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Bischofreiter M, Kölblinger C, Stumpner T, Gruber MS, Gattringer M, Kindermann H, Mattiassich G, Ortmaier R. Learning Curve for Short-Stem Total HIP Arthroplasty through an Anterolateral Approach. Medicina (Kaunas) 2023; 59:medicina59050832. [PMID: 37241064 DOI: 10.3390/medicina59050832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/05/2023] [Accepted: 04/23/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Short-stem total hip arthroplasty has become increasingly popular in recent years. While many studies have shown excellent clinical and radiological results, very little is known about the learning curve for short-stem total hip arthroplasty through an anterolateral approach. Therefore, the aim of this study was to determine the learning curve for short-stem total hip arthroplasty among five residents in training. Materials and Methods: We performed retrospective data analysis of the first 30 cases of five randomly selected residents (n = 150 cases) with no experience before the index surgery. All patients were comparable, and several surgical parameters and radiological outcomes were analyzed. Results: The only surgical parameter with a significant improvement was the surgical time (p = 0.025). The changes in other surgical parameters and radiological outcomes showed no significant changes; only trends can be derived. As a result, the correlation between surgical time, blood loss, length of stay, and incision/suture time can also be seen. Only two of the five residents showed significant improvements in all examined surgical parameters. Conclusions: There are individual differences among the first 30 cases of the five residents. Some improved their surgical skills faster than others. It could be assumed that they assimilated their surgical skills after more surgeries. A further study with more than 30 cases of the five surgeons could provide more information on that assumption.
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Affiliation(s)
- Martin Bischofreiter
- Department of Orthopedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
- Department of Orthopedic and Trauma Surgery, Clinic Diakonissen Schladming, 8970 Schladming, Austria
| | - Christina Kölblinger
- Department of Orthopedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Thomas Stumpner
- Department of Orthopedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Michael Stephan Gruber
- Department of Orthopedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Michael Gattringer
- Department of Orthopedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
- Department of Orthopedic and Trauma Surgery, Clinic Diakonissen Schladming, 8970 Schladming, Austria
| | - Harald Kindermann
- Department of Marketing and Electronic Business, University of Applied Sciences Upper Austria, 4400 Steyr, Austria
| | - Georg Mattiassich
- Department of Orthopedic and Trauma Surgery, Clinic Diakonissen Schladming, 8970 Schladming, Austria
| | - Reinhold Ortmaier
- Department of Orthopedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
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Reinbacher P, Hecker A, Friesenbichler J, Smolle M, Leitner L, Klim S, Draschl A, Colovic D, Brunnader K, Leithner A, Maurer-Ertl W. Simultaneous Bilateral Total Hip Arthroplasty with Straight-Stems and Short-Stems: Does the Short One Do a Better Job? J Clin Med 2023; 12:1028. [PMID: 36769676 PMCID: PMC9918178 DOI: 10.3390/jcm12031028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/22/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) is known to be the most successful orthopaedic surgery of the last century, but it is still struggling with controversies concerning one-stage bilateral THA. The current study aimed to compare the clinical outcome of patients with unilateral or simultaneous bilateral THA by using short-stem and straight-stem designs and focusing on operation time, blood loss, and length of hospital stay (LOS). MATERIAL AND METHODS Between 2006 and 2018, 92 patients were enrolled in this study. Forty-six patients underwent a bilateral THA in one session, and forty-six matched patients underwent a unilateral THA. In each of the two groups (unilateral vs. bilateral), 23 patients received either a straight (unilateral: 10 females, 13 males, mean age 63; bilateral: 12 females, 11 males, mean age 53 years) or short stem (unilateral: 11 females, 12 males, mean age 60 years; bilateral: 12 females, 11 males, 53 mean age 62 years). The blood count was checked preoperatively as well as one and three days after surgery. Furthermore, the operation time and LOS were investigated. RESULTS Compared to THA with straight-stems, short-stem THA showed significantly less blood loss; there was no difference in the LOS of both groups. A significantly shorter operative time was only observed in the bilateral THA. CONCLUSION The current study showed that simultaneous bilateral THA appears to be safe and reliable in patients without multiple comorbidities. In addition, short-stem THA appears to be beneficial in terms of clinical performance and outcome, and it appears to be superior to straight-stem THA, regardless of whether the patient underwent unilateral or simultaneous bilateral THA.
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Affiliation(s)
- Patrick Reinbacher
- Department of Orthopaedics & Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Andrzej Hecker
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Joerg Friesenbichler
- Department of Orthopaedics & Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Maria Smolle
- Department of Orthopaedics & Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Lukas Leitner
- Department of Orthopaedics & Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Sebastian Klim
- Department of Orthopaedics & Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Alexander Draschl
- Department of Orthopaedics & Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Danijel Colovic
- Department of Orthopaedics & Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Kevin Brunnader
- Department of Orthopaedics & Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics & Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Werner Maurer-Ertl
- Department of Orthopaedics & Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
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Tottas S, Ververidis A, Kougioumtzis I, Tilkeridis K, Tsigalou C, Karaglani M, Drosos G. MINIMA Short Stem Versus Standard Profemur (TL) Stem in Primary Total Hip Replacement: A Comparative Study. Cureus 2022; 14:e23771. [PMID: 35509762 PMCID: PMC9062282 DOI: 10.7759/cureus.23771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2022] [Indexed: 12/28/2022] Open
Abstract
Background: The objective of our study was to compare a novel squared section, tapered design - with four conicity - short stem, the MINIMA® short stem with the cementless Profemur® TL standard femoral stem in primary total hip arthroplasty (THA) in terms of functional outcomes, radiologic evaluation and other peri-operative and post-operative data. Material and methods: This is a comparative study including 46 patients undergoing primary THA. In 23 patients, the MINIMA® short stem was used. These patients were matched with another 23 patients in whom a cementless Profemur® TL standard femoral stem was used. The levels of the pain were evaluated according to the Visual Analog Scale/Numerical Rating Scale (VAS/NRS). The functional and clinical evaluation of the patients was performed with Harris Hip Score (HHS), Charnley’s Hip score, EuroQol (EQ-5D)-(EQ-100), Patient Health Questionnaire (PHQ-9), and neuropathic pain questionnaire (DN-4). The rest of the comparison data included demographic data, the American Society of Anesthesiologists score (ASA), Charlson Index score, the pre-operative diagnosis, radiographic evaluation, the days of hospitalization, the operating time, incision length, blood loss, and blood transfusion requirements and complication rates. Results: The two cohorts had comparable results regarding all patients’ peri-operative data. The radiographic assessment revealed considerable higher levels of femoral offset and femoral subsidence for the MINIMA group, but within acceptable limits for both cohorts. The majority of the functional and other scores did not give strong prominence to one specific femoral stem. Conclusion: Our comparative study underlined the efficacy of the MINIMA® short stem, due to the fact that it revealed comparable and, in some cases, relatively better short-term outcomes compared with the TL standard femoral stem. Yet, more well-designed long-term research is required in order to further establish its effectiveness.
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Affiliation(s)
- Stylianos Tottas
- Orthopeadics, University General Hospital of Alexandroupolis/Democritus University of Thrace, Alexandroupolis, GRC
| | - Athanasios Ververidis
- Orthopeadics, University General Hospital of Alexandroupolis/Democritus University of Thrace, Alexandroupolis, GRC
| | - Ioannis Kougioumtzis
- Orthopeadics, University General Hospital of Alexandroupolis/Democritus University of Thrace, Alexandroupolis, GRC
| | - Konstantinos Tilkeridis
- Orthopeadics, University General Hospital of Alexandroupolis/Democritus University of Thrace, Alexandroupolis, GRC
| | - Christina Tsigalou
- Medical-Molecular Microbiology, University General Hospital of Alexandroupolis/Democritus University of Thrace, Alexandroupolis, GRC
| | - Makrina Karaglani
- Laboratory of Pharmacology, Medical School/Democritus University of Thrace, Alexandroupolis, GRC
| | - Georgios Drosos
- Orthopeadics, University General Hosital of Alexandroupolis/Democritus University of Thrace, Alexandroupolis, GRC
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Yavari P, Baghchi B, Tavassoli M, Moshkdar P, Eslami S, Sadeghian A, Mohammadsharifi G. Comparison of two different stems for total hip arthroplasty. Int J Burns Trauma 2021; 11:170-176. [PMID: 34336381 PMCID: PMC8310869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/25/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Total hip arthroplasty (THA) is the golden standard in treating severe osteoarthritis, which has not responded to conservative treatment. This study aimed to evaluate and compare the therapeutic results of THA using Short-stem and Standard-stem prostheses. METHODS The study was a randomized clinical trial without a control group that was performed in 2020. A total number of 156 patients were recruited over three years. Patients were divided into two groups. The first group was treated with a Short-stem prosthesis and the second group was treated with a Standard-stem prosthesis. Patients were visited according to a schedule. At each visit, a control graph was prepared and the condition of the bone prosthesis and its position were examined. Also, the status of cane use and weightlifting were evaluated. Clinical signs such as pain, lameness, and the ability to climb stairs were assessed and recorded based on the Harris scale. Patients were also evaluated for surgical complications such as infection or limb length discrepancy. RESULTS Data of 140 patients were analyzed. The mean age of patients was 60.2 ± 6.38 years. The amount of bleeding in the short-stem group was significantly lower than the standard-stem group (380.17 ml versus 430.13 ml, P = 0.001). In both groups, there was a significant increase in Harris score after the end of the study compared to before the operations. Furthermore, Harris's mean score was higher in the short-stem group compared to standard-stem group. However, these significant differences were observed only in the sixth week (P < 0.0001) and the third month (P < 0.0001). CONCLUSION The use of Short-stem prosthesis in the short term can play a role in improving patient performance but in the long term evaluations, there is no apparent difference with the use of Standard-stem prostheses.
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Affiliation(s)
- Pedram Yavari
- Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | - Bahareh Baghchi
- Assistant Professor, Department of Emergency Medicine, Faculty of Medicine, Kermanshah University of Medical SciencesKermanshah, Iran
| | - Mehdi Tavassoli
- Assistant Professor of Orthopaedics, Babol University of Medical SciencesBabol, Irran
| | - Pouya Moshkdar
- Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | - Sepehr Eslami
- Department of Orthopedic Surgery, Abadan Faculty of Medical ScienceAbadan, Iran
| | - Amirhossein Sadeghian
- School of Medicine, Zabol University of Medical SciencesSistan and Baluchestan Province, Iran
| | - Ghasem Mohammadsharifi
- Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
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Tross AK, Lädermann A, Wittmann T, Schnetzke M, Nolte PC, Collin P, Raiss P. Subsidence of Uncemented Short Stems in Reverse Shoulder Arthroplasty-A Multicenter Study. J Clin Med 2020; 9:jcm9103362. [PMID: 33092155 PMCID: PMC7590048 DOI: 10.3390/jcm9103362] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/22/2020] [Accepted: 10/06/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The radiological phenomenon of subsidence following the implantation of uncemented short-stem reverse prostheses (USSP) has not yet been described. The purpose of this study was to describe the rate and potential risk factors for subsidence. We hypothesized that subsidence may be a frequent finding and that a subsidence of >5 mm (mm) is associated with an inferior clinical outcome. METHODS A total of 139 patients with an average age of 73 ± 9 years were included. The clinical and radiological outcome was evaluated at a minimum follow-up (FU) of 12 months. RESULTS No humeral component loosening was present at a mean FU of 18 (range, 12-51) months. Mean Constant Score (CS) and Subjective Shoulder Value (SSV) improved significantly from 34.3 ± 18.0 points and 37.0 ± 19.5% preoperatively to 72.2 ± 13.4 points and 80.3 ± 16.5% at final FU (p < 0.001). The average subsidence of the USSP was 1.4 ± 3.7 mm. Subsidence of >5 mm was present in 15 patients (11%). No association between a subsidence >5 mm and CS or SSV was found (p = 0.456, p = 0.527). However, a subsidence of >5 mm resulted in lower strength at final FU (p = 0.022). Complications occurred in six cases (4.2%), and the revision rate was 3.5% (five cases). CONCLUSIONS Although subsidence of USSP is a frequent radiographic finding it is not associated with loosening of the component or a decrease in the clinical outcome at short term FU. LEVEL OF EVIDENCE Level 4, retrospective study.
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Affiliation(s)
- Anna-K. Tross
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany;
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital Meyrin, Avenue Jacob-Daniel Maillard 31217 Meyrin, Switzerland;
- Faculty of Medicine, University of Geneva, Rue Michel Servet 1, 1211 Geneva, Switzerland
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Thomas Wittmann
- OCM (Orthopädische Chirurgie München), Steinerstrasse 6, 81369 Munich, Germany;
| | - Marc Schnetzke
- German Joint Centre, ATOS Clinic Heidelberg Bismarckstraße 9, 69115 Heidelberg, Germany;
- BG Trauma Center Ludwigshafen at the University of Heidelberg, Clinic for Trauma and Orthopaedic Surgery, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen on the Rhine, Germany;
| | - Philip-C. Nolte
- BG Trauma Center Ludwigshafen at the University of Heidelberg, Clinic for Trauma and Orthopaedic Surgery, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen on the Rhine, Germany;
| | - Philippe Collin
- Centre Hospitalier Privé Saint-Grégoire (Vivalto Santé), 6 Boulevard de la Boutière, 35768 Saint-Grégoire, France;
| | - Patric Raiss
- OCM (Orthopädische Chirurgie München), Steinerstrasse 6, 81369 Munich, Germany;
- Correspondence:
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