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Sinno E, Piccolo Y, Scrivano M, Rovere G, Damanti M, Panegrossi G. Native hip geometry restoration in total hip arthroplasty: a retrospective analysis of eight different short stems. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024:10.1007/s00590-024-04075-6. [PMID: 39158721 DOI: 10.1007/s00590-024-04075-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 08/11/2024] [Indexed: 08/20/2024]
Abstract
PURPOSE To compare different types of short stems (SS) in terms of native hip geometry reproducibility, analyzing centrum-collum-diaphyseal angle (CCD) and femoral offset (FO). These parameters allow the SS to be adapted to patient's anatomy in order to ensure better functional outcomes in total hip arthroplasty (THA). METHODS A total of 387 cases of SS met the inclusion criteria. CCD and FO were measured using MediCAD® software Version 6 in preoperative (preop-) and postoperative (postop-) X-rays at 6-12 months after surgery. Considering preop-CCD, the sample was divided into three groups: ≤ 124.9° (A); 125°-129.9° (B); and ≥ 130°(C). Preop- and postop-CCD and FO and the respective average difference (Δ) were examined considering the SS individually and within groups, to verify reproducibility of these parameters. RESULTS The SS considered were eight: Fitmore Zimmer, Pulchra Adler, TRIS Adler, Trifit Corin, Trilock Depuy, Actis Depuy, Profemur Microport, and SMF Smith&Nephew. Groups A, B, and C consisted, respectively, of 113, 124, and 150 cases. Considering all cases, there was a statistically significant (p < 0.05) increase in CCD and FO with surgery. Overall, Trifit and Trilock stems were the best in reproducing preop-CCD, Trifit itself followed by Pulchra and Profemur for preop-FO. In groups A and C, the reproduction of preop-CCD was better than preop-FO, in contrast in group B. With regard to preop-CCD reproduction, in group A Trifit and Pulchra, in group B Fitmore and Trifit, and in group C Fitmore and Pulchra were the best. Fitmore in group A, SMF in group B, Pulchra and Trilock in group C were the worst in reproducing preop-FO. CONCLUSION Each hip anatomy is unique, and reproduction of preop-CCD and preop-FO can be achieved with different SS characteristics. Accurate knowledge of the stems and performing correct preop- planning are crucial to allow the best restoration of the patient's native hip geometry in THA.
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Affiliation(s)
- Ennio Sinno
- Orthopaedic and Traumatology Department, S. Spirito Hospital, Lungotevere in Sassia 1, 00193, Rome, Italy.
| | - Yuri Piccolo
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences University "La Sapienza", Piazzale Aldo Moro, 5 00185, Rome, Italy
| | - Marco Scrivano
- Orthopaedic and Traumatology Department, S. Spirito Hospital, Lungotevere in Sassia 1, 00193, Rome, Italy
- Department of Orthopaedic and Trauma Surgery, S. Andrea Hospital, University "La Sapienza", Rome, Italy
| | - Giuseppe Rovere
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
- Department of Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Rome, Italy
| | - Martina Damanti
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences University "La Sapienza", Piazzale Aldo Moro, 5 00185, Rome, Italy
| | - Gabriele Panegrossi
- Orthopaedic and Traumatology Department, S. Spirito Hospital, Lungotevere in Sassia 1, 00193, Rome, Italy
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Chojnowska J, Lewko J, Chilińska J, Cybulski M, Pogroszewska W, Krajewska-Kułak E, Sierżantowicz R. The Impact of Early Rehabilitation and the Acceptance of the Disease on the Quality of Life of Patients after Hip Arthroplasty: An Observational Study. J Clin Med 2024; 13:2902. [PMID: 38792443 PMCID: PMC11122493 DOI: 10.3390/jcm13102902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/16/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
Background: The early introduction of physiotherapy significantly shortens the time required for a patient to regain full mobility after hip arthroplasty. Obtaining the expected result is determined by cooperation with a physiotherapist and the patient's involvement in the rehabilitation process. The aim of this study was to assess the quality of life, life satisfaction, and motor ability of patients after hip arthroplasty. Methods: This study included 147 patients who underwent hip arthroplasty at the Orthopedic and Trauma Department. The research material was collected using questionnaires, and the study used the Barthel Index (BI), Harris Hip Score (HHS), Visual Analogue Scale (VAS), Acceptance of Illness Scale (AIS), and Quality of Life Assessment Questionnaire (WHOQOL-BREF). In the studied group of patients, the Excia cementless endoprosthesis was primarily used (69.39%), as well as the Metha Short Hip prosthesis (15.65%), AM hip prosthesis (10.20%), and bipolar hip prosthesis (4.76%). Results: The analyzed group of patients included 95 women (64.63%) and 52 men (35.37%); the average age was 67 years. Six weeks after hip arthroplasty, mild disability occurred in 53.74% of the patients, while the remaining 46.26% had no disability, and 95.24% of the patients achieved a high level of acceptance of the disease and quality of life. Conclusions: Early improvement after hip replacement surgery contributes to eliminating the disability of the hip joint in the following areas: pain sensation, functionality, lack of deformation, and range of motion. Each subsequent stage of treatment increased the level of acceptance of the disease in the study group. The applied surgical treatment increased satisfaction with overall health and quality of life.
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Affiliation(s)
- Joanna Chojnowska
- Department of Physiotherapy, Faculty of Health Sciences, Academy of Lomza, 18-400 Lomza, Poland; (J.C.); (W.P.)
| | - Jolanta Lewko
- Department of Primary Health Care, Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Joanna Chilińska
- Department of Nursing, Faculty of Health Sciences, Academy of Lomza,18-400 Lomza, Poland;
| | - Mateusz Cybulski
- Department of Integrated Medical Care, Medical University of Bialystok, 15-089 Bialystok, Poland; (M.C.); (E.K.-K.)
| | - Wioletta Pogroszewska
- Department of Physiotherapy, Faculty of Health Sciences, Academy of Lomza, 18-400 Lomza, Poland; (J.C.); (W.P.)
| | - Elżbieta Krajewska-Kułak
- Department of Integrated Medical Care, Medical University of Bialystok, 15-089 Bialystok, Poland; (M.C.); (E.K.-K.)
| | - Regina Sierżantowicz
- Department of Surgical Nursing, Medical University of Bialystok, 15-089 Bialystok, Poland;
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Migliorini F, Coppola F, D’Addona A, Rosolani M, Della Rocca F. Revision of Failed Short Stems in Total Hip Arthroplasty. J Clin Med 2024; 13:2459. [PMID: 38730987 PMCID: PMC11084586 DOI: 10.3390/jcm13092459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 03/29/2024] [Accepted: 04/18/2024] [Indexed: 05/13/2024] Open
Abstract
Background: The current literature lacks studies which evaluate the failure of short stems in total hip arthroplasty (THA). Therefore, the present clinical investigation reported our experience with the failure of short stems in THA, evaluating the causes of failure, survivorship, and the clinical outcomes of revision arthroplasty. Methods: The present study was performed according to the STROBE guidelines. This study was conducted at the Department of Orthopaedic Surgery of the Humanitas Clinical Institute, Milan, Italy, between 2017 and 2022. All patients who underwent revision surgery of a previously implanted THA using a short stem were prospectively included in the present study. Surgeries were performed with patients in lateral position, using a minimally invasive posterolateral approach. The outcomes of interest were to report information on the type and survivorship of implants used for the revision surgery and evaluate the clinical outcomes and the rate of complications. The following patient-reported outcome measures (PROMs) used for the clinical assessment were the Western Ontario McMaster Osteo-Arthritis Index (WOMAC) and related subscales of pain, stiffness, and function, and the visual analogue scale (VAS). Results: Data from 45 patients were retrieved. Of them, 31% (14 of 45 patients) were women. The mean age was 63.7 ± 13.9 years. The mean length of the implant survivorship was 6.2 ± 5.7 years. In total, 58% (26 of 45 patients) underwent revision of all components, 36% (16 of 45 patients) revised only the stem, and 1% (3 of 45 patients) received a two-stage revision. The mean length of the follow-up was 4.4 ± 1.5 years. The cup was revised in 58% (26 of 45) of patients. At 4.4 ± 1.5 years of follow-up, the WOMAC score was 3.5 ± 1.3 and the VAS was 1.2 ± 1.3. In total, 9% (4 of 45) of patients experienced minor complications. One patient used a walking aid because of reduced function. One patient evidenced muscular hypotrophy. Two patients experienced hip dislocations. All two dislocations were managed conservatively with repositioning in the emergency room under fluoroscopy. No patient needed additional revision surgery or experienced further dislocations. Conclusions: Revision surgery is effective and safe when a short stem THA fails. At approximately four years of follow-up, all patients were highly satisfied with their clinical outcomes. Despite the relatively high number (9%), complications were of a minor entity and were successfully managed conservatively.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, 39100 Bolzano, Italy
| | - Francesco Coppola
- Residency Program, University Federico II of Naples, 80131 Naples, Italy;
| | - Alessio D’Addona
- Department of Orthopaedics, Istituto Clinico Humanitas, 20089 Milan, Italy; (A.D.); (M.R.); (F.D.R.)
| | - Marco Rosolani
- Department of Orthopaedics, Istituto Clinico Humanitas, 20089 Milan, Italy; (A.D.); (M.R.); (F.D.R.)
| | - Federico Della Rocca
- Department of Orthopaedics, Istituto Clinico Humanitas, 20089 Milan, Italy; (A.D.); (M.R.); (F.D.R.)
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Ramadanov N, Voss M, Hable R, Prill R, Hakam HT, Salzmann M, Dimitrov D, Becker R. Patient-related Predictors for the Functional Outcome of SuperPATH Hemiarthroplasty versus Conventional Approach Hemiarthroplasty: A Systematic Review and Meta-regression Analysis of Randomized Controlled Trials. Orthop Surg 2024; 16:791-801. [PMID: 38298174 PMCID: PMC10984811 DOI: 10.1111/os.14006] [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: 11/09/2023] [Revised: 01/09/2024] [Accepted: 01/09/2024] [Indexed: 02/02/2024] Open
Abstract
Specialist literature lacks evidence that explores associations between patient characteristics and the beneficial treatment effect of SuperPATH hemiarthroplasty (HA) compared with conventional approach (CA) HA. To investigate and identify patient-related predictors of the effect size of the short-term functional outcome of SuperPATH HA and CA HA by performing a systematic review and meta-regression analysis of randomized controlled trials (RCTs). A systematic search of literature was performed in PubMed, CNKI, CENTRAL of The Cochrane Library, Clinical trials, and Google Scholar until August 25, 2023. For the continuous outcome parameter Harris hip score (HHS) ≤1 week and 3 months postoperatively, mean differences (MDs) with 95% confidence intervals (CIs) were calculated. A meta-regression analysis was based on random-effects meta-analysis using the Hartung-Knapp-Sidik-Jonkman method for continuous covariates. A total of five RCTs with 404 patients were found. The following predictors of HHS ≤1 week postoperatively were identified: patient age (predictor estimate = 1.29; p < 0.01), patient age groups (predictor estimate = 14.07; p < 0.01), time to mobilization (predictor estimate = 5.51; p < 0.01). The following predictors of HHS 3 months postoperatively were identified: incision length (predictor estimate = -2.12; p < 0.01); intraoperative blood loss (predictor estimate = 0.02; p < 0.01). Patient age, time to mobilization, incision length, and intraoperative blood loss were identified as predictors of the effect size of early postoperative functional outcome as measured by HHS. Elderly patients, particularly those over 70 years of age, appear to benefit from SuperPATH HA. Based on these findings, and taking into account our limitations, we recommend that the use of minimally invasive SuperPATH HA in elderly patients should be more widely considered and not limited to elective THA patients.
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Affiliation(s)
- Nikolai Ramadanov
- Center of Orthopedics and TraumatologyUniversity Hospital Brandenburg an der Havel, Brandenburg Medical School Theodor FontaneBrandenburg an der HavelGermany
- Faculty of Health Science BrandenburgBrandenburg Medical School Theodor FontaneBrandenburg an der HavelGermany
| | - Maximilian Voss
- Center of Orthopedics and TraumatologyUniversity Hospital Brandenburg an der Havel, Brandenburg Medical School Theodor FontaneBrandenburg an der HavelGermany
| | - Robert Hable
- Faculty of Applied Computer ScienceDeggendorf Institute of TechnologyDeggendorfGermany
| | - Robert Prill
- Center of Orthopedics and TraumatologyUniversity Hospital Brandenburg an der Havel, Brandenburg Medical School Theodor FontaneBrandenburg an der HavelGermany
- Faculty of Health Science BrandenburgBrandenburg Medical School Theodor FontaneBrandenburg an der HavelGermany
| | - Hassan Tarek Hakam
- Center of Orthopedics and TraumatologyUniversity Hospital Brandenburg an der Havel, Brandenburg Medical School Theodor FontaneBrandenburg an der HavelGermany
- Faculty of Health Science BrandenburgBrandenburg Medical School Theodor FontaneBrandenburg an der HavelGermany
| | - Mikhail Salzmann
- Center of Orthopedics and TraumatologyUniversity Hospital Brandenburg an der Havel, Brandenburg Medical School Theodor FontaneBrandenburg an der HavelGermany
- Faculty of Health Science BrandenburgBrandenburg Medical School Theodor FontaneBrandenburg an der HavelGermany
| | - Dobromir Dimitrov
- Department of Surgical Propedeutics, Faculty of MedicineMedical University of PlevenPlevenBulgaria
| | - Roland Becker
- Center of Orthopedics and TraumatologyUniversity Hospital Brandenburg an der Havel, Brandenburg Medical School Theodor FontaneBrandenburg an der HavelGermany
- Faculty of Health Science BrandenburgBrandenburg Medical School Theodor FontaneBrandenburg an der HavelGermany
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Zhao Y, Sun W, Wang C, Xie X, Feng G. Comparison of clinical outcomes of supercapsular percutaneously-assisted approach total hip arthroplasty versus conventional posterior approach for total hip arthroplasty in adults: a systematic review and meta-analysis. BMC Musculoskelet Disord 2024; 25:25. [PMID: 38166873 PMCID: PMC10759432 DOI: 10.1186/s12891-023-07126-x] [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: 09/16/2023] [Accepted: 12/16/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE This meta-analysis was aimed to compare the postoperative clinical outcomes between the supercapsular percutaneously assisted total hip (SuperPATH, SP) and conventional posterior/posterolateral approach (PA) for total hip arthroplasty in patients who have failed conservative treatment for hip-related disorders. METHODS PRISMAP guidelines were followed in this systematic review. CNKI, Wanfang, PubMed, Embase, Cochrane, Web of Science databases and the reference list grey literature were searched for studies according to the search strategy. Endnote (version 20) was used to screen the searched studies according to the inclusion and exclusion criterias and extract the data from the eligible studied. RR and 95% CI were used for dichotomous variables and MD and 95% CI were used for continuous variables. All analyses and heterogeneity of outcomes were analysed by Review Manage (version 5.4). Publication bias of included studies was analysed by Stata (version 16.0). RESULTS Thirty-six randomized control studies were included. Compared to PA group, SP group had a shorter incision length, less intraoperative blood loss, a shorter length of hospital stay and do activities earlier. Hip function (HHS) was significantly improved within three months postoperatively. Pain of hip (VAS) was significantly reduced within one month postoperatively. The state of daily living (BI) was significantly improved within three months. Patients' overall health status (SF-36) improved significantly postoperatively. There was no difference in postoperative complications between the two approaches. PA had a shorter operative time and a higher accuracy of prosthesis placement. CONCLUSION The advantages of SuperPATH include accelerated functional recovery and less trauma associated with surgery. However, it required a longer operative time and implantation of the prosthesis was less accurate than that of PA.
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Affiliation(s)
- Yize Zhao
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wenchen Sun
- Anhui Medical University, Hefei, Anhui, China
| | - Chen Wang
- Anhui Medical University, Hefei, Anhui, China
| | - Xinyi Xie
- Anhui Medical University, Hefei, Anhui, China
| | - Ganjun Feng
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Yu WX, Hao YQ, Lu C, Li H, Cai YZ. Efficacy and risk factors for anxiety and depression after mini-incision hip arthroplasty for femoral head osteonecrosis. World J Psychiatry 2023; 13:1016-1026. [PMID: 38186734 PMCID: PMC10768488 DOI: 10.5498/wjp.v13.i12.1016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/25/2023] [Accepted: 11/08/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Osteonecrosis of the femoral head (ONFH) is a prevalent orthopedic issue, leading to the collapse and fragmentation of the femoral head in its advanced stages, which can severely impair patients' quality of life. Total hip arthroplasty (THA) is a clinical intervention frequently used to alleviate ONFH symptoms and reinstate hip functionality. The conventional surgical technique is invasive and comes with an extended recuperation period, posing significant challenges for patients. With the progression of medical technology, the use of the mini-incision technique in minimally invasive THA (MITHA) has become more prevalent. However, comparative studies examining the effectiveness of these two surgical procedures in treating ONFH remain scarce. Furthermore, understanding patients' psychological well-being is crucial given its profound influence on postoperative recuperation. AIM To evaluate the impact of mini-incision MITHA on ONFH treatment and to identify the risk factors associated with postoperative anxiety and depression. METHODS A retrospective study was conducted on 125 patients treated for ONFH at Xi'an Hong Hui Hospital between February 2020 and January 2022, with the term "consecutive" indicating that these patients were treated in an unbroken sequence without any selection. Among these, 60 patients (control group) underwent traditional THA, while 65 patients (observation group) were treated with mini-incision MITHA. Variations in the visual analog scale (VAS) score and the Harris hip score were monitored. Additionally, shifts in pre- and posttreatment Hamilton anxiety (HAMA) and Hamilton depression (HAMD) scale scores were recorded. Patients with both postoperative HAMA and HAMD scores of ≥ 8 were identified as those experiencing negative emotions. Logistic regression was utilized to analyze the determinants influencing these negative emotional outcomes. Comparative analyses of surgical and postoperative metrics between the two groups were also conducted. RESULTS Posttreatment results indicated a significantly higher VAS score in the control group than in the observation group, while the Harris score was considerably lower (P < 0.0001). The observation group benefited from a notably shorter operation duration, reduced blood loss, diminished incision size, and a decreased postoperative drainage time (P < 0.0001), accompanied by a reduced hospital stay and lower treatment costs (P < 0.0001). The control group had elevated posttreatment HAMA and HAMD scores in comparison to the observation group (P < 0.0001). Multivariate logistic regression revealed that being female [odds ratio (OR): 4.394, 95%CI: 1.689-11.433, P = 0.002], having a higher postoperative VAS score (OR: 5.533, 95%CI: 2.210-13.848, P < 0.0001), and having higher treatment costs (OR: 7.306, 95%CI: 2.801-19.057, P < 0.0001) were significant independent determinants influencing postoperative mood disturbances. CONCLUSION Compared to conventional THA, mini-incision MITHA offers advantages such as reduced operation time, minimal bleeding, and a shorter incision in ONFH patients. Moreover, factors such as sex, postoperative pain (reflected in the VAS score), and treatment costs significantly impact postoperative anxiety and depression.
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Affiliation(s)
- Wen-Xing Yu
- Osteonecrosis and Joint Reconstruction Ward, Xi’an Hong Hui Hospital, Xi'an Jiaotong University, Xi’an 710054, Shaanxi Province, China
| | - Yang-Quan Hao
- Osteonecrosis and Joint Reconstruction Ward, Xi’an Hong Hui Hospital, Xi'an Jiaotong University, Xi’an 710054, Shaanxi Province, China
| | - Chao Lu
- Osteonecrosis and Joint Reconstruction Ward, Xi’an Hong Hui Hospital, Xi'an Jiaotong University, Xi’an 710054, Shaanxi Province, China
| | - Hui Li
- Osteonecrosis and Joint Reconstruction Ward, Xi’an Hong Hui Hospital, Xi'an Jiaotong University, Xi’an 710054, Shaanxi Province, China
| | - Yuan-Zhen Cai
- Osteonecrosis and Joint Reconstruction Ward, Xi’an Hong Hui Hospital, Xi'an Jiaotong University, Xi’an 710054, Shaanxi Province, China
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Fernández-de-las-Peñas C, Florencio LL, de-la-Llave-Rincón AI, Ortega-Santiago R, Cigarán-Méndez M, Fuensalida-Novo S, Plaza-Manzano G, Arendt-Nielsen L, Valera-Calero JA, Navarro-Santana MJ. Prognostic Factors for Postoperative Chronic Pain after Knee or Hip Replacement in Patients with Knee or Hip Osteoarthritis: An Umbrella Review. J Clin Med 2023; 12:6624. [PMID: 37892762 PMCID: PMC10607727 DOI: 10.3390/jcm12206624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
Knee and hip osteoarthritis are highly prevalent in the older population. Management of osteoarthritis-related pain includes conservative or surgical treatment. Although knee or hip joint replacement is associated with positive outcomes, up to 30% of patients report postoperative pain in the first two years. This study aimed to synthesize current evidence on prognostic factors for predicting postoperative pain after knee or hip replacement. An umbrella review of systematic reviews was conducted to summarize the magnitude and quality of the evidence for prognostic preoperative factors predictive of postoperative chronic pain (>6 months after surgery) in patients who had received knee or hip replacement. Searches were conducted in MEDLINE, CINAHL, PubMed, PEDro, SCOPUS, Cochrane Library, and Web of Science databases from inception up to 5 August 2022 for reviews published in the English language. A narrative synthesis, a risk of bias assessment, and an evaluation of the evidence confidence were performed. Eighteen reviews (nine on knee surgery, four on hip replacement, and seven on both hip/knee replacement) were included. From 44 potential preoperative prognostic factors, just 20 were judged as having high or moderate confidence for robust findings. Race, opioid use, preoperative function, neuropathic pain symptoms, pain catastrophizing, anxiety, other pain sites, fear of movement, social support, preoperative pain, mental health, coping strategies, central sensitization-associated symptoms, and depression had high/moderate confidence for an association with postoperative chronic pain. Some comorbidities such as heart disease, stroke, lung disease, nervous system disorders, and poor circulation had high/moderate confidence for no association with postoperative chronic pain. This review has identified multiple preoperative factors (i.e., sociodemographic, clinical, psychological, cognitive) associated with postoperative chronic pain after knee or hip replacement. These factors may be used for identifying individuals at a risk of developing postoperative chronic pain. Further research can investigate the impact of using such prognostic data on treatment decisions and patient outcomes.
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Affiliation(s)
- César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), 28922 Alcorcón, Spain; (L.L.F.); (A.I.d.-l.-L.-R.); (R.O.-S.); (S.F.-N.)
- Department of Health Science and Technology, Center for Neuroplasticity and Pain (CNAP), SMI, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark;
| | - Lidiane L. Florencio
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), 28922 Alcorcón, Spain; (L.L.F.); (A.I.d.-l.-L.-R.); (R.O.-S.); (S.F.-N.)
| | - Ana I. de-la-Llave-Rincón
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), 28922 Alcorcón, Spain; (L.L.F.); (A.I.d.-l.-L.-R.); (R.O.-S.); (S.F.-N.)
| | - Ricardo Ortega-Santiago
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), 28922 Alcorcón, Spain; (L.L.F.); (A.I.d.-l.-L.-R.); (R.O.-S.); (S.F.-N.)
| | | | - Stella Fuensalida-Novo
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), 28922 Alcorcón, Spain; (L.L.F.); (A.I.d.-l.-L.-R.); (R.O.-S.); (S.F.-N.)
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Complutense University of Madrid, 28040 Madrid, Spain; (G.P.-M.); (J.A.V.-C.); (M.J.N.-S.)
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Lars Arendt-Nielsen
- Department of Health Science and Technology, Center for Neuroplasticity and Pain (CNAP), SMI, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark;
- Department of Medical Gastroenterology, Mech-Sense, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Juan A. Valera-Calero
- Department of Radiology, Rehabilitation and Physiotherapy, Complutense University of Madrid, 28040 Madrid, Spain; (G.P.-M.); (J.A.V.-C.); (M.J.N.-S.)
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Marcos J. Navarro-Santana
- Department of Radiology, Rehabilitation and Physiotherapy, Complutense University of Madrid, 28040 Madrid, Spain; (G.P.-M.); (J.A.V.-C.); (M.J.N.-S.)
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
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De Berardinis L, Senarighi M, Farinelli L, Qordja F, Gallo A, Spezia M, Gigante AP. In primary total hip arthroplasty, the direct anterior approach leads to higher levels of creatine kinase and lower levels of C-reactive protein compared to the posterolateral approach: a propensity score matching analysis of short-term follow-up data. J Orthop Surg Res 2023; 18:594. [PMID: 37568175 PMCID: PMC10416395 DOI: 10.1186/s13018-023-04084-x] [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: 04/24/2023] [Accepted: 08/07/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND This retrospective study compares the invasiveness of the direct anterior approach (DAA) and the posterolateral approach (PLA) in total hip arthroplasty (THA) by assessing three widely used inflammation-related serum markers in the first ten post-operative days. METHODS The database of our institution was mined for primary THAs conducted by the DAA or the PLA from February 2020 to June 2022. Demographics and creatine kinase (CK), C-reactive protein (CRP), and white blood cells were compared. Propensity Score Matching (PSM) analysis (1:1 ratio) was conducted based on multiple variables. RESULTS PSM analysis yielded 44 pairs of DAA and PLA patients. CK was significantly higher (p < 0.001) in the DAA than in the PLA group on postoperative day (POD) 2, 5 and 10. The POD2, POD5 and POD10 CK/preoperative CK ratio was 12.9, 5.0 and 0.8 in DAA and 8.8, 3.3 and 0.6 in PLA (p = 0.017, p = 0.012 and p = 0.025, respectively). The POD2, POD5 and POD10 CRP/preoperative CRP ratio was 95.1, 65.6 and 22.8 in PLA and 34.7, 23.3 and 8.9 in DAA (p < 0.001, p = 0.002 and p < 0.001, respectively). CONCLUSION PSM analysis of early postoperative CK and CRP values demonstrated that the DAA should be considered as a less stressful approach, not as a muscle-sparing or a minimally invasive THA approach.
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Affiliation(s)
- Luca De Berardinis
- Clinical Orthopedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/a, 60126, Ancona, AN, Italy.
| | - Marco Senarighi
- Clinical Orthopedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/a, 60126, Ancona, AN, Italy
| | - Luca Farinelli
- Clinical Orthopedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/a, 60126, Ancona, AN, Italy
| | - Fjorela Qordja
- Clinical Orthopedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/a, 60126, Ancona, AN, Italy
| | - Alberto Gallo
- Orthopedic Unit, Habilita Casa di Cura I Cedri, Via Don Guanella, 1, 28073, Fara Novarese, NO, Italy
| | - Marco Spezia
- Orthopedic Unit, Habilita Casa di Cura I Cedri, Via Don Guanella, 1, 28073, Fara Novarese, NO, Italy
| | - Antonio Pompilio Gigante
- Clinical Orthopedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/a, 60126, Ancona, AN, Italy
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