survival analysis and multivariable Cox proportional hazard analyses, adjusted for potential confounders, were performed. RESULTS After 3 years, crude revision rates due to any reason were 2.1% (95% confidence interval [CI] 1.3-3.3) for DSA, and 2.9% (CI 2.8-3.0) for PLA. Crude dislocation revision rates were 0.3% (CI 0.1-0.8) for DSA, versus 1.0% (CI 0.9-1.0) for PLA. Dislocation revision rate for DSA did not differ from DAA (0.3% [CI 0.2-0.3]). Multivariable Cox regression analysis demonstrated no overall difference in revision rates for the DSA (HR 0.6 [CI 0.4-1.09) compared with the PLA. Lower risk of revision due to dislocation was found in patients operated on through the DSA (HR 0.3 [0.1-0.9]) compared with the PLA. CONCLUSION Early nationwide results suggest that the DSA for total hip arthroplasty seems to show a tendency towards a lower risk of revision for dislocation but no overall reduced revision risk compared with the PLA.
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Affiliation(s)
- Bart Van Dooren
- Department of Orthopaedics, Medical Center Leeuwarden, Leeuwarden.
| | - Rinne M Peters
- Department of Orthopaedics, Medical Center Leeuwarden, Leeuwarden; Department of Orthopaedics, University Medical Center Groningen, Groningen
| | | | - B Willem Schreurs
- Department of Orthopaedics, Radboudumc, Nijmegen; Dutch Arthroplasty Register (LROI), 's Hertogenbosch
| | | | | | - Wierd P Zijlstra
- Department of Orthopaedics, Medical Center Leeuwarden, Leeuwarden
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Cieremans D, Shah A, Slover J, Schwarzkopf R, Meftah M. Trends in Complications and Outcomes in Patients Aged 65 Years and Younger Undergoing Total Hip Arthroplasty: Data From the American Joint Replacement Registry. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202303000-00009. [PMID: 36930818 PMCID: PMC10027031 DOI: 10.5435/jaaosglobal-d-22-00256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/27/2023] [Indexed: 03/19/2023]
Abstract
This study sought to determine common complications and the rates of readmission and revision in total hip arthroplasty patients younger than 65 years. Using the American Joint Replacement Registry, we conducted a retrospective review of all THAs in patients aged 18 to 65 years from 2012 to 2020. We excluded patients aged older than 65 years, revisions, oncologic etiology, conversion from prior surgery, and nonelective cases. Primary outcomes included cumulative revision rate, 90-day readmission rate, and reason for revision. The Kaplan-Meier method and univariate analysis were used. Five thousand one hundred fifty-three patients were included. The average age was 56.7 years (SD 7.8 years), 51% were female, 85% were White, and 89% had a Charlson Comorbidity Index of 0 (1 = 7%, >2 = 4%). The mean follow-up was 39.57 months. Fifty-three patients (1.0%) underwent revision. Seventy-four patients (1.4%) were readmitted within 90 days. Revision was more common in Black patients (P = 0.023). Survivorship was 99% (95% confidence interval, 98.7 to 99.3) and 99% (95% confidence interval, 98.5 to 99.3) at 5 and 8 years, respectively. Infection (21%), instability (15%), periprosthetic fracture (15%), and aseptic loosening (9%) were the most common indications for revision. Total hip arthroplasty performed in young and presumed active patients had a 99% survivorship at 8 years. A long-term follow-up is needed to evaluate survival trends in this growing population.
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Affiliation(s)
- David Cieremans
- From New York University Langone Orthopedic Hospital, New York, NY
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Nele W, Martina F, Stefan R, Frank L, Georg M. Impaction bone grafting for segmental acetabular defects: a biomechanical study. Arch Orthop Trauma Surg 2023; 143:1353-1359. [PMID: 34905066 PMCID: PMC9958163 DOI: 10.1007/s00402-021-04296-y] [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] [Received: 10/01/2021] [Accepted: 11/30/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Implant loosening is the most common indication for revision after total hip arthroplasty and is associated with progressive bone destruction. Contained defects can be treated with impaction bone grafting (IBG). Segmental defects are successfully restored with metal augmentation. Considering the increasing number of hip arthroplasty cases in young patients, it would appear sensible to reconstruct the bone stock for future revisions by biological bone defect reduction. The data on the treatment of segmental defects with IBG without additional stabilization are lacking. MATERIALS AND METHODS Paprosky type IIB defects were milled into 15 porcine hemipelves with segmental defect angles of 40°, 80° and 120°. Contained defects without segmental defects (Paprosky type I) and acetabula without defects served as controls. After IBG, a cemented polyethylene cup (PE) was implanted in each case. Cup migration, rotational stiffness and maximum rupture torque were determined under physiological loading conditions after 2500 cycles. RESULTS Compared with the control without defects, IBG cups showed an asymptotic migration of 0.26 mm ± 0.11 mm on average. This seating was not dependent on the size of the defect. The maximum rupture moment was also not dependent on the defect size for cups after IBG. In contrast, the torsional stiffness of cups with an 120° segmental defect angle was significantly lower than in the control group without defects. All other defects did not differ in torsional stiffness from the control without defects. CONCLUSIONS IBG did not show inferior biomechanical properties in segmental type IIB defect angles up to 80°, compared to cups without defects.
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Affiliation(s)
- Wagener Nele
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Göttingen, Georg-August-University, Robert Koch Straße 40, 37075, Göttingen, Germany.
| | - Fritsch Martina
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, 07607 Eisenberg, Germany
| | - Reinicke Stefan
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, 07607 Eisenberg, Germany
| | - Layher Frank
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, 07607 Eisenberg, Germany
| | - Matziolis Georg
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, 07607 Eisenberg, Germany
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Innocenti M, Smulders K, Willems JH, Goosen JHM, van Hellemondt G. Patient-reported outcome measures, complication rates, and re-revision rates are not associated with the indication for revision total hip arthroplasty : a prospective evaluation of 647 consecutive patients. Bone Joint J 2022; 104-B:859-866. [PMID: 35775171 DOI: 10.1302/0301-620x.104b7.bjj-2021-1739.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to explore the relationship between reason for revision total hip arthroplasty (rTHA) and outcomes in terms of patient-reported outcome measures (PROMs). METHODS We reviewed a prospective cohort of 647 patients undergoing full or partial rTHA at a single high-volume centre with a minimum of two years' follow-up. The reasons for revision were classified as: infection; aseptic loosening; dislocation; structural failure; and painful THA for other reasons. PROMs (modified Oxford Hip Score (mOHS), EuroQol five-dimension three-level health questionnaire (EQ-5D-3L) score, and visual analogue scales for pain during rest and activity), complication rates, and failure rates were compared among the groups. RESULTS The indication for revision influenced PROMs improvement over time. This finding mainly reflected preoperative differences between the groups, but diminished between the first and second postoperative years. Preoperatively, patients revised due to infection and aseptic loosening had a lower mOHS than patients with other indications for revision. Pain scores at baseline were highest in patients being revised for dislocation. Infection and aseptic loosening groups showed marked changes over time in both mOHS and EQ-5D-3L. Overall complications and re-revision rates were 35.4% and 9.7% respectively, with no differences between the groups (p = 0.351 and p = 0.470, respectively). CONCLUSION Good outcomes were generally obtained regardless of the reason for revision, with patients having the poorest preoperative scores exhibiting the greatest improvement in PROMs. Furthermore, overall complication and reoperation rates were in line with previous reports and did not differ between different indications for rTHA. Cite this article: Bone Joint J 2022;104-B(7):859-866.
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Affiliation(s)
- Matteo Innocenti
- Department of Orthopaedic Surgery, University of Florence, Florence, Italy
| | - Katrijn Smulders
- Department of Research, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Jore H Willems
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Jon H M Goosen
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Gijs van Hellemondt
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, the Netherlands
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Wang P, Wang C, Meng H, Liu G, Li H, Gao J, Tian H, Peng J. The Role of Structural Deterioration and Biomechanical Changes of the Necrotic Lesion in Collapse Mechanism of Osteonecrosis of the Femoral Head. Orthop Surg 2022; 14:831-839. [PMID: 35445585 PMCID: PMC9087473 DOI: 10.1111/os.13277] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/21/2022] [Accepted: 03/21/2022] [Indexed: 11/26/2022] Open
Abstract
Osteonecrosis of the femoral head (ONFH) is a crippling disease which is due to a lack of effective therapeutic measures. Its natural progression is rapid, the internal bone structure of the femoral head changes dramatically, and the subsequent fractures and collapse cause severe hip pain and loss of hip function. Femoral head collapse is a critical turning point in the development of ONFH and is related to the prognosis of patients. Early prevention and intervention help to preserve the hip joint and delay femoral head collapse. However, the mechanism of collapse still needs to be further studied because it is affected by different complex factors. This review discusses the underlying causes of femoral head collapse from two aspects: structural degradation and regional changes of biomechanical properties in the necrotic femoral head.
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Affiliation(s)
- Peng Wang
- Department of Bone and Joint Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Institute of Orthopaedics,Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, China
| | - Cheng Wang
- Department of Orthopedics,Engineering Research Center of Bone and Joint Precision Medicine,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
| | - Haoye Meng
- Institute of Orthopaedics,Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, China
| | - Guangbo Liu
- Institute of Orthopaedics,Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, China
| | - Huo Li
- Institute of Orthopaedics,Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, China
| | - Jianming Gao
- Institute of Orthopaedics,Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, China
| | - Hua Tian
- Department of Orthopedics,Engineering Research Center of Bone and Joint Precision Medicine,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
| | - Jiang Peng
- Department of Bone and Joint Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Institute of Orthopaedics,Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, China
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11
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Macheras GA, Lepetsos P, Galanakos SP, Papadakis SA, Poultsides LA, Karachalios TS. Early failure of an uncemented femoral stem, as compared to two other stems with similar design, following primary total hip arthroplasty performed with direct anterior approach. Hip Int 2022; 32:166-173. [PMID: 32662662 DOI: 10.1177/1120700020940671] [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] [Indexed: 02/06/2023]
Abstract
INTRODUCTION An increased risk of early femoral component loosening has been reported using the direct anterior approach (DAA) compared with other common surgical approaches. However, long-term data are scarce. The purpose of this study is: (1) to determine the incidence of early femoral loosening in a high volume, single surgeon's practice utilising the DAA approach; and (2) to examine the effect of stem design and type of coating on aseptic loosening in the early and mid-term postoperative period. METHODS A retrospective review of 1650 consecutive patients (1800 hips) who underwent total hip arthroplasty (THA) using the DAA between August 2011 and December 2017 was conducted at our institution. 3 types of uncemented femoral stems (Quadra-S, Avenir, TwinSys), with similar design, but different coating, were implanted. Patients were evaluated clinically and radiologically at 4 weeks, 3 months, 1 year, and annually thereafter. RESULTS After a mean follow-up of 46.4 months, the total incidence of revision for aseptic loosening was 0.44% (n = 8). All loose stems were Quadra-S, failing to achieve osseointegration, for an overall incidence of 0.96% (p = 0.002). None of the other stems were loose. Radiolucent lines around the proximal stem portion were visible in 75 Quadra-S stems (4.1%) on radiographs taken at 1 year postoperatively and continued to deteriorate at the latest follow-up. CONCLUSIONS In this specific cohort of patients, the increased rate of femoral stem aseptic loosening was implant-related and was attributed only to a specific type of femoral stem (Quadra-S). No relation to other factors was proven suggesting that the surface characteristics of this femoral stem and the lack of bioactive coating are responsible for the observed early femoral failures. These findings should be confirmed by additional registry work and larger population sample sizes are needed to evaluate the prosthesis performance after implantation through the DAA.
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Affiliation(s)
- George A Macheras
- 4th Department of Trauma and Orthopaedics, KAT Hospital, Athens, Greece
| | | | | | | | - Lazaros A Poultsides
- 3rd Academic Department of Orthopaedics and Trauma, Aristotle University Medical School, Thessaloniki, Greece
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12
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Patients With Ehlers-Danlos Syndromes Experience Higher Rates of Prosthetic Dislocation After Total Hip Arthroplasty and Worse Implant Survival at 5 Years. J Am Acad Orthop Surg 2022; 30:177-183. [PMID: 34967762 DOI: 10.5435/jaaos-d-21-00347] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 11/22/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Ehlers-Danlos syndromes (EDS) are genetic connective tissue disorders affecting multiple organ systems that frequently result in connective tissue hyperlaxity and early osteoarthritis. Short- and long-term outcomes after total hip arthroplasty in this cohort remain poorly characterized. METHODS Data were abstracted from the 2010 to 2018 PearlDiver Mariner administrative database. Patients with EDS undergoing total hip arthroplasty for osteoarthritis were identified and matched 1:10 to patients without a diagnosis of EDS. Ninety-day incidence of postoperative complications and hospital readmission were identified and compared. Odds of 90-day adverse events were compared using multivariate logistic regression. Finally, 5-year implant survival was compared using a log-rank test. Significance was set at P < 0.005 after Bonferroni correction. RESULTS Matching was done for 354 patients with EDS to 3,518 patients without EDS. Patients with EDS had markedly higher rates of periprosthetic dislocation within 90 days of surgery (4.2% dislocation rate in EDS vs. 1.7% in matched control subjects, P = 0.001). On multivariate analysis, patients with EDS continued to have increased odds of dislocation in the 90-day postoperative period (Odds Ratio=2.64, P = 0.001), whereas the rates of the other studied adverse events were not markedly different between groups. At 5 years, 92.7% of patients with EDS and 96.1% of the matched control subjects remained unrevised (significant log rank difference, P = 0.004). CONCLUSION Compared with patients without EDS, patients with EDS were found to have a higher rate of perioperative dislocation and markedly lower implant survival at 5 years. These findings are consistent with the increased connective tissue laxity associated with EDS.
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13
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Prentice HA, Chan PH, Royse KE, Hinman AD, Reddy NC, Paxton EW. Revision Risk in a Cohort of US Patients Younger Than 55 Undergoing Primary Elective Total Hip Arthroplasty. J Arthroplasty 2022; 37:303-311. [PMID: 34718107 DOI: 10.1016/j.arth.2021.10.014] [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: 07/27/2021] [Revised: 10/11/2021] [Accepted: 10/21/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND As indications for elective total hip arthroplasty (THA) expand to younger patients, we sought to (1) compare revision risk following primary elective THA in patients <55 years at the time of their THA to patients aged ≥65 years and (2) identify specific risk factors for revision in patients <55 years. METHODS A Kaiser Permanente's total joint replacement registry was used to conduct a cohort study including primary elective THA patients aged ≥18 (2001-2018). In total, 11,671 patients <55 years and 53,106 patients ≥65 years were included. Multiple Cox regression was used to evaluate cause-specific revision risk, including septic revision, aseptic loosening, instability, and periprosthetic fracture. Stepwise Cox regression was used to identify patient and surgical factors associated with cause-specific revision in patients <55 years. RESULTS Patients <55 years had a higher risk of septic revision (hazard ratio [HR] = 1.30, 95% confidence interval [CI] = 1.02-1.66), aseptic loosening (HR = 2.60, 95% CI = 1.99-3.40), and instability (HR = 1.35, 95% CI = 1.09-1.68), but a lower risk of revision for periprosthetic fracture (HR = 0.36, 95% CI = 0.22-0.59) compared to patients aged ≥65 years. In the <55 age group, risk factors for septic revision included higher body mass index, drug abuse, and liver disease. Hypertension, anterior approach, and ceramic-on-ceramic were associated with aseptic loosening. White race, American Society of Anesthesiologists classification ≥3, smoker, paralysis, posterior approach, ceramic-on-ceramic, and smaller head diameter were associated with instability. CONCLUSION Identified risk factors varied depending on the cause for revision. Although septic revisions were related to patient characteristics, more modifiable factors, such as implant or surgical approach, were associated with revision due to aseptic loosening and instability. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | | | - Kathryn E Royse
- Surgical Outcomes & Analysis, Kaiser Permanente, San Diego, CA
| | - Adrian D Hinman
- Department of Orthopaedics, The Permanente Medical Group, San Leandro, CA
| | - Nithin C Reddy
- Department of Orthopaedics, Southern California Permanente Medical Group, San Diego, CA
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14
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He XM, He MC, Yang P, Zhang QW, Chen ZQ, He W, Wei QS. The Therapeutic Effect of Huo Xue Tong Luo Capsules in Association Research Circulation Osseous (ARCO) Stage II Osteonecrosis of the Femoral Head: A Clinical Study With an Average Follow-up Period of 7.95 Years. Front Pharmacol 2021; 12:773758. [PMID: 34899331 PMCID: PMC8652332 DOI: 10.3389/fphar.2021.773758] [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] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Huo Xue Tong Luo (HXTL) capsules are an oral preparation that could relieve pain and ameliorate osteonecrosis in patients with asymptomatic osteonecrosis of femoral head (ONFH). We wanted to verify whether it could be a treatment option for ARCO stage II ONFH. Methods: A total of 44 patients (66 hips) with ARCO stage II ONFH were recruited from June 1996 to October 2013 (clinical trial registry number: ChiCTR-RPC-15006,290). HXTL capsules were given under a specific protocol, and the endpoint was set as femoral head collapse. The clinical indicators [including visual analog scale (VAS) and Harris Hip Score (HHS)] and radiological indicators [including Tonnis classification, ARCO stage, Japanese Investigation Committee (JIC) classification, lateral preserved angle (LPA), anterior preserved angle (APA), and combined preserved angle (CPA)] before and after treatment were compared. Kaplan–Meier survival analysis and Cox regression analysis were used to identify the risk factors associated with femoral head collapse. Result: Twenty-six males and 18 females with an average age of 38.3 ± 2.8 were followed for an average of 7.95 years. Forty-six of the 66 (69.7%) hips had no progression in pain or collapse, and patients exhibited a higher HHS (p < 0.05) after therapy. Twenty of the 66 (30.3%) hips progressed in Tonnis classification and ARCO stage, but only one of the 66 (1.5%) hips required total hip arthroplasty (THA). The Kaplan–Meier survivorship curve suggested that the survival rates were 96.97% at 5 years, 69.15% at 10 years, and 40.33% at 15 years. Patients with type A necrotic lesions on anteroposterior (AP) and frog-leg lateral (FLL) radiographs revealed 100% survival rates. Multivariate Cox regression analysis revealed that patients with an LPA ≤ 60.9 exhibited a 3.87 times higher risk of collapse of the femoral head [95% confidence interval (CI), 1.241–5.673] than did those patients with an LPA>60.9. Conclusion: HXTL capsules could be a treatment option for ARCO stage II ONFH, resulting in improved hip function and delayed progression to femoral head collapse, especially when the anterior and lateral portions of the femoral head were not affected. However, an LPA of less than 60.9° may be a risk factor for collapse of the femoral head. Clinical Trial Registration:http://www.chictr.org.cn/showproj.aspx?proj=10829, identifier ChiCTR-OPC-15007030
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Affiliation(s)
- Xiao-Ming He
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, Guangzhou, China.,Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Min-Cong He
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, Guangzhou, China.,Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Peng Yang
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, Guangzhou, China.,Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qing-Wen Zhang
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, Guangzhou, China.,Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhen-Qiu Chen
- The Third Orthopaedic Region, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wei He
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, Guangzhou, China.,Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qiu-Shi Wei
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, Guangzhou, China.,Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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15
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Habor J, Fischer MCM, Tokunaga K, Okamoto M, Radermacher K. The Patient-Specific Combined Target Zone for Morpho-Functional Planning of Total Hip Arthroplasty. J Pers Med 2021; 11:jpm11080817. [PMID: 34442461 PMCID: PMC8402039 DOI: 10.3390/jpm11080817] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/09/2021] [Accepted: 08/19/2021] [Indexed: 11/16/2022] Open
Abstract
Background Relevant criteria for total hip arthroplasty (THA) planning have been introduced in the literature which include the hip range of motion, bony coverage, anterior cup overhang, leg length discrepancy, edge loading risk, and wear. The optimal implant design and alignment depends on the patient’s anatomy and patient-specific functional parameters such as the pelvic tilt. The approaches proposed in literature often consider one or more criteria for THA planning. but to the best of our knowledge none of them follow an integrated approach including all criteria for the definition of a patient-specific combined target zone (PSCTZ). Questions/purposes (1) How can we calculate suitable THA implant and implantation parameters for a specific patient considering all relevant criteria? (2) Are the resulting target zones in the range of conventional safe zones? (3) Do patients who fulfil these combined criteria have a better outcome score? Methods A method is presented that calculates individual target zones based on the morphology, range of motion and load acting on the hip joint and merges them into the PSCTZ. In a retrospective analysis of 198 THA patients, it was calculated whether the patients were inside or outside the Lewinnek safe zone, Dorr combined anteversion range and PSCTZ. The postoperative Harris Hip Scores (HHS) between insiders and outsiders were compared. Results 11 patients were inside the PSCTZ. Patients inside and outside the PSCTZ showed no significant difference in the HHS. However, a significant higher HHS was observed for the insiders of two of the three sub-target zones incorporated in the PSCTZ. By combining the sub-target zones in the PSCTZ, all PSCTZ insiders except one had an HHS higher than 90. Conclusions The results might suggest that, for a prosthesis implanted in the PSCTZ a low outcome score of the patient is less likely than using the conventional safe zones by Lewinnek and Dorr. For future studies, a larger cohort of patients inside the PSCTZ is needed which can only be achieved if the cases are planned prospectively with the method introduced in this paper. Clinical Relevance The method presented in this paper could help the surgeon combining multiple different criteria during THA planning and find the suitable implant design and alignment for a specific patient.
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Affiliation(s)
- Juliana Habor
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, 52074 Aachen, Germany; (J.H.); (M.C.M.F.)
| | - Maximilian C. M. Fischer
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, 52074 Aachen, Germany; (J.H.); (M.C.M.F.)
| | - Kunihiko Tokunaga
- Niigata Hip Joint Center, Kameda Daiichi Hospital, Niigata City 950-0165, Japan;
| | - Masashi Okamoto
- Department of Radiology, Kameda Daiichi Hospital, Niigata City 950-0165, Japan;
| | - Klaus Radermacher
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, 52074 Aachen, Germany; (J.H.); (M.C.M.F.)
- Correspondence:
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16
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Zhang C, Chen M, Yu W, Han X, Ye J, Zhuang J. Long-term survival after cemented versus uncemented total hip arthroplasty for treatment of acute femoral neck fracture: a retrospective study with a mean 10-year follow-up. J Int Med Res 2021; 48:300060520941974. [PMID: 32924700 PMCID: PMC7493252 DOI: 10.1177/0300060520941974] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To compare the long-term survivorship and Harris hip scores (HHSs) between cemented total hip arthroplasty (CTHA) and uncemented total hip arthroplasty (UTHA) for treatment of acute femoral neck fractures (FNFs). Methods Data of 224 hips (CTHA, n = 112; UTHA, n = 112) that underwent primary surgery in our medical institution from 2005 to 2017 were retrospectively analysed. The primary endpoint was the risk of all-cause revision. The difference in the risk of all-cause revision between the two groups was assessed by Kaplan–Meier survival analysis with a log-rank test and Cox regression analysis. Results The mean postoperative follow-up was 10 years (range, 3–13 years). The Kaplan–Meier estimated 10-year implant survival rate was significantly higher in the CTHA than UTHA group (98.1% vs. 96.2%, respectively). The adjusted Cox regression analysis demonstrated a significantly lower risk of revision in the CTHA than UTHA group. At the final follow-up, the mean HHS was significantly higher in the CTHA than UTHA group (85.10 vs. 79.11, respectively). Conclusion This retrospective analysis demonstrated that CTHA provided higher survival, lower revision risk, and higher functional outcome scores than UTHA. Further follow-up is necessary to verify whether these advantages of CTHA persist over time.
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Affiliation(s)
- Chi Zhang
- Department of Joint Surgery, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Meiji Chen
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weiguang Yu
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiulan Han
- Department of Rehabilitation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Junxing Ye
- Department of Orthopaedics, The Third People's Hospital of Wuxi, Jiangsu Province; The Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Jintao Zhuang
- Department of Urology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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17
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Abstract
AIMS Joint registries typically use revision of an implant as an endpoint and report survival rates after a defined number of years. However, reporting lifetime risk of revision may be more meaningful, especially in younger patients. We aimed to assess lifetime risk of revision for patients in defined age groups at the time of primary surgery. METHODS The New Zealand Joint Registry (NZJR) was used to obtain rates and causes of revision for all primary total hip arthroplasties (THAs) performed between January 1999 and December 2016. The NZJR is linked to the New Zealand Registry of Births, Deaths and Marriages to obtain complete and accurate data. Patients were stratified by age at primary surgery, and lifetime risk of revision calculated according to age, sex, and American Society of Anesthesiologists (ASA) classification. The most common causes for revision were also analyzed for each age group. RESULTS The overall, ten-year implant survival rate was 93.6% (95% confidence interval (CI) 93.4% to 93.8%). It was lowest in the youngest age group (46 to 50 years), rising sequentially with increasing age to 97.5% in the oldest group (90 to 95 years). Lifetime risk of revision surgery was 27.6% (95% CI 27.3% to 27.8%) in those aged 46 to 50 years, decreasing with age to 1.1% (95% CI 0.0% to 5.8%) in those aged 90 to 95 years at the time of primary surgery. Higher ASA grades were associated with an increased lifetime risk of revision across all ages. The commonest causes for revision THA were aseptic loosening, infection, periprosthetic fracture, and dislocation. CONCLUSION When counselling patients preoperatively, the lifetime risk of revision may be a more meaningful and useful measure of longer-term outcome than implant survival at defined time periods. This study highlights the considerably increased likelihood of subsequent revision surgery in younger age groups. Cite this article: Bone Joint J 2021;103-B(3):479-485.
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Affiliation(s)
- Mary Nugent
- Department of Orthopaedic Surgery, Christchurch Public Hospital, Christchurch, New Zealand
| | - Simon W Young
- Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
| | | | - Gary J Hooper
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch, Christchurch, New Zealand
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18
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Tuncay İ, Tözün R, Aliyev O, Dikmen G, Uzer G, Özden VE, Yıldız F. Onlay fibula autografting technique and its comparison with cortical allograft for the reconstruction of periprosthetic bone defects around the femur. INTERNATIONAL ORTHOPAEDICS 2020; 45:71-81. [PMID: 33206205 DOI: 10.1007/s00264-020-04876-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/09/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Bone defect around the femur related to revisions or periprosthetic fractures (PFF) is an issue. We present a bone defect reconstruction technique in femoral revisions and/or PFF using fibula autograft and compared our radiological and clinical results to that of allograft. METHODS A total of 53 patients who underwent revision hip arthroplasty and/or PFF fixation with the use of cortical fibula autograft (FG group) or cortical allograft (CG group) were evaluated. After exclusions, 20 patients who had minimum two years of follow-up were investigated for each group, for their radiological and clinical outcomes. RESULTS In FG and CG groups, the median ages were 69.5(44-90) and 62(38-88) years, follow-ups were 59(28-72) and 120(48-216) months, defect lengths were seven (1-10) and ten (1-17) cm, and grafts lengths were 16.5(10-30) and 20(12-37) cm, respectively. The rate of graft incorporation was 90% in each group and median time to incorporations were seven (4-12) and 12(6-24) months (p < 0.001), and graft resorption (moderate and severe) rates were 10% and 25% (p = 0.41), respectively. Median Harris Hip (77.6 vs 78.0), WOMAC (23.2 vs 22), SF-12 physical (50.0 vs 46.1), and SF-12 mental (53.8 vs 52.5) scores were similar between the groups, respectively. Kaplan-Meier survivorship analyses revealed an estimated mean survival of 100% at six years in FG group and 90% at 14 years in CG group. CONCLUSION In the reconstruction of periprosthetic bone defects after femoral revision or PPF, onlay cortical fibula autografts provide comparable clinical and radiological outcomes to allografts. Its incorporation is faster, it is cost-effective and easy to obtain without apparent morbidity.
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Affiliation(s)
- İbrahim Tuncay
- Department of Orthopedics and Traumatology, School of Medicine, Bezmialem Vakif University, Adnan Menderes Blv., Fatih, Istanbul, 34093, Turkey
| | - Remzi Tözün
- Department of Orthopedics and Traumatology, School of Medicine, Mehmet Ali Aydınlar University, Acibadem Maslak Hospital, Darüşşafaka Büyükdere Caddesi No No:40, Sarıyer, Istanbul, 34457, Turkey
| | - Orkhan Aliyev
- Department of Orthopedics and Traumatology, School of Medicine, Bezmialem Vakif University, Adnan Menderes Blv., Fatih, Istanbul, 34093, Turkey
| | - Göksel Dikmen
- Department of Orthopedics and Traumatology, School of Medicine, Mehmet Ali Aydınlar University, Acibadem Maslak Hospital, Darüşşafaka Büyükdere Caddesi No No:40, Sarıyer, Istanbul, 34457, Turkey
| | - Gökçer Uzer
- Department of Orthopedics and Traumatology, School of Medicine, Bezmialem Vakif University, Adnan Menderes Blv., Fatih, Istanbul, 34093, Turkey
| | - Vahit Emre Özden
- Department of Orthopedics and Traumatology, School of Medicine, Mehmet Ali Aydınlar University, Acibadem Maslak Hospital, Darüşşafaka Büyükdere Caddesi No No:40, Sarıyer, Istanbul, 34457, Turkey
| | - Fatih Yıldız
- Department of Orthopedics and Traumatology, School of Medicine, Bezmialem Vakif University, Adnan Menderes Blv., Fatih, Istanbul, 34093, Turkey.
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19
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Bonilla GA, Montoya BE, Restrepo VE, Gomez MM, Sánchez AA, Sánchez JI, Rodríguez HA, Rincón JA, Solano AL, Cardona D, Martínez SL, López A, Moore JL. Institutional arthroplasty registry: what is the minimum acceptable dataset to be included in your hospital? Recommendations from a single-country national consensus using the Delphi method. INTERNATIONAL ORTHOPAEDICS 2020; 45:5-12. [PMID: 33191451 DOI: 10.1007/s00264-020-04866-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 10/30/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Institutional arthroplasty registries are very popular nowadays; however, very few efforts have been made in order to standardize the information to be collected, thus limiting the possibility of inter-institutional data interpretation. This manuscript reports the results of a single-country consensus designed to define the minimum standardized dataset to be recorded within an institutional arthroplasty registry. METHODS A national consensus was carried out among all members of the Colombian Society of Hip and Knee Surgeons using the Delphi method. Eleven questions and answers comprising every potential domain of an institutional registry of hip and knee arthroplasty were defined. According to the methodology, anonymous voting and multiple discussion rounds were performed. Three levels of agreement were defined: Strong consensus: equal to or greater than 80%, weak consensus between 70 and 79.9%, and no consensus below 70%. RESULTS All of the questions reached consensus level. The minimum dataset was defined to include demographic and clinical information, intraoperative and implant details, follow-up and early complications, implant survival, and functional outcome scores, as well as the validation model to assess information quality within the database. Currently, this dataset is being implemented voluntarily by the members of our national society. DISCUSSION A national consensus is a feasible method to build homogeneous arthroplasty registries. We recommend such an exercise since it establishes the basis to compare and add data between institutions and the joint analysis of said information in a national registry.
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Affiliation(s)
- Guillermo A Bonilla
- Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia. .,School of Medicine, Universidad de Los Andes, Bogotá, Colombia.
| | - Beatriz E Montoya
- Clinical Care Center in Joint Replacements, Clínica El Rosario, Medellín, Colombia
| | - Victoria E Restrepo
- Clinical Care Center in Joint Replacements, Clínica El Rosario, Medellín, Colombia
| | | | - Alfredo A Sánchez
- Orthopedics and Traumatology, Fundación Valle del Lili, Cali, Colombia.,School of Medicine, Universidad Icesi, Cali, Colombia
| | - Jose I Sánchez
- Group of Hip and Knee Surgery, Hospital Militar Central, Bogotá, Colombia
| | - Hugo A Rodríguez
- Hospital Infantil de San Jose, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
| | - Jairo A Rincón
- Joint Replacements Arthroplasty and Hip Arthroscopy, Keralty Group, Clínica Colsanitas S.A, Bogotá, Colombia
| | | | - Diego Cardona
- Group of Joint Replacements, Clínica Desa, Cali, Colombia
| | - Saúl L Martínez
- Orthopedics and Traumatology, Hospital Santa Clara, Bogotá, Colombia
| | | | - Jose L Moore
- Department of Orthopedics, Hospital Pablo Tobon Uribe, Medellin, Colombia
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20
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Hoskins W, Bingham R, Lorimer M, Hatton A, de Steiger RN. Early Rate of Revision of Total Hip Arthroplasty Related to Surgical Approach: An Analysis of 122,345 Primary Total Hip Arthroplasties. J Bone Joint Surg Am 2020; 102:1874-1882. [PMID: 32769807 DOI: 10.2106/jbjs.19.01289] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND A number of surgical approaches are available for total hip arthroplasty (THA), but there are limited large-volume, multi-surgeon data comparing the rates of early revisions following these approaches. The aim of this study was to compare the rate of revision of primary conventional THA related to surgical approach. METHODS Data from the Australian Orthopaedic Association National Joint Replacement Registry were analyzed for all patients who had undergone a primary THA for osteoarthritis from January 2015 to December 2018. The primary outcome measure was the cumulative percent revision (CPR) for all causes. Secondary outcome measures were major revision (a revision procedure requiring change of the acetabular and/or femoral component) and revision for specific diagnoses: fracture, component loosening, infection, and dislocation. Age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) score, femoral head size, and femoral fixation were assessed as potential confounders. RESULTS There was a total of 122,345 primary conventional THAs for which the surgical approach was recorded in the registry; 65,791 were posterior, 24,468 were lateral, and 32,086 were anterior. There was no difference in the overall CPR among approaches, but the anterior approach was associated with a higher rate of major revisions. There were differences among the approaches with regard to the types of revision. When adjusted for age, sex, ASA score, BMI, femoral head size, and femoral fixation, the anterior approach was associated with a higher rate of femoral complications-i.e., revision for periprosthetic fracture and femoral loosening. There was a lower rate of revision for infection after the anterior approach compared with the posterior approach in the entire period, and compared with the lateral approach in the first 3 months. The posterior approach was associated with a higher rate of revision for dislocation compared with both the anterior and the lateral approach in all time periods. The anterior approach was associated with a lower rate of revision compared with the lateral approach in the first 6 months only. CONCLUSIONS There was no difference in the overall early CPR among the surgical approaches, but the anterior approach was associated with a higher rate of early major revisions and femoral complications (revisions for periprosthetic fracture and femoral loosening) compared with the posterior and lateral approaches and with a lower rate of dislocation and infection. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Wayne Hoskins
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia.,Traumaplasty Melbourne, East Melbourne, Victoria, Australia
| | - Roger Bingham
- Traumaplasty Melbourne, East Melbourne, Victoria, Australia.,Department of Orthopaedics, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Michelle Lorimer
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
| | - Alesha Hatton
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
| | - Richard N de Steiger
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia.,Department of Surgery, Epworth Healthcare, The University of Melbourne, Richmond, Victoria, Australia
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21
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Chitnis AS, Mantel J, Ruppenkamp J, Bourcet A, Holy CE. Survival analysis for all-cause revision following primary total hip arthroplasty with a medial collared, triple-tapered primary hip stem versus other implants in real-world settings. Curr Med Res Opin 2020; 36:1839-1845. [PMID: 32910700 DOI: 10.1080/03007995.2020.1822309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Patients that undergo total hip replacement (THA) are at risk of revision surgery. This study evaluated the cumulative incidence of revision following a medial collared, triple tapered (MCTT) primary hip stem versus other implants in real-world settings using electronic medical records. METHODS This was a retrospective cohort study that used the Mercy Healthcare Systems - Orthopedics Database (MHSOD) to identify ACTIS total hip system, a MCTT primary hip stem for THA, and any other primary THA between 2016 and 2020. A Kaplan-Meier analysis was conducted to evaluate the risk of revision over time between the MCTT hip stem and other implants. In order to control for the confounding, a multivariable Cox model was developed to evaluate the risk of revision between the two groups. RESULTS There were 1213 patients treated with MCTT hip stem and 6916 patients treated with other implants. The Kaplan-Meier analysis showed statistically significant difference (p value = .006) in cumulative incidences for all-cause revisions between the MCTT hip stem and other implants. The cumulative incidence at 3 years was 1.08% (0.43-2.72%) for the MCTT hip stem, while it was 2.63% (2.19-3.16%) for other implants. After adjusting for patient demographics, clinical characteristics, prescribed medications, and surgeon characteristics, the multivariable Cox proportional hazard model showed the MCTT hip stem was statistically significantly associated with 57% lower risk of revisions compared with other implants (HR, 0.43; 95% CI, 0.19-0.97; p-value = .042). CONCLUSIONS This real-world study found that the incidence of revision after treatment with MCTT primary hip stem was significantly lower than for other implants.
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Affiliation(s)
- Abhishek S Chitnis
- Real World Data Sciences, Epidemiology, Medical Devices, Johnson & Johnson Co, New Brunswick, NJ, USA
| | - Jack Mantel
- Health Economics Market Access, DePuy Synthes UK, Leeds, UK
| | - Jill Ruppenkamp
- Medical Devices, Epidemiology, Johnson and Johnson Limited, New Brunswick, NJ, USA
| | - Anh Bourcet
- Health Economics Market Access, DePuy Synthes, Singapore, Singapore
| | - Chantal E Holy
- Real World Data Sciences, Epidemiology, Medical Devices, Johnson & Johnson Co, New Brunswick, NJ, USA
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