Modern total hip arthroplasty: peak of perfection or room for improvement?

Effects of Predictive Nursing Process on Elderly Patients with Total Hip Arthroplasty

Elderly individuals represent a significant demographic undergoing total hip arthroplasty, with distinct risks and complications. The study aimed to determine whether predictive nursing, guided by risk assessment, could reduce these risks and improve patient outcomes. A total of 191 elderly patients undergoing total hip arthroplasty were included in the study, with 142 patients randomly assigned to either the control or observation groups. The control group received routine care, while the observation group received predictive nursing based on comprehensive risk assessment. Various assessment tools were employed to evaluate risks such as venous thrombosis, pressure injuries, falls, joint dislocation, infections, and psychological factors. The primary outcomes included functional improvement measured by the Harris Hip Score, Activities of Daily Living (ADL), anxiety levels, and patient satisfaction. Our study demonstrated that predictive nursing interventions, guided by comprehensive risk assessment, yielded significant reductions in postoperative complications, particularly deep vein thrombosis, in elderly patients undergoing total hip arthroplasty. In addition, patients who received predictive nursing care experienced notable benefits, including shorter hospital stays, heightened satisfaction levels, enhanced hip function, improved ADL scores, and reduced anxiety levels compared with those receiving standard care. The study underscores the substantial benefits of predictive nursing interventions guided by risk assessment in improving outcomes for elderly patients undergoing total hip arthroplasty, highlighting the potential of individualized nursing care to optimize postoperative recovery and enhance patient well-being.

Can Robot-Assisted Total Hip Arthroplasty Improve the Incidence of Self-Reported Leg-Length Discrepancy? A Multicenter, Propensity Score Matching Comparative Study

BACKGROUND

Patients often report leg-length discrepancy (LLD) after total hip arthroplasty (THA). The factors behind self-reported LLD (sLLD) are unclear. Robot-assisted THA (RA-THA) offers improved precision, but its effect on sLLD has not been well studied. This study aimed to assess RA-THA's benefits in reducing sLLD and identify impacting factors.

METHODS

Patients who underwent RA-THA or conventional THA (CON-THA) at three Chinese hospitals were reviewed. Propensity score matching was used to match the RA-THA and CON-THA groups by preoperative data. Initially, 215 patients were enrolled; nine were excluded. The RA-THA group had 102 patients, and the CON-THA group had 104. After propensity score matching, 74 patients remained in each group. Postoperative outcomes, including imaging data, clinical scores, and sLLD, were compared. Patients were categorized by whether the measured LLD (mLLD) postsurgery was less than 10 mm. Disparities in data and surgical methods were compared. Univariate and multivariate logistic regression analyses identified sLLD predictors.

RESULTS

The RA-THA group showed better postoperative mLLD, cup anteversion, inclination, and offset discrepancy, but no significant differences in sLLD at 3 years. The RA-THA percentage was higher in the mild LLD group (59.4%) and lower in the severe LLD group (32.7%). Patients who had mild LLD had a lower proportion of sLLD at 3 years. Logistic regression identified preoperative mLLD, preoperative Harris Hip Score (HHS), postoperative mLLD, and postoperative HHS as significant predictors of sLLD.

CONCLUSIONS

The RA-THA may not significantly reduce sLLD. Key predictors of sLLD included preoperative mLLD, preoperative HHS, postoperative mLLD, and postoperative HHS, highlighting the need for thorough preoperative assessment and patient education for better outcomes and satisfaction.

Biomechanical properties of tetrahedral microstructure for design of the porous stem in total hip arthroplasty

Different internal strut architectures affect the biomechanical performance of porous lattice structures. This study aims to investigate these properties under various conditions using different methods.The finite element simulations of tetrahedral microstructures were conducted with varying internal strut thicknesses under different loads. The effective elastic modulus from compression tests aligned with the homogenization results. However, both the number and size of unit cells can influence the modulus at identical porosity levels. Smaller unit cell sizes demonstrated superior mechanical properties while utilizing less material.

Analysis of the causes of poor incision healing after hip and knee surgery and review of the literature

OBJECTIVE

A retrospective study was conducted to analyze the specific causes and literature review of patients who developed poor incision healing problems after hip and knee surgery.

METHODS

This was a retrospective analysis of 250 patients admitted to the Department of Orthopedics and Traumatology of the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from October 1, 2022 to August 14, 2023 for hip and knee surgery. Among them, patients, 27 males and 39 females, were found to have poor incision healing after surgery; their ages ranged from 22 - 79 years, with an average of 58.71 years; and the patients developed symptoms of poor surgical incision healing from 1 - 8 months after surgery, with an average of 2.3 months. The causes of poor incision healing after hip and knee surgery were analyzed with reference to previously documented clinical data and relevant literature.

RESULTS

According to this data, it was concluded that the surgeon's inexperience in surgical incision suturing, unskilled suturing technique, inaccurate suture selection, etc., led to the occurrence of surgical incision healing problems, which accounted for 77.28% of the cases. The patient's age, lifestyle habits, BMI, and other underlying diseases (e.g., diabetes mellitus, rheumatoid arthritis, etc.) caused poor postoperative incision healing in 22.73% of cases.

CONCLUSION

Poor intraoperative suturing by the surgeon was the main cause of poor incision healing after hip and knee arthroplasty, which can be avoided by good suturing and strict postoperative dressing changes and nursing care.

Comparing functional outcomes between 3D printed acetabular cups and traditional prosthetic implants in hip arthroplasty: a systematic review and meta analysis

OBJECTIVE

The primary research aim was to determine if the use of traditional or 3D printed prosthesis resulted in better functional outcome scores in hip arthroplasty.

METHODS

A systematic review and meta-analysis was conducted utilizing the PRISMA 2020 guidelines. Six databases (PubMed, Embase, Scopus, WebOfScience, and Cochrane Library, Google Scholar) were searched yielding 1117 article titles and abstracts. Rayyan.ai was used to detect duplicates (n = 246) and for manual screening for inclusion and exclusion criteria. Included were controlled studies of any publication time that assessed Harris Hip Score (HHS) at baseline and twelve months. Six papers were sought for full text review of which three studies totaling 195 hips met final inclusion.

RESULTS

Mean HHS in the control group went from 38.15 (± 6.02) at baseline to 80.30 (± 4.79) at twelve months follow-up, while the 3D group saw a change from 37.81 (± 5.84) to 90.60 (± 4.49). Significant and large improvements between time points were seen within the control group [p = .02, Cohen's d = 8.57 (1.48, 15.56)] and 3D group [p < 0.01, Cohen's d = 9.18 (3.50, 14.86)]. The HHS score of the 3D group improved by 10.64 points more than the HHS score of the control group, which is a statistically insignificant (p = 0.89) amount.

CONCLUSION

Group differences in pooled mean HHS scores at twelve months follow-up surpassed established minimum differences for clinical importance. High quality research should be further pursued to elucidate these findings.

Assessment of pain intensity after total hip arthroplasty using the Visual Analogue Scale (VAS)

This study aimed to assess pain intensity in patients who underwent total hip arthroplasty (THA) using the Visual Analogue Scale (VAS). The study was conducted between 2022 and 2023, enrolling 203 patients admitted to the Orthopedics Department. Participants self-reported their post-surgical pain 24 hours after THA by selecting a VAS rating that best represented their personal experience. Based on their diagnosis, participants were categorized into four relatively homogeneous groups: left-sided coxarthrosis, right-sided coxarthrosis, unilateral THA for bilateral coxarthrosis, and bilateral THA for bilateral coxarthrosis. Data were analyzed using SPSS, with frequency analysis performed using the chi-square (χ2) test. Pain intensity in patients undergoing uncemented THA ranged from mild irritation to pain requiring moderate analgesics. The statistical analysis revealed significant differences in pain frequencies across groups (χ2 (24, 203) = 37.192; P = 0.04), with variations largely attributable to the type of THA performed. VAS scores indicated that patients with unilateral THA for coxarthrosis reported moderate pain lasting up to 30 minutes, necessitating moderate-intensity analgesics. In contrast, participants undergoing bilateral THA experienced more severe pain, requiring the administration of strong analgesics for effective pain relief and increased functionality. Among surgical procedures, uncemented total hip prostheses were associated with the highest frequency of manageable pain, characterized as irritation or mild discomfort requiring moderate analgesics.

Role of Preoperative Information and Education of Patients Undergoing Total Hip Arthroplasty: A Narrative Review of the Literature

Total hip arthroplasty (THA) is a common and highly effective surgical procedure used to relieve pain and improve function in patients with severe hip arthritis and other hip disorders. While the surgical techniques and implants used in THA have advanced significantly, the importance of preoperative information and education cannot be overstated. The aim of this narrative review is to explore the effect of preoperative information and education on the outcome of THA. Key components of preoperative education and information include detailed information about the operation itself, the preoperative preparation, the postoperative pain management and rehabilitation, the possibility of postoperative complications, psychosocial support, and answers to frequently asked questions. The results of the study have confirmed the contradictory findings found in the literature concerning the impact of preoperative education on THA clinical outcomes, including pain, anxiety, functionality, postoperative rehabilitation, duration of hospitalization, and rate of complications. While, theoretically, preoperative education should have a positive effect on clinical outcomes, a plethora of studies have failed to support this hypothesis. Thus, there is a great need for properly designed, prospective, randomized, and controlled studies that have sufficient power in order to fully elucidate the role of preoperative education and information on THA outcomes.

Press-fit vs threaded acetabulum components for total hip arthroplasty - A systematic review with metanalysis

Background

Threaded acetabular components (TACs) have been shown to offer greater initial stability compared to press-fit acetabular components (PFACs). Despite these biomechanical advantages, the use of threaded cups remains. This study compares the outcomes of TACs to PFACs in total hip arthroplasty (THA), providing evidence-based data regarding their failure rates and radiological evaluation.

Methods

A meticulous research of PubMed and MEDLINE databases, following the PRISMA guidelines, was conducted, to identify all articles regarding the outcome of the use of TCAs compared to PFACs in THA. Subsequently, statistical analysis with metanalysis concerning: 1) the instances of revision due to aseptic loosening and 2) the radiological evaluations of TACs compared to PFACs and sensitivity analysis were performed.

Results

This metanalysis encompassed seven studies, enrolling 7878 cases of THA utilizing PFAC, and 6684 cases using TAC. The overall odds ratio (OR) for revision due to aseptic loosening in THA using PFAC compared to TAC was 3.10 (95 % CI 0.37-25.72). Additionally, when assessing radiolucency findings across the same categories, the pooled OR was 0.53 (95 % CI 0.26-1.08). An examination of studies with larger sample sizes revealed no statistically significant variance. After adjusting for age, no substantial difference was detected. However, upon gender adjustment, it was observed that females undergoing THA with PFAC had a 5-fold risk of revision (OR = 5.26, 95 % CI 0.25-111.91, p-value = 0.29) compared to females with TAC, although without reaching statistical significance. Moreover, females exhibited a slightly elevated risk for revision due to aseptic loosening post-PFAC THA compared to males [(OR = 5.26, 95 % CI 0.25-111.91) (OR = 2.51, 95 % CI 0.01-1051.68) respectively], and for radiolucency findings [(OR 0.74, 95 % CI 0.20-1.11) (OR 0.29, 95 % CI 0.03-3.36) respectively].

Conclusions

The PFACs remain the main option for total hip reconstruction, while TACs might be a viable alternative, especially in cases of osteoporosis.

To Stage or Not to Stage? Comparison of Patient-Reported Outcomes, Complications, and Discharge Disposition After Staged and Simultaneous Bilateral Posterior Total Hip Arthroplasty

BACKGROUND

Patients who have bilateral hip arthritis can be treated with bilateral total hip arthroplasty (bTHA) in either a staged or simultaneous fashion. The goal of this study was to determine whether staged and simultaneous posterior bTHA patients differ in regard to (1) patient-reported outcome measures, (2) 90-day complication rates, and (3) discharge dispositions and cumulative lengths of stay.

METHODS

Patients who (1) underwent simultaneous bTHA or staged bTHA (within 12 months) using the posterior approach, and (2) completed preoperative and 1-year postoperative Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement surveys were included in the study. A total of 266 patients (87 simultaneous bTHA and 179 staged bTHA) were included. Chart review was performed to collect patient-level variables, postoperative complications, discharge dispositions, and lengths of stay.

RESULTS

Staged bTHA patients had higher Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement, Lower Extremity Activity Scale, and Veterans RAND 12-Item Health Survey physical component scores compared to simultaneous bTHA patients at 6 weeks after surgery (P = .019, .006, and .008, respectively), but these differences did not meet the minimal clinically important difference threshold for any questionnaire. Simultaneous bTHA was associated with higher rate of periprosthetic fractures (P = .034) and discharge to a location other than home (P < .001).

CONCLUSIONS

There were statistically significant, but likely not clinically meaningful differences in patient-reported outcomes for staged and simultaneous bTHA patients at 6 weeks after surgery. Surgeons should be aware of the higher periprosthetic fracture risk and greater likelihood of discharge to a rehabilitation facility associated with simultaneous bTHA. Further research should aim to understand which patients may benefit most from simultaneous bTHA.

Does Artificial Intelligence Outperform Humans Using Fluoroscopic-Assisted Computer Navigation for Total Hip Arthroplasty?

Background

Successful total hip arthroplasty (THA) relies on the correct implant position. THA accuracy can be improved with the use of intraoperative fluoroscopic-assisted computer navigation. Artificial intelligence (AI) software may enhance fluoroscopic navigation; however, the accuracy of the AI compared to human-controlled software in assessing acetabular component position and leg length discrepancy (LLD) has not been studied.

Methods

We analyzed 420 consecutive primary THAs performed by a single surgeon using fluoroscopic-assisted computer navigation software. The first cohort of 211 patients required inputs from a human technician (manual), while the second cohort of 209 patients used an automated version of the software controlled by AI. The intraoperative acetabular component placement (inclination and anteversion) and LLD were recorded and compared to the 2-week postoperative standing anterior-posterior pelvis radiograph.

Results

Ninety-four percent (199/211) of cups in the manual cohort and 95% (198/209) of cups in the AI cohort were within the Lewinnek "safe-zone" (P = 1.0). In the manual cohort, 69% (146/211) of THAs had a final LLD within ±2 mm of the intraoperatively navigated LLD (ie, ΔLLD ≤2 mm). In the AI cohort, 66% (137/209) of THAs had a final LLD within ±2 mm of the intraoperatively navigated LLD (P = .47). Ninety-nine percent (209/211) of hips in the manual cohort and 98% (205/209) of hips in the AI cohort had a final LLD within ±5 mm of the intraoperatively navigated LLD (P = .45).

Conclusions

Both AI and human-controlled versions of the same navigation platform were similarly accurate for navigating cup position within the Lewinnek "safe zone" and LLD accuracy.

A prospective randomized controlled trial comparing CT-based planning with conventional total hip arthroplasty versus robotic arm-assisted total hip arthroplasty

Aims

Achieving accurate implant positioning and restoring native hip biomechanics are key surgeon-controlled technical objectives in total hip arthroplasty (THA). The primary objective of this study was to compare the reproducibility of the planned preoperative centre of hip rotation (COR) in patients undergoing robotic arm-assisted THA versus conventional THA.

Methods

This prospective randomized controlled trial (RCT) included 60 patients with symptomatic hip osteoarthritis undergoing conventional THA (CO THA) versus robotic arm-assisted THA (RO THA). Patients in both arms underwent pre- and postoperative CT scans, and a patient-specific plan was created using the robotic software. The COR, combined offset, acetabular orientation, and leg length discrepancy were measured on the pre- and postoperative CT scanogram at six weeks following surgery.

Results

There were no significant differences for any of the baseline characteristics including spinopelvic mobility. The absolute error for achieving the planned horizontal COR was median 1.4 mm (interquartile range (IQR) 0.87 to 3.42) in RO THA versus 4.3 mm (IQR 3 to 6.8; p < 0.001); vertical COR mean 0.91 mm (SD 0.73) in RO THA versus 2.3 mm (SD 1.3; p < 0.001); and combined offset median 2 mm (IQR 0.97 to 5.45) in RO THA versus 3.9 mm (IQR 2 to 7.9; p = 0.019). Improved accuracy was observed with RO THA in achieving the desired acetabular component positioning (root mean square error for anteversion and inclination was 2.6 and 1.3 vs 8.9 and 5.3, repectively) and leg length (mean 0.6 mm vs 1.4 mm; p < 0.001). Patient-reported outcome measures were comparable between the two groups at baseline and one year. Participants in the RO THA group needed fewer physiotherapy sessions postoperatively (median six (IQR 4.5 to 8) vs eight (IQR 6 to 11; p = 0.005).

Conclusion

This RCT suggested that robotic-arm assistance in THA was associated with improved accuracy in restoring the native COR, better preservation of the combined offset, leg length correction, and superior accuracy in achieving the desired acetabular component positioning. Further evaluation through long-term and registry data is necessary to assess whether these findings translate into improved implant survival and functional outcomes.

Factors associated with decreased length of stay following robotic arm-assisted and conventional total hip arthroplasty

Aims

Postoperative length of stay (LOS) and discharge dispositions following arthroplasty can be used as surrogate measurements for improvements in patients' pathways and costs. With the increasing use of robotic technology in arthroplasty, it is important to assess its impact on LOS. The aim of this study was to identify factors associated with decreased LOS following robotic arm-assisted total hip arthroplasty (RO THA) compared with the conventional technique (CO THA).

Methods

This large-scale, single-institution study included 1,607 patients of any age who underwent 1,732 primary THAs for any indication between May 2019 and January 2023. The data which were collected included the demographics of the patients, LOS, type of anaesthetic, the need for treatment in a post-anaesthesia care unit (PACU), readmission within 30 days, and discharge disposition. Univariate and multivariate logistic regression models were used to identify factors and the characteristics of patients which were associated with delayed discharge.

Results

The multivariate model identified that age, female sex, admission into a PACU, American Society of Anesthesiologists grade > II, and CO THA were associated with a significantly higher risk of a LOS of > two days. The median LOS was 54 hours (interquartile range (IQR) 34 to 78) in the RO THA group compared with 60 hours (IQR 51 to 100) in the CO THA group (p < 0.001). The discharge dispositions were comparable between the two groups. A higher proportion of patients undergoing CO THA required PACU admission postoperatively, although without reaching statistical significance (7.2% vs 5.2%, p = 0.238).

Conclusion

We found that among other baseline characteristics and comorbidities, RO THA was associated with a significantly shorter LOS, with no difference in discharge destination. With the increasing demand for THA, these findings suggest that robotic assistance in THA could reduce costs. However, randomized controlled trials are required to investigate the cost-effectiveness of this technology.

Threshold for anterior acetabular component overhang correlated with symptomatic iliopsoas impingement after total hip arthroplasty

Aims

Mechanical impingement of the iliopsoas (IP) tendon accounts for 2% to 6% of persistent postoperative pain after total hip arthroplasty (THA). The most common initiator is anterior acetabular component protrusion, where the anterior margin is not covered by anterior acetabular wall. A CT scan can be used to identify and measure this overhang; however, no threshold exists for determining symptomatic anterior IP impingement due to overhang. A case-control study was conducted in which CT scan measurements were used to define a threshold that differentiates patients with IP impingement from asymptomatic patients after THA.

Methods

We analyzed the CT scans of 622 patients (758 THAs) between May 2011 and May 2020. From this population, we identified 136 patients with symptoms suggestive of IP impingement. Among them, six were subsequently excluded: three because the diagnosis was refuted intraoperatively, and three because they had another obvious cause of impingement, leaving 130 hips (130 patients) in the study (impingement) group. They were matched to a control group of 138 asymptomatic hips (138 patients) after THA. The anterior acetabular component overhang was measured on an axial CT slice based on anatomical landmarks (orthogonal to the pelvic axis).

Results

The impingement group had a median overhang of 8 mm (interquartile range (IQR) 5 to 11) versus 0 mm (IQR 0 to 4) for the control group (p < 0.001). Using receiver operating characteristic curves, an overhang threshold of 4 mm was best correlated with a diagnosis of impingement (sensitivity 79%, specificity 85%; positive predictive value 75%, negative predictive value 85%).

Conclusion

Pain after THA related to IP impingement can be reasonably linked to acetabular overhang if it exceeds 4 mm on a CT scan. Below this threshold, it seems logical to look for another cause of IP irritation or another reason for the pain after THA before concluding that impingement is present.

Primary Versus Secondary Total Knee Arthroplasty for Tibial Plateau Fractures in Patients Aged 55 or Over-A Systematic Review and Meta-Analysis

BACKGROUND

Total knee arthroplasty allows immediate postoperative weight-bearing and is increasingly recognized as a suitable treatment option for older patients who have tibial plateau fractures (TPFs). This systematic review evaluated the clinical and functional outcomes associated with primary versus secondary TKA for the treatment of TPFs in patients aged ≥55 years.

METHODS

Various databases were searched from inception to December 2021. Studies investigating outcomes of primary TKA (pTKA) as the initial treatment for TPFs in patients of mean age ≥55 years or those investigating outcomes of secondary TKA (sTKA) following any other primary treatment for TPFs were included. Quality of included studies was assessed using a methodological scale. Of 767 potentially relevant studies, 12 studies comprising 341 patients were included: 121 patients underwent (pTKA) and 220 patients underwent sTKA. There were 3 high-quality studies. Patients in the sTKA cohort were significantly younger at the time of TKA compared with those undergoing pTKA (mean 61.3 versus 72.2 years, P < .001, 95% confidence interval (CI) 8.2 to 13.6).

RESULTS

Intraoperative and postoperative complication rates were lower with pTKA; in particular, sTKA was associated with a significantly increased rate of stiffness requiring reintervention and patella tendon rupture. Functional outcome was greater after pTKA, but this did not reach statistical significance (85.2 versus 79.9%, P = .359, 95% CI -16.7 to 6.1).

CONCLUSION

Primary TKA was associated with lower complication rates than secondary TKA after TPF. In appropriate cases of TPF in older adults, it may be preferable to proceed with TKA as primary treatment rather than delaying until after fracture union or malunion.

Effects of ulinastatin combined with dexmedetomidine on cognitive dysfunction and emergence agitation in elderly patients who underwent total hip arthroplasty

BACKGROUND

With the continuous growth of the modern elderly population, the risk of fracture increases. Hip fracture is a common type of fracture in older people. Total hip arthroplasty (THA) has significant advantages in relieving chronic pain and promoting the recovery of hip joint function.

AIM

To investigate the effect of ulinastatin combined with dexmedetomidine (Dex) on the incidences of postoperative cognitive dysfunction (POCD) and emergence agitation in elderly patients who underwent THA.

METHODS

A total of 397 patients who underwent THA from February 2019 to August 2022. We conducted a three-year retrospective cohort study in Shaanxi Provincial People's Hospital. Comprehensive demographic data were obtained from the electronic medical record system. We collected preoperative, intraoperative, and postoperative data. One hundred twenty-nine patients who were administered Dex during the operation were included in the Dex group. One hundred fifty patients who were intravenously injected with ulinastatin 15 min before anesthesia induction were included in the ulinastatin group. One hundred eighteen patients who were administered ulinastatin combined with Dex during the operation were included in the Dex + ulinastatin group. The patients' perioperative conditions, hemodynamic indexes, postoperative Mini-Mental State Examination (MMSE) scores, Ramsay score, incidence of POCD, and serum inflammatory cytokines were evaluated.

RESULTS

There was a significant difference in the 24 h visual analogue scale score among the three groups, and the score in the Dex + ulinastatin group was the lowest (P < 0.05). Compared with the Dex and ulinastatin group, the MMSE scores of the Dex + ulinastatin group were significantly increased at 1 and 7 d after the operation (all P < 0.05). Compared with those in the Dex and ulinastatin groups, incidence of POCD, levels of serum inflammatory cytokines in the Dex + ulinastatin group were significantly decreased at 1 and 7 d after the operation (all P < 0.05). The observer's assessment of the alertness/sedation score and Ramsay score of the Dex + ulinastatin group were significantly different from those of the Dex and ulinastatin groups on the first day after the operation (all P < 0.05).

CONCLUSION

Ulinastatin combined with Dex can prevent the occurrence of POCD and emergence agitation in elderly patients undergoing THA.

Risk Factors Analysis and Nomogram Model Establishment of Hidden Blood Loss in Overweight and Obese Elderly Patients After Total Hip Arthroplasty

Background

Total hip arthroplasty (THA) has become the first-choice treatment for elderly patients with end-stage hip disease. The high amount of hidden blood loss (HBL) in overweight and obese patients after THA not only affects rapid recovery, but also results in a greater economic burden. We aimed to identify risk factors that contribute to elevated HBL in overweight and obese patients after THA by retrospective analysis, and establish a nomogram prediction model for massive HBL in overweight and obese patients after THA.

Methods

A total of 505 overweight and obese patients treated with THA were included and randomly divided into modeling and validation sets according to a 7:3 ratio. The demographic and relevant clinical data of the patients were collected. The independent risk factors affecting HBL after THA in overweight and obese patients were obtained by Pearson, independent sample T-test, and multiple linear regression analyses. R software was used to establish a nomogram prediction model for postoperative HBL, as well as a receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA).

Results

HBL was 911±438 mL, accounting for 79.5±13.1% of the total perioperative blood loss (1104±468 mL). A multiple linear regression analysis showed that HBL was associated with necrosis of the femoral head, absence of hypertension, longer operative time, higher preoperative erythrocytes, and higher preoperative D-dimer levels. The areas under the ROC curve (AUC) for the modeling and validation sets were 0.751 and 0.736, respectively, while the slope of the calibration curve was close to 1. The DCA curve demonstrated a better net benefit at a risk of HBL ≥1000 ml in both the training and validation groups.

Conclusion

HBL was an important component of total blood loss (TBL) after THA in overweight and obese patients. Necrosis of the femoral head, absence of hypertension, longer operative time, higher preoperative erythrocytes, and higher preoperative D-dimer levels were independent risk factors for postoperative HBL in these patients. The predictive model constructed based these data had better discriminatory power and accuracy, and could result in better net benefit for patients.

Perioperative nursing care for hip arthroplasty patients with concomitant hypertension: A minireview

Hip replacement (HA) is mainly indicated for the elderly, who generally suffer from various underlying diseases such as hypertension. This article provides a review of the key points of perioperative nursing care for patients with hypertension undergoing HA. It analyzes the key points of care during the perioperative period (preoperative, intraoperative, and postoperative) and proposes directions for the development of perioperative nursing care for HA. The prognosis for patients can be improved through the modification of traditional medical approaches and the application of new technologies and concepts.

Relevant Predictors in the Association Between Patients' Functional Status and Scar Outcomes After Total Hip Arthroplasty

BACKGROUND

We aimed to investigate the relevant predictors in the association between the functional status and the consequences of the persistence of scars in patients with traumatic versus non-traumatic coxarthrosis after total hip arthroplasty (THA).

METHODS

A total of 203 patients undergoing THA after traumatic or non-traumatic coxarthrosis were asked to complete the Mekeres' Psychosocial Internalization Scale (MPIS), in which they self-evaluated on a Likert scale (between one and five) by selecting the rating that corresponded to their personal opinion and the activities of daily living (ADL) form at six months postoperative. The statistical data were processed using the IBM SPSS Statistics software version 22.0 (IBM Corp., Armonk, NY). A combined assessment of the internalization of scars using MPIS and ADL forms after THA allowed for the identification of relevant predictors of the quality of life six months post-surgery in patients with traumatic or non-traumatic coxarthrosis.

RESULTS

Depending on the coxarthrosis etiology (traumatic or non-traumatic), the results were further processed by a univariate ANOVA, considering the independent variables represented by symptoms, the number of surgical procedures, and the postoperative evolution, which are acting on the outcomes of physical functioning (the dependent variable) in the postoperative phase. In the case of the traumatic group, our results suggest that the number of surgical interventions, the ability to internalize scars, and autonomy in terms of body care are predictors of the quality of life. In patients with non-traumatic coxarthrosis, an important role in predicting quality of life is played by the administered treatment and the ability to maintain their autonomy regarding self-hygiene six months post-surgery.

CONCLUSIONS

The predictive regression equation suggests that the quality of life in patients with traumatic coxarthrosis can be predicted by the number of surgical interventions, the administered treatment, the ability to internalize scars, and the autonomy regarding body care activities. On the other hand, for patients with non-traumatic coxarthrosis, an important role in predicting the quality of life is played by the treatment and the ability to maintain autonomy in terms of body hygiene activities.

The invasiveness of robot-assisted total hip replacement is similar to that of conventional surgery

Robot-assisted total hip arthroplasty (R-THA) is increasingly being performed throughout the world. The invasiveness of this operation is unknown. We retrospectively reviewed the cohort of consecutive osteonecrosis of the femoral head (ONFH) patients who received primary R-THA or manual THA (M-THA) from January 2020 to January 2022 in our institution. One experienced surgeon performed all procedures. We calculated the propensity score to match similar patients in different groups by multivariate logistic regression analysis for each patient. We included confounders consisting of age, sex, body mass index (BMI), and operation time. Preoperative serum markers and Harris hip scores (HHS), postoperative serum markers at first day and third day, complications rate, postoperative HHS and Forgotten Joint Score (FJS) at 6 months after surgery of different cohorts were compared. We analyzed 218 ONFH patients treated with THA (98 R-THA patients, and 120 M-THA patients). After propensity score matching, we generated cohorts of 95 patients in R-THA and M-THA groups. We found no significant difference in preoperative serum markers and HHS. In the R-THA cohort, the PLT count was significantly lower on the postoperative day 1 (192.36 ± 41.72 × 109/L Vs 210.47 ± 72.85 × 109/L, p < 0.05). The Hb level was significantly lower on the postoperative third day in the R-THA cohort (98.52 ± 12.99 g/L Vs 104.74 ± 13.15 g/L, p < 0.05). There was no significant difference in the other serum markers between the cohorts on postoperative day 1 and 3 (p > 0.05). The FJS was significantly higher in the R-THA than M-THA group (p = 0.01). There was no significant difference in the postoperative HHS or complication rate between the groups (p > 0.05). The R-THA is not associated with a serious invasiveness compared to M-THA. Patients who underwent R-THA had a better early function compared to those who underwent M-THA.

Risk factors for liner wear and head migration in total hip arthroplasty: a systematic review

Total hip arthroplasty (THA) is a successful orthopaedic surgical procedure, and its longevity depends on bearing components and implant fixation. Optimizing polyethylene and ceramics has led to improved wear parameters and contributed to improved long-term outcomes. The present systematic review investigated whether time span from implantation, patient characteristics and performance status exert an influence on liner wear and head migration in THA. This study was conducted in conformity to the 2020 PRISMA guidelines. All the clinical investigations which reported quantitative data on the amount of liner wear and head migration in THA were considered. Only studies which reported quantitative data at least on one of the following patient characteristics were suitable: mean age, mean BMI (kg/m2), sex, side, time span between the index THA and the last follow-up (months) were eligible. A multiple linear model regression analysis was employed to verify the association between patient characteristics and the amount of liner wear and/or head migration. The Pearson Product-Moment Correlation Coefficient was used to assess the association between variables. Data from 12,629 patients were considered. The mean length of the follow-up was 90.5 ± 50.9 months. The mean age of patients at surgery was 58.4 ± 9.4 years, and the mean BMI was 27.2 ± 2.5 kg/m2. 57% (7199 of 12,629 patients) were women, and in 44% (5557 of 12,629 patients) THAs were performed on the left. The mean pre-operative Harris hip score was 46.5 ± 6.0 points. There was evidence of a moderate positive association between the amount of liner wear and the time elapsed between the index surgery to the follow-up (P = 0.02). There was evidence of a moderate positive association between the amount of head migration and the time elapsed between the index surgery to the follow-up (P = 0.01). No further statistically significant association was found. The time elapsed between the index surgery to the follow-up was the most important factor which influence the head migration and liner wear in THA. Patients' characteristics and preoperative physical activity did not influence the amount of head migration and liner wear.

Patient-Reported Outcome Measures in Conventional Total Hip Arthroplasty Versus Robotic-Arm Assisted Arthroplasty: A Prospective Cohort Study With Minimum 3 Years' Follow-Up

BACKGROUND

Robotic-arm assisted total hip arthroplasty (RO THA) has been shown to improve the accuracy of component positioning compared with conventional total hip arthroplasty (CO THA). This study reports Patient-Reported Outcome Measures (PROMs) of a previous trial that showed that RO THA was associated with improved accuracy and reduced outliers in acetabular component positioning compared with CO THA.

METHODS

This prospective cohort study included 50 patients undergoing CO THA versus 50 patients receiving RO THA. The Oxford hip score, Forgotten Joint Score (FJS), University of California at Los Angeles hip score were recorded at a minimum of 3 years following surgery.

RESULTS

At minimum 3 years follow-up, there was no statistically significant difference in CO THA versus RO THA with respect to the Oxford hip score [median 42(6.25) versus 41(5.5), P = .914]; FJS [89 (9.25) versus 86 (9), P = .065], and University of California at Los Angeles score [median 7.5 (3) versus 7 (2), P = .381]. None of the study patients had dislocations or underwent revision surgery within 3 years follow-up.

CONCLUSION

The previously reported improvement in accuracy of acetabular component in this study population did not translate to statistically significant improvements in PROMs. Patients in both groups achieved excellent PROMs and there was a trend towards higher FJS scores postoperatively in the RO THA group that did not reach statistical significance. Further studies are needed to assess the significance of these findings on longer-term clinical outcomes and implant survivorships, and also to explore the impact of the enhanced RO THA workflow and functional implant positioning on these outcomes.

Ischial screw fixation can prevent cup migration in 3D-printed custom acetabular components for complex hip reconstruction

INTRODUCTION

Custom acetabular components have become an established method of treating massive acetabular bone defects in hip arthroplasty. Complication rates, however, remain high and migration of the cup is still reported. Ischial screw fixation (IF) has been demonstrated to improve mechanical stability for non-custom, revision arthroplasty cup fixation. We hypothesize that ischial fixation through the flange of a custom acetabular component aids in anti-rotational stability and prevention of cup migration.

METHODS

Electronic patient records were used to identify a consecutive series of 49 custom implants in 46 patients from 2016 to 2022 in a unit specializing in complex joint reconstruction. IF was defined as a minimum of one screw inserted into the ischium passing through a hole in a flange on the custom cup. The mean follow-up time was 30 months. IF was used in 36 cups. There was no IF in 13 cups. No difference was found between groups in age (68.9 vs. 66.3, P = 0.48), BMI (32.3 vs. 28.2, P = 0.11) or number of consecutively implanted cups (3.2 vs. 3.6, P = 0.43). Aseptic loosening with massive bone loss was the primary indication for revision. There existed no difference in Paprosky grade between the groups (P = 0.1). 14.2% of hips underwent revision and 22.4% had at least one dislocation event.

RESULTS

No ischial fixation was associated with a higher risk of cup migration (6/13 vs. 2/36, X² = 11.5, P = 0.0007). Cup migration was associated with an increased risk for all cause revision (4/8 vs. 3/38, X² = 9.96, P = 0.0016, but not with dislocation (3/8 vs. 8/41, X² = 1.2, P = 0.26).

CONCLUSION

The results suggest that failure to achieve adequate ischial fixation, with screws passing through the flange of the custom component into the ischium, increases the risk of cup migration, which, in turn, is a risk factor for revision.