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Saraglis G, Muscat J, Shankarappa Y, Mohammad Elgeweny MS, Mohamed Hussein MM. A Radiographic Evaluation of Uncemented Total Hip Replacements and the Role of Uncemented Implants in the Management of Hip Osteoarthritis in the Elderly Population. Cureus 2023; 15:e50487. [PMID: 38222132 PMCID: PMC10787170 DOI: 10.7759/cureus.50487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction The idea of an uncemented, fully coated hydroxyapatite (HA) stem was introduced almost 40 years ago, aiming to achieve a solid biological fixation by preserving natural bone activity. While many studies underline the longevity of uncemented total hip replacement (THR), NHS England's Best Practice Tariff (BPT) recommends using cemented implants in patients over the age of 69, with financial penalties when this policy is not met. At the same time, the 'paradox' of increased use of uncemented implants worldwide has been well described, with many surgeons using them regardless of the age group of the patient. Materials and methods This study focuses on the radiographic evaluation of the uncemented Pinnacle/Corail total hip replacement construct in 123 patients of all age groups who underwent an elective procedure, with a minimum radiographic follow-up of two years. Implant information (collared or non-collared stem), femur type (Dorr classification), age, gender, and revision rate were collected and radiographic analysis of the femoral stem and acetabular component was performed for the immediate post-operative, six-month, one- to two-year follow-up radiograph of all patients. We conducted a statistical analysis, dividing the patients into two groups based on age: those above or below 69 years old. Results There was no statistically significant difference in rates of radiographic lucency after two years with regard to the femoral component. Both collared and non-collared stems seem to perform equally well, with no significant difference detected. However, a statistically significant difference in rates of radiographic lucency of the acetabular cup was noted between the two age groups (p=0.018), with higher rates detected in the under-69-year-old age group. Conclusion This study demonstrates that, radiographically, the uncemented Pinnacle/Corail construct performs equally well in all age groups. In our cohort of patients, the age of the patient did not predict the osseointegration of the implant in the short-term follow-up.
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Affiliation(s)
- Georgios Saraglis
- Trauma and Orthopaedics, Bedfordshire NHS Foundation Trust, Bedford, GBR
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Fahlbusch H, Budin M, Volk A, von Rehlingen Prinz F, Linke P, Citak M, Gehrke T, Ohlmeier M. Long-term outcomes of total hip arthroplasty in patients with developmental dysplasia of the hip: a minimum 21-year follow-up. Arch Orthop Trauma Surg 2023; 143:6609-6616. [PMID: 37421515 DOI: 10.1007/s00402-023-04970-3] [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: 03/26/2023] [Accepted: 06/26/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE Early osteoarthritis (OA) due to developmental dysplasia of the hip (DDH) is a known indication for total hip arthroplasty (THA). Though screening tools and joint-preserving procedures have been established successfully, there still is a relevant number of patients suffering DDH. Due to the lack of long-term outcome studies, we like to close this gap and present the results of a highly specialized center. METHODS The study included 126 patients, who were treated in our institution with primary THA for DDH between January 1997 and December 2000. At the time of final follow-up, at a mean of 23 years postoperatively, 110 patients (121 hips) were clinically evaluated using the Harris-Hip Score. In addition, complication and surgical revision rates were assessed. We collected surgery-related data like implant choice and special surgical features such as autologous acetabular reconstruction or femoral osteotomies. Additionally, the severity of preoperative DDH was measured radiographically according to Crowe classification. RESULTS There were 91 female (83%) and 19 male (17%) patients with an average age of 51 ± 9.5 years (range 21-65) included. Mean follow-up was 23 ± 1.3 years (21-25), with a minimum of 21 years being necessary for inclusion. Using revision for any indication as primary endpoint, the Kaplan-Meier survivorship was 98.3% at 10 years and 81.8% at final follow-up. The overall revision rate was 18% (22 cases), which were split up as follows: 20 (17%) implant failures (loosened or broken components), one (1%) periprosthetic infection and one (1%) periprosthetic fracture. Regarding complications, we observed nine (7%) dislocations and one case (1%) with severe heterotopic ossification that required surgical excision. The mean Harris-Hip score at latest follow-up was 78 ± 14 points (32-95). CONCLUSIONS Though implants and surgical techniques have improved over time, our results suggest THA in patients suffering DDH to be seriously challenging with relatively high overall complications in long-term observation and fair clinical outcome after 21 years postoperatively. There is evidence that prior osteotomy might be associated with a higher revision rate.
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Affiliation(s)
- Hendrik Fahlbusch
- Department of Orthopedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstrasse 2, 22767, Hamburg, Germany
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Maximilian Budin
- Department of Orthopedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstrasse 2, 22767, Hamburg, Germany
| | - Annabelle Volk
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Fidelius von Rehlingen Prinz
- Department of Orthopedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstrasse 2, 22767, Hamburg, Germany
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Philip Linke
- Department of Orthopedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstrasse 2, 22767, Hamburg, Germany
| | - Mustafa Citak
- Department of Orthopedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstrasse 2, 22767, Hamburg, Germany
| | - Thorsten Gehrke
- Department of Orthopedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstrasse 2, 22767, Hamburg, Germany
| | - Malte Ohlmeier
- Department of Orthopedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstrasse 2, 22767, Hamburg, Germany.
- Department of Orthopaedic and Trauma Surgery, UKM Marienhospital, Mauritiusstraße 5, 48565, Steinfurt, Germany.
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Jasina A, Enz A, Knoop A, Jones G, Ellenrieder M, Mittelmeier W, Lutter C. Constrained metal-on-metal hip arthroplasty: ever heard of a 50-year survival story? ORTHOPADIE (HEIDELBERG, GERMANY) 2023:10.1007/s00132-023-04380-8. [PMID: 37171637 DOI: 10.1007/s00132-023-04380-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND The history of total hip arthroplasty dates back to the first half of the twentieth century. Data on hip endoprostheses implanted during the 1960s and 1970s suggest widely varying survival rates of the prosthesis. CASE A case of a patient who underwent total hip arthroplasty in 1972 using a Sivash prosthesis, developed in 1956 in the former Soviet Union, is presented in this article. The prosthesis has remained unrevised in the patient's body for 50 years and he continues to be widely free of implant-related symptoms. Despite the constrained metal-on-metal design of the implant, which can lead to adverse reactions to metal debris, no elevated systemic metal ion levels were detected. CONCLUSION The likelihood of encountering patients with prosthesis survival beyond 50 years is still rare. Nevertheless, changing demographics and the steadily improving designs and materials of hip endoprostheses may likely result in such cases.
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Affiliation(s)
- Andrzej Jasina
- Department for Orthopaedics, Rostock University Medical Center, Doberaner Str. 142, 18057, Rostock, Germany.
| | - Andreas Enz
- Department for Orthopaedics, Rostock University Medical Center, Doberaner Str. 142, 18057, Rostock, Germany
| | - Annalena Knoop
- Department for Orthopaedics, Rostock University Medical Center, Doberaner Str. 142, 18057, Rostock, Germany
| | | | - Martin Ellenrieder
- Department for Orthopaedics, Rostock University Medical Center, Doberaner Str. 142, 18057, Rostock, Germany
| | - Wolfram Mittelmeier
- Department for Orthopaedics, Rostock University Medical Center, Doberaner Str. 142, 18057, Rostock, Germany
| | - Christoph Lutter
- Department for Orthopaedics, Rostock University Medical Center, Doberaner Str. 142, 18057, Rostock, Germany
- Leeds Beckett University, Leeds, UK
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The potential value of observational studies of elective surgical interventions using routinely collected data. Ann Epidemiol 2022; 76:13-19. [DOI: 10.1016/j.annepidem.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 10/03/2022] [Accepted: 10/06/2022] [Indexed: 11/23/2022]
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Comparing modern uncemented, hybrid and cemented implant combinations in older patients undergoing primary total hip arthroplasty, a New Zealand Joint Registry study. Arch Orthop Trauma Surg 2022; 143:3597-3604. [PMID: 36102955 DOI: 10.1007/s00402-022-04610-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 08/29/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND Multiple joint registries have reported better implant survival for patients aged > 75 years undergoing total hip arthroplasty (THA) with cemented implant combinations when compared to hybrid or uncemented implant combinations. However, there is considerable variation within these broad implant categories, and it has therefore been suggested that specific implant combinations should be compared. We analysed the most common contemporary uncemented (Corail/Pinnacle), hybrid (Exeter V40/Trident) and cemented (Exeter V40/Exeter X3) implant combinations in the New Zealand Joint Registry (NZJR) for patients aged > 75 years. METHODS All THAs performed using the selected implants in the NZJR for patients aged > 75 years between 1999 and 2018 were included. Demographic data, implant type, and outcome data including implant survival, reason for revision, and post-operative Oxford Hip Scores were obtained from the NZJR, and detailed survival analyses were performed. Primary outcome was revision for any reason. Reason for revision, including femoral or acetabular failure, and time to revision were recorded. RESULTS 5427 THAs were included. There were 1105 implantations in the uncemented implant combination group, 3040 in the hybrid implant combination group and 1282 in the cemented implant combination group. Patient reported outcomes were comparable across all groups. Revision rates were comparable between the cemented implant combination (0.31 revisions/100 component years) and the hybrid implant combination (0.40 revisions/100 component years) but were statistically significantly higher in the uncemented implant combination (0.80/100 component years). Femoral-sided revisions were significantly greater in the uncemented implant combination group. CONCLUSION The cemented implant and hybrid implant combinations provide equivalent survival and functional outcomes in patients aged over 75 years. Caution is advised if considering use of the uncemented implant combination in this age group, predominantly due to a higher risk of femoral-sided revisions. The authors recommend comparison of individual implants rather than broad categories of implants.
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Cole MW, Ross BJ, Collins LK, Imonugo O, Sherman WF. The Impact of Celiac Disease on Complication Rates After Total Joint Arthroplasty: A Matched Cohort Study. Arthroplast Today 2022; 17:205-210.e3. [PMID: 36254209 PMCID: PMC9568673 DOI: 10.1016/j.artd.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/02/2022] [Indexed: 11/25/2022] Open
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Li H, Tan KG, Li Z, Wu X, Cai G, Zhu W, Huang T, Wang W, Crawford R, Mao X. Impaction Bone Grafting with Low Dose Irradiated Freeze-Dried Allograft Bone for Acetabular Reconstruction. Orthop Surg 2022; 14:2519-2526. [PMID: 36017764 PMCID: PMC9531074 DOI: 10.1111/os.13471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 07/10/2022] [Accepted: 07/25/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Reconstruction of acetabular defects has been extremely challenging in both primary and revision total hip arthroplasty (THA). Impaction bone grafting (IBG) can restore the acetabulum bone mass and anatomically reconstruct the acetabulum. Our study aimed to report the short and medium-term clinical and radiographic outcomes of IBG for acetabular reconstruction in the cemented THA in the Chinese population. METHODS This was a single-center retrospective review enrolling 57 patients between May 2013 and July 2019. The patients with acetabular defects were treated with IBG, using low dose irradiated freeze-dried allograft bone with or without autograft bone, in the cemented THA performed by one senior surgeon. Harris hip score (HHS), standard pelvis anterior-posterior radiograph and lateral hip radiograph were obtained before operation and at 1 week, 3 months, 12 months, and yearly. Graft osteointegration was evaluated by Oswestry's criteria, and complication was documented at the last follow-up. Independent sample ANOVA test and Pearson chi-square tests are used for statistical analysis. RESULTS There were 61 hips in 57 patients. The average follow-up time was 35.59 months (5-77 months). According to AAOS classification, a total of 18 hips were identified as segmental bone deficiency (type I), with 21 and 22 hips for cavitary bone deficiency (type II) and the combined bone deficiency (type III), respectively. The average HHS was improved from 44.49 (range: 32-58) preoperatively to 86.98 (range: 78-93) postoperatively. Graft osteointegration was satisfactory (Oswestry score ≥2) in all patients. No dislocation occurred in the 57 patients (61 hips) during follow-up. Although one cup migrated, no revision, re-revision, radiographic loosening, graft bone lysis, or postoperative complications were detected at the final follow-up. CONCLUSIONS IBG with low-dose irradiated freeze-dried allograft bone in acetabular bone defect reconstruction is a reliable technique for restoring acetabular bone defects in THA.
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Affiliation(s)
- Hongxing Li
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | | | - Zhiling Li
- Center of Health Management, The Central Hospital of Shaoyang, Shaoyang, China
| | - Xiaoxin Wu
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Guangping Cai
- Department of endocrinology, The Xiangya Hospital, Central South University, Changsha, China
| | - Weihong Zhu
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Tianlong Huang
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wanchun Wang
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ross Crawford
- Department of Orthopedic, Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Xinzhan Mao
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
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Ryan JC, Duensing IM, Novicoff WM, Browne JA. Are We Training Surgeons to Cement a Femoral Component in Hip Arthroplasty? The Trainees' Perspective. J Arthroplasty 2022; 37:S536-S539. [PMID: 35276274 DOI: 10.1016/j.arth.2022.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/13/2022] [Accepted: 03/02/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The importance of surgical technique is widely recognized when cementing a femoral component in hip arthroplasty. Concern exists that surgeon trainees in the United States are not being adequately trained in cement technique. The purpose of this study is to describe recent trainees' perceived experience with their training in this skill. METHODS Orthopedic graduate candidates attending a national board review course were polled with an anonymous 15-question survey regarding their experiences during training with cemented femoral components. Means and standard deviations were calculated for Likert scale questions, and univariate statistics were used to compare answers for select questions. RESULTS A total of 152 surveys were completed. Ninety percent of respondents anticipated that they would be performing hemiarthroplasty for fracture in their future practice, 99% of whom anticipated using cement for stem fixation in at least some of these cases. Only a minority of respondents planned further training in an adult reconstruction fellowship (21%). Only 37% of residents perceived their training in cement technique to be comprehensive or very comprehensive, with 17% reporting that their training was inadequate or nonexistent. Forty percent reported being less than satisfied with their training. Although 96% of residents felt prepared to implant a cementless femoral component, only 82% felt adequately trained to properly cement a femoral implant. Feeling prepared to perform a well done cemented femoral stem correlated with higher percentage of cemented stems in training and higher satisfaction with training (both P = .001). CONCLUSION Although most trainees feel prepared to cement a femoral component, many young surgeons do not perceive that they are receiving adequate training in femoral cement technique.
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Affiliation(s)
- J Conner Ryan
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Ian M Duensing
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Wendy M Novicoff
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - James A Browne
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
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Kacmaz IE, Turgut A, Basa CD, Bilgin E, Reisoglu A, Kalenderer O. Comparison of the Reliability of Three Scoring Systems Used to Decide Whether to Apply Cement in Hip Arthroplasty Among Fracture Patients and the Effect of Surgical Experience: The Spotorno, Dorr, and Canal Flare Indices. J Arthroplasty 2022; 37:1348-1353. [PMID: 35337947 DOI: 10.1016/j.arth.2022.03.062] [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: 02/09/2022] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND No consensus has been reached regarding the best index to decide whether to use cement during hip replacement surgery. Therefore, this study compared the reliability of three frequently used scoring systems. The secondary purpose was to evaluate the effect of surgical experience on the decision to use cement. METHODS Anteroposterior radiographs of 60 hips were assessed by four orthopedic surgeons and four orthopedic residents. The observers were asked to make measurements using the Spotorno criteria, the Dorr index, and the canal flare index, and to decide whether to use a cemented or cementless femoral stem. The same X-rays were sent to all participants, in a different order, 4 weeks later, for a second evaluation. The SPSS software (version 24.0) was used for the statistical analysis. Intraobserver agreement was determined for all observers via the intraclass correlation coefficient (ICC), and interobserver reliability was calculated using the weighted kappa (κ) statistic. RESULTS The average age of the patients were 73.1 ± 12.1 years. Thirty-three (55%) patients were female and thirty-two (53.3%) had fractures on the right side. Intraobserver agreement was "excellent" for all participants according to the Spotorno criteria. The canal flare index had the lowest intra-observer agreement. The highest interobserver agreement was found using the Spotorno criteria. CONCLUSION The intra- and interobserver reliabilities of the Spotorno criteria were higher than those of the Dorr index and the canal flare index. The Spotorno criteria was more useful for deciding between cemented and un-cemented hip arthroplasty.
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Affiliation(s)
- Ismail Eralp Kacmaz
- Department of Orthopaedics and Traumatology, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Ali Turgut
- Department of Orthopaedics and Traumatology, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Can Doruk Basa
- Department of Orthopaedics and Traumatology, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Emre Bilgin
- Department of Orthopaedics and Traumatology, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Ali Reisoglu
- Department of Orthopaedics and Traumatology, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Onder Kalenderer
- Department of Orthopaedics and Traumatology, Tepecik Training and Research Hospital, İzmir, Turkey
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KUIJPERS MFL, VAN STEENBERGEN LN, SCHREURS BW, HANNINK G. Patient-reported outcome of 95% of young patients improves after primary total hip arthroplasty: identification of 3 recovery trajectories in 3,207 patients younger than 55 years from the Dutch Arthroplasty Register. Acta Orthop 2022; 93:560-567. [PMID: 35727110 PMCID: PMC9211000 DOI: 10.2340/17453674.2022.3140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Little is known about the outcome after receiving total hip arthroplasty (THA), specifically in young patients. We identified different recovery trajectories in young patients using data from the Dutch Arthroplasty Register (LROI). We also explored whether risk factors commonly associated with functional outcome were associated with recovery trajectory. PATIENTS AND METHODS We used HOOS-PS score data up to 1 year postoperatively from the LROI from all patients younger than 55 years who received a primary THA between 2014 and 2019. To investigate whether different recovery trajectories could be distinguished, we performed latent class growth analysis (LCGA). Subsequently, we used multinomial logistic regression analyses to explore factors associated with class membership. RESULTS 3,207 patients were included. LCGA identified 3 groups of patients: optimal responders (75%), good responders (21%), and poor responders (4.7%). Female sex (RR 1.1; 95% CI 1.1-1.1), ASA II (RR 1.1; CI 1.0-1.1), ASA III-IV (RR 1.1; CI 1.0-1.2), smoking (RR 1.1; CI 1.0-1.1), cemented fixation (RR 1.2; CI 1.1-1.2), and a 22-28 mm head diameter (RR 1.1; CI 1.0-1.2) were associated with "good responder" class membership. ASA II (RR 1.1; 1.0-1.2), ASA III-IV (RR 1.2; 1.1-1.3), smoking (RR 1.2; CI 1.1-1.2), and hybrid fixation (RR 1.2; CI 1.0-1.2) were associated with "poor responder" class membership. INTERPRETATION 3 recovery trajectories could be identified. Female sex, higher ASA classifications, smoking, cemented or hybrid fixation, and small head diameter were associated with a suboptimal result after primary THA in young patients. These findings can aid in the process to determine which patients are at risk of a suboptimal outcome.
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Affiliation(s)
- Martijn F L KUIJPERS
- Department of Orthopaedics, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen
| | - Liza N VAN STEENBERGEN
- Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Implantaten), ‘s Hertogenbosch
| | - B Willem SCHREURS
- Department of Orthopaedics, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen,Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Implantaten), ‘s Hertogenbosch
| | - Gerjon HANNINK
- Department of Operating Rooms, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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Mirulla AI, Muccioli GMM, Fratini S, Zaffagnini S, Ingrassia T, Bragonzoni L, Innocenti B. Analysis of different geometrical features to achieve close-to-bone stiffness material properties in medical device: A feasibility numerical study. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 221:106875. [PMID: 35588661 DOI: 10.1016/j.cmpb.2022.106875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE In orthopedic medical devices, elasto-plastic behavior differences between bone and metallic materials could lead to mechanical issues at the bone-implant interface, as stress shielding. Those issue are mainly related to knee and hip arthroplasty, and they could be responsible for implant failure. To reduce mismatching-related adverse events between bone and prosthesis mechanical properties, modifying the implant's internal geometry varying the bulk stiffness and density could be the right approach. Therefore, this feasibility study aims to assess which in-body gap geometry improves, by reducing, the bulk stiffness. METHODS Using five finite element models, a uniaxial compression test in five cubes with a 20 mm thickness was simulated and analyzed. The displacements, strain and Young Modulus were calculated in four cubes, each containing internal prismatic gaps with different transversal sections (squared, hexagonal, octagonal, and circular). Those were compared with a fifth full-volume cube used as control. RESULTS The most significant difference have been achieved in displacement values, in cubes containing internal gaps with hexagonal and circular transversal sections (82 µm and 82.5 µm, respectively), when compared to the full-volume cube (69.3 µm). CONCLUSIONS This study suggests that hexagonal and circular shape of the gaps allows obtaining the lower rigidity in a size range of 4 mm, offering a starting approach to achieve a "close-to-bone" material, with a potential use in prosthetic devices with limited thickness.
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Affiliation(s)
- Agostino Igor Mirulla
- Department of Engineering, University of Palermo, Viale delle Scienze Ed.8, Palermo 90128, Italy; Department for Life Quality Studies, University of Bologna, Rimini 47921, Italy.
| | - Giulio Maria Marcheggiani Muccioli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna 40136, Italy; 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna 40136, Italy
| | - Stefano Fratini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna 40136, Italy
| | - Stefano Zaffagnini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna 40136, Italy; 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna 40136, Italy
| | - Tommaso Ingrassia
- Department of Engineering, University of Palermo, Viale delle Scienze Ed.8, Palermo 90128, Italy
| | - Laura Bragonzoni
- Department for Life Quality Studies, University of Bologna, Rimini 47921, Italy
| | - Bernardo Innocenti
- BEAMS Department (Bio Electro and Mechanical Systems), Université Libre de Bruxelles, Bruxelles 1050, Belgium
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Vanstockstraeten S, Ghijselings S, Vles GF, Simon JP. Excellent Long-Term Survival Rate of Polished, Tapered, Cemented Stems in Patients Aged 35 Years or Younger With Avascular Necrosis or Inflammatory Arthritis of the Hip. J Arthroplasty 2022; 37:897-904.e1. [PMID: 35093544 DOI: 10.1016/j.arth.2022.01.055] [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: 10/26/2021] [Revised: 01/04/2022] [Accepted: 01/20/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) for avascular necrosis (AVN) or inflammatory arthritis (IA) comes with a relatively high risk of aseptic stem loosening, especially in young patients. There are limited long-term data on the survivorship of polished, tapered, cemented stems in this population. We therefore performed a single-center retrospective study investigating the survival of this particular stem type in young patients with AVN or IA. METHODS All patients aged ≤35 years who had received a THA for AVN or IA operated on by the senior author between 1990 and 2010 at the University Hospitals Leuven were identified. In total, 85 THAs in 62 patients were included. Primary endpoint was revision of the femoral component for aseptic loosening. Secondary endpoints were revision of the acetabular component for aseptic loosening, revision for other reasons, and the presence of radiolucencies around the components. RESULTS The mean follow-up for the entire cohort was 18.0 ± 5.3 years (range 8.0-28.9). Taking revision for aseptic loosening as endpoint, the survival of cemented stems was 100% after 15 years and 95.1% after 20 years. Survival of uncemented cups (91.3%) was significantly better than survival of cemented cups (50.3%) after 20 years of follow-up for aseptic loosening. Taking revision for any reason as endpoint, the survival of THAs with uncemented and cemented cups was 90% and 43.1% at 20 years respectively. Radiolucencies developed in the cement mantles around 11 of the 81 nonrevised stems, mainly in zones 1 and 7. CONCLUSION In this cohort of young patients with high-risk profiles for aseptic stem loosening, polished, tapered, cemented stems showed excellent long-term survival rates and they therefore remain a viable alternative to uncemented stem designs.
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Affiliation(s)
- Sanne Vanstockstraeten
- Department of Development and Regeneration, Faculty of Medicine, Institute for Orthopaedic Research and Training (IORT), KU Leuven, Belgium; Division of Orthopedics, University Hospitals, Leuven, Belgium
| | - Stijn Ghijselings
- Department of Development and Regeneration, Faculty of Medicine, Institute for Orthopaedic Research and Training (IORT), KU Leuven, Belgium; Division of Orthopedics, University Hospitals, Leuven, Belgium
| | - Georges Frederic Vles
- Department of Development and Regeneration, Faculty of Medicine, Institute for Orthopaedic Research and Training (IORT), KU Leuven, Belgium; Division of Orthopedics, University Hospitals, Leuven, Belgium
| | - Jean-Pierre Simon
- Department of Development and Regeneration, Faculty of Medicine, Institute for Orthopaedic Research and Training (IORT), KU Leuven, Belgium; Division of Orthopedics, University Hospitals, Leuven, Belgium
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13
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Raja BS, Gowda AK, Singh S, Ansari S, Kalia RB, Paul S. Comparison of functional outcomes and complications of cemented vs uncemented total hip arthroplasty in the elderly neck of femur fracture patients: A systematic review and meta-analysis. J Clin Orthop Trauma 2022; 29:101876. [PMID: 35515344 PMCID: PMC9062326 DOI: 10.1016/j.jcot.2022.101876] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/03/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE The neck of femur fractures in the elderly is a global concern. These fractures impair the quality of living and add to morbidity and mortality. A Multitude of treatment options for the same. This systematic review focuses on evaluating outcomes between cemented and uncemented total hip replacement in the elderly population with neck of femur fractures. MATERIAL AND METHODS The search was conducted in databases PubMed, Embase, Scopus, open grey, and Cochrane following PRISMA guidelines. The studies fulfilling the inclusion criteria were included, scrutinized for data analysis, and also quality appraisal of all the included studies was conducted to be included in this article. RESULTS A total of 7 studies were included (2 RCT, 5 retrospective studies) comprising 1171 THRs. Data analysis showed a higher HHS in cemented compared to uncemented(p < 0.001). The uncemented group had a significantly higher rate of revision, dislocation, and periprosthetic fracture compared to cemented group(p < 0.001). However, VAS score, loosening rates, and heterotopic ossification were similar in both statistically insignificant groups. CONCLUSION Choosing between cemented and uncemented techniques had been a controversy with lesser data due to higher morbidity and mortality. This systematic review provides information regarding functional outcomes and complications in both groups. The cemented group had better outcomes and lesser complications which should be preferred in elderly patients as the conclusion of this study. However, a larger RCT with better follow-up is still required. LEVEL OF EVIDENCE Level I, systematic review and meta-analysis.
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Affiliation(s)
- Balgovind S. Raja
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Aditya K.S. Gowda
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | | | - Sajid Ansari
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Roop Bhushan Kalia
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India,Corresponding author.
| | - Souvik Paul
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
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14
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Botterill J, Khatkar H. The role of hydroxyapatite coating in joint replacement surgery - Key considerations. J Clin Orthop Trauma 2022; 29:101874. [PMID: 35515345 PMCID: PMC9062319 DOI: 10.1016/j.jcot.2022.101874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022] Open
Abstract
The use of a porous hydroxyapatite (HA) coating has definitively increased the durability and biocompatibility of joint replacement prostheses (JRP) since its introduction. This article will contextualise the properties of porous HA and relate these characteristics to its clinical function. Novel strategies to encourage osseointegration will also be explored, alongside their clinical relevance. All major literature databases were scrutinised for literature relevant to the scope of our review. The role of Hydroxyapatite was evaluated, alongside further strategies to augment bone ingrowth. HA coatings remain the most optimal coating for widespread clinical use. Advantages are conferred due to the method of application, the tribology and the biocompatibility of the material. Further strategies are available to augment bone ingrowth, pertaining to biological modifications and implantation of external factors. An evaluation of the literature has described the relative long term performance of the HA coated JRPs both in isolation and when compared with cemented prosthesis. Metanalyses have shown HA coated JRPs to perform as well as cemented prosthesis in terms of survivability over both short and long term follow ups. Concerning strategies to augment osseointegration, consideration should be given to form and function of the coating surface, as this provides the basis for cell adherence, proliferation, and differentiation.
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Affiliation(s)
- Jonathan Botterill
- Corresponding author. 35 Wall Brown Way, HP19 9BW, Aylesbury, United Kingdom.
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15
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Panghate A, Jogani AD, Panchal S, Desai J, Marathe N, Rathod R. An evaluation of peri-operative clinical, serological and radiological parameters in hip arthroplasties -a prospective observational study of Indian cohorts. J Orthop 2022; 30:98-102. [PMID: 35250197 PMCID: PMC8889370 DOI: 10.1016/j.jor.2022.01.009] [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: 07/18/2021] [Revised: 01/27/2022] [Accepted: 01/27/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The scarcity of mortality data in our country led to systematic effort with aim of evaluating peri-operative parameters associated with mortality in hip arthroplasties to determine better fixation method and reducing avoidable variables. MATERIALS & METHODS 252 consecutive patients (133 males and 119 females; Mean age 58.68 years) operated for hip arthroplasties (cemented & uncemented THR and bipolar hemiarthroplasty) were observed prospectively for 2 years. Heart-rate, O2 saturation and BP were recorded at specific surgical steps and post-operatively for 48 h. Post-operative Trop-T and 2D Echocardiography were done in all patients and D-Dimer and CTPA in indicated ones. All post-operative deaths were extensively studied. RESULTS - Majority (63%) were operated for traumatic indications.48% belonged to ASA grade-1, 46% grade-2 and 4% grade-3. There was statistically significant association of diagnosis (traumatic aetiology), ASA grade 2, raised Troponin -T, raised D-dimer and pulmonary embolism with mortality. Mortality rate in our study at post-op 48 h was 5.5%, 30 day- 8% and 1-year mortality rate was 19%. With total of 14 deaths, 8 deaths (57.14%) occurred among 127 cemented arthroplasties and 6 deaths (42.86%) among 125 uncemented arthroplasties. CONCLUSIONS Selection of implant (cemented or uncemented) made no difference in eventual mortality. Collaborative effort of orthopaedic surgeon, anaesthetist and experts from respective fields in elderly high-risk patient with vigilant post-operative surveillance for minimum 48 h would help in lowering mortality associated with hip arthroplasties.
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Affiliation(s)
- Atul Panghate
- Seth GS Medical College & KEM Hospital, Mumbai, 400012, India
| | | | - Sameer Panchal
- Dept of Orthopaedics, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, 400008, India,Corresponding author. Dept of Orthopaedics, Grant medical College and Sir JJ group of hospitals, Mumbai, 400008, India.
| | - Jigar Desai
- Seth GS Medical College & KEM Hospital, Mumbai, 400012, India
| | | | - Rajkumar Rathod
- Lilavati Hospital and Research Centre, Bandra West, Mumbai, 400050, India
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16
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Bloch BV, White JJE, Matar HE, Berber R, Manktelow ARJ. Should patient age thresholds dictate fixation strategy in total hip arthroplasty? Bone Joint J 2022; 104-B:206-211. [PMID: 35094580 DOI: 10.1302/0301-620x.104b2.bjj-2021-1199.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Total hip arthroplasty (THA) is a very successful and cost-effective operation, yet debate continues about the optimum fixation philosophy in different age groups. The concept of the 'cementless paradox' and the UK 'Getting it Right First Time' initiative encourage increased use of cemented fixation due to purported lower revision rates, especially in elderly patients, and decreased cost. METHODS In a high-volume, tertiary referral centre, we identified 10,112 THAs from a prospectively collected database, including 1,699 cemented THAs, 5,782 hybrid THAs, and 2,631 cementless THAs. The endpoint was revision for any reason. Secondary analysis included examination of implant survivorship in patients aged over 70 years, over 75 years, and over 80 years at primary THA. RESULTS Cemented fixation had the lowest implant survival in all age groups, with a total ten-year survivorship of 97.0% (95% confidence interval (CI) 95.8 to 97.8) in the cemented group, 97.6% (95% CI 96.9 to 98.1) in the hybrid group, and 97.9% (95% CI 96.9 to 98.6) in the cementless group. This was not statistically significant (p = 0.092). There was no age group where cemented fixation outperformed hybrid or cementless fixation. CONCLUSION While all fixation techniques performed well at long-term follow-up, cemented fixation was associated with the lowest implant survival in all age groups, including in more elderly patients. We recommend that surgeons should carefully monitor their own outcomes and use fixation techniques that they are familiar with, and deliver the best outcomes in their own hands. Cite this article: Bone Joint J 2022;104-B(2):206-211.
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Affiliation(s)
- Benjamin V Bloch
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jonathan J E White
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Hosam E Matar
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Reshid Berber
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Andrew R J Manktelow
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, UK
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17
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Trebše R, Valič M, Savarin D, Milošev I, Levašič V. Survival rate of total hip replacements with matched and with mixed components with 10.7 years mean follow-up. Hip Int 2022; 32:32-38. [PMID: 33213223 DOI: 10.1177/1120700020972710] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Mixing and matching components from different manufacturers in total hip arthroplasty is a frequently used off-label praxis. The clinical consequences of this procedure have not been studied in detail. METHODS 860 patients with matched and 1067 patients with mixed primary total hip replacement (THR) components carried out between 1 January 2002 and 31 December 2004, were selected from our Institution registry. The analysis endpoint was set at 1 January 2016. THRs with poorly performing components were excluded from study groups. Kaplan-Meier survival curves for both groups were calculated and compared using the Log-Rank test and the demographic data using the chi-square test. Correlations between demographic data and revisions were calculated using bivariate correlation. RESULTS 28 revisions were carried out in the matched group and 67 in the mixed group. The 14-year overall survival probability was significantly better in the former (96.0%) than in the mixed group (92.7%) (p = 0.002). Survival, free of aseptic and septic failures, was statistically, significantly higher in the matched group (p = 0.026 and p = 0.007, respectively).The survival of the mixed subgroup with heads and stems from the same manufacturer did not differ statistically from that of the matched group (p = 0.079). CONCLUSIONS In contrast to the results listed in the National Joint Registry and the New Zealand Joint Registry, the survival probability in our study was, statistically, significantly higher in total hip replacements using components of the same manufacturer. Importantly, mixing and matching the components of different manufacturers led to similar survival providing the head and the stem were from the same manufacturer.
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Affiliation(s)
- Rihard Trebše
- Valdoltra Orthopaedic Hospital, Ankaran, Slovenia.,Faculty of Medicine, University of Ljubljana, Slovenia
| | - Matej Valič
- Valdoltra Orthopaedic Hospital, Ankaran, Slovenia
| | | | - Ingrid Milošev
- Valdoltra Orthopaedic Hospital, Ankaran, Slovenia.,Jožef Stefan Institute, Ljubljana, Slovenia
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18
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Wang K, Kenanidis E, Suleman K, Miodownik M, Avadi M, Horne D, Thompson J, Tsiridis E, Moazen M. Differences between two sequential uncemented stem sizes in total hip arthroplasty: A comparative biomechanical study and potential clinical implications. SICOT J 2022; 8:43. [DOI: 10.1051/sicotj/2022043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Early failure of uncemented femoral stems associated with incorrect sizing is a known postoperative complication. Surgeons are often faced with the question of whether an uncemented stem of adequate stability or a larger-sized stem should be implanted, especially when the proximal femoral cancellous bone is adequate. The biomechanical effect of sub-optimal stem sizing in the femur remains unclear. This study investigated the mechanical behaviour of two sequential sized uncemented stems of the same type. Methods: Six laboratory models of synthetic non-osteoporotic femora were randomly divided into two groups and implanted with either a nominal or oversized uncemented hydroxyapatite-coated nonporous titanium collarless stem. Stiffness, uniaxial strain, and pattern of strain distribution were measured under an anatomical one-legged stance. Results: Oversized stems demonstrated a higher overall stiffness compared to nominal; however, this was not statistically significant. The nominal stem showed a higher strain in the neck and the proximal medial diaphyseal region. The oversized stem showed higher strains in the distal region around the implant tip. Conclusion: Opting to use a larger stem may potentially increase primary stability, thus allowing safer early mobility. However, higher stiffness may lead to stress shielding, bone loss, and thigh pain in the long term. In addition, strains in the diaphysis and the tip of the stem may predispose to periprosthetic fractures, especially in osteoporotic bones, making this a relatable aspect for users and biomechanical loading. Given the wide range of complex factors that need to be considered when choosing stem size in uncemented THA surgery, this study’s results should be interpreted cautiously.
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19
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GUIMARÃES RODRIGOPEREIRA, VIAMONT-GUERRA MARÍAROXANA, ANTONIOLI ELIANE, LENZA MARIO. TOTAL HIP ARTHROPLASTY IN THE PUBLIC HEALTH SYSTEM OF SÃO PAULO: COMPARING TYPES OF FIXATION. ACTA ORTOPÉDICA BRASILEIRA 2022; 30:e251150. [DOI: 10.1590/1413-785220223005e251150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/22/2021] [Indexed: 11/13/2022]
Abstract
ABSTRACT Brazil lacks registries on the prevalence of primary total hip arthroplasty (THA) fixation methods. Objective: (i) to describe the demographic profile of patients who underwent THA in the public health system of the municipality of São Paulo during the last 12 years and (ii) to compare fixation methods regarding costs, hospital stay length, and death rates. Methods: This is an ecological study conducted with data available on TabNet, a platform belonging to DATASUS. Public data (from the government health system) on THA procedures performed in São Paulo from 2008 to 2019 were extracted. Gender, age, city region, THA fixation method, number of surgeries, costs, hospital stay length, and death rates were analyzed. Results: We analyzed 7,673 THA, of which 6220 (81%) were performed via cementless/hybrid fixation and 1453 (19%), via the cemented technique. Cementless/hybrid fixation had a higher cost (US$ 495.27) than the cemented one (p < 0.001). Nevertheless, hospital stay length was 0.87 days longer for cemented fixation than the cementless/hybrid one. We found no significant difference in death rates between THA fixation methods. Conclusion: THA cementless/hybrid fixation is prevalent in the municipality of São Paulo, which had higher total costs and shorter hospitalizations than cemented fixation. We found no difference between THA fixation methods and death rates. Level of Evidence IV, Case Series.
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20
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Austin MS, Ashley BS, Bedard NA, Bezwada HP, Hannon CP, Fillingham YA, Kolwadkar YV, Rees HW, Grosso MJ, Zeegen EN. What is the Level of Evidence Substantiating Commercial Payers' Coverage Policies for Total Joint Arthroplasty? J Arthroplasty 2021; 36:2665-2673.e8. [PMID: 33867209 DOI: 10.1016/j.arth.2021.03.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/08/2021] [Accepted: 03/14/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The prevalence of total joint arthroplasty (TJA) in the United States has drawn the attention of health care stakeholders. The payers have also used a variety of strategies to regulate the medical necessity of these procedures. The purpose of this study was to examine the level of evidence of the coverage policies being used by commercial payers in the United States. METHODS The references of the coverage policies of four commercial insurance companies were reviewed for type of document, level of evidence, applicability to a TJA population, and success of nonoperative treatment in patients with severe degenerative joint disease. RESULTS 282 documents were reviewed. 45.8% were primary journal articles, 14.2% were level I or II, 41.2% were applicable to patients who were candidates for TJA, and 9.9% discussed the success of nonoperative treatment in patients who would be candidates for TJA. CONCLUSION Most of the references cited by commercial payers are of a lower level of scientific evidence and not applicable to patients considered to be candidates for TJA. This is relatively uniform across the reviewed payers. The dearth of high-quality literature cited by commercial payers reflects the lack of evidence and difficulty in conducting high level studies on the outcomes of nonoperative versus operative treatment for patients with severe, symptomatic osteoarthritis. Patients, surgeons, and payers would all benefit from such studies and we encourage professional societies to strive toward that end through multicenter collaboration.
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Affiliation(s)
- Matthew S Austin
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Blair S Ashley
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Nicholas A Bedard
- Department of Orthopaedic Surgery, University of Iowa Hospitals & Clinics, Iowa City, IA
| | | | - Charles P Hannon
- Department of Orthopaedic Surgery, The Mayo Clinic, Ochester, MN
| | - Yale A Fillingham
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Yogesh V Kolwadkar
- Department of Orthopaedic Surgery, VA Central California Health Care System, Fresno, CA
| | - Harold W Rees
- Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood, IL
| | - Matthew J Grosso
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA; Connecticut Joint Replacement Institute, Hartford, CT
| | - Erik N Zeegen
- Department of Orthopaedic Surgery, University of California Los Angeles, Santa Monica, CA
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21
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Sarpong NO, Grosso MJ, Lakra A, Herndon CL, Jennings E, Shah RP, Geller JA, Cooper HJ. Outcomes and survivorship after conversion of failed hip hemiarthroplasty to total hip arthroplasty. Hip Int 2021; 31:388-392. [PMID: 31822131 DOI: 10.1177/1120700019891427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Arthroplasty is the treatment of choice for elderly patients with displaced femoral neck fractures. When compared to total hip arthroplasty (THA), higher revision rates have been reported for hemiarthroplasty (HA). Conversion of failed HA to THA can be complex, especially in the elderly population at risk for revision surgery complications. We report a single institution's experience with conversion of failed HA to THA at mid-term follow-up. METHODS We identified patients converted from failed HA to THA from 2006 to 2016. Clinical data including indication for index and conversion surgery, maintenance or revision of femoral component during conversion, operative time, estimated blood loss, postoperative complications, and need for revision surgery were collected. Descriptive statistics were analysed in SPSS. RESULTS The cohort included 21 men and 39 women (mean age of 74.5 years). The mean follow-up after conversion HA to THA was 2.8 years. During conversion surgery, the femoral component was revised in 75.0% and retained in 25.0% of cases. After conversion HA to THA, the rate of major complications and re-revision at 2 years was 11.7% and 10.0%, respectively. Femoral revision versus retention did not affect complication rates (11.1% vs. 6.7%; p = 0.31) or re-revision rates (8.9% vs. 13.3%; p = 1.0). CONCLUSIONS In this high-risk population, mid-term follow-up demonstrated tolerable complication and re-revision rates, the majority of which were for instability. We observed high rates of femoral component revision during conversion THA, although this did not increase the likelihood of postoperative complications or need for future surgery.
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Affiliation(s)
- Nana O Sarpong
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Matthew J Grosso
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Akshay Lakra
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Carl L Herndon
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Emma Jennings
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Roshan P Shah
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Jeffrey A Geller
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - H John Cooper
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
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22
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Jin SY, Jin JY, Cheon JH, Yoon TR, Park KS. Survival Analysis of Total Hip Arthroplasty for High Hip Dislocation Secondary to Developmental Dysplasia or Septic Arthritis of the Hip. J Arthroplasty 2021; 36:1671-1677. [PMID: 33248922 DOI: 10.1016/j.arth.2020.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/25/2020] [Accepted: 11/03/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND This retrospective study was conducted to know clinical and radiographic outcomes, complication rate, and survival of THA in patients with high hip dislocation secondary to developmental dysplasia(DDH) or septic arthritis of the hip(SSH). METHODS Between March 2005 and September 2014, there were consecutive series of 53 THAs in patients with a highly dislocated hip secondary to DDH or SSH. Of these, 48 hips (DDH 24 and SSH 24) were reviewed at a mean follow-up of 7.9 years(range, 5.0-14.3 years). The mean age at the time of THA was 39.1 years(range, 18.0-59.0 years). RESULTS Intraoperative blood loss, total drainage and blood transfusion amounts, and mean time to greater trochanter union were significantly lower in the DDH group than in the SSH group (P = .001, P = .039 and P = .014, and P = .015, respectively). No significant difference in Kaplan-Meier survivorship was observed between groups (log-rank, P = .343). The survival rates with an endpoint of cup aseptic loosening in cases with a cemented cup at 7.9 and 10 years (68.1% and 60.5%, respectively) were significantly lower than those in cementless cup cases (100%) at the same checkpoints (P = .019).. CONCLUSION We found similar clinical outcomes between the DDH and SSH groups. However, due to poor bone quality and a lack of containment, cementless acetabular cups could not be performed in more than 50% of patients. Our experience shows that revision cementless fixation cup was possible due to reconstitution of the acetabulum in cases with failed cemented fixation.
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Affiliation(s)
- Sheng-Yu Jin
- Department of Orthopedic Surgery, Center for Joint Disease Chonnam National University Hwasun Hospital, Jeonnam, Republic of Korea
| | - Jing-Yao Jin
- Department of Orthopedic Surgery, Center for Joint Disease Chonnam National University Hwasun Hospital, Jeonnam, Republic of Korea
| | - Jae-Hyeok Cheon
- Department of Orthopedic Surgery, Center for Joint Disease Chonnam National University Hwasun Hospital, Jeonnam, Republic of Korea
| | - Taek-Rim Yoon
- Department of Orthopedic Surgery, Center for Joint Disease Chonnam National University Hwasun Hospital, Jeonnam, Republic of Korea
| | - Kyung-Soon Park
- Department of Orthopedic Surgery, Center for Joint Disease Chonnam National University Hwasun Hospital, Jeonnam, Republic of Korea
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23
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Veldman HD, de Bot RTAL, Heyligers IC, Boymans TAEJ, Hiligsmann M. Cost-effectiveness analyses comparing cemented, cementless, hybrid and reverse hybrid fixation in total hip arthroplasty: a systematic overview and critical appraisal of the current evidence. Expert Rev Pharmacoecon Outcomes Res 2021; 21:579-593. [PMID: 33472442 DOI: 10.1080/14737167.2021.1878880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: This study aims to present an overview and critical appraisal of all previous studies comparing costs and outcomes of the different modes of fixation in total hip arthroplasty (THA). A secondary aim is to provide conclusions regarding the most cost-effective mode of implant fixation per gender and age-specific population in THA, based on high quality studies.Methods: A systematic search was conducted to identify cost-effectiveness analyses (CEAs) comparing different modes of implant fixation in THA. Analysis of results was done with solely CEAs that had a high methodological quality.Results: A total of 12 relevant studies were identified and presented, of which 5 were considered to have the methodological rigor for inclusion in the analysis of results. These studies found that either cemented or hybrid fixation was the most cost-effective implant fixation mode for most age- and gender-specific subgroups.Conclusion: Currently available well performed CEAs generally support the use of cemented and hybrid fixation for all age-groups relevant for THA and both genders. However, these findings were mainly based on a single database and depended on assumptions made in the studies' methodology. Issues discussed in this paper have to be considered and future work is needed.
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Affiliation(s)
- H D Veldman
- Zuyderland Medical Center, Dept. Of Orthopaedic Surgery and Traumatology, Heerlen, The Netherlands.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Dept. Of Health Services Research, Maastricht, The Netherlands
| | - R T A L de Bot
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Dept. Of Health Services Research, Maastricht, The Netherlands.,Maastricht University Medical Center, dept. of Orthopaedics, Maastricht, The Netherlands
| | - I C Heyligers
- Zuyderland Medical Center, Dept. Of Orthopaedic Surgery and Traumatology, Heerlen, The Netherlands.,School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
| | - T A E J Boymans
- Maastricht University Medical Center, dept. of Orthopaedics, Maastricht, The Netherlands
| | - M Hiligsmann
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Dept. Of Health Services Research, Maastricht, The Netherlands
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24
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Latessa I, Ricciardi C, Jacob D, Jónsson H, Gambacorta M, Improta G, Gargiulo P. Health technology assessment through Six Sigma Methodology to assess cemented and uncemented protheses in total hip arthroplasty. Eur J Transl Myol 2021; 31. [PMID: 33709655 PMCID: PMC8056159 DOI: 10.4081/ejtm.2021.9651] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/12/2021] [Indexed: 02/07/2023] Open
Abstract
The purpose of this study is to use Health Technology Assessment (HTA) through the Six Sigma (SS) and DMAIC (Define, Measure, Analyse, Improve, Control) problem-solving strategies for comparing cemented and uncemented prostheses in terms of the costs incurred for Total hip arthroplasty (THA) and the length of hospital stay (LOS). Multinomial logistic regression analysis for modelling the data was also performed. Quantitative parameters extracted from gait analysis, electromyography and computed tomography images were used to compare the approaches, but the analysis did not show statistical significance. The variables regarding costs were studied with the Mann-Whitney and Kruskal-Wallis tests. No statistically significant difference between cemented and uncemented prosthesis for the total cost of LOS was found, but the cost of the surgeon had an influence on the overall expenses, affecting the cemented prosthetic approach. The material costs of surgery for the uncemented prosthesis and the cost of theatre of surgery for the cemented prosthesis were the most influential. Multinomial logistic regression identified the Vastus Lateralis variable as statistically significant. The overall accuracy of the model is 93.0%. The use of SS and DMAIC cycle as tools of HTA proved that the cemented and uncemented approaches for THA have similar costs and LOSy.
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Affiliation(s)
- Imma Latessa
- University Hospital of Naples "Federico II", Department of Public Health, Naples, Italy; Reykjavík University, Institute for Biomedical and Neural Engineering, Reykjavík.
| | - Carlo Ricciardi
- Reykjavík University, Institute for Biomedical and Neural Engineering, Reykjavík, Iceland; University Hospital of Naples 'Federico II', Department of Advanced Biomedical Sciences, Naples.
| | - Deborah Jacob
- Reykjavík University, Institute for Biomedical and Neural Engineering, Reykjavík.
| | - Halldór Jónsson
- University of Iceland, Faculty of Medicine, Reykjavík, Iceland; Landspítali Hospital, Orthopaedic Clinic, Reykjavík.
| | | | - Giovanni Improta
- University Hospital of Naples "Federico II", Department of Public Health, Naples.
| | - Paolo Gargiulo
- Reykjavík University, Institute for Biomedical and Neural Engineering, Reykjavík, Iceland; Landspítali Hospital, Department of Science, Reykjavík.
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Almaawi A, Alzuhair A, AlHakbani A, Benfaris D, Al-Abdullatif F, Alabdulkarim NH, Awwad W. Comparison of Ceramic-on-Ceramic and Ceramic-on-Highly-Crosslinked-Polyethylene in Primary Total Hip Arthroplasty: Findings of a Meta-Analysis. Cureus 2021; 13:e13304. [PMID: 33738155 PMCID: PMC7958929 DOI: 10.7759/cureus.13304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction An optimal hip implant is biocompatible, durable, and resistant to chemical and mechanical wear. This analysis aimed to compare failure (revision) and complication rates between ceramic-on-ceramic (CoC) and ceramic-on-highly-crosslinked-polyethylene (CoHXLPE) implants. Methods This review comprised of scientific literature published between 1995 and 2019. We included randomized controlled trials in adults (>18 years) that presented results of CoC and CoHXLPE total hip arthroplasty (THA) with more than two years of mean follow-up and drafted in English. The primary outcomes for this analysis were complications, revision rates, and loosening rates. Results Eight studies (1,689 hips) were included in this systematic review. There was no significant differences between COC and CoHXLPE for the risk of post-surgical complications (relative risk [RR]: 1.98, 95% confidence interval [CI]: 0.83-4.69, P = 0.12). Revision rates (RR: 1.25, 95% CI: 0.71-2.20, P = 0.43] and loosening rates between the two implants were not significantly different (RR: 1.17, 95% CI: 0.30-4.52, P = 0.82). Conclusion We report no significant differences between CoHXLPE and CoC in adults undergoing primary THA. Although introduced relatively recently, CoHXLPE is a cost-effective bearing that can be used for younger patients with no risk of increased complications in comparison to CoC. Further studies with longer follow-up periods are recommended to confirm the findings of this meta-analysis.
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Affiliation(s)
| | | | | | | | | | | | - Waleed Awwad
- Orthopaedic Surgery, King Saud University, Riyadh, SAU
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26
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Schauberger A, Klug A, Hagebusch P, Kemmerer M, Hoffmann R, Gramlich Y. Explantation, Followed by Serial Debridement Without Antibiotic Spacers and Subsequent Revision With Cementless Components, Is Associated With High Remission Rates and Low Mortality in Periprosthetic Hip Joint Infections. J Arthroplasty 2020; 35:3274-3284. [PMID: 32624380 DOI: 10.1016/j.arth.2020.06.006] [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: 03/24/2020] [Revised: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND In difficult-to-treat cases, it is necessary to add debridement steps in prosthesis-free interval of 2-stage exchange. We aimed to analyze the functional and clinical outcome of patients treated with a multistage exchange of total hip arthroplasty without the use of spacers, rather only cementless implants. METHODS Between 2009 and 2018, 84 patients (mean age: 67.3 [39-90] years) suffering chronic late-onset periprosthetic joint infection (PJI) were treated using a multistage prosthesis exchange without spacers. The mean follow-up was 70 ± 45.3 [14-210] months. The treatment included prosthesis exchange and at least 1 additional revision step before a reimplantation, owing to ongoing acute infection in the prosthesis-free interval. High-efficiency antimicrobial therapy was administered in between, which was discontinued after cementless revision implantation. RESULTS The mean number of revisions between explantation and implantation was 2.6 (1-9). The most common microorganism was Staphylococcus epidermidis (53.6%) followed by Staphylococcus aureus (16.7%) and Cutibacterium acnes (11.9%). The bacterial load was more than one bacterium per patient in 38% of cases. All patients could be treated using a cementless implant. PJI remission was achieved in 92% of cases. Overall, 9 prostheses (11%) were replaced because of an ongoing PJI or fracture. The mean modified Harrison Hip Score was 63.4 (22-88) points. No patient died. CONCLUSION Multistage total hip arthroplasty exchange showed high remission rates and low mortality in difficult-to-treat cases. Spacer-free and multistage treatment had no negative effect on the success rate or functional outcome, consistent with the results of published 2-stage exchange studies. Implantation of an uncemented press-fit prosthesis was possible in all patients with no elevated periprosthetic fracture rate.
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Affiliation(s)
- Alice Schauberger
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Alexander Klug
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Paul Hagebusch
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Matthias Kemmerer
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Reinhard Hoffmann
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Yves Gramlich
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
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Jo S, Lee SH, Yoon SJ. Clinical Outcomes of Total Hip Arthroplasty for Displaced Femoral Neck Fractures in Patients 80 Years of Age and Older Selected by Clinical Frailty Score. Hip Pelvis 2020; 32:148-155. [PMID: 32953707 PMCID: PMC7476787 DOI: 10.5371/hp.2020.32.3.148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 06/29/2020] [Accepted: 06/29/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose The utility of total hip arthroplasty (THA) for the treatment of displaced femoral neck fractures in elderly patients (≥80 years of age) remains controversial as a patient's general condition is an essential factor impacting recovery. This study aims to determine if THA is a valuable option for appropriately selected elderly patients. Materials and Methods All patients underwent cementless THA using a direct lateral approach with a rectangular stem. Eighty-two patients ≥80 years of age underwent THA due to a displaced femoral neck. Clinical frailty scale (CFS) scores <5 were indicated for THA. The modified Harris hip score (mHHS), visual analogue scale (VAS), and patient satisfaction were used to assess outcomes. Results Nine of 82 patients died in the study period with another underlying disease. One, a 90-year-old male with pneumonia expired in the intensive care unit at 7-day postoperatively, while the other eight died due to causes unrelated to THA. Of the remaining 73 patients: (i) mean mHHS score increased to 80.57±21.36 at 1-year postoperatively; (ii) VAS was 2.3±0.9 points six-months postoperatively; and (iii) 78.7% of patients reported that they were very satisfied or satisfied 1-year postoperatively. The number of perioperative complications was 10.8% (9 hips) without the need for revision surgery. Conclusion The use of THA in patients ≥80 years of age with low CFS scores (<5) described here yielded favorable results and a relatively low rate of complications. However, a well-controlled comparative study or randomized trial is required to further refine selection criteria for THA in this patient population.
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Affiliation(s)
- Suenghwan Jo
- Department of Orthopaedics, School of Medicine, Chosun University, Gwangju, Korea
| | - Se Hwan Lee
- Department of Orthopedic Surgery, Jeonbuk National University Hospital, Jeonju, Korea
| | - Sun-Jung Yoon
- Department of Orthopedic Surgery, Jeonbuk National University Hospital, Jeonju, Korea
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28
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Strain shielding for cemented hip implants. Clin Biomech (Bristol, Avon) 2020; 77:105027. [PMID: 32447179 DOI: 10.1016/j.clinbiomech.2020.105027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 04/27/2020] [Accepted: 04/29/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Long-term survival of hip implants is of increasing relevance due to the rising life expectancy. The biomechanical effect of strain shielding as a result of implant insertion may lead to bone resorption, thus increasing risk for implant loosening and periprosthetic fractures. Patient-specific quantification of strain shielding could assist orthopedic surgeons in choosing the biomechanically most appropriate prosthesis. METHODS Validated quantitative CT-based finite element models of five femurs in intact and implanted states were considered to propose a systematic algorithm for strain shielding quantification. Three different strain measures were investigated and the most appropriate measure for strain shielding quantification is recommended. It is used to demonstrate a practical femur-specific implant selection among three common designs. FINDINGS Strain shielding measures demonstrated similar trends in all Gruen zones except zone 1, where the volumetric strain measure differed from von-Mises and maximum principal strains. The volumetric strain measure is in better agreement with clinical bone resorption records. It is also consistent with the biological mechanism of bone remodeling so it is recommended for strain shielding quantification. Applying the strain shielding algorithm on three different implants for a specific femur suggests that the collared design is preferable. Such quantitative biomechanical input is valuable for practical patient specific implant selection. INTERPRETATION Volumetric strain should be considered for strain shielding examination. The presented methodology may potentially enable patient-specific pre-operative strain shielding evaluation so to minimize strain shielding. It should be further used in a longitudinal study so to correlate between strain shielding predictions and clinical bone resorption.
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29
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Okike K, Chan PH, Prentice HA, Paxton EW, Burri RA. Association Between Uncemented vs Cemented Hemiarthroplasty and Revision Surgery Among Patients With Hip Fracture. JAMA 2020; 323:1077-1084. [PMID: 32181848 PMCID: PMC7078801 DOI: 10.1001/jama.2020.1067] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 01/27/2020] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Consensus guidelines and systematic reviews have suggested that cemented fixation is more effective than uncemented fixation in hemiarthroplasty for displaced femoral neck fractures. Given that these recommendations are based on research performed outside the United States, it is uncertain whether these findings also reflect the US experience. OBJECTIVE To compare the outcomes associated with cemented vs uncemented hemiarthroplasty in a large US integrated health care system. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of 12 491 patients aged 60 years and older who underwent hemiarthroplasty treatment of a hip fracture between 2009 and 2017 at 1 of the 36 hospitals owned by Kaiser Permanente, a large US health maintenance organization. Patients were followed up until membership termination, death, or the study end date of December 31, 2017. EXPOSURES Hemiarthroplasty (prosthetic replacement of the femoral head) fixation via bony growth into a porous-coated implant (uncemented) or with cement. MAIN OUTCOMES AND MEASURES The primary outcome measure was aseptic revision, defined as any reoperation performed after the index procedure involving exchange of the existing implant for reasons other than infection. Secondary outcomes were mortality (in-hospital, postdischarge, and overall), 90-day medical complications, 90-day emergency department visits, and 90-day unplanned readmissions. RESULTS Among 12 491 patients in the study cohort who underwent hemiarthroplasty for hip fracture (median age, 83 years; 8660 women [69.3%]), 6042 (48.4%) had undergone uncemented fixation and 6449 (51.6%) had undergone cemented fixation, and the median length of follow-up was 3.8 years. In the multivariable regression analysis controlling for confounders, uncemented fixation was associated with a significantly higher risk of aseptic revision (cumulative incidence at 1 year after operation, 3.0% vs 1.3%; absolute difference, 1.7% [95% CI, 1.1%-2.2%]; hazard ratio [HR], 1.77 [95% CI, 1.43-2.19]; P < .001). Of the 6 prespecified secondary end points, none showed a statistically significant difference between groups, including in-hospital mortality (1.7% for uncemented fixation vs 2.0% for cemented fixation; HR, 0.94 [95% CI, 0.73-1.21]; P = .61) and overall mortality (cumulative incidence at 1 year after operation: 20.0% for uncemented fixation vs 22.8% for cemented fixation; HR, 0.95 [95% CI, 0.90-1.01]; P = .08). CONCLUSIONS AND RELEVANCE Among patients with hip fracture treated with hemiarthroplasty in a large US integrated health care system, uncemented fixation, compared with cemented fixation, was associated with a statistically significantly higher risk of aseptic revision. These findings suggest that US surgeons should consider cemented fixation in the hemiarthroplasty treatment of displaced femoral neck fractures in the absence of contraindications.
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Affiliation(s)
- Kanu Okike
- Hawaii Permanente Medical Group, Kaiser Permanente, Honolulu
| | - Priscilla H. Chan
- Surgical Outcomes and Analysis Department, Kaiser Permanente, San Diego, California
| | - Heather A. Prentice
- Surgical Outcomes and Analysis Department, Kaiser Permanente, San Diego, California
| | - Elizabeth W. Paxton
- Surgical Outcomes and Analysis Department, Kaiser Permanente, San Diego, California
| | - Robert A. Burri
- The Permanente Medical Group, Kaiser Permanente, San Rafael, California
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Chen L, Hong G, Lin T, Huang L, Zhang Q, He W. [Short- and mid-term effectiveness of impaction bone allograft with acetabular components in treatment of severe acetabular defects]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:341-346. [PMID: 32174080 DOI: 10.7507/1002-1892.201904153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the short- and mid-term effectiveness of revision hip arthroplasty by using impaction bone allograft and acetabular components in treatment of severe acetabular defects. Methods A clinical data of 42 patients (44 hips) with severe acetabular defects between February 2011 and May 2018 were retrospectively analyzed. All patients underwent revision hip arthroplasty by using impaction bone allograft and acetabular components. Cemented cup (24 cases, 24 hips) and non-cemented cup (18 cases, 20 hips) were used in the revision surgery. There were 17 males and 25 females with an average age of 62.8 years (range, 22-84 years). The interval between the first total hip arthroplasty and revision was 2.5-12.0 years (mean, 8.3 years). The patients were accepted revision surgery for prosthesis aseptic loosening in 32 hips (31 cases) and the periprosthetic infection in 12 hips (11 cases). Twenty-nine hips (28 cases) were Paprosky type ⅢA and 15 hips (14 cases) were type ⅢB. The preoperative Harris score was 22.25±10.31 and the height of hip rotation center was (3.67±0.63) cm and the length difference of lower limbs was (3.41±0.64) cm. Results The operation time was 130-245 minutes (mean, 186 minutes) and the intraoperative blood loss was 600-2 400 mL (mean, 840 mL). The postoperative drainage volume was 250-1 450 mL (mean, 556 mL). Superficial infection of the incision occurred in 1 case, and the incisions healed by first intention in the other patients. All patients were followed up 6-87 months, with an average of 48.6 months. At last follow-up, the Harris score was 85.85±9.31, which was significantly different from the preoperative score ( t=18.563, P=0.000). Imaging examination revealed that the allogeneic bone gradually fused with the host bone, and no obvious bone resorption was observed. At last follow-up, the height of the hip rotation center was (1.01±0.21) cm, which was significantly different from the preoperative level ( t=17.549, P=0.000); the length difference of lower limbs was (0.62±0.51) cm, which was significantly different from the preoperative level ( t=14.211, P=0.000). The Harris score in the cemented group and non-cemented group increased significantly at last follow-up. The height of the hip rotation center decreased, and the hip rotation centers of both groups were within the Ranawat triangle zone. The length difference of the lower limbs also decreased, and the differences in all indexes were significant between pre- and post-operation ( P<0.05). There was significant difference in the height of the hip rotation center between groups ( t=2.095, P=0.042), but there was no significant difference in the Harris score and the length difference of lower limbs between groups ( P>0.05). Conclusion For severe acetabular defect (Paprosky type Ⅲ), the hip can be reconstructed with the impaction bone allograft and cemented or non-cemented components in revision hip arthroplsty. The short- and mid-term effectiveness are satisfactory.
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Affiliation(s)
- Leilei Chen
- Third Department of Orthopedics, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China;The Lab of Orthopaedics and Traumatology of Chinese Medicine of Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China
| | - Guoju Hong
- The Lab of Orthopaedics and Traumatology of Chinese Medicine of Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China;The First Medical College, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China;Devision of Orthopeadic Surgery, the University of Alberta, Canada
| | - Tianye Lin
- The Lab of Orthopaedics and Traumatology of Chinese Medicine of Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China;The First Medical College, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China
| | - Linfeng Huang
- The Lab of Orthopaedics and Traumatology of Chinese Medicine of Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China;The First Medical College, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China
| | - Qingwen Zhang
- Third Department of Orthopedics, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China;The Lab of Orthopaedics and Traumatology of Chinese Medicine of Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China
| | - Wei He
- Third Department of Orthopedics, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China;The Lab of Orthopaedics and Traumatology of Chinese Medicine of Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China
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Hoellwarth JS, Al Muderis M, Rozbruch SR. Cementing Osseointegration Implants Results in Loosening: Case Report and Review of Literature. Cureus 2020; 12:e7066. [PMID: 32226668 PMCID: PMC7089626 DOI: 10.7759/cureus.7066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 02/21/2020] [Indexed: 12/11/2022] Open
Abstract
Skeletal transcutaneous osseointegration was performed on a 54-year-old female transfemoral amputee. None of the available osseointegration implants achieved press-fit stability, so an implant was cemented in position. Although initially stable, by six months the patient reported painful loading and radiographs revealed cement mantle lucency. The osseointegration implant was removed, antibiotics were delivered via implanted spacer and intravenously, and revision osseointegration three months later achieved appropriate immediate press-fit stability. Cemented transcutaneous osseointegration implants loosen within one year. Osseointegration is only successful when bone grows directly onto the implant.
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Affiliation(s)
| | - Munjed Al Muderis
- Orthopaedic Surgery, Macquarie University Hospital, Macquarie Park, AUS
| | - S Robert Rozbruch
- Limb Salvage and Amputation Reconstruction Center, Hospital for Special Surgery, New York, USA
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Klug A, Gramlich Y, Hoffmann R, Pfeil J, Drees P, Kutzner KP. Trends in Total Hip Arthroplasty in Germany from 2007 to 2016: What Has Changed and Where Are We Now? ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2019; 159:173-180. [PMID: 31711254 DOI: 10.1055/a-1028-7822] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The number of total hip arthroplasties (THA) is rising in many industrialized nations. At the same time, the evidence regarding different types of prostheses and fixation techniques is constantly evolving. Therefore, this study aimed to analyze changes in THA by these advancements during the last decade. METHODS A retrospective analysis of data provided by the Federal Statistical Office of Germany from 2007 to 2016 was conducted using codes from the German procedure classification system and associated International Statistical Classification of Diseases and Related Health Problems codes. THA procedures were evaluated according to diagnoses, sex, and age of patients, along with the distribution of different prosthesis types. Additionally, changes in these parameters over time were analyzed. RESULTS From 2007 to 2016 a total of 2 157 041 primary THA procedures were performed in Germany, with an increase of 14.4% over this period. Overall, cementless standard THA (STHA) was used most frequently (50.0%), followed by hybrid variants (18.8%), hemiarthroplasties (15.9%), cemented standard THA (cSTHA; 9.2%), cementless short-stem THA (ssTHA; 4.8%), and hip resurfacing (HR; 0.9%) techniques. During the study period, the number of cSTHA and HR decreased significantly, whereas the use of STHA and ssTHA rose substantially, with a significantly higher application of these procedures in the elderly population. While osteoarthritis of the hip joint was the main indication for THA, several procedure-specific differences were identified. CONCLUSION The present data clearly demonstrate an increase in the use of cementless fixation for THA in Germany during the last decade and document a rise in ssTHA in recent years with, in contrast, the use of HR decreasing to a minimum.
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Affiliation(s)
- Alexander Klug
- Unfallchirurgie und Orthopädische Chirurgie, BG Unfallklinik Frankfurt am Main
| | - Yves Gramlich
- Unfallchirurgie und Orthopädische Chirurgie, BG Unfallklinik Frankfurt am Main
| | - Reinhard Hoffmann
- Unfallchirurgie und Orthopädische Chirurgie, BG Unfallklinik Frankfurt am Main
| | - Joachim Pfeil
- Klinik für Orthopädie und Unfallchirurgie, St. Josefs Hospital Wiesbaden
| | - Philipp Drees
- Zentrum für Orthopädie und Unfallchirurgie (ZOU), Universitätsmedizin Mainz
| | - Karl Philipp Kutzner
- Klinik für Orthopädie und Unfallchirurgie, St. Josefs Hospital Wiesbaden.,Zentrum für Orthopädie und Unfallchirurgie (ZOU), Universitätsmedizin Mainz
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Evaluation of new hip prosthesis design with finite element analysis. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2019; 42:1033-1038. [DOI: 10.1007/s13246-019-00802-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 09/16/2019] [Accepted: 09/17/2019] [Indexed: 10/25/2022]
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34
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Challenges of pre-clinical testing in orthopedic implant development. Med Eng Phys 2019; 72:49-54. [DOI: 10.1016/j.medengphy.2019.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 08/24/2019] [Indexed: 01/23/2023]
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Cantrell WA, Samuel LT, Sultan AA, Acuña AJ, Kamath AF. Operative Times Have Remained Stable for Total Hip Arthroplasty for >15 Years: Systematic Review of 630,675 Procedures. JB JS Open Access 2019; 4:e0047. [PMID: 32043063 PMCID: PMC6959906 DOI: 10.2106/jbjs.oa.19.00047] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Understanding trends in operative times has become increasingly important in light of total hip arthroplasty (THA) being added to the Centers for Medicare & Medicaid Services (CMS) 2019 Potentially Misvalued Codes List. The purpose of this review was to explore the mean THA operative times reported in the literature in order (1) to determine if they have increased, decreased, or remained the same for patients reported on between 2000 and 2019 and (2) to determine what factors might have contributed to the difference (or lack thereof) in THA operative time over a contemporary study period. METHODS The PubMed and EBSCOhost databases were queried to identify all articles, published between 2000 and 2019, that reported on THA operative times. The keywords used were "operative," "time," and "total hip arthroplasty." An article was included if the full text was available, it was written in English, and it reported operative times of THAs. An article was excluded if it did not discuss operative time; it reported only comparative, rather than absolute, operative times; or the cohort consisted of total knee arthroplasties (TKAs) and THAs, exclusively of revision THAs, or exclusively of robotic THAs. Data on manual or primary THAs were extracted from studies including robotic or revision THAs. Thirty-five articles reporting on 630,675 hips that underwent THA between 1996 and 2016 met our criteria. RESULTS The overall weighted average operative time was 93.20 minutes (range, 55.65 to 149.00 minutes). When the study cohorts were stratified according to average operative time, the highest number fell into the 90 to 99-minute range. Operative time was stable throughout the years reported. Factors that led to increased operative times included increased body mass index (BMI), less surgical experience, and the presence of a trainee. CONCLUSIONS The average operative time across the included articles was approximately 95 minutes and has been relatively stable over the past 2 decades. On the basis of our findings, we cannot support CMS lowering the procedural valuation of THA given the stability of its operative times and the relationship between operative time and cost.
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Affiliation(s)
- William A Cantrell
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Linsen T Samuel
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Assem A Sultan
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Alexander J Acuña
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
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Callahan A, Fries JA, Ré C, Huddleston JI, Giori NJ, Delp S, Shah NH. Medical device surveillance with electronic health records. NPJ Digit Med 2019; 2:94. [PMID: 31583282 PMCID: PMC6761113 DOI: 10.1038/s41746-019-0168-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 08/15/2019] [Indexed: 12/18/2022] Open
Abstract
Post-market medical device surveillance is a challenge facing manufacturers, regulatory agencies, and health care providers. Electronic health records are valuable sources of real-world evidence for assessing device safety and tracking device-related patient outcomes over time. However, distilling this evidence remains challenging, as information is fractured across clinical notes and structured records. Modern machine learning methods for machine reading promise to unlock increasingly complex information from text, but face barriers due to their reliance on large and expensive hand-labeled training sets. To address these challenges, we developed and validated state-of-the-art deep learning methods that identify patient outcomes from clinical notes without requiring hand-labeled training data. Using hip replacements-one of the most common implantable devices-as a test case, our methods accurately extracted implant details and reports of complications and pain from electronic health records with up to 96.3% precision, 98.5% recall, and 97.4% F1, improved classification performance by 12.8-53.9% over rule-based methods, and detected over six times as many complication events compared to using structured data alone. Using these additional events to assess complication-free survivorship of different implant systems, we found significant variation between implants, including for risk of revision surgery, which could not be detected using coded data alone. Patients with revision surgeries had more hip pain mentions in the post-hip replacement, pre-revision period compared to patients with no evidence of revision surgery (mean hip pain mentions 4.97 vs. 3.23; t = 5.14; p < 0.001). Some implant models were associated with higher or lower rates of hip pain mentions. Our methods complement existing surveillance mechanisms by requiring orders of magnitude less hand-labeled training data, offering a scalable solution for national medical device surveillance using electronic health records.
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Affiliation(s)
- Alison Callahan
- Center for Biomedical Informatics Research, Stanford University, 1265 Welch Road, Stanford, CA USA 94305
| | - Jason A. Fries
- Center for Biomedical Informatics Research, Stanford University, 1265 Welch Road, Stanford, CA USA 94305
- Department of Computer Science, Stanford University, 353 Serra Mall, Stanford, CA USA 94305
| | - Christopher Ré
- Department of Computer Science, Stanford University, 353 Serra Mall, Stanford, CA USA 94305
| | - James I. Huddleston
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, 450 Broadway Street, Redwood City, CA USA 94063
| | - Nicholas J. Giori
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, 450 Broadway Street, Redwood City, CA USA 94063
- Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA USA 94304
| | - Scott Delp
- Department of Bioengineering, Stanford University, 318 Campus Drive, Stanford, CA USA 94305
| | - Nigam H. Shah
- Center for Biomedical Informatics Research, Stanford University, 1265 Welch Road, Stanford, CA USA 94305
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Hernandez NM, Fruth KM, Larson DR, Kremers HM, Sierra RJ. Conversion of Failed Hemiarthroplasty to Total Hip Arthroplasty Remains High Risk for Subsequent Complications. J Arthroplasty 2019; 34:2030-2036. [PMID: 31147247 DOI: 10.1016/j.arth.2019.04.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/12/2019] [Accepted: 04/19/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Few studies have described the outcomes following conversion of failed hemiarthroplasties to total hip arthroplasty (THA) and the impact of mortality when estimating implant survivorship. The aims of this study were to evaluate the following: (1) the risks and predictors of complications, dislocations, reoperations, and revisions and (2) the extent of competing risk of death when evaluating outcomes in patients converted from hemiarthroplasty to THA. METHODS The study comprised 389 patients treated with conversion THA following hemiarthroplasty for femoral neck fractures between 1985 and 2014. Revision rates were calculated using both the Kaplan-Meier method and cumulative incidence accounting for death as a competing risk. Risk factors were evaluated using Cox regression models. RESULTS During an average 9.3 years of follow-up, there were 122 complications, 34 dislocations, 69 reoperations, and 51 revisions. Conversion for periprosthetic fractures was associated with a higher risk of reoperations (hazard ratio 4.30, 95% confidence interval 1.94-9.52). Increasing age was a risk factor for reoperations (hazard ratio 1.32, 95% confidence interval 1.10-1.59). No decrease in the rate of complications, dislocations, reoperations, or revisions was observed over the entire 30 years of the study either when evaluating year of surgery as a continuous variable or when comparing specific calendar year intervals (1985-1989, 1990-1999, 2000-2009, 2010-2014) (P > .05). Compared to the cumulative incidence accounting for the competing risk of death, the Kaplan-Meier method overestimated the risk of revision by 7% at 15 years and 10% at 20 years. CONCLUSION Conversion from hemiarthroplasty to THA remains at high risk for subsequent complications. The cumulative incidence estimate provides a more accurate estimate of revision risk.
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Affiliation(s)
| | - Kristin M Fruth
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Dirk R Larson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | - Rafael J Sierra
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
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Total Hip Arthroplasty Performed for Coxarthrosis Preserves Long-Term Physical Function: A 40-Year Experience. HSS J 2019; 15:122-132. [PMID: 31327942 PMCID: PMC6609668 DOI: 10.1007/s11420-019-09676-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 02/07/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Measures of long-term success of total hip arthroplasty (THA) over the past 50 years have focused primarily on implant survival, with less evidence on long-term functional outcomes. QUESTIONS/PURPOSES We aimed to study 20-to-40-year functional outcomes after primary THA. We investigated the extent to which (1) functional outcomes after THA are maintained long term; (2) patient characteristics such as age, hip disease diagnosis, and comorbidities affect recovery of function and survivorship after THA; and (3) patients' overall function after THA is affected by the need for revision, the aging process, and associated comorbidities. METHODS We retrospectively reviewed outcomes of the senior author's patients between 1968 and 1993. Of 1207 patients, we identified 167 patients (99 female, 68 male; 276 primary THAs) who were at least 65 years old at follow-up and had at least 20 years of follow-up. Mean age at surgery was 55 years; mean follow-up time was 27 years. Bilateral THAs were performed in 109 patients (65%), and revisions in 81 patients (48.5%). Clinical outcomes including pain level, walking ability, range of motion, and overall function were determined by the Hospital for Special Surgery (HSS) hip scoring system. Contralateral and revision surgery, as well as patient age, sex, and body mass index, were included as covariates. To account for unequally spaced follow-up time points and competing causes of functional decline (e.g., age, contralateral hip disease, and need for revision THA), a latent class mixed model approach was used to identify unobserved classes of patients who had similar outcomes. Linear, quadratic, and piecewise-polynomial growth models were considered for class identification. The best fitting model was determined based on Bayesian information criterion. RESULTS A four-class model of this patient population was identified: (1) the Elderly Class, who had a mean age of 62 years at the time of primary THA; (2) the Bilateral Class, who underwent simultaneous or staged bilateral THA; (3) the Revision Class, who required at least one revision; and (4) the Youngest Class, who had a mean age of 49 years. After an initial period of improvement in all groups, the functional trajectory diverged according to classifications. Age was the strongest determinant of long-term outcome, with HSS hip scores in the Elderly Class declining after about 20 years. The Youngest Class maintained good-to-excellent hip function for over 30 years. Revision THA and contralateral THA accounted for a temporary decline in function, after which overall good function was regained for the long term. CONCLUSIONS All classes in the study population enjoyed good-to-excellent outcomes after THA for about 20 years. Thereafter, functional decline was attributed more to aging than to the need for revision. One or more revision THA did not negatively influence long-term clinical outcomes, suggesting that, even for younger patients, symptoms, rather than the avoidance of possible revision, should be the primary determining factor when indicating THA.
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Implant Fixation and Risk of Prosthetic Joint Infection Following Primary Total Hip Replacement: Meta-Analysis of Observational Cohort and Randomised Intervention Studies. J Clin Med 2019; 8:jcm8050722. [PMID: 31117318 PMCID: PMC6571822 DOI: 10.3390/jcm8050722] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 05/11/2019] [Accepted: 05/16/2019] [Indexed: 12/31/2022] Open
Abstract
Prosthetic joint infection (PJI), although uncommon, is a dreaded and devastating complication of total hip replacement (THR). Whether implant-related factors, such as the fixation method, influences the risk of PJI following THR is contentious. We conducted a systematic review and meta-analysis to evaluate the body of evidence linking fixation methods (cemented, uncemented, hybrid, or reverse hybrid) with the risk of PJI following primary THR. Observational studies and randomised controlled trials (RCTs) comparing fixation methods, and reporting PJI incidence following THR, were identified through MEDLINE, Embase, Web of Science, Cochrane Library, and reference lists of relevant studies up to 24 April 2019. Summary measures were relative risks (RRs) (95% confidence intervals, CIs). We identified 22 eligible articles (based on 11 distinct observational cohort studies comprising 2,260,428 THRs and 4 RCTs comprising 945 THRs). In pooled analyses of observational studies, all cemented fixations (plain and antibiotic combined), plain cemented fixations, hybrid fixations, and reverse hybrid fixations were each associated with an increased overall PJI risk when compared with uncemented fixations: 1.10 (95% CI: 1.04–1.17), 1.50 (95% CI: 1.27–1.77), 1.49 (95% CI: 1.36–1.64), and 1.49 (95% CI: 1.14–1.95), respectively. However, in the first six months, uncemented fixations were associated with increased PJI risk when compared to all cemented fixations. Compared to antibiotic-loaded cemented fixations, plain cemented fixations were associated with an increased PJI risk (1.52; 95% CI: 1.36–1.70). One RCT showed an increased PJI risk comparing plain cemented fixations with antibiotic-loaded cemented fixations. Uncemented and antibiotic-loaded cemented fixations remain options for the prevention of PJI in primary THR.
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Gkagkalis G, Goetti P, Mai S, Meinecke I, Helmy N, Bosson D, Kutzner KP. Cementless short-stem total hip arthroplasty in the elderly patient - is it a safe option?: a prospective multicentre observational study. BMC Geriatr 2019; 19:112. [PMID: 30995903 PMCID: PMC6472082 DOI: 10.1186/s12877-019-1123-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 03/27/2019] [Indexed: 12/15/2022] Open
Abstract
Background Due to its bone preserving philosophy, short-stem total hip arthroplasty (THA) has primarily been recommended for young and active patients. However, there may be benefits for elderly patients given a less invasive operative technique due to the short curved implant design. The purpose of this study was to compare the clinical and radiological outcomes as well as perioperative complications of a calcar-guided short stem between a young (< 60 years) and a geriatric (> 75 years) population. Methods Data were collected in a total of 5 centers, and 400 short-stems were included as part of a prospective multicentre observational study between 2010 and 2014 with a mean follow-up of 49.2 months. Preoperative femur morphology was analysed using the Dorr classification. Clinical and radiological outcomes were assessed in both groups as well as perioperative complications, rates and reasons for stem revision. Results No differences were found for the mean visual analogue scale (VAS) values of rest pain, load pain, and satisfaction, whereas Harris Hip Score (HHS) was slightly better in the young group. Comparing both groups, none of the radiological parameters that were assessed (stress-shielding, cortical hypertrophy, radiolucency, osteolysis) reached differences of statistical significance. While in young patients aseptic loosening is the main cause of implant failure, in the elderly group particularly postoperative periprosthetic fractures due to accidental fall have to be considered to be of high risk. The incidence of periprosthetic fractures was found to be 0% in Dorr type A femurs, whereas in Dorr types B and C fractures occurred in 2.1 and 22.2% respectively. Conclusions Advanced age alone is not necessarily to be considered as contra-indications for calcar-guided short-stem THA, although further follow-up is needed. However, markedly reduced bone quality with femur morphology of Dorr type C seems to be associated with increased risk for postoperative periprosthetic fractures, thus indication should be limited to Dorr types A and B. Trial registration German Clinical Trials Register; DRKS00012634, 07.07.2017 (retrospectively registered).
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Affiliation(s)
- Georgios Gkagkalis
- Department of Orthopaedic Surgery, Hôpital du Sacré-Cœur, Université de Montréal, 5400 boul. Gouin Ouest, Montréal, QC, H4J 1C5, Canada.,Department of Orthopaedic Surgery, Nyon Hospital, Chemin Monastier 10, 1260, Nyon, Switzerland
| | - Patrick Goetti
- Department of Orthopaedic Surgery and Traumatology, Lausanne University Hospital - CHUV, Rue du Bugnon 21, 1011, Lausanne, Switzerland
| | - Sabine Mai
- Vitos Orthopaedic Clinic Kassel, Wilhelmshöher Allee 345, 34131, Kassel, Germany
| | - Ingmar Meinecke
- Helios Park-Clinic Leipzig, Strümpellstr. 41, 04289, Leipzig, Germany
| | - Näder Helmy
- Bürgerspital Solothurn, Schöngrünstr. 42, 4500, Solothurn, Switzerland
| | - Dominique Bosson
- Department of Orthopaedic Surgery, Nyon Hospital, Chemin Monastier 10, 1260, Nyon, Switzerland
| | - Karl Philipp Kutzner
- Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany.
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Ji B, Wahafu T, Li G, Zhang X, Wang Y, Momin M, Cao L. Single-stage treatment of chronically infected total hip arthroplasty with cementless reconstruction: results in 126 patients with broad inclusion criteria. Bone Joint J 2019; 101-B:396-402. [PMID: 30929477 DOI: 10.1302/0301-620x.101b4.bjj-2018-1109.r1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIMS Single-stage revision is not widely pursued due to restrictive inclusion criteria. In this study, we evaluated the results of single-stage revision of chronically infected total hip arthroplasty (THA) using broad inclusion criteria and cementless implants. PATIENTS AND METHODS Between 2010 and 2016, 126 patients underwent routine single-stage revision with cementless reconstruction with powdered vancomycin or imipenem poured into the medullary cavity and re-implantation of cementless components. For patients with a culture-negative hip, fungal infections, and multidrug-resistant organisms, a direct intra-articular infusion of pathogen-sensitive antibiotics was performed postoperatively. Recurrence of infection and clinical outcomes were evaluated. Three patients died and 12 patients (none with known recurrent infection) were lost to follow-up. There were 111 remaining patients (60 male, 51 female) with a mean age of 58.7 (sd 12.7; 20 to 79). RESULTS Of these 111 patients, 99 (89.2%) were free of infection at a mean follow-up time of 58 months (24 to 107). A recurrent infection was observed in four of the 23 patients (17.4%) with culture-negative infected hip. The success rate in patients with multidrug-resistant organisms was 84.2% (16/19). The mean postoperative Harris hip score was 79.6 points (63 to 92) at the most recent assessment. CONCLUSION Routine single-stage revision with cementless reconstruction can be a viable option for the treatment of chronically infected THA. The results of this study will add to the growing body of evidence supporting routine use of single-stage revision for the treatment of chronically infected THA. Cite this article: Bone Joint J 2019;101-B:396-402.
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Affiliation(s)
- B Ji
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - T Wahafu
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - G Li
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - X Zhang
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Y Wang
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - M Momin
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - L Cao
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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Luo Y, Yang Z, Yeersheng R, Li D, Kang P. Clinical outcomes and quality of life after total hip arthroplasty in adult patients with a history of infection of the hip in childhood: a mid-term follow-up study. J Orthop Surg Res 2019; 14:38. [PMID: 30709358 PMCID: PMC6359810 DOI: 10.1186/s13018-019-1074-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 01/23/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Total hip arthroplasty for adult patients with a history of infection of the hip in childhood could be a more technically demanding procedure due to complicated anatomy and the possibility of reinfection. Here, we conducted a mid-term analysis of clinical outcomes in such patients after primary cementless total hip arthroplasty (THA). METHODS We reviewed 101 patients (101 hips; 51 men; mean age, 52.3 years) who underwent cementless THA between 2008 and 2015, at a mean of 24 years (range, 11-43) since the resolution of childhood hip infection. Patients were followed up for a mean of 6.1 years (range, 2.1-9.6). Clinical outcomes and quality of life after THA were assessed at final follow-up. RESULTS No cases of infection were reported during the follow-up, and patients showed significant improvement in Harris Hip Score, for which the mean score increased from 48.5 to 90 points; the modified Merle d'Aubigne and Postel (MAP) Hip Score; the Hip Dysfunction and Osteoarthritis Outcome Score; the SF-12; and mean limb length discrepancy, which decreased from 3.4 to 1.1 cm. During follow-up, four cases of prosthesis dislocation, three of transient sciatic paralysis, seven of femoral fracture, five of heterotopic ossification, and 19 of osteolysis were recorded. Revision surgery was performed for two patients, one for isolated loosening of the acetabular component and another for loosening of the femoral stem. CONCLUSION Cementless THA can effectively treat patients with a quiescent period of infection of the hip of more than 10 years, resulting in good functional outcomes and fewer complications. Risk of infection recurrence after THA in these patients seems extremely low.
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Affiliation(s)
- Yue Luo
- Department of Orthopedics, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Zhouyuan Yang
- Department of Orthopedics, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Releken Yeersheng
- Department of Orthopedics, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Donghai Li
- Department of Orthopedics, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Pengde Kang
- Department of Orthopedics, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China.
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Aboltins CA, Antoci V, Bhattacharyya S, Cross M, Ducheyne P, Freiberg AA, Hailer N, Kay P, Ketonis C, Klement MR, Köse N, Lee M, Mitchell P, Nandi S, Palacio JC, Perry K, Prieto H, Shahi A, Trebše R, Turner D, Wu CT, Yazdi H. Hip and Knee Section, Prevention, Prosthesis Factors: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S309-S320. [PMID: 30348551 DOI: 10.1016/j.arth.2018.09.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Kim JT, Jeong HJ, Lee SJ, Kim HJ, Yoo JJ. Does Proximally Coated Single-Wedge Cementless Stem Work Well in Dorr Type C Femurs? Minimum 10-year Followup. Indian J Orthop 2019; 53:94-101. [PMID: 30905988 PMCID: PMC6394166 DOI: 10.4103/ortho.ijortho_160_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Total hip arthroplasty (THA) with a proximally coated single-wedge (PSW) cementless stem had been generally considered not to be suitable for Dorr Type C femurs. This study compares the long term outcomes of PSW stem according to the type of proximal femoral geometry. MATERIALS AND METHODS 307 primary THAs in 247 patients were performed with PSW cementless stem and followed up for over 10 years in this retrospective study. According to Dorr's criteria, 89 femurs were classified as Type A, 156 as Type B, and 62 as Type C. They were followed up for an average of 13.2 years (range 10.0-17.3 years). All the hips were evaluated clinically and radiologically. RESULTS There was no significant difference in stem survivorship and clinical outcomes including the incidence of thigh pain and the mean postoperative Harris hip score (HHS) in all three groups. No significant differences were observed in osteolysis, pedestal formation, or cortical hypertrophy among the groups. Radiolucent lines <2 mm in thickness in Gruen zone 4 and 7 (P = 0.003 and P = 0.044, respectively), spot-weld (P < 0.001), and stress shielding (P = 0.010) of proximal femur were more pronounced in Dorr C type femora than in Type A or B. Fifty-six intraoperative fractures were identified among 307 hips with PSW stems. The incidence of intraoperative or postoperative femoral fractures was not significantly different among the groups. CONCLUSIONS From over a 10-year followup, the PSW stem provided a recommendable option with satisfactory outcomes and excellent stem survivorship regardless of the Dorr type.
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Affiliation(s)
- Jung-Taek Kim
- Department of Orthopedic Surgery, Ajou University School of Medicine, Ajou Medical Center, Yeongtong-gu, Suwon-si, Gyeonggi-do, Korea
| | - Hyung Jun Jeong
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Jongno-gu, Seoul, Korea
| | - Soong Joon Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Jongno-gu, Seoul, Korea
| | - Hee Joong Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Jongno-gu, Seoul, Korea,Medical Research Center, Seoul National University College of Medicine, Jongno-gu, Seoul, Korea
| | - Jeong Joon Yoo
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Jongno-gu, Seoul, Korea,Address for correspondence: Dr. Jeong Joon Yoo, Department of Orthopedic Surgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea. E-mail:
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Rony L, Lancigu R, Hubert L. Intraosseous metal implants in orthopedics: A review. Morphologie 2018; 102:231-242. [PMID: 30348489 DOI: 10.1016/j.morpho.2018.09.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/28/2018] [Accepted: 09/28/2018] [Indexed: 04/21/2023]
Abstract
Metal implants are biomaterials widely used in orthopedics. They are both used in osteosynthesis and arthroplasty. Their mechanical properties, biocompatibility and resistance to corrosion make them a widely used option in orthopedics. Alloys are the most commonly used metals in orthopedics. As far as physical traumas are concerned, implants such as screws, plates and/or nails are used for osteosynthesis as they ensure the stability of the fractured area and contribute to bone healing. Prostheses are used in arthroplasty to restore joint function for as long as possible. Contact between bone and the prosthesis induces bone remodeling at the interface between metal and bone even if the metal is recognized as biocompatible. Upon time, the interface between the metal implant and the bony tissue is continuously modified and adapted. Hip prosthesis is a typical example of intraosseous metal implant whose bone/implant interface has been extensively studied. Metal can be altered in vivo by different mechanisms including corrosion and fretting. An altered torque friction leads to wear debris that accumulate in the peri-prosthetic tissues causing metallosis.
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Affiliation(s)
- L Rony
- Groupe Études Remodelage Osseux et bioMatériaux (GEROM), LabCom NextBone, SFR 42 08, université d'Angers, CHU d'Angers, IRIS-IBS institut de biologie en santé, 49933 Angers cedex, France; Département de chirurgie osseuse, CHU d'Angers, 49033 Angers cedex, France.
| | - R Lancigu
- Département de chirurgie osseuse, CHU d'Angers, 49033 Angers cedex, France
| | - L Hubert
- Département de chirurgie osseuse, CHU d'Angers, 49033 Angers cedex, France
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Gelderman SJ, Jutte PC, Boellaard R, Ploegmakers JJW, Vállez García D, Kampinga GA, Glaudemans AWJM, Wouthuyzen-Bakker M. 18F-FDG-PET uptake in non-infected total hip prostheses. Acta Orthop 2018; 89:634-639. [PMID: 30334468 PMCID: PMC6300734 DOI: 10.1080/17453674.2018.1525931] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) can be used in the diagnostic work-up of a patient with suspected periprosthetic joint infection (PJI) but, due to a lack of accurate interpretation criteria, this technique is not routinely applied. Since the physiological uptake pattern of FDG around a joint prosthesis is not fully elucidated, we determined the physiological FDG uptake in non-infected total hip prostheses. Patients and methods - Patients treated with primary total hip arthroplasty (1995-2016) who underwent a FDG-PET/CT for an indication other than a suspected PJI were retrospectively evaluated. Scans were both visually and quantitatively analyzed. Semi-quantitative analysis was performed by calculating maximum and peak standardized uptake values (SUVmax and SUVpeak) by volume of interests (VOIs) at 8 different locations around the prosthesis. Results - 58 scans from 30 patients were analyzed. In most hips, a diffuse heterogeneous uptake pattern around the prosthesis was observed (in 32/38 of the cemented prostheses, and in 16/20 of the uncemented prostheses) and most uptake was located around the neck of the prosthesis. The median SUVmax in the cemented group was 2.66 (95% CI 2.51-3.10) and in the uncemented group 2.87 (CI 2.65-4.63) (Median difference = -0.36 [CI -1.2 to 0.34]). In uncemented prostheses, there was a positive correlation in time between the age of the prosthesis and the FDG uptake (rs = 0.63 [CI 0.26-0.84]). Interpretation - Our study provides key data to develop accurate interpretation criteria to differentiate between physiological uptake and infection in patients with a prosthetic joint.
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Affiliation(s)
- Stefan J Gelderman
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen;; ,Correspondence:
| | - Paul C Jutte
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen;;
| | - Ronald Boellaard
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen;;
| | - Joris J W Ploegmakers
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen;;
| | - David Vállez García
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen;;
| | - Greetje A Kampinga
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Andor W J M Glaudemans
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen;;
| | - Marjan Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Jain S, Magra M, Dube B, Veysi VT, Whitwell GS, Aderinto JB, Emerton ME, Stone MH, Pandit HG. Reverse hybrid total hip arthroplasty. Bone Joint J 2018; 100-B:1010-1017. [PMID: 30062952 DOI: 10.1302/0301-620x.100b8.bjj-2017-1297.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims This study aimed to evaluate implant survival of reverse hybrid total hip arthroplasty (THA) at medium-term follow-up. Patients and Methods A consecutive series of 1082 THAs in 982 patients with mean follow-up of 7.9 years (5 to 11.3) is presented. Mean age was 69.2 years (21 to 94). Of these, 194 (17.9%) were in patients under 60 years, 663 (61.3%) in female patients and 348 (32.2%) performed by a trainee. Head size was 28 mm in 953 hips (88.1%) or 32 mm in 129 hips (11.9%). Survival analysis was performed and subgroups compared using log rank tests. Results Ten-year survival (122 hips at risk) was 97.2% (95% confidence interval (CI) 95.77 to 98.11) for all-cause revision. There was no difference in survival by age (p = 0.50), gender (p = 0.78), head size (p = 0.63) or surgeon grade (p = 0.36). No acetabular components underwent revision for aseptic loosening in the entire series. Four (0.4%) aseptic stem failures occurred early at a mean of 2.5 years (0.6 to 4.8) and were associated with age under 60 years (p = 0.015). There was no difference in survival by gender (p = 0.12), head size (p = 0.43) or surgeon grade (p = 0.77) for stem revision. Conclusion This is the largest reported study into reverse hybrid THA and it confirms successful outcomes, irrespective of age, gender, head size and surgeon grade. Cite this article: Bone Joint J 2018;100-B:1010-17.
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Affiliation(s)
- S Jain
- Department of Orthopaedic Surgery, Chapel Allerton Hospital, Leeds, UK
| | - M Magra
- Department of Orthopaedic Surgery, Chapel Allerton Hospital, Leeds, UK
| | - B Dube
- University of Leeds, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital
| | - V T Veysi
- Department of Orthopaedic Surgery, Chapel Allerton Hospital, Leeds, UK
| | - G S Whitwell
- Department of Orthopaedic Surgery, Chapel Allerton Hospital, Leeds, UK
| | - J B Aderinto
- Department of Orthopaedic Surgery, Chapel Allerton Hospital, Leeds, UK
| | - M E Emerton
- Department of Orthopaedic Surgery, Chapel Allerton Hospital, Leeds, UK
| | - M H Stone
- Department of Orthopaedic Surgery, Chapel Allerton Hospital, Leeds, UK
| | - H G Pandit
- University of Leeds, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, UK
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Shin T, Lim D, Kim YS, Kim SC, Jo WL, Lim YW. The biological response to laser-aided direct metal-coated Titanium alloy (Ti6Al4V). Bone Joint Res 2018; 7:357-361. [PMID: 29922456 PMCID: PMC5987684 DOI: 10.1302/2046-3758.75.bjr-2017-0222.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives Laser-engineered net shaping (LENS) of coated surfaces can overcome the limitations of conventional coating technologies. We compared the in vitro biological response with a titanium plasma spray (TPS)-coated titanium alloy (Ti6Al4V) surface with that of a Ti6Al4V surface coated with titanium using direct metal fabrication (DMF) with 3D printing technologies. Methods The in vitro ability of human osteoblasts to adhere to TPS-coated Ti6Al4V was compared with DMF-coating. Scanning electron microscopy (SEM) was used to assess the structure and morphology of the surfaces. Biological and morphological responses to human osteoblast cell lines were then examined by measuring cell proliferation, alkaline phosphatase activity, actin filaments, and RUNX2 gene expression. Results Morphological assessment of the cells after six hours of incubation using SEM showed that the TPS- and DMF-coated surfaces were largely covered with lamellipodia from the osteoblasts. Cell adhesion appeared similar in both groups. The differences in the rates of cell proliferation and alkaline phosphatase activities were not statistically significant. Conclusions The DMF coating applied using metal 3D printing is similar to the TPS coating, which is the most common coating process used for bone ingrowth. The DMF method provided an acceptable surface structure and a viable biological surface. Moreover, this method is automatable and less complex than plasma spraying. Cite this article: T. Shin, D. Lim, Y. S. Kim, S. C. Kim, W. L. Jo, Y. W. Lim. The biological response to laser-aided direct metal-coated Titanium alloy (Ti6Al4V). Bone Joint Res 2018;7:357–361. DOI: 10.1302/2046-3758.75.BJR-2017-0222.R1.
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Affiliation(s)
- T Shin
- Department of Mechanical Engineering, Sejoing University; Corentec, Central R&D Center, Seoul, South Korea
| | - D Lim
- Department of Mechanical Engineering, Sejoing University, Seoul, South Korea
| | - Y S Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - S C Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - W L Jo
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Y W Lim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, South Korea
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Abstract
Total hip arthroplasty (THA) is a very satisfactory surgical procedure for end-stage hip disorders. Implant modifications, such as large femoral heads to improve stability, porous metals to enhance fixation and alternative bearings to improve wear, have been introduced over the last decade in order to decrease the rate of early and late failures. There is a changing pattern of THA failure modes. The relationship between failure modes and patient-related factors, and the time and type of revision are important for understanding and preventing short and late failure of implants. The early adoption of innovations in either technique or implant design may lead to an increased risk of early failure.
Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170068
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Affiliation(s)
- Theofilos Karachalios
- School of Health Sciences, Faculty of Medicine, University of Thessalia, University General Hospital of Larissa, Mezourlo Region, 41110 Larissa, Greece
| | - George Komnos
- Orthopaedic Department, University General Hospital of Larissa, Greece
| | - Antonios Koutalos
- Orthopaedic Department, University General Hospital of Larissa, Greece
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50
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Robinson PD, McEwan J, Adukia V, Prabhakar M. Osteoarthritis and arthroplasty of the hip and knee. Br J Hosp Med (Lond) 2018; 79:C54-C59. [DOI: 10.12968/hmed.2018.79.4.c54] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Paul D Robinson
- Senior House Officer, Department of Trauma and Orthopaedics, Salisbury District Hospital, Salisbury SP2 8BJ
| | - Jo McEwan
- Specialist Registrar, Department of Trauma and Orthopaedics, Salisbury District Hospital, Salisbury
| | - Vidhi Adukia
- Senior House Officer, Department of Trauma and Orthopaedics, Queen Alexandra Hospital, Portsmouth
| | - Makarahalli Prabhakar
- Consultant, Department of Trauma and Orthopaedics, Salisbury District Hospital, Salisbury
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