What's New in Hip Replacement

Efficacy and safety of pericapsular nerve group block in total hip arthroplasty: a meta-analysis and systematic review

INTRODUCTION

Ensuring effective perioperative pain control is a crucial aspect of rehabilitation programs following total hip arthroplasty. This study presents a comprehensive meta-analysis and systematic review to assess the efficacy and safety of pericapsular nerve group block (PENG) in the context of total hip arthroplasty.

EVIDENCE ACQUISITION

A systematic search was conducted in multiple databases, including PubMed, Embase, Cochrane Library, and Web of Science, to identify relevant randomized controlled studies investigating the efficacy and safety of PENG for total hip arthroplasty. The search was conducted up until 1st June 2023. Data analysis was performed using Stata v. 15.0.

EVIDENCE SYNTHESIS

A total of 721 individuals participated in this study, which included 13 randomized controlled trials. Among them, 377 individuals were assigned to the experimental group, while 344 individuals were assigned to the control group. The findings from the meta-analysis indicated that the application of PENG yielded favorable outcomes in terms of reducing six-hour pain scores (SMD=-0.63, 95% CI -1.18, -0.09) and 24-hour pain scores (SMD=-1.45, 95% CI -2.51, -0.29). Moreover, it was found to decrease opioid consumption (SMD=-0.84, 95% CI -1.35, -0.34), without causing a significant increase in nausea and vomiting (RR=0.75, 95% CI 0.45, 1.23) or urinary retention (RR=2.46, 95% CI 0.49, 12.31).

CONCLUSIONS

Based on the latest findings, PENG has been shown to effectively decrease pain scores within six and 24 hours following total hip arthroplasty. However, its effectiveness in pain control diminishes after 48 hours. Additionally, PENG has demonstrated the ability to reduce opioid consumption without an accompanying increase in adverse drug events.

Characterisation of Selected Materials in Medical Applications

Tissue engineering is an interdisciplinary field of science that has developed very intensively in recent years. The first part of this review describes materials with medical and dental applications from the following groups: metals, polymers, ceramics, and composites. Both positive and negative sides of their application are presented from the point of view of medical application and mechanical properties. A variety of techniques for the manufacture of biomedical components are presented in this review. The main focus of this work is on additive manufacturing and 3D printing, as these modern techniques have been evaluated to be the best methods for the manufacture of medical and dental devices. The second part presents devices for skull bone reconstruction. The materials from which they are made and the possibilities offered by 3D printing in this field are also described. The last part concerns dental transitional implants (scaffolds) for guided bone regeneration, focusing on polylactide–hydroxyapatite nanocomposite due to its unique properties. This section summarises the current knowledge of scaffolds, focusing on the material, mechanical and biological requirements, the effects of these devices on the human body, and their great potential for applications.

Analysis of Clinical Effect after Treatment of Patients with Femoral Neck Fracture Using Total or Hemihip Arthroplasty

OBJECTIVE

To investigate the difference in clinical outcomes between total hip arthroplasty (THA) and hemiarthroplasty (HA) in patients with femoral neck fracture.

METHOD

To retrospectively analyze 96 patients (96 hips) with femoral neck fracture treated in our hospital and distinguish them into THA group (50 patients with 50 hips) and HA group (46 patients with 46 hips) according to the difference of their chosen surgical procedure, and to compare the difference in perioperative indexes, postoperative hip function, occurrence of near and long-term complications, long-term imaging performance, and revision rate between the two groups.

RESULT

The operating time, intraoperative blood loss, and total drainage were greater in the THA group than in the HA group (P < 0.05). At 6 months after surgery, the Harris score of the hip joint was higher in the HA group than in the THA group. At 3 years after surgery, the Harris score was higher in the THA group than in the HA group (P < 0.05). At 3 years after surgery, the excellent hip function rates were 86.00% and 67.39% in the THA and HA groups, respectively, with statistically significant difference between the groups. The incidence of long-term complications was significantly lower in the THA group than in the HA group (P < 0.05). The anteversion and abduction angles of patients in the HA group were smaller than those in the THA group at 6 months after surgery (P < 0.05). The WOMAC scores of the THA group were better than those of the HA group at 3 years after surgery (P < 0.05).

CONCLUSION

Compared with hemiarthroplasty, total hip arthroplasty has a longer operative time and more postoperative bleeding, but the complication rate is relatively lower in the long term, and the patients have better long-term hip function recovery, so total hip arthroplasty is recommended for patients with femoral neck fracture with an expected survival time longer than 3 years.

Future of total hip arthroplasty with the Metha short stem in modern surgeries

The aim of the study was to analyse the results of uncemented total hip replacement, using the Metha (metaphyseal) stem. A total of 158 patients (70 females and 88 males) were qualified to the study and submitted to total hip arthroplasty (183 procedures altogether), using the Metha stem. The mean age of the patients on the day of surgery was 51.7 years (the range from 17 to 69 years). The mean follow up period was 9.2 years (the range from 5 to 13.5 years). Preoperative assessments gave poor scores, according to the Merle d’Aubigne and Postel classification, modified by Charnley. The average improvement after surgery, according to the used scale, was 6.9 points. A very good outcome was recorded in 154 cases (84.2%), a good outcome was achieved in 20 cases (10.9%) and a poor outcome was confirmed in 9 cases, while no satisfactory case was observed. Poor outcomes were associated with implant loosening. Extraskeletal ossification was noted in 10 cases (5.5%). According to the Kaplan–Meier estimator, the 10-year survival was 93.2% and 97.3% for the whole implant and the stem alone, respectively. 1. Our follow-up period of more than 9 years on the average, indicates that Metha stems produce excellent clinical and functional results in operated young patients with advanced degenerative changes of the hip joint. 2. Assuming a proper qualification for the procedure, the absence of complications and a correct surgical technique, which is slightly more difficult, when compared to standard stem implantation, the risk of aseptic loosening is fairly negligible.

Contralateral Lower-Limb Functional Status Before Total Hip Arthroplasty: An Important Indicator for Postoperative Gait Speed

BACKGROUND

Postoperative gait speed, especially comfortable gait speed, is an important factor for predicting function after total hip arthroplasty (THA). In this study, we examined factors related to gait speed, including preoperative lower and upper-limb functional parameters and postoperative lower-limb alignment. In addition, we examined factors related to postoperative good comfortable gait speed (≥1.34 m/s: one indicator of a good clinical outcome). The purpose of this study was to determine if better preoperative functional parameters had a positive effect on postoperative gait speed.

METHODS

This prospective case-control study included 91 patients with hip osteoarthritis who underwent unilateral THA. Patients who had undergone a prior hip surgical procedure or had Crowe type-3 and 4 hips, complications after THA, knee osteoarthritis-related pain, and severe lumbar conditions were excluded. The 1-leg standing time (OLST) and knee extensor strength of the operatively treated side and the contralateral side and the functional reach test were examined preoperatively and at 1 year postoperatively. The leg-length discrepancy and global offset compared with the contralateral side and leg lengthening were examined using 3-dimensional models captured through computed tomographic scans.

RESULTS

The preoperative contralateral side OLST was a significant factor (p < 0.001) for postoperative comfortable gait speed, and the preoperative contralateral-side knee extensor strength was a significant factor (p = 0.018) for postoperative maximum gait speed. Leg-length discrepancy and differences in global offset after THA were not significant factors for postoperative gait speed. The preoperative comfortable gait speed with a cutoff value of 1.115 m/s (area under the receiver operating characteristic curve, 0.690 [95% confidence interval, 0.569 to 0.810]; p = 0.003; sensitivity of 65.5% and specificity of 74.2%) was an independent factor associated with a good postoperative comfortable gait speed. Preoperative contralateral-side OLST was a significant factor (p = 0.027) for preoperative comfortable gait speed.

CONCLUSIONS

The preoperative contralateral-side, lower-limb functional status is a significant factor for postoperative gait speed. Early surgical intervention before the contralateral-side function declines or a preoperative rehabilitation intervention on the contralateral side may improve THA outcome.

LEVEL OF EVIDENCE

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Zurich Cementless Dual Mobility Cup for Canine Total Hip Prosthesis: Implant Characteristics and Surgical Outcome in 105 Cases

Dislocation after total hip arthroplasty (THA) remains a troublesome complication, and a source of frustration for the owner and the surgeon. The dislocation rate of hip prostheses in dogs is reported to range from 4 to 15%, representing the most common short-term complication. This is especially true in large and giant breed dogs, usually requiring revision surgery. With the increase in the number of THA being performed in veterinary surgery, reducing or preventing complications such as postoperative THA dislocation will be of paramount importance. The Zurich cementless dual mobility (DM) system allows impingement-free range of angulation of 80 to 132 degrees between the ceramic head and the polyether ether ketone (PEEK) cup when combined with the range of the PEEK cup in the outer metal cup. In this article, we review the use of the DM cup in THA in large and giant breed dogs, in terms of its history, biomechanics, outcomes and complications based on 105 cases.

Early Outcome Comparison of the Posterior Approach and the Superior Approach for Primary Total Hip Arthroplasty

Background

The superior approach for total hip arthroplasty (THA) is a minimally invasive, tissue-sparing technique that may have clinical and economic benefits. The purpose of this study was to compare early outcomes between the posterior approach and the superior approach in primary THA. Our hypothesis was that the superior approach would have a noninferior length of stay (LOS), discharge destination, and blood loss compared with the posterior approach.

Methods

All primary THAs performed by a single surgeon at one institution were retrospectively reviewed over a 2-year period (2015-2017). There were 676 patients, 40.4% of whom underwent a posterior approach and 59.6% underwent a superior approach. LOS, discharge destination, blood loss, and operating room time were analyzed. Gender, body mass index, and American Society of Anesthesiologists status were recorded and controlled.

Results

The posterior approach was independently associated with an almost threefold higher risk of prolonged LOS (>2 days, P < .001) (odds ratio: 2.90, 95% confidence interval: 1.87-4.49; P < .001). The mean LOS for the superior approach was 1.71 days vs 2.17 days for the posterior group (P < .001). Fewer patients in the superior approach cohort were discharged to a rehabilitation facility (8.9% vs 17.9%, P < .001). The mean operative time was shorter in the superior group (91.8 vs 95.8, P = .001). There was no statistically significant difference in acute postoperative blood loss. There were no dislocations or reoperations in either group.

Conclusions

The superior approach to THA was associated with a significantly shorter length of hospital stay and lower rate of discharge to rehab than the posterior approach. This approach can be used as a safe, minimally invasive, and tissue-sparing variation of a standard posterior approach for THA and has promising early outcomes.