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Scanlon CM, Christensen T, Bieganowski T, Buehring W, Meftah M, Hepinstall MS. "Stuck in the middle": the missing lumbosacral link in total hip arthroplasty. Hip Int 2024; 34:482-486. [PMID: 38469810 DOI: 10.1177/11207000231223706] [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] [Indexed: 03/13/2024]
Abstract
INTRODUCTION Spinopelvic mobility drives functional acetabular position, influencing dislocation risk after total hip arthroplasty (THA). Patients have been described as "stuck sitting" or "stuck standing" based on pelvic tilt (PT). We hypothesised that some patients are "stuck in the middle," meaning their PT changes minimally from sitting to standing - increasing their risk of dislocation. METHODS We reviewed 195 patients with standing and sitting whole body radiographs prior to THA. Standing anterior pelvic plane tilt (APPT) and standing and sitting sacral slope (SS) were measured and used to calculate sitting APPT. Normal standing and sitting were defined as APPT >-10° and <-20°, respectively. Spinal stiffness was classified as <10° change in sacral slope between sitting and standing. Patients were categorised as: (A) able to fully sit and stand; (B) "stuck sitting" - able to fully sit; unable to fully stand; (C) "stuck standing" - able to fully stand; unable to fully sit; or (D) "stuck in the middle" - unable to sit or stand fully. RESULTS 84 patients could sit and stand normally (A), 22 patients were stuck sitting (B), 76 patients were stuck standing (C), and 13 patients were stuck in the middle (D). While 111 patients (56.9%) were considered stuck, only 58 patients (29.7%) met criteria for spinal stiffness. DISCUSSION We identified a subset of patients with stiff spines and abnormal PT in both sitting and standing, including 37.1% of patients who would be classified as "stuck sitting" based only on standing radiographs. Placing acetabular components in less than anatomic anteversion in these patients may increase posterior dislocation risk.
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Affiliation(s)
| | - Thomas Christensen
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Thomas Bieganowski
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Weston Buehring
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Morteza Meftah
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
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Secrist ES, Boutelle K, Pekas DR, Neal DC, Adrados M, Moskal JT, Coobs BR. Surgical Approach Does Not Influence Instability Risk in Revision Total Hip Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00586-2. [PMID: 38871065 DOI: 10.1016/j.arth.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 06/02/2024] [Accepted: 06/04/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Although the direct anterior (DA) approach has increased in popularity for primary total hip arthroplasty (THA), there is limited evidence regarding its use for revision THA. It is unknown whether the dislocation benefit seen in the primary setting translates to revision cases. METHODS This retrospective review compared the dislocation rates of revision THA performed through DA versus postero-lateral (PL) approaches at a single institution (2011 to 2021). Exclusion criteria included revision for instability, ≥ 2 prior revisions, approaches other than DA or PL, and placement of dual-mobility or constrained liners. There were 182 hips in 173 patients that met the inclusion criteria. The average follow-up was 6.5 years (range, 2 to 8 years). RESULTS There was a trend toward more both-component revisions being performed through the PL approach. There were no differences in dislocation rates between the DA revision and PL revision cohorts, which were 8.1% (5 of 72) and 7.5% (9 of 120), respectively (P = .999). Dislocation trended lower when the revision approach was discordant from the primary approach compared to cases where primary and revision had a concordant approach (4.9 versus 8.5%), but this was not statistically significant (P = .740). No significant differences were found in return to operating room, 90-day emergency department visits, or 90-day readmissions. However, the length of stay was significantly shorter in patients who had DA revisions after a primary PL procedure (P = .021). CONCLUSIONS Dislocation rates following revision THA did not differ between the DA and PL approaches irrespective of the primary approach. Surgeons should choose their revision approach based on their experience and the specific needs of the patient.
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Affiliation(s)
- Eric S Secrist
- Department of Orthopaedic Surgery, Carilion Clinic Institute for Orthopaedics & Neurosciences, Roanoke, Virginia
| | - Kelly Boutelle
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Devon R Pekas
- Department of Orthopaedic Surgery, Carilion Clinic Institute for Orthopaedics & Neurosciences, Roanoke, Virginia
| | - David C Neal
- Department of Orthopaedic Surgery, Carilion Clinic Institute for Orthopaedics & Neurosciences, Roanoke, Virginia
| | - Murillo Adrados
- Department of Orthopaedic Surgery, Carilion Clinic Institute for Orthopaedics & Neurosciences, Roanoke, Virginia; Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Joseph T Moskal
- Department of Orthopaedic Surgery, Carilion Clinic Institute for Orthopaedics & Neurosciences, Roanoke, Virginia; Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Benjamin R Coobs
- Department of Orthopaedic Surgery, Carilion Clinic Institute for Orthopaedics & Neurosciences, Roanoke, Virginia; Virginia Tech Carilion School of Medicine, Roanoke, Virginia
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Iturregui JM, Sebro R, Baranek M, Garner HW, Stanborough RO, Goulding KA, Ledford CK, Wilke BK. Direct anterior approach associated with lower dislocation risk after primary total hip arthroplasty in patients with prior lumbar spine fusion. Hip Int 2023; 33:1043-1048. [PMID: 36891586 DOI: 10.1177/11207000231155797] [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] [Indexed: 03/10/2023]
Abstract
BACKGROUND While there has been much interest in the increased dislocation rate in total hip arthroplasty (THA) patients with a lumbar spine fusion (LSF), there is minimal literature comparing the risk based on surgical approach. The purpose of this study was to determine if a direct anterior (DA) approach was protective against dislocation when compared to the anterolateral and posterior approaches in this high-risk patient population. METHODS A retrospective review was performed of 6554 THAs performed at our institution from January 2011 to May 2021. 294 (4.5%) patients had a prior LSF and were included in the analysis. The surgical approach, timing of LSF in relation to THA, vertebral levels fused, timing of THA dislocation, and the need for revision surgery were recorded for statistical analysis. RESULTS In total, 39.7.3% of patients underwent a DA approach (n = 117), 25.9% underwent an anterolateral approach (n = 76), and 34.3% underwent a posterior approach (n = 101). There was no difference in number of vertebral levels fused between groups (mean 2.5, all p > 0.05). There was a total of 13 (4.4%) THA dislocation events, with an average time from surgery to dislocation of 5.6 months (0.3-30.5 months). There were fewer dislocations in the DA cohort (0.9%) in comparison to both the anterolateral (6.6%, p = 0.036) and posterior groups (6.9%, p = 0.026). CONCLUSIONS The DA approach demonstrated a significantly lower THA dislocation rate compared to both the anterolateral and posterior approaches in patients with a concomitant LSF.
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Affiliation(s)
- Jose M Iturregui
- Department of Orthopaedic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Ronnie Sebro
- Department of Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Morgan Baranek
- Department of Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Hillary W Garner
- Department of Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | | | - Krista A Goulding
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Cameron K Ledford
- Department of Orthopaedic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Benjamn K Wilke
- Department of Orthopaedic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
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Borsinger TM, Chandi SK, Puri S, Debbi EM, Blevins JL, Chalmers BP. Total Hip Arthroplasty: An Update on Navigation, Robotics, and Contemporary Advancements. HSS J 2023; 19:478-485. [PMID: 37937097 PMCID: PMC10626925 DOI: 10.1177/15563316231193704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/05/2023] [Indexed: 11/09/2023]
Abstract
While total hip arthroplasty (THA) remains effective for improvement of pain and function in patients with osteoarthritis and avascular necrosis, there remain areas of continued pursuit of excellence, including decreasing rates of dislocation, leg length discrepancy, implant loosening, and infection. This review article covers several bearing surfaces and articulations, computer-assisted navigation and robotic technology, and minimally invasive surgical approaches that have sought to improve such outcomes. Perhaps the most significant improvement to THA implant longevity has been the broad adoption of highly cross-linked polyethylene, with low wear rates. Similarly, navigation and robotic technology has proven to more reproducibly achieve intraoperative component positioning, which has demonstrated clinical benefit with decreased risk of dislocation in a number of studies. Given the projected increase in THA over the coming decades, continued investigation of effective incorporation of technology, soft tissue-sparing approaches, and durable implants is imperative to continued pursuit of improved outcomes in THA.
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Affiliation(s)
- Tracy M Borsinger
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Sonia K Chandi
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Simarjeet Puri
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Eytan M Debbi
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Jason L Blevins
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Brian P Chalmers
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
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Driesman A, Yang CC. Clinical outcomes of DAA and related techniques in hip arthroplasty. ARTHROPLASTY 2023; 5:42. [PMID: 37653546 PMCID: PMC10472647 DOI: 10.1186/s42836-023-00198-z] [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: 04/05/2023] [Accepted: 06/14/2023] [Indexed: 09/02/2023] Open
Abstract
Total hip arthroplasty (THA) has been one of the most successful surgical interventions in recent memory and is nicknamed by some the "Surgery of the Century". Over the past decade, there has been a drastic change in THA management with the rise of the direct anterior approach both globally and in the USA market. While many would remark that this has been driven by false marketing, it is clear that the direct anterior approach can be an effective and safe way to perform a THA.It is the goal of this review to highlight evidence of its outcomes and clinical advantages, in particular, how it can decrease dislocation, even in high-risk individuals, and result in faster recovery in the early postoperative period with decreased muscular inflammation. We will also highlight its major disadvantages, including but not limited to increased wound complications and risk for periprosthetic fracture. Hopefully, this review will provide up-to-date information on the current state of the direct anterior approach and provide recommendations on patients that would be optimal candidates for this technique.
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Brush PL, Santana A, Toci GR, Slotkin E, Solomon M, Jones T, Saxena A. Surgeon Estimations of Acetabular Cup Orientation Using Intraoperative Fluoroscopic Imagining Are Unreliable. Arthroplast Today 2023; 20:101109. [PMID: 36938353 PMCID: PMC10018435 DOI: 10.1016/j.artd.2023.101109] [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: 09/09/2022] [Revised: 12/12/2022] [Accepted: 01/22/2023] [Indexed: 03/21/2023] Open
Abstract
Background Accurate acetabular cup orientation is associated with decreased revision rates and improved outcomes of primary total hip arthroplasty. This study assesses surgeon's ability to estimate both the acetabular component inclination and anteversion angles via intraoperative fluoroscopy (IF) images. Methods We surveyed orthopedic surgeons to estimate acetabular component inclination and anteversion based on 20 IF images of total hip arthroplasty through a direct anterior approach. Postoperative computed-tomography scans were used to calculate the true inclination and anteversion component angles. The absolute difference between the true and estimated values was calculated to determine the mean and standard deviation of the survey results. Interrater reliability was determined through interclass correlation coefficients. Results A majority of surgeons preferred the direct anterior approach (83.3%) and utilized IF during surgery (70%). Surgeons surveyed were on average 5.9° away from the true value of inclination (standard deviation = 4.7) and 8.8° away from the true value of anteversion (standard deviation = 6.0). Respondents were within 5° of both inclination and anteversion in 19.7% of cases, and within 10° in 57.3% of cases. All surgeons were determined to have poor reliability in estimating anteversion (interclass correlation coefficient < 0.5). Only 2 surgeons were determined to have moderate reliability when estimating inclination. Conclusions Surgeons, when solely relying on IF for the estimation of anteversion and inclination, are unreliable. Utilization of other techniques in conjunction with IF would improve observer reliability.
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Affiliation(s)
- Parker L. Brush
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
- Corresponding author. Rothman Orthopaedic Institute, 925 Chestnut Street, Philadelphia, PA, USA. Tel.: +1 316 993 3876.
| | - Adrian Santana
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Gregory R. Toci
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Eric Slotkin
- Orthopaedic Associates of Reading, Tower Health, Reading Hopsital, West Reading, PA, USA
| | - Michael Solomon
- Sydney Orthopaedic Specialists, Prince of Wales Private Hospital, Randwick, Australia
| | | | - Arjun Saxena
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
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Fontalis A, Raj RD, Kim WJ, Gabr A, Glod F, Foissey C, Kayani B, Putzeys P, Haddad FS. Functional implant positioning in total hip arthroplasty and the role of robotic-arm assistance. INTERNATIONAL ORTHOPAEDICS 2023; 47:573-584. [PMID: 36496548 PMCID: PMC9877061 DOI: 10.1007/s00264-022-05646-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Accurate implant positioning, tailored to the phenotype and unique biomechanics of each patient is the single most important objective in achieving stability in THA and maximise range of motion. The spine-pelvis-hip construct functions as a single unit adapting to postural changes. It is widely accepted in the literature that no universaltarget exists and variations in spinopelvic mobility mandate adjustments to the surgical plan; thus bringing to the fore the concept of personalised, functional component positioning. METHODS This manuscript aims to outline the challenges posed by spinopelvic imbalance and present a reproducible, stepwise approach to achieve functional-component positioning. We also present the one-year functional outcomes and Patient Reported Outcome Measures of a prospective cohort operated with this technique. RESULTS AND CONCLUSION Robotic-arm assisted Total Hip Arthroplasty has facilitated enhanced planning based on the patient's phenotype and evidence suggests it results in more reproducible and accurate implant positioning. Preservation of offset, avoiding leg-length discrepancy, accurate restoration of the centre of rotation and accomplishing the combinedversion target are very important parameters in Total Hip Arthroplasty that affect post-operative implant longevity, patient satisfaction and clinical outcomes.
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Affiliation(s)
- Andreas Fontalis
- grid.439749.40000 0004 0612 2754Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK ,grid.83440.3b0000000121901201Division of Surgery and Interventional Science, University College London, Gower Street, London, WC1E 6BT UK
| | - Rhody David Raj
- grid.439749.40000 0004 0612 2754Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
| | - Woo Jae Kim
- grid.439749.40000 0004 0612 2754Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
| | - Ayman Gabr
- grid.439749.40000 0004 0612 2754Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
| | - Fabrice Glod
- Hôpitaux Robert Schuman, Luxembourg City, Luxembourg
| | - Constant Foissey
- grid.413306.30000 0004 4685 6736Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence, Lyon, France
| | - Babar Kayani
- grid.439749.40000 0004 0612 2754Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
| | | | - Fares S. Haddad
- grid.439749.40000 0004 0612 2754Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK ,grid.83440.3b0000000121901201Division of Surgery and Interventional Science, University College London, Gower Street, London, WC1E 6BT UK
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8
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Jo S, Lee HJ, Lim WB, Lee HJ, Choi SK. Driving Simulator Brake Reaction Parameters After Total Hip Arthroplasty According to Different Surgical Approaches. J Arthroplasty 2022; 37:1809-1815. [PMID: 35398522 DOI: 10.1016/j.arth.2022.04.001] [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: 02/07/2022] [Revised: 03/31/2022] [Accepted: 04/02/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The aim of this study is to validate the point of normalization of braking following total hip arthroplasty (THA) and to determine the relevance of the surgical approach. METHODS Brake reaction parameters (BRPs), including brake reaction time, total brake time, and brake pedal depression force were measured in 90 patients who underwent primary arthroplasty of the right hip (42 with direct anterior approach and 48 with posterolateral approach) using a modern driving simulator. The driving parameters were measured preoperatively and every 2 weeks postoperatively until the eighth week. BRPs were measured in 40 subjects without hip problems, and the results were used as a control. Statistical assessment was performed to analyze when the patients' reaction to braking recovered to that of the control group with respect to different surgical approaches and also according to the pain. RESULTS Preoperative BRPs of the patients undergoing THA were prolonged compared to the control group and were normalized at the sixth week following the operation. Although BRPs of the direct anterior approach group showed significantly better improvement compared to the posterolateral approach group (total brake time at week 2, brake reaction time and brake pedal depression at week 4), both groups reached baseline value at week 6. In addition, we found no correlation between the pain score and BRPs. CONCLUSION The results of the current study indicate that the response to braking events normalizes at 6 weeks following THA in young active patients and is irrelevant to the surgical approach.
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Affiliation(s)
- Suenghwan Jo
- Department of Orthopaedic Surgery, Chosun University Hospital, Gwangju, South Korea; Chosun University, School of Medicine, Gwangju, South Korea
| | - Hyeon Joon Lee
- Department of Orthopaedic Surgery, Chosun University Hospital, Gwangju, South Korea
| | - Won Bong Lim
- Chosun University, School of Medicine, Gwangju, South Korea
| | - Hyo Jun Lee
- Department of Orthopaedic Surgery, Chosun University Hospital, Gwangju, South Korea
| | - Soo Kyung Choi
- Chosun University, School of Medicine, Gwangju, South Korea
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Galvain T, Mantel J, Kakade O, Board TN. Treatment patterns and clinical and economic burden of hip dislocation following primary total hip arthroplasty in England. Bone Joint J 2022; 104-B:811-819. [PMID: 35775184 PMCID: PMC9251137 DOI: 10.1302/0301-620x.104b7.bjj-2021-1732.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Aims The aim of this study was to estimate the clinical and economic burden of dislocation following primary total hip arthroplasty (THA) in England. Methods This retrospective evaluation used data from the UK Clinical Practice Research Datalink database. Patients were eligible if they underwent a primary THA (index date) and had medical records available 90 days pre-index and 180 days post-index. Bilateral THAs were excluded. Healthcare costs and resource use were evaluated over two years. Changes (pre- vs post-THA) in generic quality of life (QoL) and joint-specific disability were evaluated. Propensity score matching controlled for baseline differences between patients with and without THA dislocation. Results Among 13,044 patients (mean age 69.2 years (SD 11.4), 60.9% female), 191 (1.5%) had THA dislocation. Two-year median direct medical costs were £15,333 (interquartile range (IQR) 14,437 to 16,156) higher for patients with THA dislocation. Patients underwent revision surgery after a mean of 1.5 dislocations (1 to 5). Two-year costs increased to £54,088 (IQR 34,126 to 59,117) for patients with multiple closed reductions and a revision procedure. On average, patients with dislocation had greater healthcare resource use and less improvement in EuroQol five-dimension index (mean 0.24 (SD 0.35) vs 0.44 (SD 0.35); p < 0.001) and visual analogue scale (0.95 vs 8.85; p = 0.038) scores, and Oxford Hip Scores (12.93 vs 21.19; p < 0.001). Conclusion The cost, resource use, and QoL burden of THA dislocation in England are substantial. Further research is required to understand optimal timing of revision after dislocation, with regard to cost-effectiveness and impact on QoL. Cite this article: Bone Joint J 2022;104-B(7):811–819.
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Affiliation(s)
- Thibaut Galvain
- Global Health Economics, Johnson and Johnson Medical Devices, New Brunswick, New Jersey, USA
| | - Jack Mantel
- Health Economics and Market Access, DePuy Synthes, Leeds, UK
| | | | - Tim N Board
- Centre for Hip Surgery, Wrightington Hospital, Wigan, UK
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Scott CEH, Clement ND, Davis ET, Haddad FS. Modern total hip arthroplasty: peak of perfection or room for improvement? Bone Joint J 2022; 104-B:189-192. [PMID: 35094584 DOI: 10.1302/0301-620x.104b2.bjj-2022-0007] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Chloe E H Scott
- Royal Infirmary of Edinburgh, Edinburgh, UK.,The Bone & Joint Journal , London, UK.,Bone & Joint Research , London, UK.,University of Edinburgh, Edinburgh, UK
| | | | | | - Fares S Haddad
- The Bone & Joint Journal , London, UK.,University College London Hospitals, The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, UK
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11
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Fontalis A, Berry DJ, Shimmin A, Slullitel PA, Buttaro MA, Li C, Malchau H, Haddad FS. Prevention of early complications following total hip replacement. SICOT J 2021; 7:61. [PMID: 34851264 PMCID: PMC8634898 DOI: 10.1051/sicotj/2021060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 10/29/2021] [Indexed: 01/01/2023] Open
Abstract
Total hip arthroplasty (THA) has been quoted as "the operation of the century", owing to its efficacy and the substantial improvements evidenced with respect to functional patient outcomes and quality of life. However, early postoperative complications are often inevitable, hence it is imperative to take every step to prevent them and minimise morbidity and mortality. This manuscript focuses on the most common early complications following THA, namely venous thromboembolism (VTE), prosthetic joint infection, periprosthetic fracture, instability, and leg length inequality. It aims to outline effective risk stratification strategies and prevention measures that could apply to the wider Orthopaedic community.
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Affiliation(s)
- Andreas Fontalis
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals, London NW1 2BU, UK - University College London, Division of Surgery and Interventional Science, Gower Street, London, WC1E 6BT, UK
| | | | - Andrew Shimmin
- Melbourne Orthopaedic Group, Windsor, Victoria 3181, Australia - Monash University, Windsor, Ontario N9B 3P4, Australia
| | - Pablo A Slullitel
- Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Martin A Buttaro
- Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Cao Li
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, 137 South LiYuShan Road, Urumqi, Xinjiang 830054, China
| | - Henrik Malchau
- Harvard Medical School, Harvard University, Boston, MA 02115, USA
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals, London NW1 2BU, UK - University College London, Division of Surgery and Interventional Science, Gower Street, London, WC1E 6BT, UK
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12
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Shi T, Wang Q, Shen S, Shi Y, Huang J, Lu K, Jiang Q. The influence of different THA surgical approaches on Patient's early postoperative anxiety and depression. BMC Musculoskelet Disord 2021; 22:858. [PMID: 34625082 PMCID: PMC8501680 DOI: 10.1186/s12891-021-04746-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/24/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Total hip arthroplasty (THA) is generally considered to be one of the most successful orthopedic surgical procedures. However, no research has been conducted on the postoperative mental health of patients who underwent different approaches of THA. This paper seeks to compare the differences among three THA approaches: the normal lateral approach (NLA), the direct anterior approach (DAA) and the orthopädische chirurgie münchen (OCM) regarding their influence on patients' postoperative anxiety and depression. METHOD A total of 95 THA patients were recruited for this study. All patients' preoperative information including results of Harris, SF-36 and Visual Analogue Scale (VAS) was carefully evaluated. Surgery-related data as well as five-day postoperative data were also collected. Three months after the surgery, a telephone follow-up was conducted to further evaluate patients' HADS and SF-36 results. RESULT In the three-month postoperative evaluation of anxiety and depression, the NLA group scored significantly higher than both the DAA group and the OCM group, which was found relevant to the patient's incision length and five-day postoperative VAS results. A correlation between anxiety scores and the days of postoperative hospitalization was also noticed. Further analysis of patients' psychological state based on the SF-36 results revealed considerable differences in viability (VT) and social function (SF) between the NLA group and the OCM group. Other surgery-related data and postoperative data all demonstrated better results of the DAA group and the OCM group compared to the NLA group. CONCLUSION Among the three different surgical approaches of THA, DAA and OCM compared with NLA are found to ease patients' postoperative anxiety and depression. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Tianshu Shi
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, PR China
| | - Qianjin Wang
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, PR China
| | - Siyu Shen
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, PR China
| | - Yong Shi
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, PR China
| | - Jian Huang
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Ke Lu
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, 60612, USA.
| | - Qing Jiang
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, PR China.
- Laboratory for Bone and Joint Disease, Model Animal Research Center (MARC), Nanjing University, Nanjing, 210093, Jiangsu, PR China.
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Clohisy JC, Haddad FS. The Hip Society Members Meeting 2020 and 2021 awards. Bone Joint J 2021. [PMID: 34192908 DOI: 10.1302/0301-620x.103b7.bjj-2021-0847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- John C Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Fares S Haddad
- Editor-in-Chief, University College London Hospitals NHS Foundation Trust, London, UK.,The Bone & Joint Journal, London, UK
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