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Carender CN, Bothun CE, Sierra RJ, Trousdale RT, Abdel MP, Bedard NA. Contemporary Aseptic Revision Total Hip Arthroplasty in Patients ≤50 Years of Age: Results of >500 Cases. J Bone Joint Surg Am 2024:00004623-990000000-01082. [PMID: 38687829 DOI: 10.2106/jbjs.23.01467] [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] [Indexed: 05/02/2024]
Abstract
BACKGROUND There has been a paucity of long-term outcomes data on aseptic revision total hip arthroplasties (THAs) in the young adult population. The purpose of this study was to evaluate implant survivorship, complications, and clinical outcomes in a large cohort of contemporary aseptic revision THAs in patients ≤50 years of age at the time of the surgical procedure. METHODS We identified 545 aseptic revision THAs performed at a single academic institution from 2000 to 2020 in patients who were 18 to 50 years of age. Patients who underwent conversion THAs and patients with a history of any ipsilateral hip infection were excluded. The mean age was 43 years, the mean body mass index (BMI) was 29 kg/m2, and 63% were female. The index indication for revision THA was aseptic loosening in 46% of cases, polyethylene wear or osteolysis in 28% of cases (all revisions of conventional polyethylene), and dislocation in 11% of cases. There were 126 hips (23%) that had undergone at least 1 previous revision (median, 1 revision [range, 1 to 5 revisions]). The mean follow-up was 10 years. RESULTS In the entire cohort, the 20-year survivorship free of any re-revision was 76% (95% confidence interval [95% CI], 69% to 82%). There were 87 re-revisions, with 31 dislocations, 18 cases of aseptic loosening of the femoral component, and 16 periprosthetic joint infections (PJIs) being the most common reasons for re-revision. Dislocation as the indication for the index revision was associated with an increased risk of re-revision (hazard ratio, 2.9; p < 0.001). The 20-year survivorship free of any reoperation was 73% (95% CI, 66% to 78%). There were 75 nonoperative complications (14%), including 32 dislocations. The mean Harris hip score significantly improved (p < 0.001) from 65 preoperatively to 81 at 10 years postoperatively. CONCLUSIONS Contemporary aseptic revision THAs in patients ≤50 years of age demonstrated a re-revision risk of approximately 1 in 4 at 20 years. Dislocation, aseptic loosening of the femoral component, and PJI were the most common reasons for re-revision. Index revision THAs for dislocation had a 3 times higher risk of re-revision. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Parilla FW, Anthony CA, Bartosiak KA, Pashos GE, Thapa S, Clohisy JC. Ten Year Outcomes of Contemporary Total Hip Arthroplasty in Adolescent and Young Adult Patients are Favorable. J Arthroplasty 2024; 39:754-759. [PMID: 37778641 DOI: 10.1016/j.arth.2023.09.032] [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: 04/04/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND The purpose of this study was to assess 10-year patient-reported outcome measures, complications, polyethylene wear-rates, and implant survivorships in patients ≤30 years of age treated with contemporary total hip arthroplasty (THA). METHODS We retrospectively assessed 121 patients (144 hips) who underwent THA at age ≤30 years (mean 23 [range, 11 to 30]) at an average follow-up duration of 10.7 years (range, 8 to 17). Highly-crosslinked polyethylene acetabular liners were used in all cases. Femoral heads were ceramic (74%) or cobalt-chrome (26%). There were 52 hips (36%) that had previous surgery and 31 hips (22%) were in patients who had associated major systemic comorbidities. We analyzed the modified Harris Hip scores, University of California Los Angeles Activity Scores, major complications, polyethylene wear-rates, and implant survivorships. RESULTS At final follow-up, the average modified Harris Hip scores improved from 47 (±15.1) to 81 (±19.5) with an average 34-point improvement. The University of California Los Angeles scores improved from 4.0 (±2.3) to 6.0 (±2.4). The major complication rate was 5.6%. There were 6 hips (4.2%) that were revised. Indications for revision included instability (3, 2.1%), late infection (1, 0.7%), liner dissociation (1, 0.7%), and acetabular loosening (1, 0.7%). Mean linear (0.0438 mm/y) and volumetric (29.07 mm3/y) wear rates were low. No periprosthetic osteolysis was detected in any hip. Survivorship free from revision for any reason was 97.2, 95.8, and 95.8% at 5, 10, and 15 years. CONCLUSIONS Contemporary THA in patients ≤30 years of age is associated with marked clinical improvements at 10-year follow-up and encouraging survivorship estimates at 15 years.
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Affiliation(s)
- Frank W Parilla
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Chris A Anthony
- Penn Orthopaedics at Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kimberly A Bartosiak
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Gail E Pashos
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Susan Thapa
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - John C Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
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Lin YS, DeClercq JJ, Ayers GD, Gilmor RJ, Collett G, Jain NB. Incidence and Clinical Risk Factors of Post-Operative Complications following Primary Total Hip Arthroplasty: A 10-Year Population-Based Cohort Study. J Clin Med 2023; 13:160. [PMID: 38202167 PMCID: PMC10780046 DOI: 10.3390/jcm13010160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/19/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024] Open
Abstract
Background: Total hip arthroplasty (THA) has become a growing treatment procedure for debilitating hip pathologies. Patients experienced post-operative complications and revision surgeries according to large THA registries. To fully understand the short-term and long-term post-operative outcomes following THA, the purpose of this study is to examine the incidence of post-operative complications following primary THA and to examine how this trend has changed over 10 years within community hospitals in the US using large databases. Methods: This study queried the State Inpatient Database (SID) for primary THA between 2006 and 2015. Individual patients were followed forward in time until the first instance of a post-operative complication. The multivariable logistic regression analyses were computed to examine which post-operative complications were independent predictors of pre-operative comorbidities. Results: Median age of patients was 67 years, and 56% of patients were female. Females with avascular necrosis (AVN) as an indication for THA had a 27% higher risk of complication. Females with osteoarthritis (OA) as an indication for THA had a 6% higher risk of complication. Post-operative complications occurred with higher frequencies in the first two months of THA and the highest risks of THA complications within the first 6 months. Conclusion: The most common indication is OA in elders with primary THA. Females and those of black ethnicity showed the greatest risks of THA complications. Data from our large study can be used to understand post-operative complications and readmissions after THA. Our study also provides data on risk factors associated with these complications.
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Affiliation(s)
- Yen-Sheng Lin
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX 75390, USA; (Y.-S.L.); (G.C.)
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, TX 75390, USA
| | - Joshua J. DeClercq
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN 37212, USA (G.D.A.)
| | - Gregory D. Ayers
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN 37212, USA (G.D.A.)
| | | | - Garen Collett
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX 75390, USA; (Y.-S.L.); (G.C.)
| | - Nitin B. Jain
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX 75390, USA; (Y.-S.L.); (G.C.)
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, TX 75390, USA
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN 37212, USA (G.D.A.)
- Department of Population & Data Sciences, University of Texas Southwestern, Dallas, TX 75390, USA
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Mazur M, Steelman K, Sayeed Z, Chen C, Darwiche H, Little B. Total Hip Arthroplasty in the Ultrayoung. Arthroplast Today 2023; 23:101181. [PMID: 37731593 PMCID: PMC10507074 DOI: 10.1016/j.artd.2023.101181] [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: 02/04/2023] [Revised: 06/21/2023] [Accepted: 07/01/2023] [Indexed: 09/22/2023] Open
Abstract
Background Total hip arthroplasty (THA) procedures provide a surgical option for "ultrayoung" patients ≤30 years old with end-stage hip arthropathy. This has historically been coupled with concerns over early component failure and challenging surgical technique leading to increased risk of overall morbidity. The purpose of this study is to better elucidate the poorly defined indications and outcomes for THA in ultrayoung patients with end-stage hip disease. Methods A total of 40 THAs in 35 patients ≤30 years old performed at our institution from 2009 to 2016 were retrospectively followed for an average of 2 years (median 11 months, interquartile range 1-31.25). Primary outcome measure was THA revision. Patient demographics were compared against outcomes. The effects on revision rate of hip joint pathology and type of bearing surface were investigated. T-test, chi-square test, and bivariate correlation were performed to determine statistical significance (P < .05). Machine learning was used to determine the normalized important factor leading to THA revision. Results Fifteen male and 25 female patients were included. Median patient age was 23 (interquartile range 19-27) years, with an average body mass index of 27.0 ± 7.9. A majority of THAs were indicated for osteonecrosis (32) and bearing surface type was predominantly metal-on-highly cross-linked polyethylene (36). The overall revision rate was 7.5%, without a correlation between revision and demographic characteristics. Revision surgery was significantly correlated with bearing surface type (P = .028). Important factors for revision were age (100%), bearing surface type (84.7%), and body mass index (52.1%). Conclusions In patients ≤30 years old, THAs performed with the use of modern implants and surgical methods show satisfactory survivorship and functional outcomes with short-term follow-up.
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Affiliation(s)
- Matthew Mazur
- Department of Orthopedic Surgery, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Kevin Steelman
- Department of Orthopedic Surgery, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Zain Sayeed
- Department of Orthopedic Surgery, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Chaoyang Chen
- Department of Orthopedic Surgery, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Hussein Darwiche
- Department of Orthopedic Surgery, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Bryan Little
- Department of Orthopedic Surgery, Detroit Medical Center, Wayne State University, Detroit, MI, USA
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Morris EJ, Gray K, Gibbons PJ, Grayson J, Sullivan J, Amorim AB, Burns J, McKay MJ. Evaluating the Use of PROMs in Paediatric Orthopaedic Registries. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1552. [PMID: 37761513 PMCID: PMC10528097 DOI: 10.3390/children10091552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023]
Abstract
Patient-reported outcome measures (PROMs) provide structured information on the patient's health experience and facilitate shared clinical decision-making. Registries that collect PROMs generate essential information about the clinical course and efficacy of interventions. Whilst PROMs are increasingly being used in adult orthopaedic registries, their use in paediatric orthopaedic registries is not well known. The purpose of this systematic review was to identify the frequency and scope of registries that collect PROMs in paediatric orthopaedic patient groups. In July 2023, six databases were systematically searched to identify studies that collected PROMs using a registry amongst patients aged under 18 years with orthopaedic diagnoses. Of 3190 identified articles, 128 unique registries were identified. Three were exclusively paediatric, 27 were majority paediatric, and the remainder included a minority of paediatric patients. One hundred and twenty-eight registries collected 72 different PROMs, and 58% of these PROMs were not validated for a paediatric population. The largest group of orthopaedic registries collected PROMs on knee ligament injuries (21%). There are few reported dedicated orthopaedic registries collecting PROMs in paediatric populations. The majority of PROMs collected amongst paediatric populations by orthopaedic registries are not validated for patients under the age of 18 years. The use of non-validated PROMs by registries greatly impedes their utility and impact. Dedicated orthopaedic registries collecting paediatric-validated PROMs are needed to increase health knowledge, improve decision-making between patients and healthcare providers, and optimise orthopaedic management.
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Affiliation(s)
- Eleanor J. Morris
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
- Sydney Children’s Hospitals Network, The Children’s Hospital at Westmead, Sydney 2145, Australia;
| | - Kelly Gray
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney 2109, Australia;
| | - Paul J. Gibbons
- Sydney Children’s Hospitals Network, The Children’s Hospital at Westmead, Sydney 2145, Australia;
| | - Jane Grayson
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
| | - Justin Sullivan
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
| | - Anita B. Amorim
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
| | - Joshua Burns
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
- Sydney Children’s Hospitals Network, Paediatric Gait Analysis Service of New South Wales, Sydney 2145, Australia
| | - Marnee J. McKay
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
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Chen AG, Sogbein OA, McClure JA, Reid J, Welk B, Lanting BA, Degen RM. Total Hip Arthroplasty in Patients Aged 40 to 60 years old: A Population-Based Study. J Arthroplasty 2023:S0883-5403(23)00383-2. [PMID: 37100095 DOI: 10.1016/j.arth.2023.04.027] [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: 12/05/2022] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 04/28/2023] Open
Abstract
INTRODUCTION Contemporary total hip arthroplasty (THA) has resolved many implant longevity concerns in younger patients. Patients in their fourth and fifth decades of life are projected to be the fastest growing demographic of THA patients. We aimed to assess this demographic to evaluate the: 1) rate of THA over time; 2) cumulative incidence of revision; and 3) identify risk factors for revision. METHODS A retrospective population-based study of patients between 40 and 60 years old undergoing primary THA was conducted using administrative data from a large clinical data repository. A total of 28,414 patients were included for analysis with a mean age of 53 years (range, 40-60 years) and median follow up of 9 years (range, 0-17 years). Linear regressions were used to assess annual rates of THA in this cohort over time. Kaplan-Meier analysis was used to determine cumulative incidence of revision. Multivariate cox proportional hazards models were used to determine association of variables with revision risk. RESULTS The annual rate of THA in our population increased by 60.7% over the study period (P <0.0001). Cumulative incidence of revision was 2.9% at 5-years and 4.8% at 10-years. Younger age, women, non-osteoarthritis diagnosis, medical complications, and annual surgeon volume < 60 THA were associated with increased revision risk. CONCLUSION Demand for THA continues to dramatically increase in this cohort. Risk of revision was low but multiple risk factors were identified. Future studies will help delineate the effect of these variables on revision risk and assess implant survivorship beyond 10 years.
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Affiliation(s)
- Aaron G Chen
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | - Olawale A Sogbein
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | - J Andrew McClure
- Department of Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Jennifer Reid
- Department of Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Blayne Welk
- Institute for Clinical Evaluative Sciences (ICES), Western, London, Ontario, Canada; Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, St. Joseph's Healthcare, London, Ontario, Canada
| | - Brent A Lanting
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | - Ryan M Degen
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, Ontario, Canada.
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Sharma AK, Grammatopoulos G, Pierrepont JW, Madurawe CS, Innmann MM, Vigdorchik JM, Shimmin AJ. Sacral Slope Change From Standing to Relaxed-Seated Grossly Overpredicts the Presence of a Stiff Spine. J Arthroplasty 2023; 38:713-718.e1. [PMID: 35588904 DOI: 10.1016/j.arth.2022.05.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/12/2022] [Accepted: 05/10/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Several authors propose that a change in sacral slope of ≤10° between the standing and relaxed-seated positions (ΔSSstanding→relaxed-seated) identifies a patient with a stiff lumbar spine and has suggested the use of dual-mobility bearings for such patients undergoing a total hip arthroplasty (THA). The aim of this study was to assess how accurately ΔSSstanding→relaxed-seated can identify patients with a stiff spine. METHODS A prospective, multicentre, consecutive cohort series of 312 patients had standing, relaxed-seated, and flexed-seated lateral radiographs prior to THA. ΔSSstanding→relaxed-seated was determined by the change in sacral slope between the standing and relaxed-seated positions. Lumbar flexion (LF) was defined as the difference in lumbar lordotic angle between standing and flexed-seated. LF ≤20° was considered a stiff spine. The predictive value of ΔSSstanding→relaxed-seated for characterizing a stiff spine was assessed. RESULTS A weak correlation between ΔSSstanding→relaxed-seated and LF was identified (r2 = 0.13). Eighty six patients (28%) had ΔSSstanding→relaxed-seated ≤10° and 19 patients (6%) had a stiff spine. Of the 86 patients with ΔSSstanding→relaxed-seated ≤10°, 13 had a stiff spine. The positive predictive value of ΔSSstanding→relaxed-seated ≤10° for identifying a stiff spine was 15%. CONCLUSION In this cohort, ΔSSstanding→relaxed-seated ≤10° was not correlated with a stiff spine. Using this simplified approach could lead to a 7-fold overprediction of patients with a stiff lumbar spine and abnormal spinopelvic mobility, unnecessary use of dual-mobility bearings, and incorrect component alignment targets. Referring to patients with ΔSSstanding→relaxed-seated ≤10° as being stiff is misleading. The flexed-seated position should be used to effectively assess a patient's spine mobility prior to THA.
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Affiliation(s)
- Abhinav K Sharma
- Department of Orthopaedic Surgery, University of California, Irvine, School of Medicine, Orange, California
| | | | | | | | - Moritz M Innmann
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada; Division of Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Jonathan M Vigdorchik
- Department of Orthopedic Surgery, Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, New York, New York
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Baxter SN, Kelmer GC, Brennan JC, Johnson AH, Turcotte JJ, King PJ. Acetabular Total Hip Arthroplasty Revision: A Summary of Operative Factors, Outcomes, and Comparison of Approaches. J Arthroplasty 2023:S0883-5403(23)00076-1. [PMID: 36773658 DOI: 10.1016/j.arth.2023.01.056] [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: 11/02/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Revision total hip arthroplasty (THA) presents a greater risk to patients than primary THA, and surgical approach may impact outcomes. This study aimed to summarize acetabular revisions at our institution and to compare outcomes between direct anterior and posterior revision THA. METHODS A series of 379 acetabular revision THAs performed from January 2010 through August 2022 was retrospectively reviewed. Preoperative, perioperative, and postoperative factors were summarized for all revisions and compared between direct anterior and posterior revision THA. RESULTS The average time to acetabular revision THA was 10 years (range, 0.04 to 44.1), with mechanical failure (36.7%) and metallosis (25.6%) being the most prevalent reasons for revision. No differences in age, body mass index, or sex were noted between groups. Anterior revision patients had a significantly shorter length of stay (2.2 versus 3.2 days, P = .003) and rate of discharge to a skilled nursing facility (7.5 versus 25.2%, P = .008). In the 90-day postoperative period, 9.2% of patients returned to the emergency department (n = 35) and twelve patients (3.2%) experienced a dislocation. There were 13.2% (n = 50) of patients having a rerevision during the follow-up period with a significant difference between anterior and posterior approaches (3.8 versus 14.7%, respectively, P = .049). CONCLUSION This study provides some evidence that the anterior approach may be protective against skilled nursing facility discharge and rerevision and contributes to decreased lengths of stay. We recommend surgeons select the surgical approach for revision THA based on clinical preferences and patient factors.
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Affiliation(s)
- Samantha N Baxter
- Luminis Health Orthopedics, Anne Arundel Medical Center, Annapolis, Maryland
| | - Grayson C Kelmer
- Luminis Health Orthopedics, Anne Arundel Medical Center, Annapolis, Maryland; Campbell University School of Osteopathic Medicine, Lillington, North Carolina
| | - Jane C Brennan
- Luminis Health Orthopedics, Anne Arundel Medical Center, Annapolis, Maryland
| | - Andrea H Johnson
- Luminis Health Orthopedics, Anne Arundel Medical Center, Annapolis, Maryland
| | - Justin J Turcotte
- Luminis Health Orthopedics, Anne Arundel Medical Center, Annapolis, Maryland
| | - Paul J King
- Luminis Health Orthopedics, Anne Arundel Medical Center, Annapolis, Maryland
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Fernandez-Fernandez R, Moraleda-Novo L, De Armas JN, Cruz-Pardos A. Outcome measures and survivorship following total hip arthroplasty in adolescent population. INTERNATIONAL ORTHOPAEDICS 2022; 46:2785-2791. [PMID: 35945465 DOI: 10.1007/s00264-022-05536-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/28/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND The most frequent indication for total hip arthroplasty (THA) in adolescent patients has been juvenile idiopathic arthritis (JIA). However, in recent years, other causes have become more prevalent. QUESTIONS/PURPOSES (1) What is the survivorship following THA across the diagnostic spectrum in adolescent population? (2) How are quality of life results affected by systemic medical conditions? METHODS We retrospectively reviewed all consecutive THA in patients under 21 years of age, performed at our Institution between 1993 and 2018. There were 34 prostheses implanted in 26 patients with a mean age of 18.4 years (range 11 to 21). The most frequent diagnosis was JIA (14 hips), followed by avascular necrosis (10 hips). Patient reported outcomes were assessed using Harris and Oxford Hip Scores (HHS and OHS), Visual Analogue Scale (VAS) and EuroQol-5D. Survivorship for revision and aseptic loosening was determined with Kaplan Meier analysis. RESULTS At final follow-up, the overall survival rate was of 89.3% at 12-year follow-up. Three acetabular components underwent revision surgery for aseptic loosening. Clinical HHS significantly improved from 37.5 to 90.6 points (p < 0.001). Mean OHH was 37.4 points, with a final VAS of 1.64 points. Mean 5Q-5D was 0.704 with an interquartile range of 0.4 to 1.0. JIA patients displayed worse pre-operative HHS scores, and at final follow-up had worse HHS, OHS, VAS and EQ-5D scores compared to the rest of the patients. Complications included three intra-operative femoral fractures, one sciatic nerve palsy and one adductor contracture. CONCLUSION THA in adolescent patients provides improved functional outcomes with acceptable revision rates at mid-term follow-up.
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Affiliation(s)
| | | | | | - Ana Cruz-Pardos
- La Paz University Hospital, Pso. Castellana 261, 28046, Madrid, Spain
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10
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Comparing uncemented, hybrid and cemented primary total hip arthroplasty in young patients, a New Zealand Joint Registry study. Arch Orthop Trauma Surg 2022; 142:2371-2380. [PMID: 34319471 DOI: 10.1007/s00402-021-04085-7] [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] [Received: 04/14/2021] [Accepted: 07/21/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Despite increasing use of uncemented implants in young patients undergoing total hip arthroplasty (THA), there is minimal evidence for specific implant combinations in this group. We analysed the most commonly used uncemented (Corail-Pinnacle), hybrid (Exeter-Trident/Tritanium), and fully cemented (Exeter) implant combinations in the New Zealand Joint Registry (NZJR) in patients aged under 40 and between 40 and 55 years. METHODS All THAs recorded in the NZJR between 1999 and 2018 were included. The 40-55 and < 40 age groups were analysed separately. 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. The primary outcome was revision for any reason. RESULTS We identified 4152 THAs in the 40-55 group and 422 in the < 40 group. In the 40-55 group, revision rates and patient-reported outcome measure scores were comparable between the uncemented implant combination (0.70/100 component years) and the hybrid implant combination (0.62/100 component years), whereas the cemented implant combination exhibited a statistically significant higher revision rate (1.75/100 component years) (p < 0.001). In the < 40 group, revision rate for the hybrid implant combination (0.46/100 component years) was significantly lower than the uncemented implant combination (1.54/100 component years). CONCLUSION The most commonly used hybrid and uncemented implant combinations provided equivalent survival and functional outcomes in patients aged 40-55 years. More research is required to guide implant selection in patients aged < 40 years. The authors suggest a transition away from comparing classes of implants (cemented, uncemented, hybrid) given the diverse product range within these categories.
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Alsheikh KA, Alhandi AA, Almutlaq MS, Alhumaid LA, Shaheen N. The Outcomes and Revision Rate of Total Hip Arthroplasty in a Single Tertiary Center: A Retrospective Study. Cureus 2022; 14:e27981. [PMID: 36120254 PMCID: PMC9468514 DOI: 10.7759/cureus.27981] [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] [Accepted: 08/13/2022] [Indexed: 11/14/2022] Open
Abstract
Introduction Total hip arthroplasty (THA) is a commonly performed and successful orthopedic practice procedure. However, failure of arthroplasty may require revision THA and pose substantial clinical challenges for orthopedic surgeons. Therefore, this retrospective study aimed to estimate the revision rate of THA and its risk factors at a tertiary care hospital. Methods A retrospective cohort study was conducted in 2021 of patients who had undergone THA during 2016-2020 in a tertiary care hospital. All patients above 18 years old who had a THA were included in the study. The data was collected from patients' medical charts/electronic databases. Results A total of 148 THAs were included in this study. In total, 77 (52%) were females, and 71 (48%) were males. The average age of our patients was 49±17 years old, and the mean recorded BMI was 29.6. A total of 62% (n=92/148) of our participants were shown to have at least one comorbid disease, with hypertension being the most common comorbidity. Our findings show that half of the patients, 74 (50%), had a THA due to both primary and secondary osteoarthritis, 37 (25%) patients had avascular necrosis of the hip, and 25 (17%) were due to trauma. The most performed surgical approach was Kocher-Langenbeck (posterior) approach on 128 (86%), followed by the Hardinge (lateral) approach on 20 (13.51%). The most observed complication in the patients was postoperative pain in 35 (23.65%), followed by UTIs in 5 (3.38%). Of the 148 patients, nine (6.08%) had revision surgery. Regarding the revision rate, male patients were associated with a significantly higher rate of revision (P=<0.001), and older patients had a significantly increased risk of revision (P=0.026). Patients who developed complications, such as UTI, were associated with a higher revision rate (P=0.035). Also, a posterior approach (Kocher-Langenbeck) of the procedure was significantly linked to an increased risk of revision (P=0.014). Conclusion All in all, there are multiple associated factors with an increased incidence of revision THA. For example, male patients, older patients, complication development during the hospital stay, and posterior surgical approach were all associated with a significantly higher rate of revision.
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Survival and complications of total hip arthroplasty using third-generation dual-mobility cups with non-cross-linked polyethylene liners in patients younger than 55years. Orthop Traumatol Surg Res 2022; 108:103208. [PMID: 35081455 DOI: 10.1016/j.otsr.2022.103208] [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: 10/04/2020] [Revised: 07/01/2021] [Accepted: 07/21/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND In younger patients, total hip prostheses are subjected to wide motion ranges and wear-inducing forces. Dual-mobility cups (DMCs) are effective in decreasing the risk of dislocation. However, wear and osteolysis have been reported with first-generation DMCs. These complications have not been assessed in younger patients managed with third-generation DMCs associated with a lower risk of intra-prosthetic dislocation (IPD). We therefore designed a retrospective study of patients younger than 55years at THA with third-generation DMCs. Our objectives were to evaluate (1) the complication rate, and (2) the survival rate. HYPOTHESIS The rate of complications of THA with third-generation DMCs in patients younger than 55years of age is comparable to that in the general population of THA patients. MATERIAL AND METHODS This retrospective study included 79 consecutive patients (91 hips) who had total hip arthroplasty (THA) between 2007 and 2012. We included all patients younger than 55years who underwent primary THA with a third-generation DMC and a liner made of non-cross-linked polyethylene. The patients were evaluated clinically and radiologically. RESULTS Mean follow-up was 9.8years (range: 2-13years). At last follow-up, no patient had experienced prosthetic dislocation or IPD. Aseptic and septic cup loosening each occurred in 1 patient. In all, 7 (7.7%) patients required revision surgery with exchange of at least one component (cup loosening, n=2; neck fracture with a short stem fixed to the neck, n=1; peri-prosthetic femoral fracture, n=1; infection, n=1; and femoral-stem loosening, n=2). Peri-acetabular osteolysis developed in 2 (2.2%) hips. Cup survival to aseptic loosening was 98.9% (95% confidence interval, 97%-100%) and survival to revision for any reason except infection was 95.6% (95% confidence interval, 82%-100%). DISCUSSION In patients younger than 55years, third-generation DMCs were associated with absence of prosthetic dislocation, absence of IPD, and a low revision rate for cup loosening, in the medium term. These implants therefore constitute a viable treatment option in younger patients requiring THA. LEVEL OF EVIDENCE IV, retrospective study.
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Prentice HA, Chan PH, Royse KE, Hinman AD, Reddy NC, Paxton EW. Revision Risk in a Cohort of US Patients Younger Than 55 Undergoing Primary Elective Total Hip Arthroplasty. J Arthroplasty 2022; 37:303-311. [PMID: 34718107 DOI: 10.1016/j.arth.2021.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/11/2021] [Accepted: 10/21/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND As indications for elective total hip arthroplasty (THA) expand to younger patients, we sought to (1) compare revision risk following primary elective THA in patients <55 years at the time of their THA to patients aged ≥65 years and (2) identify specific risk factors for revision in patients <55 years. METHODS A Kaiser Permanente's total joint replacement registry was used to conduct a cohort study including primary elective THA patients aged ≥18 (2001-2018). In total, 11,671 patients <55 years and 53,106 patients ≥65 years were included. Multiple Cox regression was used to evaluate cause-specific revision risk, including septic revision, aseptic loosening, instability, and periprosthetic fracture. Stepwise Cox regression was used to identify patient and surgical factors associated with cause-specific revision in patients <55 years. RESULTS Patients <55 years had a higher risk of septic revision (hazard ratio [HR] = 1.30, 95% confidence interval [CI] = 1.02-1.66), aseptic loosening (HR = 2.60, 95% CI = 1.99-3.40), and instability (HR = 1.35, 95% CI = 1.09-1.68), but a lower risk of revision for periprosthetic fracture (HR = 0.36, 95% CI = 0.22-0.59) compared to patients aged ≥65 years. In the <55 age group, risk factors for septic revision included higher body mass index, drug abuse, and liver disease. Hypertension, anterior approach, and ceramic-on-ceramic were associated with aseptic loosening. White race, American Society of Anesthesiologists classification ≥3, smoker, paralysis, posterior approach, ceramic-on-ceramic, and smaller head diameter were associated with instability. CONCLUSION Identified risk factors varied depending on the cause for revision. Although septic revisions were related to patient characteristics, more modifiable factors, such as implant or surgical approach, were associated with revision due to aseptic loosening and instability. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | | | - Kathryn E Royse
- Surgical Outcomes & Analysis, Kaiser Permanente, San Diego, CA
| | - Adrian D Hinman
- Department of Orthopaedics, The Permanente Medical Group, San Leandro, CA
| | - Nithin C Reddy
- Department of Orthopaedics, Southern California Permanente Medical Group, San Diego, CA
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14
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Moran MM, Wessman P, Rolfson O, Bohl DD, Kärrholm J, Keshavarzian A, Sumner DR. The risk of revision following total hip arthroplasty in patients with inflammatory bowel disease, a registry based study. PLoS One 2021; 16:e0257310. [PMID: 34735461 PMCID: PMC8568118 DOI: 10.1371/journal.pone.0257310] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 08/30/2021] [Indexed: 11/25/2022] Open
Abstract
Inflammatory bowel disease (IBD) is characterized by chronic inflammation of the intestinal tract and is associated with decreased bone mineral density. IBD patients are at higher risk of osteopenia, osteoporosis and fracture compared to non-IBD patients. The impact of IBD on the performance of orthopedic implants has not been well studied. We hypothesized that a history of IBD at the time of primary total hip arthroplasty (THA) would increase the risk of subsequent failure as assessed by revision surgery. A retrospective implant survival analysis was completed using the Swedish Hip Arthroplasty Registry and the Sweden National Patient Register. A total of 150,073 patients undergoing THA for osteoarthritis within an 18-year period were included in the study. THA patients with (n = 2,604) and without (n = 147,469) a history of IBD at the time of THA were compared with primary revision as the main endpoint and adjusted using sex, age category and comorbidity (Elixhauser scores) as covariates. We found that patients with a history of IBD had a relatively higher risk of revision surgery for septic causes while the non-IBD patients had a relatively higher risk of revision for aseptic causes (p = 0.004). Our findings suggest there may be an association between gut health and THA performance.
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Affiliation(s)
- Meghan M. Moran
- Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL, United States of America
| | - Peter Wessman
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ola Rolfson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Daniel D. Bohl
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, United States of America
| | - Johan Kärrholm
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ali Keshavarzian
- Division of Digestive Diseases and Nutrition, Department of Internal Medicine, Rush Medical College, Chicago, IL, United States of America
| | - D. Rick Sumner
- Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL, United States of America
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, United States of America
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15
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LeBrun DG, Shen TS, Bovonratwet P, Morgenstern R, Su EP. Hip Resurfacing vs Total Hip Arthroplasty in Patients Younger than 35 Years: A Comparison of Revision Rates and Patient-Reported Outcomes. Arthroplast Today 2021; 11:229-233. [PMID: 34692960 PMCID: PMC8516816 DOI: 10.1016/j.artd.2021.09.004] [Citation(s) in RCA: 3] [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] [Received: 04/10/2021] [Revised: 08/24/2021] [Accepted: 09/07/2021] [Indexed: 11/24/2022] Open
Abstract
Background Hip resurfacing arthroplasty (HRA) and total hip arthroplasty (THA) are two treatment options for end-stage degenerative hip conditions. The objective of this single-center retrospective cohort study was to compare implant survival and patient-reported outcomes (PROs) in young patients (≤35 years) who underwent HRA or THA. Methods All patients aged 35 years or younger who underwent HRA or THA with a single high-volume arthroplasty surgeon between 2004 and 2015 were reviewed. The sample included 33 THAs (26 patients) and 76 HRAs (65 patients). Five-year implant survival and minimum 2-year PROs were compared between patient cohorts. Results Three patients in the THA group (9%) were revised within 5 years for instability (n = 1), squeaking (n = 1), or squeaking with a ceramic liner fracture (n = 1). No patients who underwent HRA were revised. The University of California, Los Angeles, activity score, modified Harris Hip score, and Hip Dysfunction and Osteoarthritis Outcome Scores for Joint Replacement increased by 74%, 64%, and 49%, respectively, among all patients. Compared to the HRA cohort, patients who underwent THA had lower preoperative and postoperative University of California, Los Angeles, activity, modified Harris Hip score, and Hip Dysfunction and Osteoarthritis Outcome Scores for Joint Replacement scores, yet there were no differences in the absolute improvements in any of the three measures between the two groups. Conclusions Excellent functional outcomes were seen in young patients undergoing either HRA or THA. Although young patients undergoing THA started at lower preoperative baseline and postoperative PROs than patients undergoing HRA, both groups improved by an equal amount after surgery, suggesting that both HRA and THA afford a similar degree of potential improvement in a young population.
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Affiliation(s)
- Drake G LeBrun
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Tony S Shen
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Patawut Bovonratwet
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Rachelle Morgenstern
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Edwin P Su
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
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16
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Sequeira SB, Labaran LA, Bell JE, Amin RM, Rao SS, Werner BC. Compensated Cirrhosis Is Associated With Increased Risk of Complications Following Total Hip Arthroplasty in a Large Medicare Database. J Arthroplasty 2021; 36:1361-1366.e1. [PMID: 33121848 DOI: 10.1016/j.arth.2020.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The aim of this study is to evaluate medical and surgical complications of liver cirrhosis patients following total hip arthroplasty (THA), with attention to different etiologies of cirrhosis and their financial burden following THA. METHODS In total, 18,321 cirrhotics and 722,757 non-cirrhotics who underwent primary elective THA between 2006 and 2013 were identified from a retrospective database review. This cohort was further subdivided into 2 major etiologies of cirrhosis (viral and alcoholic cirrhosis) and other cirrhotic etiology. Cirrhotics were compared to non-cirrhotics for hospital length of stay, 90-day mean total charges and reimbursement, hospital readmission, and major medical and arthroplasty-specific complications. RESULTS Cirrhosis was associated with increased rates of major medical complications (4.3% vs 2.4%; odds ratio [OR] 1.20, P < .001), minor medical complications, transfusion (3.4% vs 2.1%; OR 1.16, P = .001), encephalopathy, disseminated intravascular coagulation, and readmission (13.5% vs 8.6%; OR 1.18, P < .001) within 90 days. Cirrhosis was associated with increased rates of revision, periprosthetic joint infection, hardware failure, and dislocation within 1 year postoperatively (3.1% vs 1.6%; OR 1.37, P < .001). Cirrhosis independently increased hospital length of stay by 0.14 days (P < .001), and it independently increased 90-day charges and reimbursements by $13,791 (P < .001) and $1707 (P < .001), respectively. Viral and alcoholic cirrhotics had higher rates of 90-day and 1-year complications compared to controls-other causes only had higher rates of 90-day medical complications, encephalopathy, readmission, and 1-year revision, hardware failure, and dislocation compared to controls. CONCLUSION Cirrhosis, especially viral and alcoholic etiologies, is associated with higher risk of early postoperative complications and healthcare utilization following elective THA.
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Affiliation(s)
- Sean B Sequeira
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Lawal A Labaran
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Joshua E Bell
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Raj M Amin
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Sandesh S Rao
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
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Morgenstern R, Denova TA, Ren R, Su EP. A Comparative Cohort Study With a 20-Year Age Gap: Hip Resurfacing in Patients Aged ≤35 Years and Patients Aged ≥55 Years. Arthroplast Today 2020; 7:22-28. [PMID: 33521193 PMCID: PMC7818604 DOI: 10.1016/j.artd.2020.11.006] [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: 06/15/2020] [Revised: 10/14/2020] [Accepted: 11/01/2020] [Indexed: 10/28/2022] Open
Abstract
Background This single-center retrospective cohort study aimed to evaluate and compare implant survival and patient-reported outcome measures in 2 distinct age groups separated by 20 years who underwent hip resurfacing arthroplasty (HRA). Methods Between 2005 and 2014, 2042 HRAs were performed by a single-surgeon, and 75 and 377 hips from patients aged ≤35 years and ≥55 years, respectively, were included in this study. Implant survival was determined for all available hips. Clinical features and patient-reported outcome measures were collected. Results Seven hips were revised, 4 for aseptic loosening of one or both components, one for infection, one for accelerated wear and metallosis, and one for femoral neck fracture. There was no difference in all-cause 10-year revision, with 97.1% (95% confidence interval 80.9 to 99.6) and 99.6% (95% confidence interval: 97 to 99.9) survivorship in younger and older patients, respectively (P = .246). Preoperatively, younger patients were less active than older patients on the Lower Extremity Activity Scale (LEAS) or University of California, Los Angeles, activity scale, but at follow-up, younger patients outpaced older ones. Conclusion Original to our study was the isolation and comparison of 2 distinct age groups. With excellent results in disparate age groups, HRA can be applied to a broad patient demographic and is suitable for those patients who want to achieve a high activity level as defined by Lower Extremity Activity Scale or University of California, Los Angeles, scores.
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Affiliation(s)
- Rachelle Morgenstern
- Department of Orthopedic Surgery, Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery, New York, NY, USA
| | - Thomas Alastair Denova
- Department of Orthopedic Surgery, Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery, New York, NY, USA
| | - Renee Ren
- Department of Orthopedic Surgery, Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery, New York, NY, USA
| | - Edwin P Su
- Department of Orthopedic Surgery, Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery, New York, NY, USA
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18
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Buddhdev PK, Vanhegan IS, Khan T, Hashemi-Nejad A. Early to medium-term outcomes of uncemented ceramic-bearing total hip arthroplasty in teenagers for paediatric hip conditions. Bone Joint J 2020; 102-B:1491-1496. [PMID: 33135445 DOI: 10.1302/0301-620x.102b11.bjj-2020-0668.r1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Despite advances in the treatment of paediatric hip disease, adolescent and young adult patients can develop early onset end-stage osteoarthritis. The aims of this study were to address the indications and medium-term outcomes for total hip arthroplasty (THA) with ceramic bearings for teenage patients. METHODS Surgery was performed by a single surgeon working in the paediatric orthopaedic unit of a tertiary referral hospital. Databases were interrogated from 2003 to 2017 for all teenage patients undergoing THA with a minimum 2.3 year follow-up. Data capture included patient demographics, the underlying hip pathology, number of previous surgeries, and THA prostheses used. Institutional ethical approval was granted to contact patients for prospective clinical outcomes and obtain up-to-date radiographs. In total, 60 primary hips were implanted in 51 patients (35 female, 16 male) with nine bilateral cases. The mean age was 16.7 years (12 to 19) and mean follow-up was 9.3 years (2.3 to 16.8). RESULTS The most common indication for teenage hip arthroplasty was avascular necrosis secondary to slipped upper femoral epiphysis (31%; n = 16). Overall, 64% of patients (n = 33) had undergone multiple previous operations. The survival at follow-up was 97%; two patients required revision for aseptic loosening (one femoral stem, one acetabular component). Both patients had fused hips noted at the time of arthroplasty. A further two patients had radiolucent lines but were asymptomatic. At latest follow-up the mean Oxford Hip Score was 44 (31 to 48) and a Visual Analogue Scale measurement of 1.5, indicating satisfactory function. CONCLUSION Operating on this cohort can be complicated by multiple previous surgeries and distorted anatomy, which in some cases require custom-made prostheses. We have demonstrated a good outcome with low revision rate in this complex group of patients. Cite this article: Bone Joint J 2020;102-B(11):1491-1496.
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Affiliation(s)
- Pranai K Buddhdev
- Catterall Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, UK
| | - Ivor S Vanhegan
- Catterall Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, UK
| | - Tahir Khan
- Catterall Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, UK
| | - Aresh Hashemi-Nejad
- Catterall Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, UK
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19
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Jones LC, Kaste SC, Karol SE, DeFeo B, Kim HKW, Neel MD, Levin AS. Team approach: Management of osteonecrosis in children with acute lymphoblastic leukemia. Pediatr Blood Cancer 2020; 67:e28509. [PMID: 32860663 DOI: 10.1002/pbc.28509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 11/08/2022]
Abstract
With current treatments for acute lymphoblastic leukemia (ALL), the overall prognosis for survival is favorable. Increasing emphasis is placed on recognizing and managing the long-term consequences of ALL and its treatment, particularly involving osteonecrosis. Early osteonecrosis diagnosis and management may improve outcomes and is best accomplished through coordinated teams that may include hematologic oncologists, radiologists, orthopedic surgeons, physical therapists, and the patient and their family. Magnetic resonance imaging is the "gold standard" for diagnosis of early-stage and/or multifocal osteonecrosis. Treatments for osteonecrosis in ALL patients are risk stratified and may include observation, corticosteroid or chemotherapy adjustment, and pharmaceutical or surgical approaches.
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Affiliation(s)
- Lynne C Jones
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sue C Kaste
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee.,Leukemia/Lymphoma Division, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Seth E Karol
- Leukemia/Lymphoma Division, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Brian DeFeo
- Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Harry K W Kim
- Center for Excellence in Hip Disorders, Texas Scottish Rite Hospital for Children, UT Southwestern Medical Center, Dallas, Texas
| | - Michael D Neel
- Division of Orthopaedics, St. Jude Children's Research Hospital, Memphis, TN
| | - Adam S Levin
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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20
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Roškar S, Antolič V, Mavčič B. Surgeon-stratified cohort analysis of 1976 cementless Zweymüller total hip arthroplasties from a single hospital with 23,255 component years of follow-up. Arch Orthop Trauma Surg 2020; 140:1275-1283. [PMID: 32519076 DOI: 10.1007/s00402-020-03517-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The third-generation Zweymüller hip endoprosthesis has been used for decades with excellent results in arthroplasty registries, but surgeon-stratified reports on this implant are still scarce. The aim of the presented single-hospital cohort analysis of the third-generation Endoplus-Zweymüller primary total hip arthroplasty was to determine implant survival rates until the first revision/removal at 10/15/20/25 years after implantation and to find out whether implant survival depended on the operating surgeon, patient's age and gender, operated side (right/left), season of the year and the set of implanted components (SL-PLUS femur, BICON-PLUS acetabulum or both components). MATERIALS AND METHODS The retrospective observational cohort study included 1976 consecutive patients with primary BICON/SL-PLUS Zweymüller hip endoprosthesis implanted at the same operating theater block of the University Medical Centre Ljubljana, Department of Orthopaedic Surgery (Ljubljana, Slovenia) between January 1, 1993 and May 1, 2014. Survival analyses were performed with the Kaplan-Meier method and the Cox regression analysis after minimum 5 and maximum 26 years of follow-up. RESULTS At 10/15/20/25 years after implantation, the cumulative proportion of revision-free surviving Zweymüller total hip endoprostheses was 92/90/85/81% and the cumulative proportion with unremoved immobile components was 93/91/87/84%, respectively. After adjustment for age, gender and operated side, less experienced surgeons (odds ratios 2.34-5.00), season of the year at primary implantation (spring vs. winter odds ratio 1.74) and the use of BICON-PLUS acetabulum with femoral stem from another manufacturer (odds ratio 2.23) were significant risk factors of worse implant survival. CONCLUSIONS The study presents the largest published third-generation Zweymüller BICON/SL-PLUS total hip arthroplasty cohort from a single non-developmental hospital with 23,255 component years of observation. Study findings indicate the impact of environmental factors at primary implantation and variability between different surgeons on the long-term implant survival.
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Affiliation(s)
- Samo Roškar
- Faculty of Medicine, University of Ljubljana, Zaloška 9, 1000, Ljubljana, Slovenia
| | - Vane Antolič
- Faculty of Medicine, University of Ljubljana, Zaloška 9, 1000, Ljubljana, Slovenia.,Department of Orthopaedic Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Blaž Mavčič
- Faculty of Medicine, University of Ljubljana, Zaloška 9, 1000, Ljubljana, Slovenia. .,Department of Orthopaedic Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia.
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21
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Jaeger S, Uhler M, Schroeder S, Beckmann NA, Braun S. Comparison of Different Locking Mechanisms in Total Hip Arthroplasty: Relative Motion between Cup and Inlay. MATERIALS 2020; 13:ma13061392. [PMID: 32204382 PMCID: PMC7142960 DOI: 10.3390/ma13061392] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/11/2020] [Accepted: 03/16/2020] [Indexed: 01/03/2023]
Abstract
The resulting inflammatory reaction to polyethylene (PE) wear debris, which may result in osteolysis, is still considered to be a main reason for aseptic loosening. In addition to the primary wear in hip joint replacements caused by head-insert articulation, relative motions between the PE liner and the metal cup may cause additional wear. In order to limit this motion, various locking mechanisms were used. We investigated three different locking mechanisms (Aesculap, DePuy, and Zimmer Biomet) to address the resulting relative motion between the acetabular cup and PE liner and the maximum disassembly force. A standardized setting with increasing load levels was used in combination with optically based three-dimensional measurements. In addition the maximum disassembly forces were evaluated according to the ASTM F1820-13 standard. Our data showed significant differences between the groups, with a maximum relative motion at the maximum load level (3.5 kN) of 86.5 ± 32.7 µm. The maximum axial disassembly force was 473.8 ± 94.6 N. The in vitro study showed that various locking mechanisms may influence cup-inlay stability.
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Affiliation(s)
- Sebastian Jaeger
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg University, 69118 Heidelberg, Germany; (S.S.); (S.B.)
- Correspondence: (S.J.); (M.U.)
| | - Maximilian Uhler
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg University, 69118 Heidelberg, Germany; (S.S.); (S.B.)
- Correspondence: (S.J.); (M.U.)
| | - Stefan Schroeder
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg University, 69118 Heidelberg, Germany; (S.S.); (S.B.)
| | - Nicholas A. Beckmann
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg University, 69118 Heidelberg, Germany;
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland
| | - Steffen Braun
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg University, 69118 Heidelberg, Germany; (S.S.); (S.B.)
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22
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Osawa Y, Hasegawa Y, Seki T. Long-Term Outcomes of Eccentric Rotational Acetabular Osteotomy Combined With Femoral Osteotomy for Hip Dysplasia. J Arthroplasty 2020; 35:17-22. [PMID: 31500914 DOI: 10.1016/j.arth.2019.07.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/06/2019] [Accepted: 07/30/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND This study aimed at investigating the clinical outcomes of eccentric rotational acetabular osteotomy (ERAO) combined with intertrochanteric valgus osteotomy (ITVO) over a period of more than 10 years. METHODS This is a case-control study of 39 patients (40 hips) who underwent ERAO combined with ITVO for hip dysplasia (ITVO group). Patients were matched for age, sex, follow-up period, and preoperative joint stage to 78 patients (80 hips) who underwent ERAO alone (ERAO group). We compared the clinical and radiographic outcomes and the survival rates between the groups. RESULTS The Harris Hip Score at the final follow-up was significantly lower in the ITVO group than in the ERAO group. The postoperative center edge angle, acetabular head index, and minimum joint space were significantly smaller in the ITVO group than in the ERAO group. The survival rates for the conversion to total hip arthroplasty end point were not significantly different between groups. However, survival rates for the Harris Hip Score < 80 end point were significantly poorer in the ITVO group than in the ERAO group. CONCLUSION The long-term results of ERAO combined with ITVO were not satisfactory from a hip function perspective. ERAO combined with ITVO should be indicated in only young active patients with pre-osteoarthritis and initial stages of osteoarthritis.
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Affiliation(s)
- Yusuke Osawa
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yukiharu Hasegawa
- Department of Rehabilitation, Kansai University of Welfare and Sciences, Kashiwara, Osaka, Japan
| | - Taisuke Seki
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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23
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Intramedullary Nailing of a Periprosthetic Intertrochanteric Fracture in the Setting of Prior Hip Resurfacing: A New Technique for Fracture Fixation. Tech Orthop 2019. [DOI: 10.1097/bto.0000000000000418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Mahiques-Segura G, Lizaur-Utrilla A, Vizcaya-Moreno MF, Miralles-Muñoz FA, Lopez-Prats FA. A Comparison Study of the Outcomes of Ceramic-on-Ceramic Total Hip Arthroplasty in Young vs Older Patients: A Minimum 10-Year Follow-Up Prospective Matched Study. J Arthroplasty 2019; 34:1731-1735. [PMID: 31003784 DOI: 10.1016/j.arth.2019.03.049] [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: 02/08/2019] [Revised: 03/11/2019] [Accepted: 03/15/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this study is to analyze the outcome and prosthesis survival in patients aged between 20 and 40 years who received a cementless total hip arthroplasty (THA) with a minimum follow-up of 10 years compared to older patients. METHODS Prospective matched comparative study was conducted between 94 young patients with mean age of 37.2 (range 22-40) years and 90 older patients with mean age of 64.7 (range 60-70) years treated with ceramic-on-ceramic THA. Clinical outcomes were assessed by the Harris Hip Score, reduced Western Ontario and MacMaster University (WOMAC), and Short-Form-12 (SF12) questionnaires. Radiological evaluation was also performed. The primary outcome was the THA survival rate. RESULTS Mean follow-up of 13.6 (range, 10-15) years. At the final follow-up, there was no significant difference between groups in Harris Hip Score (P = .356), WOMAC-pain (P = .461), SF12-physical (P = .305), or SF12-mental (P = .511), but younger group had significantly higher WOMAC-function score (P = .013). There were 7 revisions in the younger group and 4 in the older group (P = .197). The 14-year prosthesis survival for any reason was 93.2% (95% confidence interval [CI] 86.7-99.7) in the younger group and 98.3% (95% CI 95.1-100) in the older group (P = .189). For aseptic reason, the 14-year survival was 94.7% (95% CI 88.9-100) in the younger group and 98.3% (95% CI 95.1-100) in the older group (P = .332). CONCLUSION At minimum follow-up of 10 years, THA with cementless stem and ceramic-on-ceramic bearing provides successful survival and functional outcomes in young patients between 20 and 40 years old.
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Affiliation(s)
| | - Alejandro Lizaur-Utrilla
- Department of Orthopaedic Surgery, Elda University Hospital, Elda, Alicante, Spain; Department of Traumatology and Orthopaedics, Miguel Hernandez University, San Juan de Alicante, Alicante, Spain
| | - Maria F Vizcaya-Moreno
- Department of Nursing, Clinical Research Group, Faculty of Health Sciences, University of Alicante, San Vicente del Raspeig, Alicante, Spain
| | | | - Fernando A Lopez-Prats
- Department of Traumatology and Orthopaedics, Miguel Hernandez University, San Juan de Alicante, Alicante, Spain
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25
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Halvorsen V, Fenstad AM, Engesæter LB, Nordsletten L, Overgaard S, Pedersen AB, Kärrholm J, Mohaddes M, Eskelinen A, Mäkelä KT, Röhrl SM. Outcome of 881 total hip arthroplasties in 747 patients 21 years or younger: data from the Nordic Arthroplasty Register Association (NARA) 1995-2016. Acta Orthop 2019; 90:331-337. [PMID: 31088343 PMCID: PMC6718182 DOI: 10.1080/17453674.2019.1615263] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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 - The literature is scarce on the outcome of the youngest patients with total hip arthroplasties (THAs). We analyzed register data, revision risk, and related factors in patients 21 years or younger with THAs in the Nordic Arthroplasty Register Association (NARA). Patients and methods - We included all THA patients 21 years or younger reported during 1995 through 2016 to the Danish, Finnish, Norwegian, and Swedish hip arthroplasty registers and merged these into the NARA dataset. Primary outcome was any implant revision. Results - We identified 881 THAs in 747 patients. Mean age at primary surgery was 18 years (9-21). The indications for THA were pediatric hip diseases (33%), systemic inflammatory disease (23%), osteoarthritis (4%), avascular necrosis (12%), hip fracture sequelae (7%), and other diagnoses (21%). Unadjusted 10-year survival for all THAs was 86%. Comparison between indications showed no differences in survival. Uncemented implants were used most frequently. Survival for uncemented and cemented implants was the same adjusted for sex, indication, head size, and time period for primary surgery. Aseptic loosening was the main cause of revision. Interpretation - Both cemented and uncemented fixations seem to be a viable option in this age group, but with a lower implant survival than in older patient groups.
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Affiliation(s)
- Vera Halvorsen
- Division of Orthopedic Surgery, Oslo University Hospital Ulleval, Oslo, Norway; ,Correspondence:
| | - Anne Marie Fenstad
- Norwegian Arthroplasty Registry, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway;
| | - Lars B Engesæter
- Norwegian Arthroplasty Registry, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway; ,Department of Clinical Medicine, University of Bergen, Bergen, Norway;
| | - Lars Nordsletten
- Division of Orthopedic Surgery, Oslo University Hospital Ulleval, Oslo, Norway; ,University of Oslo, Oslo, Norway;
| | - Søren Overgaard
- Department of Orthopaedic Surgery, Traumatology and Odense University Hospital, and Department of Clinical Research, University of Southern Denmark, Odense, Denmark; ,Danish Hip Arthroplasty Register, Denmark;
| | - Alma B Pedersen
- Danish Hip Arthroplasty Register, Denmark; ,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark;
| | - Johan Kärrholm
- The Swedish Hip Arthroplasty Register, Sweden; ,Department of Orthopaedics, Institute of Surgical Sciences, Sahlgrenska University Hospital, University of Gothenburg, Sweden;
| | - Maziar Mohaddes
- The Swedish Hip Arthroplasty Register, Sweden; ,Department of Orthopaedics, Institute of Surgical Sciences, Sahlgrenska University Hospital, University of Gothenburg, Sweden;
| | - Antti Eskelinen
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland; ,The Finnish Arthroplasty Register, Finland;
| | - Keijo T Mäkelä
- The Finnish Arthroplasty Register, Finland; ,Department of Orthopaedics and Traumatology, Turku University Hospital, Turku
| | - Stephan M Röhrl
- Division of Orthopedic Surgery, Oslo University Hospital Ulleval, Oslo, Norway;
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26
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Haddad FS. Are we the victims of our own success? Bone Joint J 2019; 101-B:753-754. [PMID: 31256670 DOI: 10.1302/0301-620x.101b7.bjj-2019-0628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Fares S Haddad
- The Bone & Joint Journal, Professor of Orthopaedic Surgery, University College London Hospitals, The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, UK
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27
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Sarpong NO, Grosso MJ, Lakra A, Held MB, Herndon CL, Cooper HJ. Hemiarthroplasty Conversion: A Comparison to Primary and Revision Total Hip Arthroplasty. J Arthroplasty 2019; 34:1168-1173. [PMID: 30890392 DOI: 10.1016/j.arth.2019.02.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/13/2019] [Accepted: 02/20/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Arthroplasty is the standard of care for elderly patients with displaced femoral neck fractures, with viable options including hemiarthroplasty (HA) and total hip arthroplasty (THA). With time, HA may need to be converted to THA, but it is unclear whether this is more similar to primary or revision THA. We compare complication and revision rates between these groups within 90 days and 2 years postoperatively. METHODS We retrospectively reviewed 3 cohorts of patients treated at our institution: primary, conversion, and revision THA. Outcomes studied included intraoperative data, postoperative complications, and revision rates. We analyzed the groups using both parametric (analysis of variance test) and nonparametric (chi-squared test) statistics. RESULTS Operative time between primary THA (108.0 minutes), conversion HA (147.9 minutes), and revision THA (160.1 minutes) cohorts differed significantly (P = .011). Estimated blood loss was also different between primary THA (386 mL), conversion HA (587 mL), and revision THA cohorts (529 mL) (P = .011). At 2 years, major complication rates between primary THA (6.2%), conversion HA (11.7%), and revision THA (26.7%) cohorts also differed significantly (P = .003), as was the revision rate in the primary THA (4.6%), conversion HA (10.0%), and revision THA (18.3%) cohorts (P = .043). CONCLUSION This is the first study to compare short-term and midterm complications between primary, conversion, and revision THA. We observed conversion HA had similar operative time and estimated blood loss to revision THA, which was significantly higher than primary THA. However, we found that conversion HA more closely resembled primary THA with respect to perioperative complications rates.
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Affiliation(s)
- Nana O Sarpong
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Matthew J Grosso
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Akshay Lakra
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Michael B Held
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Carl L Herndon
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - H John Cooper
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
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28
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Mohaddes M, NaucléR E, Kärrholm J, Malchau H, Odin D, Rolfson O. Implant survival and patient-reported outcome following total hip arthroplasty in patients 30 years or younger: a matched cohort study of 1,008 patients in the Swedish Hip Arthroplasty Register. Acta Orthop 2019; 90:249-252. [PMID: 30938232 PMCID: PMC6534239 DOI: 10.1080/17453674.2019.1599776] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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 - The outcome of total hip arthroplasty (THA) in younger patients is suggested to be inferior compared with the general THA population. There is a lack of studies with long-term follow up for very young patients. We report on implant survival and patient-reported outcome in patients aged 30 years or younger. Patients and methods - Data on THAs performed in Sweden between the years 2000 and 2016 were included. There were 504 patients 30 years or younger with complete demographic and surgical data (study group). A matched comparison group older than 30 years was identified. Implant survival was analyzed using the Kaplan-Meier method. Patient-reported outcome was analyzed in a subgroup of patients. Results - The 10-year and 15-year implant survivorship for the study group was 90% and 78%, respectively. The corresponding figures for the patients older than 30 years were 94% and 89%. The median preoperative EQ-5D index was lower in the study group; the improvement in EQ-5D index was similar between the study and the comparison groups. The preoperative EQ-VAS was lower and the improvement in EQ-VAS at 1 year was larger in the study group. Interpretation - The promising 10-year implant survival and 1-year improvement in patient-reported outcome suggests that THA is a feasible option in the patients 30 years or younger.
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Affiliation(s)
- Maziar Mohaddes
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden;; ,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Correspondence:
| | - Emma NaucléR
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden;;
| | - Johan Kärrholm
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden;; ,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Malchau
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden;; ,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Daniel Odin
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden;;
| | - Ola Rolfson
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden;; ,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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29
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Callaghan JJ, Haddad FS. International Hip Society: a new partnership: proceedings of the International Hip Society. Bone Joint J 2018; 100-B:829-830. [PMID: 29954206 DOI: 10.1302/0301-620x.100b7.bjj-2018-0550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- J J Callaghan
- University of Iowa, Iowa City, Iowa, USA and Immediate Past President, International Hip Society
| | - F S Haddad
- University College London Hospitals, The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH London, UK
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