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Wijnen A, Seeber GH, Dietz G, Dijkstra B, Dekker JS, Vermeulen KM, Slager GEC, Hessel A, Lazovic D, Bulstra SK, Stevens M. Effectiveness of rehabilitation for working-age patients after a total hip arthroplasty: a comparison of usual care between the Netherlands and Germany. BMC Musculoskelet Disord 2023; 24:525. [PMID: 37370054 DOI: 10.1186/s12891-023-06654-w] [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: 02/13/2023] [Accepted: 06/19/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Postoperative rehabilitation after primary total hip arthroplasty (p-THA) differs between the Netherlands and Germany. Aim is to compare clinical effectiveness and to get a first impression of cost effectiveness of Dutch versus German usual care after p-THA. METHODS A transnational prospective controlled observational trial. Clinical effectiveness was assessed with self-reported questionnaires and functional tests. Measurements were taken preoperatively and 4 weeks, 12 weeks, and 6 months postoperatively. For cost effectiveness, long-term economic aspects were assessed from a societal perspective. RESULTS 124 working-age patients finished the measurements. German usual care leads to a significantly larger proportion (65.6% versus 47.5%) of satisfied patients 12 weeks postoperatively and significantly better self-reported function and Five Times Sit-to-Stand Test (FTSST) results. German usual care is generally 45% more expensive than Dutch usual care, and 20% more expensive for working-age patients. A scenario analysis assumed that German patients work the same number of hours as the Dutch, and that productivity costs are the same. This analysis revealed German care is still more expensive but the difference decreased to 8%. CONCLUSIONS German rehabilitation is clinically advantageous yet more expensive, although comparisons are less straightforward as the socioeconomic context differs between the two countries. TRIAL REGISTRATION The study is registered in the German Registry of Clinical Trials (DRKS00011345, 18/11/2016).
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Affiliation(s)
- Annet Wijnen
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- University Hospital for Orthopaedics and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany
| | - Gesine H Seeber
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- University Hospital for Orthopaedics and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany
| | - Günter Dietz
- Clinic for Orthopedic and Rheumatological Rehabilitation, Reha-Zentrum Am Meer Bad Zwischenahn, Bad Zwischenahn, Germany
- Praxis Für Orthopädie, Bad Zwischenahn, Germany
| | - Baukje Dijkstra
- Department of Orthopedics, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Johan S Dekker
- Department of Orthopedics, Ommelander Ziekenhuis Groningen, Scheemda, The Netherlands
| | - Karin M Vermeulen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Geranda E C Slager
- Department of Physical Therapy, School of Health Care Studies, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Aike Hessel
- Deutsche Rentenversicherung Oldenburg, Bremen, Germany
| | - Djordje Lazovic
- University Hospital for Orthopaedics and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany
| | - Sjoerd K Bulstra
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin Stevens
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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Patel N, Golwala P. Approaches for Total Hip Arthroplasty: A Systematic Review. Cureus 2023; 15:e34829. [PMID: 36919077 PMCID: PMC10008322 DOI: 10.7759/cureus.34829] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2023] [Indexed: 02/12/2023] Open
Abstract
These surgical procedures have their own challenges, limitations, and success rate. The choice of surgical approach will depend on many factors including the surgeon's choice, type of pathology, bone stock, age of the patient, and experience of the surgeon. Whichever approach is used for total hip arthroplasty (THA), the primary goals of the surgery would be pain relief and enhancement in the quality of the patient's life suffering from hip pathologies. To further understand the advantages and potential pitfalls associated with different surgical approaches, we conducted a review study comparing different surgical approaches for THA in terms of their clinical and functional outcomes. All the studies done on surgical approaches used in THA published articles in the English language and from 2015 onward were included in the review. The databases searched were COCHRANE, MEDLINE, PEDRO, CINHAL, etc. Search engines that were searched were Google Scholar, Pub Med, and Science Direct. As per the inclusion criteria, out of 50 studies, 26 studies were included in the study which underwent critical analysis. Considering all the factors reviewed from the literature, the posterior approach or posterolateral approach is optimally beneficial.
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Affiliation(s)
- Niketa Patel
- Department of Physiotherapy, Sumandeep Vidyapeeth Deemed to be University, Vadodara, IND
| | - Paresh Golwala
- Department of Orthopedics, Sumandeep Vidyapeeth Deemed to be University, Vadodara, IND
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Reichert JC, Wassilew GI, von Rottkay E, Noeth U. Compared learning curves of the direct anterior and anterolateral approach for minimally invasive hip replacement. Orthop Rev (Pavia) 2022; 14:37500. [PMID: 36034727 PMCID: PMC9404252 DOI: 10.52965/001c.37500] [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] [Indexed: 09/28/2023] Open
Abstract
Minimally invasive hip arthroplasty becomes increasingly popular. It is technically challenging and the approaches used are associated with a considerable learning curve. This nurtures concerns regarding patient safety, surgical training, and cost effectiveness. Consequently, we initiated a study comparing the learning curves of a supervised trainee surgeon utilizing both the anterolateral and direct anterior approach (DAA) when introduced to minimally invasive hip replacement surgery. Outcome measurements included the Harris hip score (HHS), cup inclination and anteversion, offset and leg length, stem placement, surgical time and complications. Time from incision to suture decreased significantly over time but did not differ between both groups. The functional outcomes (HHS) after six weeks and three months were comparable (p=0.069 and 0.557) and within the expected range equalling 90.3 (anterior) and 89.2 (anterolateral) points. With both approaches safe component placement was readily achieved. Both offset and leg length, however, were reconstructed more reliably with the DAA (p=0.02 and 0.001). A higher rate of dislocations was seen with the anterior, more perioperative infections with the anterolateral approach. We suggest that supervision by an experienced surgeon favourably influences the learning curves for both the minimally invasive DAA and anterolateral approach and conclude that the greatest improvement is seen within the first 60 cases.
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Affiliation(s)
- Johannes C Reichert
- Department of Orthopedics and Orthopaedic Surgery, University Medicine Greifswald; Department of Orthopaedic and Trauma Surgery, Evangelisches Waldkrankenhaus Spandau
| | - Georgi I Wassilew
- Department of Orthopedics and Orthopaedic Surgery, University Medicine Greifswald
| | - Eberhard von Rottkay
- Department of Orthopaedic and Trauma Surgery, Evangelisches Waldkrankenhaus Spandau
| | - Ulrich Noeth
- Department of Orthopaedic and Trauma Surgery, Evangelisches Waldkrankenhaus Spandau
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Chen X, Liu H, Wang H, Zheng L, Li J, Yan L. Case report: A 3-year follow-up study of simultaneous bilateral total hip arthroplasty for Femoral head necrosis in a patient with Kashin-Beck Disease. Front Surg 2022; 9:978697. [PMID: 36003279 PMCID: PMC9393417 DOI: 10.3389/fsurg.2022.978697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 07/25/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Kashin-Beck Disease (KBD) is an endemic disease predominantly affecting joint and skeletal muscle, predisposing the articular cartilage to degeneration and necrosis. Currently,staged total hip arthroplasty is a common surgical method for advanced femoral head necrosis from KBD, but there are no reports in the literature on simultaneous bilateral total hip arthroplasty (SB-THA) for patients with KBD. Case presentation A 42-year-old male from Shaanxi Province, an endemic area, had bilateral hip pain for 4 years, with hips inversion and a crossed gait. After preoperative preparation, a SB-THA was performed by a posterolateral approach. Postoperative medication and functional exercises were administered and the patient was followed up for at least 3 years after discharge. The patient's hip mobility, hip scores and quality of life scores were recorded in detail during the follow-up. Result The patient stopped antibiotic treatment on the postoperative day-2, and all inflammatory indicators showed normal and started appropriate exercise, and the pain score decreased significantly. On the postoperative day-7, the patient had gradually adapted to various forms of rehabilitation exercises. He was discharged from the hospital on the postoperative day-10 and continued to be followed up. From the preoperative period to the last follow-up, the patient's bilateral hip mobility and functional scores improved significantly, and no adverse events such as hip pain, prosthesis loosening or dislocation were found at the last follow-up. Conclusion The patient's performance was satisfactory both intraoperatively and in the early postoperative period, but the hip scores and quality of life scores began to plateau or even decline from the third year after surgery to the last follow-up, probably due to the influence of further damage to articular cartilage in other parts of the body.
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Affiliation(s)
- Xiangyu Chen
- Medical College, Yangzhou University, Yangzhou, China
| | - Haibin Liu
- Fu County People’s Hospital, Yan'an, China
| | - Houqing Wang
- Medical College, Yangzhou University, Yangzhou, China
| | | | - Jiayu Li
- Dalian Medical University, Dalian, China
| | - Lianqi Yan
- Joint Department, Northern Jiangsu People’s Hospital (NJPH), Yangzhou, China
- Correspondence: Lianqi Yan
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Rykov K, Meys TWGM, Knobben BAS, Sietsma MS, Reininga IHF, Ten Have BLEF. MRI Assessment of Muscle Damage After the Posterolateral Versus Direct Anterior Approach for THA (Polada Trial). A Randomized Controlled Trial. J Arthroplasty 2021; 36:3248-3258.e1. [PMID: 34116911 DOI: 10.1016/j.arth.2021.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/26/2021] [Accepted: 05/07/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There is controversy in literature whether the direct anterior approach (DAA) results in less muscle damage compared with the posterolateral approach (PLA) for total hip arthroplasty. The aim of this randomized controlled trial was to assess muscle damage between these two approaches. METHODS Forty-six patients were included. Muscle atrophy, determined with the Goutallier classification, and muscle surface of twelve muscles were analyzed on magnetic resonance imaging images made preoperatively and one year postoperatively. Differences in component placement after DAA or PLA were assessed on radiographs. Harris hip scores and Hip disability and Osteoarthritis and Outcome Score were used as functional outcomes. RESULTS External rotator musculature was damaged in both approaches. After PLA, the obturator muscles showed significantly more atrophy and a decrease in muscle surface. After DAA, the tensor fascia latae showed an increased muscle atrophy and the psoas muscle showed a decreased muscle surface. An increase in muscle surface was seen for the rectus femoris, sartorius, and quadratus femoris after both approaches. The muscle surface of the gluteus medius and iliacus was also increased after PLA. No difference in muscle atrophy was found between the approaches for these muscles. The inclination angle of the cup in PLA was significantly higher. No differences were found in functional outcomes. CONCLUSION Different muscle groups were affected in the two approaches. After PLA, the external rotators were more affected, whereas the tensor fascia latae and psoas muscles were more affected after DAA.
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Affiliation(s)
- Kyrill Rykov
- Department of Orthopaedic Surgery, Martini Hospital Groningen, the Netherlands
| | - Tim W G M Meys
- Department of Radiology, Martini Hospital Groningen, the Netherlands
| | - Bas A S Knobben
- Department of Orthopaedic Surgery, Martini Hospital Groningen, the Netherlands
| | - Maurits S Sietsma
- Department of Orthopaedic Surgery, Martini Hospital Groningen, the Netherlands
| | - Inge H F Reininga
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Bas L E F Ten Have
- Department of Orthopaedic Surgery, Martini Hospital Groningen, the Netherlands
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Reichert JC, von Rottkay E, Roth F, Renz T, Hausmann J, Kranz J, Rackwitz L, Nöth U, Rudert M. A prospective randomized comparison of the minimally invasive direct anterior and the transgluteal approach for primary total hip arthroplasty. BMC Musculoskelet Disord 2018; 19:241. [PMID: 30025519 PMCID: PMC6053824 DOI: 10.1186/s12891-018-2133-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 06/14/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The presented prospective randomized controlled single-centre study compares the clinical outcome up to 12 months after total hip arthroplasty using a minimally invasive single-incision direct anterior (DAA) and a direct transgluteal lateral approach. METHODS A total of 123 arthroplasties were evaluated utilizing the Harris Hip Score (HHS), the extra short musculoskeletal functional assessment questionnaire (XSFMA), the Short Form 36 (SF-36) health survey, a Stepwatch™ Activity Monitor (SAM), and a timed 25 m foot walk (T25-FW). Postoperative x-ray images after THA were reviewed to determine inclination and stem positioning. RESULTS At final follow-up, the XSFMA functional index scores were 10.3 (anterior) and 15.08 (lateral) while the bother index summed up to a score of 15.8 (anterior) and 21.66 (lateral) respectively, thus only differing significantly for the functional index (p = 0.040 and p = 0.056). The SF-36 physical component score (PCS) was 47.49 (anterior) and 42.91 (lateral) while the mental component score (MCS) summed up to 55.0 (anterior) and 56.23 (lateral) with a significant difference evident for the PCS (p = 0.017; p = 0.714). Patients undergoing THA through a DAA undertook a mean of 6402 cycles per day while those who had undergone THA through a transgluteal approach undertook a mean of 5340 cycles per day (p = 0.012). Furthermore, the obtained outcome for the T25-FW with 18.4 s (anterior) and 19.75 s (lateral) and the maximum walking distance (5932 m and 5125 m) differed significantly (p = 0.046 and p = 0.045). The average HHS showed no significant difference equaling 92.4 points in the anterior group and 91.43 in the lateral group (p = 0.477). The radiographic analysis revealed an average cup inclination of 38.6° (anterior) and 40.28° (lateral) without signs of migration. CONCLUSION In summary, our outcomes show that after 1 year THA through the direct anterior approach results in a higher patient activity compared to THA utilizing a transgluteal lateral approach while no differences regarding hip function are evident. TRIAL REGISTRATION DRKS00014808 (German Clinical Trial Register DRKS); date of registration: 31.05.2018.
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Affiliation(s)
- Johannes C Reichert
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Center for Musculoskeletal Research, Julius-Maximilians-University, Brettreichstraße 11, 97074, Würzburg, Germany. .,Department of Orthopaedic and Trauma Surgery, Evangelisches Waldkrankenhaus Spandau, Stadtrandstrasse 555, 13589, Berlin, Germany.
| | - Eberhard von Rottkay
- Department of Orthopaedic and Trauma Surgery, Evangelisches Waldkrankenhaus Spandau, Stadtrandstrasse 555, 13589, Berlin, Germany
| | - Franz Roth
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Center for Musculoskeletal Research, Julius-Maximilians-University, Brettreichstraße 11, 97074, Würzburg, Germany
| | - Tim Renz
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Center for Musculoskeletal Research, Julius-Maximilians-University, Brettreichstraße 11, 97074, Würzburg, Germany
| | - Johannes Hausmann
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Center for Musculoskeletal Research, Julius-Maximilians-University, Brettreichstraße 11, 97074, Würzburg, Germany
| | - Julius Kranz
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Center for Musculoskeletal Research, Julius-Maximilians-University, Brettreichstraße 11, 97074, Würzburg, Germany
| | - Lars Rackwitz
- Department of Orthopaedic and Trauma Surgery, Evangelisches Waldkrankenhaus Spandau, Stadtrandstrasse 555, 13589, Berlin, Germany
| | - Ulrich Nöth
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Center for Musculoskeletal Research, Julius-Maximilians-University, Brettreichstraße 11, 97074, Würzburg, Germany.,Department of Orthopaedic and Trauma Surgery, Evangelisches Waldkrankenhaus Spandau, Stadtrandstrasse 555, 13589, Berlin, Germany
| | - Maximilian Rudert
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Center for Musculoskeletal Research, Julius-Maximilians-University, Brettreichstraße 11, 97074, Würzburg, Germany
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Seeber GH, Wijnen A, Lazovic D, Bulstra SK, Dietz G, van Lingen CP, Stevens M. Effectiveness of rehabilitation after a total hip arthroplasty: a protocol for an observational study for the comparison of usual care in the Netherlands versus Germany. BMJ Open 2017; 7:e016020. [PMID: 28801413 PMCID: PMC5629641 DOI: 10.1136/bmjopen-2017-016020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Osteoarthritis is the most common joint disorder worldwide. Total hip arthroplasty (THA) is considered one of the most effective treatments for end-stage hip osteoarthritis. The number of THAs is expected to increase dramatically in the coming decades. Usual postoperative rehabilitation after primary THA differs between the German and the Dutch system. In the Netherlands, patients undergo fast-track surgery and are discharged into their home environment within a few days without receiving any aftercare. In Germany, patients stay in the hospital for about 12 days before being transferred to a rehabilitation centre for a period of 3 weeks. The superficially more cost-effective Dutch system of usual care after THA is judged critically in both countries due to suboptimal rehabilitation outcomes. The aim of this study is therefore to compare the Dutch with the German usual care rehabilitation after primary THA. It is hypothesised that the German procedure is more effective in terms of functional outcomes and patient satisfaction than the Dutch procedure and that in the long run the German approach is more cost-effective than the Dutch system. METHODS AND ANALYSIS Medical effectiveness will be assessed at four different time points by means of patient self-reported questionnaires and functional tests. Assessments include the Hip disability and Osteoarthritis Outcome Score, Patient Acceptable Symptom State, Short Form 36, EuroQol 5 Dimensions 3 Level Questionnaire, Timed Up & Go Test and Five Times Sit-to-Stand Test. Additionally, long-term economic aspects in both countries will be assessed from a societal perspective, to get a first impression on whether cutting costs for rehabilitation, as practised in the Netherlands, really disburdens the healthcare system efficiently. ETHICS AND DISSEMINATION The study is approved by the Institutional Review Boards of both University Medical Center Groningen (METc2015/483) and Hannover Medical School (no 2874-2015) and will be conducted according to the principles of the Declaration of Helsinki (64th, 2013). The results of the study will be published in international peer-reviewed scientific journals. Patient data will be presented anonymously in any publication or scientific journal. TRIAL REGISTRATION NUMBER DRKS00011345; Pre-results.
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Affiliation(s)
- Gesine H Seeber
- Universitätsklinik für Orthopädie und Unfallchirurgie Pius-Hospital Oldenburg, Medizinischer Campus Universität Oldenburg, Oldenburg, Germany
| | - Annet Wijnen
- Universitätsklinik für Orthopädie und Unfallchirurgie Pius-Hospital Oldenburg, Medizinischer Campus Universität Oldenburg, Oldenburg, Germany
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Djordje Lazovic
- Universitätsklinik für Orthopädie und Unfallchirurgie Pius-Hospital Oldenburg, Medizinischer Campus Universität Oldenburg, Oldenburg, Germany
| | - Sjoerd K Bulstra
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Günter Dietz
- Klinik für Orthopädische und Rheumatologische Rehabilitation Reha-Zentrum am Meer Bad Zwischenahn, Bad Zwischenahn, Germany
| | | | - Martin Stevens
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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