Total hip arthroplasty at the rothman institute

Total Hip Arthroplasty in Ochronotic Arthropathy: A Case Report

Introduction

Total hip arthroplasty (THA) is a common procedure used to treat various hip conditions. However, patients with ochronotic arthropathy, a rare genetic disorder characterized by the abnormal accumulation of homogentisic acid, are at a higher risk of post-surgical dislocation and instability due to poor bone quality and joint degeneration.

Case Report

This case study features a 52-year-old male patient diagnosed with ochronotic arthropathy who underwent bilateral THA with the use of a dual mobility cup (DMC). Ochronotic arthropathy had caused significant joint degeneration and stiffness, leading to considerable functional impairment.

Conclusion

The application of a DMC in THA for patients with ochronotic arthropathy has shown promising outcomes. The DMC offers increased range of motion and improved stability, effectively reducing the risk of post-surgical dislocation and implant failure. This case study highlights the potential of DMC as a viable solution for addressing the challenges posed by poor bone quality in patients with ochronotic arthropathy undergoing THA.

Minimum 25-Year Results of a Tapered Titanium Porous Plasma Spray Coated Femoral Component

BACKGROUND

Previous studies have reported excellent results with tapered, titanium, porous plasma-sprayed components in patients undergoing uncemented primary total hip arthroplasty (THA). The purpose of this study was to examine survival and clinical results at a minimum 25-year follow-up.

METHODS

We reviewed all patients who underwent primary THA at our center through 1995 with a specific femoral component that was essentially unchanged since its 1984 introduction, except porous coating was continued circumferentially in 1987, a hydroxyapatite-coated option was offered in 1988, and an offset option was added in 1999. There were 332 patients (396 THA) who had a minimum 25-year follow-up (range, 25 to 37). Mean age at surgery was 48 years (range, 21 to 70 years). Mean follow-up in nonfailed patients was 29 years (range, 25 to 37 years).

RESULTS

There were 31 femoral revisions (7.8%): 9 infections, 3 failures of ingrowth, 5 aseptic loosening, 8 osteolysis well-fixed, 2 periprosthetic fractures, 2 polyethylene wear with trochanteric avulsion, 1 component breakage, and 1 malalignment well-fixed. Kaplan-Meier survival with the endpoint of all-cause stem revision was 94.8% (95% confidence interval: ±0.9%) at 37 years, and with the endpoint of aseptic loosening/failure of ingrowth was 98.7% (95% confidence interval: ±0.5) at 37 years. Harris hip scores improved significantly from 43 preoperatively to 76 most recently.

CONCLUSION

This tapered, titanium, porous plasma spray-coated femoral component continues to demonstrate high long-term survival with a low rate of femoral component revision for any reason or aseptic loosening/failure of ingrowth.

Tripolar Constrained and Dual Mobility Liners Are Both Successful When Cemented Into Tantalum Acetabular Revision Shells in Complex Revision Total Hip Arthroplasty

Background

Instability is a common complication after revision total hip arthroplasty. Tripolar constrained (TC) and dual mobility (DM) liners cemented into tantalum acetabular revision (TM) shells are established alternatives that reduce instability risk. This study compares outcomes of TC and DM liners cemented into TM shells in complex revision hip replacements.

Methods

Fifty cases using a TM shell and a TC or DM cemented liner with at least 12 months of follow-up were identified. There were 25 TC and 25 DM liners. Clinical, radiographic, and patient-reported outcomes were collected. Reasons for re-revision and failures were analyzed.

Results

The average age was 73 years in the TC group and 75 years in the DM group. The median follow-up duration was 50 months (23 - 96) and 13 months (12 – 21) for the TC and DM groups, respectively. The mean Harris Hip Score improved from 37 to 61 for the TC group and from 51 to 73 in the DM group at the last review. Two TC cases required revision for wear and liner failure. One DM insert was changed at reoperation for periprosthetic femur fracture. There were no failures of cement fixation in either group and no revisions for cup loosening.

Conclusions

In complex revision hip replacement with a history of instability or judged to have a high risk of instability postoperatively, TC and DM liners cemented into tantalum revision shells are both successful, giving acceptable results. The improved arc of movement with DM liners, minimizing impingement, makes them preferable except when there is a global abductor deficiency or severe joint laxity.

Dual Mobility in Total Hip Arthroplasty: Biomechanics, Indications and Complications-Current Concepts

Dual-mobility (DM) articulations are increasingly utilized to prevent or manage hip instability after total hip arthroplasty (THA). DM cups offer enhanced stability due to the dual articulation resulting in larger jump distance and greater range of motion before impingement. Improvement in design features and biomaterials has contributed to increased interest in dual-mobility articulations due to lower risk of complications compared to their historic rates. The incidence of implant-specific complications like intra-prosthetic dislocation (IPD) and wear has reduced with newer-generation implants. DM THAs are used in primary THA in patients with high risk for dislocation, e.g. neuromuscular disorder, femoral neck fracture, spinopelvic deformity, etc. They offer an attractive alternative option to constrained liner for treatment of hip instability in revision THA. The medium- to short-term results with DM THA have been encouraging in primary and revision THA. However, there are concerns of fretting, corrosion and long-term survivorship with DM THA. Hence, longer-term studies and surveillance are required for the safe use of DM THA in clinical practice.

Research on the inhibition for aseptic loosening of artificial joints by Sr-doped calcium polyphosphate (SCPP)in vivo

Aseptic loosening of artificial joints is the most common complication after artificial joint replacement. Finding the solution to tackle aseptic loosening of artificial joints is a focus in bone and joint surgery research field.In vitrostudies of Sr-doped calcium polyphosphate (SCPP) have found by our team that it could promote osteoblast proliferation and inhibit osteoclast activity, and it has a potential inhibitory effect on aseptic loosening by suppressing the expression of receptor activator of nuclear factor-κ B ligand and improving the expression of OPG. The present study aims to confirm the conclusionin vitroby the mean of animal experiment. The Ti rod prosthesis coated with SCPP, calcium polyphosphate (CPP), and Ultra-high molecular weight polyethylene (UHMWPE were implanted in the femur (the internal surface of bone tunnel was also coated with SCPP, CPP and UHMWPE respectively). Radiography (x-rays, micro-CT), histochemistry (Hematoxylin-eosin staining (HE), methylene blue-acid fuchsin, Von Kossa histological staining), molecular biology (alkaline phosphatase and TRAP5b factors, Mir21-5p and Mir 26a-5p) were performed to analyzed the effects of SCPP within 20 weeks. The Radiography results showed that osteolysis with various severity occurred in all groups, and SCPP group had the mildest osteolysis. Histochemistry results showed that arthritis was milder in SCPP and CPP groups, while the bone formation in SCPP group was most significant. Its bone reconstruction effect was the best as well. The Molecular biology results showed that the bone reconstruction was out-sync in each group. Compared with other groups, the bone resorption occurred at the latest and the bone resorption time was the shortest in experimental animals of SCPP group. All results indicated that SCPP could promote osteoblast activity and bone reconstruction, improve the integration of bone interface between prosthesis and base bone, reduce osteoclast activity and shorten the osteoclast action time at the implantation sitein vivo. Thus, it could postpone or alleviate the occurrence and development of aseptic looseningin vivo. Therefore, SCPP could be a promising material for the construction of artificial joints with the ability to resist aseptic loosening.

Traumatic Hip Fracture and Primary Elective Total Hip Patients are Not the Same: A Comparison of Comorbidity Burden, Hospital Course, Postoperative Complications, and Cost of Care Analysis

OBJECTIVES

To compare patient admission comorbidity profiles, length of stay, readmission rate, postoperative complications, mortality rate, and cost of care between acute geriatric hip fractures (HF) and elective total hip arthroplasties (THA).

METHODS

Retrospective cohort.

SETTING

Multicenter health care system.

PATIENTS

Eighteen thousand forty-two geriatric HF treated with operative fixation or arthroplasty and 8761 elective total hip patients were reviewed.

MAIN OUTCOME MEASUREMENTS

Charlson Comorbidity Index, length of stay, ICU admission, readmission rate, postoperative complications, mortality rates, and cost of care.

RESULTS

Medical comorbidities: chronic pulmonary disease, chronic kidney disease, coronary artery disease, heart failure, liver cirrhosis, and cerebrovascular disease were higher in HF patients as was mean Charlson Comorbidity Index (P < 0.001). Albumin was lower and HgbA1c higher in HF patients (P < 0.001). Average length of stay was 5.0 versus 2.6 days (P < 0.001) with 8.5% of HF patients being managed in the ICU versus 1.8% of THA patients. Readmission rates for HF and THA patients were 21.4% and 6.2%, respectively (P < 0.001). Minor and major complications were higher in the HF cohort (P < 0.001), as were 30-day (1.97% vs. 0.17%) and 1-year mortality rates (3.49% vs. 0.40%) (P < 0.001). Mean hospital cost of care was nearly 15,000 US dollars more expensive in HF patients when compared to the elective THA cohort (P < 0.001).

CONCLUSIONS

HF patients have increased comorbidity burdens, lengths of stay, ICU admissions, readmission rates, complications, mortality, and costs of care than patients with elective total hip arthroplasty. In the era of pay for quality performance, health systems must reconcile the difference between these 2 patient cohorts.

LEVEL OF EVIDENCE

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

Intrafat Sequestration of Artemisinin Disguised as a Purulent Collection during a Posterolateral Hip Approach

The posterolateral hip approach is the oldest and most used way to implant total hip arthroplasty. The anterior part of the oblique portion of this posterolateral approach corresponds more or less to the superolateral quadrant of the buttock in which the intramuscular injection of various drugs, including the compounds derived from artemisinin, is carried out. Thus, in a malarial endemic area where gluteal injections of the compounds derived from artemisinin are not rare, poor performance of an injection by the deposition of the product in the fat and not deeply in the muscle can be at the origin of the sequestration of the drug in adipose tissue and give the macroscopic appearance of a pus. The authors present a case of intrafat sequestration of artemisinin taken for purulent collection during a posterolateral hip approach for total hip arthroplasty.

Templating Hip Arthroplasty

BACKGROUND:

Different methods have been developed and employed with variable degrees of success in pre-operative templating for total hip arthroplasty. Preoperative templating, especially digital templating, has been claimed to have increased the effectiveness of total hip arthroplasty by improving the precision of prediction of prosthetic implant size.

AIMS:

The overall aim of this systematic review is to identify whether the use of pre-operative templating in total hip arthroplasty procedures has resulted in increased accuracy, reliability and precision of the procedure. Various methods of templating, like traditional acetate overlay and digital method of templating that includes a single radiographic marker and double radiographic marker methods, have been compared to establish the most reliable method of templating.

METHODS:

We searched the PubMed, Google Scholar Cochrane Central Register of Controlled Trials (CENTRAL), and MEDLINE (1966 to present), EMBASE (1980 to present), CINAHL (1982 to present), Psych INFO (1967 to present) and Clinical Trials Gov.

CONCLUSION:

The results of this systemic review suggest that preoperative templating is resulting in an enormous increase in the accuracy of total hip arthroplasty and among various methods, King Mark is the most reliable method.

Robotic total hip arthroplasty

Modern total hip replacement is typically effective and durable, but early failures do occur. Component position influences functional outcome, durability, and risk of complications. Surgical robotics provides the detail-oriented surgeon with a robust tool to optimize the accuracy and precision of total hip arthroplasty, with the potential to minimize risk of mechanical failure. This article describes efficient workflows for using surgical robotics to optimize surgical precision without increasing surgical complexity.

Dual mobility cups in total hip arthroplasty

Total hip arthroplasty (THA) is considered one of the most successful surgical procedures in orthopaedics. With the increase in the number of THAs performed in the world in the next decades, reducing or preventing medical and mechanical complications such as post-operative THA instability will be of paramount importance, particularly in an emerging health care environment based on quality control and patient outcome. Dual mobility acetabular component (also known as unconstrained tripolar implant) was introduced in France at the end of the 1970s as an alternative to standard sockets, to reduce the risk of THA dislocation in patients undergoing primary THA in France. Dual mobility cups have recently gained wider attention in the United States as an alternative option in the prevention and treatment of instability in both primary and revision THA and offer the benefit of increased stability without compromising clinical outcomes and implant longevity. In this article, we review the use of dual mobility cup in total hip arthroplasty in terms of its history, biomechanics, outcomes and complications based on more than 20 years of medical literature.

Dual mobility in total hip arthroplasty

Dual-mobility articulations have shown promising results. Postoperative instability remains the most common reason for revision of a total hip arthroplasty (THA). Dual-mobility cups have been shown to decrease the rate of dislocation in primary THA and have been used to treat and prevent instability in revision THA. Greater range of motion and a greater head-to-neck ratio and a greater jump distance are achieved, resulting in a lower risk of instability. Concerns with dual-mobility cups include wear and intraprosthetic dislocation. Specific design modifications have aimed to improve cup fixation and decrease polyethylene wear and the risks of intraprosthetic dislocation.