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Tjønneland A, Nielsen PT, Jakobsen T. Biomechanics of a collum-fixated short stem in total hip arthroplasty. J Orthop 2024; 52:61-66. [PMID: 38435312 PMCID: PMC10901692 DOI: 10.1016/j.jor.2024.02.027] [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: 11/02/2023] [Accepted: 02/19/2024] [Indexed: 03/05/2024] Open
Abstract
Background Biomechanical reconstruction of the hip significantly impacts the clinical outcome and implant survival. Our knowledge is limited of the ability of neck-stabilised prostheses to restore hip biomechanics. We hypothesised that hip biomechanics, specifically leg length and global offset (GO), may be restored to an acceptable range using the Primoris™ stem. Methods and material In this retrospective study, we analysed 152 patients who underwent total hip replacement (THA) using the short collum-fixated stem Primoris™.The primary outcomes were hip parameters measured by x-ray following THA using the Primoris™ stem. After surgery, the biomechanical parameters used were measured at the arthroplasty and the native contralateral side of the same x-ray. The X-rays were taken one year after the patient's surgery.1. GO.2. Leg length discrepancy (LLD).3. Neck shaft angle (NSA). Results We recorded an average GO of -3.4 mm (standard deviation (SD) 7.2) and an average LLD of +3.8 mm (SD 6.4). Furthermore, we registered an average 14-degree NSA increase (SD 7.4). Conclusion The Primoris™ neck-stabilised stem enabled hip anatomy restoration to a favourable range with respect to GO and LLD as the average difference fell within ±5 mm. However, the stem tended to be implanted in valgus.
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Affiliation(s)
- Anders Tjønneland
- Interdisciplinary Orthopaedics, Department of Orthopaedic Surgery, Aalborg University Hospital, Hobrovej 18-22, 9100, Aalborg, Denmark
| | - Poul Torben Nielsen
- Interdisciplinary Orthopaedics, Department of Orthopaedic Surgery, Aalborg University Hospital, Hobrovej 18-22, 9100, Aalborg, Denmark
| | - Thomas Jakobsen
- Interdisciplinary Orthopaedics, Department of Orthopaedic Surgery, Aalborg University Hospital, Hobrovej 18-22, 9100, Aalborg, Denmark
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Stisen MB, Mechlenburg I, Bearne LM, Godfrey E, Pedersen AB, Sørensen D. Exploring needs, barriers to, and facilitators of rehabilitation exercise following revision hip replacement - A grounded theory study. Disabil Rehabil 2023:1-9. [PMID: 38117004 DOI: 10.1080/09638288.2023.2295008] [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: 04/23/2023] [Accepted: 12/09/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE Evidence on rehabilitation after revision total hip replacement (THR) is inadequate and development of rehabilitation interventions is warranted. Even so, little is known about patients' experiences with revision THR rehabilitation. This study aimed to explore patients' rehabilitation exercise experiences after revision THR. MATERIALS AND METHODS Using constructivist grounded theory, we conducted semi-structured qualitative interviews with twelve patients with completed or almost completed rehabilitation exercise after revision THR. Data collection and analysis were a constant comparative process conducted in three phases; initial, focused, and theoretical. FINDINGS From the data, we generated a substantial theory of the participant's circumstances and ability to integrate rehabilitation exercise into their everyday life after revision THR. Four categories were constructed based on patients' experiences in different contexts: hesitance, fear avoidance, self-commitment, and fidelity. CONCLUSIONS This study highlighted that patients' expectations, past experiences, attitudes, trusts, and circumstances interact to influence engagement and adherence to rehabilitation exercise and described four categories relating to the integration of revision THR rehabilitation exercise into their everyday life. Clinicians should be aware of and account for these categories during rehabilitation exercise. Tailored individual rehabilitation exercise interventions and clinician approaches to optimize engagement and adherence are needed among patients with revision THR.
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Affiliation(s)
- Martin B Stisen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus,Denmark
| | - Inger Mechlenburg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus,Denmark
| | - Lindsay M Bearne
- Population Health Research Institute, St George's University of London, London, UK
- Department of Population Health Sciences, School of Life Course & Population Sciences, King's College London, London, UK
| | - Emma Godfrey
- Department of Population Health Sciences, School of Life Course & Population Sciences, King's College London, London, UK
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alma B Pedersen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Dorthe Sørensen
- Research Centre for Health and Welfare Technology, Programme for Rehabilitation, VIA University College, Aarhus, Denmark
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Nugen F, Vera Garcia DV, Sohn S, Mickley JP, Wyles CC, Erickson BJ, Taunton MJ. Application of Natural Language Processing in Total Joint Arthroplasty: Opportunities and Challenges. J Arthroplasty 2023; 38:1948-1953. [PMID: 37619802 DOI: 10.1016/j.arth.2023.08.047] [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: 12/14/2022] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023] Open
Abstract
Total joint arthroplasty is becoming one of the most common surgeries within the United States, creating an abundance of analyzable data to improve patient experience and outcomes. Unfortunately, a large majority of this data is concealed in electronic health records only accessible by manual extraction, which takes extensive time and resources. Natural language processing (NLP), a field within artificial intelligence, may offer a viable alternative to manual extraction. Using NLP, a researcher can analyze written and spoken data and extract data in an organized manner suitable for future research and clinical use. This article will first discuss common subtasks involved in an NLP pipeline, including data preparation, modeling, analysis, and external validation, followed by examples of NLP projects. Challenges and limitations of NLP will be discussed, closing with future directions of NLP projects, including large language models.
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Affiliation(s)
- Fred Nugen
- Orthopedic Surgery Artificial Intelligence Laboratory (OSAIL), Mayo Clinic, Rochester, Minnesota; Radiology Informatics Lab (RIL), Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Diana V Vera Garcia
- Orthopedic Surgery Artificial Intelligence Laboratory (OSAIL), Mayo Clinic, Rochester, Minnesota; Radiology Informatics Lab (RIL), Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Sunghwan Sohn
- Orthopedic Surgery Artificial Intelligence Laboratory (OSAIL), Mayo Clinic, Rochester, Minnesota; Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - John P Mickley
- Orthopedic Surgery Artificial Intelligence Laboratory (OSAIL), Mayo Clinic, Rochester, Minnesota; Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Cody C Wyles
- Orthopedic Surgery Artificial Intelligence Laboratory (OSAIL), Mayo Clinic, Rochester, Minnesota; Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Bradley J Erickson
- Radiology Informatics Lab (RIL), Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Michael J Taunton
- Orthopedic Surgery Artificial Intelligence Laboratory (OSAIL), Mayo Clinic, Rochester, Minnesota; Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Intravenous diclofenac and orphenadrine for the treatment of postoperative pain after remifentanil-based anesthesia : A double-blinded, randomized, placebo-controlled study. Wien Klin Wochenschr 2023; 135:67-74. [PMID: 36576555 PMCID: PMC9938044 DOI: 10.1007/s00508-022-02131-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 11/14/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Postoperative intravenous diclofenac reduces patient opioid demand and is commonly used in surgical units. Orphenadrine is mainly used in combination with diclofenac for musculoskeletal injuries and postoperative pain control. The objective of this study was to compare the analgesic efficacy of diclofenac-orphenadrine, diclofenac alone and saline. METHODS We performed a double-blind, randomized, placebo-controlled, parallel-group, single-center clinical study investigating the opioid-sparing effect of a combination of diclofenac and orphenadrine versus diclofenac alone versus isotonic saline solution. Initially 72 patients were included and received total intravenous anesthesia during cruciate ligament surgery. All patients were postoperatively treated with a patient-controlled analgesia (PCA) device containing hydromorphone. Pharmacological safety was assessed by laboratory parameters, vital signs, and delirium detection scores. RESULTS There was no significant difference between the groups in cumulative dose of PCA analgesics required after 24 h postsurgery, with 5.90 mg (SD ± 2.90 mg) in the placebo group, 5.73 mg (SD ± 4.75 mg) in the diclofenac group, and 4.13 mg (SD ± 2.57 mg) in the diclofenac-orphenadrine group. Furthermore, there was no significant difference between the groups in cumulative dose of PCA analgesics required 2 h postsurgery (n = 65). Mean dose of hydromorphone required after 2 h was 1.54 mg (SD ± 0.57 mg) in the placebo group, 1.56 mg (SD ± 1.19 mg) in the diclofenac-only group, and 1.37 mg (SD ± 0.78 mg) in the diclofenac-orphenadrine group. However, when comparing the diclofenac-orphenadrine group and the diclofenac group combined to placebo there was a significant reduction in PCA usage in the first 24 h postsurgery. In total, there were 25 adverse events reported, none of which were rated as severe. CONCLUSION Orphenadrine-diclofenac failed to significantly reduce postoperative opioid requirements. However, in an exploratory post hoc analysis the diclofenac-orphenadrine and the diclofenac group combined versus placebo showed a tendency to reduce opioid demand in postoperative pain control. Further research is required to determine the value of orphenadrine as an adjuvant in a multimodal approach for postoperative pain management.
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van Schie P, Hasan S, van Bodegom-Vos L, Schoones JW, Nelissen RGHH, Marang-van de Mheen PJ. International comparison of variation in performance between hospitals for THA and TKA: Is it even possible? A systematic review including 33 studies and 8 arthroplasty register reports. EFORT Open Rev 2022; 7:247-263. [PMID: 35446260 PMCID: PMC9069858 DOI: 10.1530/eor-21-0084] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
In order to improve care for total hip and knee arthroplasties (THA/TKA), hospitals may want to compare their performance with hospitals in other countries. Pooling data across countries also enable early detection of infrequently occurring safety issues. We therefore aimed to assess the between-hospital variation and definitions used for revision, readmission, and complications across countries. PubMed, Embase, Web of Science, Cochrane library, Emcare, and Academic Search Premier were searched from January 2009 to August 2020 for studies reporting on: (i) primary THA/TKA; (ii) revision, readmission, or complications; and (iii) between-hospital variation. Most recent registry reports of Network of Orthopedic Registries of Europe members were also reviewed. Two reviewers independently screened records, extracted data, and assessed the risk of bias using the Integrated quality Criteria for the Review Of Multiple Study designs tool for studies and relevant domains for registries. We assessed agreement for the following domains: (i) outcome definition; (ii) follow-up and starting point; (iii) case-mix adjustment; and (iv) type of patients and hospitals included. Between-hospital variation was reported in 33 (1 high-quality, 13 moderate-quality, and 19 low-quality) studies and 8 registry reports. The range of variation for revision was 0–33% for THA and 0–27% for TKA varying between assessment within hospital admission until 10 years of follow-up; for readmission, 0–40% and 0–32% for THA and TKA, respectively; and for complications, 0–75% and 0–50% for THA and TKA, respectively. Indicator definitions and methodological variables varied considerably across domains. The large heterogeneity in definitions and methods used likely explains the considerable variation in between-hospital variation reported for revision, readmission, and complications , making it impossible to benchmark hospitals across countries or pool data for earlier detection of safety issues. It is necessary to collaborate internationally and strive for more uniformity in indicator definitions and methods in order to achieve reliable international benchmarking in the future.
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Affiliation(s)
- Peter van Schie
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands.,Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| | - Shaho Hasan
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jan W Schoones
- Walaeus Library, Leiden University Medical Centre, Leiden, The Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Perla J Marang-van de Mheen
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
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Taylor-Williams O, Inderjeeth CA, Almutairi KB, Keen H, Preen DB, Nossent JC. Total Hip Replacement in Patients with Rheumatoid Arthritis: Trends in Incidence and Complication Rates Over 35 Years. Rheumatol Ther 2022; 9:565-580. [PMID: 34997912 PMCID: PMC8964887 DOI: 10.1007/s40744-021-00414-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 12/09/2021] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Advances in rheumatoid arthritis (RA) management have made disease remission achievable. We evaluated trends in total hip replacement (THR) and postoperative outcomes in patients with RA in Western Australia (WA) over more than three decades. METHODS This was a retrospective analysis of routinely collected prospective data from a state-wide registry containing longitudinally linked administrative health data based on International Classification of Diseases (ICD) diagnostic and procedural codes. We included patients with two or more diagnostic codes for RA (between 1980 and 2015) and studied THR incidence rates (THR IR) and complication rates (revision, peri-prosthetic fracture, infection, venous thrombosis, and mechanical loosening). Survival rates were estimated by Kaplan-Meier method and predictors analyzed by Cox regression. RESULTS We followed 9201 RA patients over 111,625 person-years, during which 1560 patients (16.9%) underwent THR. From 1985 to 2015, THR IR (per 1000 RA patient-years) decreased from 20.8 (95% CI 20.1-21.5) to 7.3 (95% CI 7.2-7.5), and 5-year THR-free survival increased from 84.3 to 95.3% (1980-2015). Ten-year prosthetic survival was 91.2%. Complication rates in the first 5 years post-THR decreased significantly from 13.1 to 3.7% (p < 0.001). Mechanical complications such as loosening and periprosthetic fracture rates decreased significantly (> 35%, P < 0.05), while infection and revision did not change over the observation period (p > 0.05). CONCLUSIONS Over the last 30 years in RA patients, THR IR and mechanical complication rates decreased significantly, but the medical complication of infection has not changed significantly.
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Affiliation(s)
- Owen Taylor-Williams
- Rheumatology Group, Medical School, University of Western Australia, 35 Stirling Highway (M503), Perth, WA, Australia
| | - Charles A Inderjeeth
- Rheumatology Group, Medical School, University of Western Australia, 35 Stirling Highway (M503), Perth, WA, Australia
- Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Khalid B Almutairi
- Rheumatology Group, Medical School, University of Western Australia, 35 Stirling Highway (M503), Perth, WA, Australia
| | - Helen Keen
- Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, WA, Australia
- Department of Rheumatology, Fiona Stanley Hospital, Perth, WA, Australia
| | - David B Preen
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Johannes C Nossent
- Rheumatology Group, Medical School, University of Western Australia, 35 Stirling Highway (M503), Perth, WA, Australia.
- Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, WA, Australia.
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Mäkelä K, Hailer NP. Editorial: Different, yet strong together: the Nordic Arthroplasty Register Association (NARA). Acta Orthop 2021; 92:635-637. [PMID: 34231441 PMCID: PMC8648399 DOI: 10.1080/17453674.2021.1947006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Keijo Mäkelä
- Past NARA Chairman, Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Nils P. Hailer
- Co-Editor/NARA Chairman, Department of Surgical Sciences—Orthopaedics, Uppsala University, Uppsala, Sweden,Correspondence: Nils P. Hailer, Department of Surgical Sciences—Orthopaedics, Uppsala University, Uppsala, Sweden,
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Yeroushalmi D, Singh V, Maher N, Gabor JA, Zuckerman JD, Schwarzkopf R. Excellent mid-term outcomes with a hemispheric titanium porous-coated acetabular component for total hip arthroplasty: 7-10 year follow-up. Hip Int 2021; 33:404-410. [PMID: 34412531 DOI: 10.1177/11207000211040181] [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] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Third-generation hemispheric, titanium porous-coated (HTPC) acetabular cups have been shown to achieve good biologic fixation through enhanced porous ingrowth surfaces. They also allow for a wide range of bearing options, including polyethylene, dual-mobility, and ceramic liners. The purpose of the study is to review the mid-term clinical outcomes an HTPC acetabular cup with a minimum of 7-year follow-up. METHODS A retrospective, observational study was conducted on all consecutive patients who underwent total hip arthroplasty (THA) with an HTCP acetabular cup at an urban, tertiary referral centre. Descriptive statistics were used describe baseline patient characteristics. Outcomes collected included postoperative complications, survival free of reoperations, and presence of osteolysis at latest imaging follow-up. Implant survival was analysed using the Kaplan-Meier method. RESULTS 118 cases (114 primary, 4 revision) underwent THA with the HTCP acetabular cup at an average follow-up of 8.16 ± 0.85 years (range 7.02-10.28 years). Mean patient age at the time of surgery was 61.29 ± 12.04 years. All cases utilised a high-molecular-weight polyethylene (HMWPE) liner. None of the acetabular cups showed loosening or migration at the latest follow-up. There were 2 revisions in our study, 1 for abductor mechanism disruption and 1 due to surgical site infection where the acetabular cup was revised. Kaplan-Meier survivorship analysis for all-cause revision at 7 and 10-year follow-up showed a survival rate of 99.1% (95% confidence interval, 94.1-99.9%). Survivorship analysis for aseptic acetabular revision at 10-year follow-up showed a survival rate of 100%. CONCLUSIONS At long-term follow-up, no radiologic and minimal clinical complications were identified in this series. The HTPC acetabular cup system, used in conjunction with a HMWPE liner, demonstrates excellent outcomes and survivorship when compared to earlier mid-term studies published in the literature.
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Affiliation(s)
| | - Vivek Singh
- NYU Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Nolan Maher
- NYU Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | | | | | - Ran Schwarzkopf
- NYU Orthopedic Hospital, NYU Langone Health, New York, NY, USA
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Ødegaard KS, Ouyang L, Ma Q, Buene G, Wan D, Elverum CW, Torgersen J, Standal T, Westhrin M. Revealing the influence of electron beam melted Ti-6Al-4V scaffolds on osteogenesis of human bone marrow-derived mesenchymal stromal cells. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2021; 32:97. [PMID: 34406475 PMCID: PMC8373740 DOI: 10.1007/s10856-021-06572-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/23/2021] [Indexed: 06/13/2023]
Abstract
Porous Titanium-6Aluminum-4Vanadium scaffolds made by electron beam-based additive manufacturing (AM) have emerged as state-of-the-art implant devices. However, there is still limited knowledge on how they influence the osteogenic differentiation of bone marrow-derived mesenchymal stromal cells (BMSCs). In this study, BMSCs are cultured on such porous scaffolds to determine how the scaffolds influence the osteogenic differentiation of the cells. The scaffolds are biocompatible, as revealed by the increasing cell viability. Cells are evenly distributed on the scaffolds after 3 days of culturing followed by an increase in bone matrix development after 21 days of culturing. qPCR analysis provides insight into the cells' osteogenic differentiation, where RUNX2 expression indicate the onset of differentiation towards osteoblasts. The COL1A1 expression suggests that the differentiated osteoblasts can produce the osteoid. Alkaline phosphatase staining indicates an onset of mineralization at day 7 in OM. The even deposits of calcium at day 21 further supports a successful bone mineralization. This work shines light on the interplay between AM Ti64 scaffolds and bone growth, which may ultimately lead to a new way of creating long lasting bone implants with fast recovery times.
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Affiliation(s)
- Kristin S Ødegaard
- Department of Mechanical and Industrial Engineering, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lingzi Ouyang
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Qianli Ma
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Glenn Buene
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Di Wan
- Department of Mechanical and Industrial Engineering, Norwegian University of Science and Technology, Trondheim, Norway
| | - Christer W Elverum
- Department of Mechanical and Industrial Engineering, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jan Torgersen
- Department of Mechanical and Industrial Engineering, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Therese Standal
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marita Westhrin
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Kholinne E, Arya A, Jeon IH. Complications of modern design total elbow replacement. J Clin Orthop Trauma 2021; 19:42-49. [PMID: 34141570 PMCID: PMC8176365 DOI: 10.1016/j.jcot.2021.05.008] [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: 05/09/2021] [Accepted: 05/12/2021] [Indexed: 11/25/2022] Open
Abstract
Total elbow arthroplasty is an important surgical option for advanced arthritis of the elbow. Semi-constrained linked prosthesis is still a popular choice, however, complications and revisions after TER remain high. Aseptic loosening and infection are two most common mode of failure. Periprosthetic fracture, implant failure, and triceps insufficiency have also been reported. Revision arthroplasty needs careful preoperative planning to tackle deficiency in soft tissue and osseous structure. Impaction, strut allograft or allograft prosthesis composite graft should be considered for failed TER.
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Affiliation(s)
- Erica Kholinne
- Faculty of Medicine, Universitas Trisakti, Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta, Indonesia
| | - Anand Arya
- Department of Trauma & Orthopaedic Surgery, King's College Hospital, London, United Kingdom
| | - In-Ho Jeon
- Department of Orthopaedic Surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, South Korea,Corresponding author. Department of Orthopaedic Surgery, Asan Medical Center, School of Medicine, University of Ulsan, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, South Korea.
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Comparison of different fixation techniques for periprosthetic fractures: a biomechanical study of a new implant. INTERNATIONAL ORTHOPAEDICS 2021; 45:1817-1826. [PMID: 33866388 DOI: 10.1007/s00264-021-05028-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/29/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The ideal treatment method for periprosthetic fractures is controversial due to the risks of current methods. Single-cortex screw fixation in prosthesis may lead to implant failure. Therefore, we aimed to develop an implant that lowers the risk for complications. For this study, we designed and tested two new implant models. The first model was a plate with a combination of U nails and cerclage holes. The second model was a U nail plate with a screw, which combines a plate screw with U nail (staples). Our study aimed to compare the stability of two newly designed implants with classical treatment modalities. We used 27 (in 3 groups) artificial bone models and 9 different test models. METHODS The ISO 7206-4:2010 (E) standards were used for 27 bones in nine groups tested under laboratory conditions. In our study, we examined nine different groups. In group 1, hip the prosthesis was extracted, and a revision femoral stem was embedded. In group 2, periprosthetic fractures were repaired with a plate and cable. In group 3, periprosthetic fractures were repaired with a plate and stapler. In group 4, periprosthetic fractures were repaired with a plate and stapler cable. In group 5, periprosthetic fractures were repaired with a plate stapler and screw. Groups 6 and 7 were the control groups. Group 6 was the only artificial bone group, and group 7 was the prosthesis embedded bone group. Group 8 was periprosthetic fractures treated with unicortical screw fixation with cerclage, and group 9 was periprosthetic fractures treated with unicortical screw fixation. Axial loading was applied to the bones. The yield strength of the system was determined by loading the synthetic bone models with a constant compression speed of 5 mm/min through the centre of motion using the Geratech SH 2000 testing system. During the tests, load and displacement values were recorded, and the stiffness of the models was calculated based on those values. RESULTS According to our results, the greatest durability was found in the revision hip prosthesis group (1511 N), and the weakest performance was found in the plate with the stapler implant group (163N). When comparing the data of groups according to compression, significant differences were found in group 2 with groups 1, 4, 5, and 7; group 3 with group 1; group 8 with groups 1 and 5; and group 9 with 1, 5, 7, and according to breakage, significant differences were found in group2 with groups 1, 3, 5, and 7; group 3 with group 1; group 8 with groups 1 and 5; and group 9 with groups 1, 5, and 7 (p<0.001). DISCUSSION The revision hip prosthesis treatment for periprosthetic fractures showed the best performance, followed by the plate with stapler screw. In older patients, U nail-augmented implants may be a good alternative for periprosthetic fractures. Unicortical screw and cerclage wire combination fixation results were unsatisfactory results in this study. CONCLUSION This is an experimental study, so further studies, especially patient-specific studies, should be made to expand the findings of this study.
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Jämsä P, Reito A, Oksala N, Eskelinen A, Jämsen E. Does chronic kidney disease affect implant survival after primary hip and knee arthroplasty? Bone Joint J 2021; 103-B:689-695. [PMID: 33789475 DOI: 10.1302/0301-620x.103b4.bjj-2020-0715.r2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To investigate whether chronic kidney disease (CKD) is associated with the risk of all-cause revision or revision due to a periprosthetic joint infection (PJI) after primary hip or knee arthroplasty. METHODS This retrospective cohort study comprised 18,979 consecutive hip and knee arthroplasties from a single high-volume academic hospital. At a median of 5.6 years (interquartile range (IQR) 3.5 to 8.1), all deaths and revisions were counted. To overcome the competing risk of death, competing risk analysis using the cumulative incidence function (CIF) was applied to analyze the association between different stages of CKD and revisions. Confounding factors such as diabetes and BMI were considered using either a stratified CIF or the Fine and Gray model. RESULTS There were 2,111 deaths (11.1%) and 677 revisions (3.6%) during the follow-up period. PJI was the reason for revision in 162 cases (0.9%). For hip arthroplasty, 3.5% of patients with CKD stage 1 (i.e. normal kidney function, NKF), 3.8% with CKD stage 2, 4.2% with CKD stage 3, and 0% with CKD stage 4 to 5 had undergone revision within eight years. For knee arthroplasty, 4.7% with NKF, 2.7% with CKD stage 2, 2.4% with CKD stage 3, and 7% of CKD stage 4 to 5 had had undergone revision. With the exception of knee arthroplasty patients in whom normal kidney function was associated with a greater probability of all-cause revision, there were no major differences in the rates of all-cause revisions or revisions due to PJIs between different CKD stages. The results remained unchanged when diabetes and BMI were considered. CONCLUSION We found no strong evidence that CKD was associated with an increased risk of all-cause or PJI-related revision. Selection bias probably explains the increased amount of all-cause revision operations in knee arthroplasty patients with normal kidney function. The effect of stage 4 to 5 CKD was difficult to evaluate because of the small number of patients. Cite this article: Bone Joint J 2021;103-B(4):689-695.
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Affiliation(s)
- Pyry Jämsä
- Coxa Hospital for Joint Replacement, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Aleksi Reito
- Coxa Hospital for Joint Replacement, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Niku Oksala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland.,Cardiovascular Research Center, Tampere, Finland
| | | | - Esa Jämsen
- Coxa Hospital for Joint Replacement, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Carlsson IK, Ekstrand E, Åström M, Stihl K, Arner M. Construct validity, floor and ceiling effects, data completeness and magnitude of change for the eight-item HAKIR questionnaire: a patient-reported outcome in the Swedish National Healthcare Quality Registry for hand surgery. HAND THERAPY 2021; 26:3-16. [PMID: 37905195 PMCID: PMC10584055 DOI: 10.1177/1758998320966018] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 09/22/2020] [Indexed: 11/02/2023]
Abstract
Introduction The aim of this study was to evaluate the construct validity, floor and ceiling effects, data completeness and magnitude of change over time for the eight-item patient questionnaire (HQ-8) in the Swedish Healthcare Quality Registry for hand surgery (HAKIR). Methods Construct validity was investigated through predefined hypotheses and correlation statistics between the single items in HQ-8 (pain on load, pain on motion without load, pain at rest, stiffness, weakness, numbness, cold sensitivity and ability to perform daily activities) and QuickDASH. Floor and ceiling effects and data completeness were analysed at preoperative (n = 13,197), three months (n =10,702) and one year (n = 9,986) responses from hand surgery patients. Effect sizes were calculated for pre- and postoperative change scores in elective conditions and postoperative scores for acute conditions. Results Correlation coefficients at pre, 3 and 12 months ranged from 0.44 to 0.79 in the total group. No ceiling effect occurred, but a floor effect for the total group was noted for all items at all follow-ups. Missing responses were < 2.6% except for cold sensitivity. The effect sizes varied from small to large for individual items in elective diagnoses. For acute injuries, small effect sizes were found. Discussion This study provides evidence of construct validity of HQ-8, lack of ceiling effect, expected floor effect, good data completeness and an ability to detect changes over time. The results indicate that HQ-8 measures unique aspects of disability. The HQ-8 could complement the Quick-DASH in describing patient-reported outcomes after hand surgery.
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Affiliation(s)
- Ingela K Carlsson
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Translational Medicine – Hand Surgery, Lund University, Malmö, Sweden
| | - Elisabeth Ekstrand
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Mikael Åström
- Data Analytics and Register Centrum, Region Skåne, Sweden
| | - Kerstin Stihl
- Department of Hand Surgery, Södersjukhuset, Stockholm, Sweden
| | - Marianne Arner
- Department of Hand Surgery, Södersjukhuset, Stockholm, Sweden
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
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Hermansen LL, Viberg B, Hansen L, Overgaard S. "True" Cumulative Incidence of and Risk Factors for Hip Dislocation within 2 Years After Primary Total Hip Arthroplasty Due to Osteoarthritis: A Nationwide Population-Based Study from the Danish Hip Arthroplasty Register. J Bone Joint Surg Am 2021; 103:295-302. [PMID: 33347013 DOI: 10.2106/jbjs.19.01352] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hip dislocation is one of the leading indications for revision of total hip arthroplasty (THA) implants, and the extent of this complication is often measured by the number of revisions. The exact incidence of dislocation can be difficult to establish as closed reductions may not be captured in available registers. The purpose of this study was to identify the "true" cumulative incidence of hip dislocation (revisions and closed reductions) after primary THA, and the secondary aim was to identify risk factors for dislocation. METHODS From the Danish Hip Arthroplasty Register, we identified 31,105 primary THAs indicated by primary osteoarthritis that had been performed from 2010 to 2014 and had 2 years of follow-up. Dislocations were identified through extraction from the Danish National Patient Register. Matching diagnosis and procedure codes were deemed correct while non-matching codes were reviewed through a comprehensive, nationwide review of patient files. Risk factors were analyzed with multiple logistic regression analysis and presented as odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS Our review of patient files identified 1,861 dislocations in 1,079 THAs, which corresponds to a 2-year cumulative incidence of 3.5% (CI = 3.3% to 3.7%). This was a 50% increase compared with the correctly coded dislocations captured by administrative register data only. Patients who were <65 years of age had a lower dislocation risk (OR = 0.70; CI = 0.59 to 0.83) and those who were >75 years of age had a higher risk (OR = 1.32; CI = 1.14 to 1.52) compared with those who were 65 to 75. Male sex (OR = 0.86; CI = 0.75 to 0.98), cemented fixation (OR = 0.71; CI = 0.58 to 0.87), and lateral approach (OR = 0.28; CI = 0.16 to 0.49) were all associated with a lower risk. A head size of 32 mm was associated with a higher risk of dislocation (OR = 1.27; CI = 1.10 to 1.46) than 36-mm heads, whereas dual-mobility cups had a reduced risk (OR = 0.13; CI = 0.05 to 0.36). CONCLUSIONS We found the "true" cumulative incidence of dislocations within 2 years after primary THAs performed between 2010 and 2014 in Denmark to be 3.5%. Age, sex, American Society of Anesthesiologists (ASA) score, head size and type, fixation method, and surgical approach were independent significant factors for dislocation. Comprehensive search algorithms are needed in order to identify all dislocations so that this complication can be accurately reported in national registers.
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Affiliation(s)
- Lars L Hermansen
- Department of Orthopaedics, Hospital of South West Jutland, Esbjerg, Denmark.,Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.,Departments of Clinical Research (L.L.H. and S.O.) and Regional Health Research (B.V.), University of Southern Denmark, Odense, Denmark.,Odense Patient Data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Bjarke Viberg
- Departments of Clinical Research (L.L.H. and S.O.) and Regional Health Research (B.V.), University of Southern Denmark, Odense, Denmark.,Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | - Lars Hansen
- Department of Orthopaedics, Hospital of South West Jutland, Esbjerg, Denmark
| | - Soeren Overgaard
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.,Departments of Clinical Research (L.L.H. and S.O.) and Regional Health Research (B.V.), University of Southern Denmark, Odense, Denmark
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15
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Pedersen AB, Mailhac A, Garland A, Overgaard S, Furnes O, Lie SA, Fenstad AM, Rogmark C, Kärrholm J, Rolfson O, Haapakoski J, Eskelinen A, Mäkelä KT, Hailer NP. Similar early mortality risk after cemented compared with cementless total hip arthroplasty for primary osteoarthritis: data from 188,606 surgeries in the Nordic Arthroplasty Register Association database. Acta Orthop 2021; 92:47-53. [PMID: 33143515 PMCID: PMC7919915 DOI: 10.1080/17453674.2020.1842003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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 - Current literature indicates no difference in 90-day mortality after cemented compared with cementless total hip arthroplasty (THA). However, previous studies are hampered by potential selection bias and suboptimal adjustment for comorbidity confounding. Therefore, we examined the comorbidity-adjusted mortality up to 90 days after cemented compared with cementless THA performed due to osteoarthritis.Patients and methods - Using the Nordic Arthroplasty Register Association database, 2005-2013, we included 108,572 cemented and 80,034 cementless THA due to osteoarthritis. We calculated the Charlson comorbidity index of each patient based on data from national patient registers. The Kaplan-Meier method was used to estimate unadjusted all-cause mortality. Cox regression was used to estimate hazard ratios (HR) with 95% confidence intervals (CI) for 14, 30-, and 90-day mortality comparing cemented with cementless THA, adjusting for age, sex, comorbidity, nation, and year of surgery.Results - Cumulative all-cause mortality within 90 days was 0.41% (CI 0.37-0.46) after cemented and 0.26% (CI 0.22-0.30) after cementless THA. The adjusted HR for cemented vs. cementless fixation was 0.97 (CI 0.79-1.2), and similar risk estimates were obtained for mortality within 14 (adjusted HR 0.91 [CI 0.64-1.3]) and 30 days (adjusted HR 0.94 [CI 0.71-1.3]). We found no clinically relevant differences in mortality between cemented and cementless THA in analyses stratified by age, sex, Charlson comorbidity index, or year of surgery.Interpretation - After adjustment for comorbidity as an important confounder, we observed similar early mortality between the 2 fixation techniques.
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Affiliation(s)
- Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; ,Correspondence:
| | - Aurélie Mailhac
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark;
| | - Anne Garland
- Department of Surgical Sciences/Orthopedics, Uppsala University, Uppsala, Sweden; ,The Swedish Hip Arthroplasty Registry, Registercentrum Västra Götaland, Gothenburg, Sweden;
| | - Søren Overgaard
- Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Odense, Denmark, and the Danish Hip Arthroplasty Register;
| | - Ove Furnes
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway; ,Department of Clinical Medicine, University of Bergen, Norway;
| | - Stein Atle Lie
- Department of Clinical Medicine, University of Bergen, Norway; ,Department of Clinical Dentistry, University of Bergen, Bergen, Norway;
| | - Anne Marie Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway;
| | - Cecilia Rogmark
- Department of Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden; ,The Swedish Hip Arthroplasty Registry, Registercentrum Västra Götaland, Gothenburg, Sweden;
| | - Johan Kärrholm
- The Swedish Hip Arthroplasty Registry, Registercentrum Västra Götaland, Gothenburg, Sweden; ,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden;
| | - Ola Rolfson
- The Swedish Hip Arthroplasty Registry, Registercentrum Västra Götaland, Gothenburg, Sweden; ,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden;
| | - Jaason Haapakoski
- Finnish Arthroplasty Register, National Institute for Health and Welfare, Helsinki, Finland;
| | - Antti Eskelinen
- Finnish Arthroplasty Register, National Institute for Health and Welfare, Helsinki, Finland; ,Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, University of Tampere, Tampere, Finland;
| | - Keijo T Mäkelä
- Finnish Arthroplasty Register, National Institute for Health and Welfare, Helsinki, Finland; ,Department of Orthopedics and Traumatology, Turku University Hospital, Turku, Finland
| | - Nils P Hailer
- Department of Surgical Sciences/Orthopedics, Uppsala University, Uppsala, Sweden; ,The Swedish Hip Arthroplasty Registry, Registercentrum Västra Götaland, Gothenburg, Sweden;
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Van Steenbergen LN, Mäkelä KT, Kärrholm J, Rolfson O, Overgaard S, Furnes O, Pedersen AB, Eskelinen A, Hallan G, Schreurs BW, Nelissen RGHH. Total hip arthroplasties in the Dutch Arthroplasty Register (LROI) and the Nordic Arthroplasty Register Association (NARA): comparison of patient and procedure characteristics in 475,685 cases. Acta Orthop 2021; 92:15-22. [PMID: 33167753 PMCID: PMC7919880 DOI: 10.1080/17453674.2020.1843875] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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 - Collaborations between arthroplasty registries are important in order to create the possibility of detecting inferior implants early and improve our understanding of differences between nations in terms of indications and outcomes. In this registry study we compared patient and procedure characteristics, and revision rates in the Nordic Arthroplasty Register Association (NARA) database and the Dutch Arthroplasty Register (LROI).Patients and methods - All total hip arthroplasties (THAs) performed in 2010-2016 were included from the LROI (n = 184,862) and the NARA database (n = 290,823), which contains data from Denmark, Norway, Sweden, and Finland. Descriptive statistics and Kaplan-Meier survival analyses based on all reasons for revision and stratified by fixation were performed and compared between countries.Results - In the Netherlands, the proportion of patients aged < 55 years (9%) and male patients (34%) was lower than in Nordic countries (< 55 years 11-13%; males 35-43%); the proportion of osteoarthritis (OA) (87%) was higher compared with Sweden (81%), Norway (77%), and Denmark (81%) but comparable to Finland (86%). Uncemented fixation was used in 62% of patients in the Netherlands, in 70% of patients in Denmark and Finland, and in 28% and 19% in Norway and Sweden, respectively. The 5-year revision rate for THAs for OA was lower in Sweden (2.3%, 95% CI 2.1-2.5) than in the Netherlands (3.0%, CI 2.9-3.1), Norway (3.8%, CI 3.6-4.0), Denmark (4.6%, CI 4.4-4.8), and Finland (4.4%, CI 4.3-4.5). Revision rates in Denmark, Norway, and Finland were higher for all fixation groups.Interpretation - Patient and THA procedure characteristics as well as revision rates evinced some differences between the Netherlands and the Nordic countries. The Netherlands compared best with Denmark in terms of patient and procedure characteristics, but resembled Sweden more in terms of short-term revision risk. Combining data from registries like LROI and the NARA collaboration is feasible and might possibly enable tracking of potential outlier implants.
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Affiliation(s)
- Liza N Van Steenbergen
- Dutch Arthroplasty Register (LROI), ‘s- Hertogenbosch, the Netherlands; ,Correspondence:
| | - Keijo T Mäkelä
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland; ,The Finnish Arthroplasty Register, Helsinki, Finland;
| | - Johan Kärrholm
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden; ,Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; ,The Swedish Hip Arthroplasty Register, Gothenburg, Sweden;
| | - Ola Rolfson
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden; ,Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; ,The Swedish Hip Arthroplasty Register, Gothenburg, Sweden;
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark; ,Department of Clinical Research, University of Southern Denmark, Odense, Denmark; ,The Danish Hip Arthroplasty Register, Aarhus, Denmark;
| | - Ove Furnes
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway; ,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway;
| | - Alma B Pedersen
- The Danish Hip Arthroplasty Register, Aarhus, Denmark; ,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark;
| | - Antti Eskelinen
- The Finnish Arthroplasty Register, Helsinki, Finland; ,Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, University of Tampere, Tampere, Finland;
| | - Geir Hallan
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway; ,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark;
| | - Berend W Schreurs
- Dutch Arthroplasty Register (LROI), ‘s- Hertogenbosch, the Netherlands; ,Department of Orthopaedics, Radboudumc, Nijmegen, the Netherlands;
| | - Rob G H H Nelissen
- Dutch Arthroplasty Register (LROI), ‘s- Hertogenbosch, the Netherlands; ,Department of Orthopaedics, Leiden University Medical Centre, Leiden, the Netherlands
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17
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Structural and Biomedical Properties of Common Additively Manufactured Biomaterials: A Concise Review. METALS 2020. [DOI: 10.3390/met10121677] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Biomaterials are in high demand due to the increasing geriatric population and a high prevalence of cardiovascular and orthopedic disorders. The combination of additive manufacturing (AM) and biomaterials is promising, especially towards patient-specific applications. With AM, unique and complex structures can be manufactured. Furthermore, the direct link to computer-aided design and digital scans allows for a direct replicable product. However, the appropriate selection of biomaterials and corresponding AM methods can be challenging but is a key factor for success. This article provides a concise material selection guide for the AM biomedical field. After providing a general description of biomaterial classes—biotolerant, bioinert, bioactive, and biodegradable—we give an overview of common ceramic, polymeric, and metallic biomaterials that can be produced by AM and review their biomedical and mechanical properties. As the field of load-bearing metallic implants experiences rapid growth, we dedicate a large portion of this review to this field and portray interesting future research directions. This article provides a general overview of the field, but it also provides possibilities for deepening the knowledge in specific aspects as it comprises comprehensive tables including materials, applications, AM techniques, and references.
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Yu W, Han X, Chen W, Mao S, Zhao M, Zhang X, Han G, Ye J, Chen M, Zhuang J. Conversion from a failed proximal femoral nail anti-rotation to a cemented or uncemented total hip arthroplasty device: a retrospective review of 198 hips with previous intertrochanteric femur fractures. BMC Musculoskelet Disord 2020; 21:791. [PMID: 33256693 PMCID: PMC7702693 DOI: 10.1186/s12891-020-03806-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 11/19/2020] [Indexed: 11/12/2022] Open
Abstract
Background At present, it is unclear which device (uncemented or cemented total hip arthroplasty [UTA or CTA, respectively]) is more suitable for the conversion of a failed proximal femoral nail anti-rotation (PFNA). The aim of this review was to assess the outcomes of failed PFNAs converted to a UTA or CTA device in elderly individuals with intertrochanteric femoral fractures (IFFs). Methods Two hundred fifty-eight elderly individuals (258 hips) with IFFs who underwent a conversion to a UTA or CTA device following failed PFNAs during 2007–2017 were retrospectively identified from the China Southern Medical Centre (CSMC) database. The primary endpoint was the Harris Hip Score (HHS); secondary endpoint was the key orthopaedic complication rate. Results The median follow-up was 65 months (60–69 months). Significant distinctions were observed (87.26 ± 16.62 for UTA vs. 89.32 ± 16.08 for CTA, p = 0.021; 86.61 ± 12.24 for symptomatic UTA vs. 88.68 ± 13.30 for symptomatic CTA, p = 0.026). A significant difference in the overall key orthopaedic complication rate was detected (40.8% [40/98] vs. 19.0% [19/100], p = 0.001). Apparent distinctions were detected in terms of the rate of revision, loosening, and periprosthetic fracture (11.2% for UTA vs 3.0% for CTA, p = 0.025; 13.2% for UTA vs 5.0% for CTA, p = 0.043; 10.2% for UTA vs 3.0% for CTA, p = 0.041, respectively). Conclusion For elderly individuals with IFFs who suffered a failed PFNA, CTA devices may have a noteworthy advantage in regard to the revision rate and the rate of key orthopaedic complications compared with UTA devices, and CTA revision should be performed as soon as possible, regardless of whether these individuals have symptoms.
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Affiliation(s)
- Weiguang Yu
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Xiulan Han
- Department of Rehabilitation, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Wenli Chen
- Department of Neurosurgery, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Shuai Mao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Mingdong Zhao
- Department of Orthopaedics, Jinshan Hospital, Fudan University, Longhang Road No. 1508, Jinshan District, Shanghai, 201508, China
| | - Xinchao Zhang
- Department of Orthopaedics, Jinshan Hospital, Fudan University, Longhang Road No. 1508, Jinshan District, Shanghai, 201508, China.
| | - Guowei Han
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Junxing Ye
- Department of Orthopaedics, The Affiliated Hospital of Jiangnan University, No. 1000, Hefeng Road, Wuxi, 214000, Jiangsu, China.
| | - Meiji Chen
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China.
| | - Jintao Zhuang
- Department of Urology, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China.
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Jolbäck P, Nauclér E, Bülow E, Lindahl H, Mohaddes. A small number of surgeons outside the control-limit: an observational study based on 9,482 cases and 208 surgeons performing primary total hip arthroplasties in western Sweden. Acta Orthop 2020; 91:581-586. [PMID: 32507069 PMCID: PMC8025681 DOI: 10.1080/17453674.2020.1772584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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 - Feedback programs relating to surgeon levels have been introduced in some orthopedic quality registers around the globe. The aim of an established surgeon feedback program is to help surgeons understand their practice and enable an analysis of their own results. There is no surgeon feedback program in Sweden in the orthopedic quality registers and there is a fear that a feedback system might pinpoint surgeons as poor performers, partly due to patient case mix. As a step prior to the introduction of a future possible feedback program in Sweden, we assessed the variation in the occurrence of adverse events (AE) within 90 days and reoperations within 2 years between surgeons in western Sweden and explored the number of surgeons outside the control-limit following primary total hip arthroplasties (THAs).Patients and methods - Patient data, surgical data, and information on the surgeons, relating to surgeries performed in 2011-2016, were retrieved from 9 publicly funded hospitals in western Sweden. Data from medical hospital records, the Swedish Hip Arthroplasty Register (SHAR) and a regional patient register located in western Sweden were linked to a database. Funnel plots with control-limits based on upper 95% and 99.8% confidence intervals (CI) were used to illustrate the variation between surgeons in terms of the outcome and to explore the number of surgeons outside the control-limit. Both observed and standardized proportions are explored. The definition of surgeons outside the control-limit in the study is a surgeon above the upper 95% CI.Results - The study comprised 9,482 primary THAs due to osteoarthritis performed by 208 surgeons, where 91% of the included primary THAs were performed by orthopedic specialists and 9% by trainees. The mean overall annual volume for all surgeons was 27. The observed overall mean rate for AEs within 90 days for all surgeons was 6.2% (5.8-6.7) and for reoperations within 2 years 1.8% (1.7-2.2). The proportion of surgeons outside the 95% CI was low for both AEs (0-5%) and reoperations within 2 years (0-1%) in 2011-2016. The corresponding numbers were even lower for AEs (0-3%) but similar for reoperations (0-1%) after standardization for differences in case mix. In a sub-analysis when the number of surgeries performed was restricted to more than 10 primary THAs annually to being evaluated, almost half or more of all the surgeons were excluded from the annual analysis. The result of this restriction was that all surgeons outside the control-limit disappeared after standardization for both AEs and reoperations for all the years investigated. Considering the complete period of 6 years, less than 1% (1 high-volume surgeon for AEs and 2 high-volume surgeons for reoperations) after risk adjustments were outside the 95% CI, and no surgeons were outside the 99.8% CI.Interpretation - In a Swedish setting, the variation in surgeon performance, as measured by AEs within 90 days and reoperations within 2 years following primary THA, was small and 3% or less of the surgeons were outside the 95% CI for the investigated years after adjustments for case mix. The risk for an individual surgeon to be regarded as having poor performance when creating surgeon-specific feedback in the SHAR is very low when volume and patient risk factors are considered.
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Affiliation(s)
- Per Jolbäck
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg; ,Department of Orthopaedics, Skaraborg Hospital, Lidköping; ,Swedish Hip Arthroplasty Register, Gothenburg; ,Research and Development Centre, Skaraborg Hospital, Skövde, Sweden,Correspondence:
| | | | - Erik Bülow
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg; ,Swedish Hip Arthroplasty Register, Gothenburg;
| | - Hans Lindahl
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg; ,Department of Orthopaedics, Skaraborg Hospital, Lidköping;
| | | | - Mohaddes
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg; ,Swedish Hip Arthroplasty Register, Gothenburg;
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Mallmin H, Nyström A, Hailer NP. Reply to Denosumab in Prevention of Implant Migration. J Bone Miner Res 2020; 35:1826-1827. [PMID: 32761916 DOI: 10.1002/jbmr.4109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/01/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Hans Mallmin
- Department of Surgical Sciences, Section of Orthopaedics, Uppsala Universitet, Uppsala, Sweden
| | - Andreas Nyström
- Department of Surgical Sciences, Section of Orthopaedics, Uppsala Universitet, Uppsala, Sweden
| | - Nils P Hailer
- Department of Surgical Sciences, Section of Orthopaedics, Uppsala Universitet, Uppsala, Sweden
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21
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Boeckstyns MEH. Commentary on: Arpe total joint arthroplasty for trapeziometacarpal osteoarthritis: 80 thumbs in 63 patients with a minimum of 10 years follow-up. J Hand Surg Eur Vol 2020; 45:470-471. [PMID: 32407195 DOI: 10.1177/1753193420913460] [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: 02/03/2023]
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22
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Palija S, Bijeljac S, Manojlovic S, Jovicic Z, Jovanovic M, Cvijic P, Dragicevic-Cvjetkovic D. Effectiveness of different doses and routes of administration of tranexamic acid for total hip replacement. INTERNATIONAL ORTHOPAEDICS 2020; 45:865-870. [PMID: 32377783 DOI: 10.1007/s00264-020-04585-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/27/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE The aim of the study is to show the therapeutic efficacy, safety, and cost-benefit of using tranexamic acid (TXA), as well as the superiority of the route of administration and amount of dose in primary cementless total hip replacement (THR). METHODS In this prospective, randomized, double-blind study, we divided 200 patients into five groups of 40 patients each. The placebo group did not receive TXA. Three groups received 2 g TXA each (intravenous, topical, and combined intravenous + topical), while the fifth, combined + group, received 4 g TXA. Total blood loss was calculated, number of transfusions and thromboembolic vascular incidents were monitored, and a cost-benefit analysis of the use of TXA was performed. RESULTS Regardless of the route of administration, TXA statistically significantly reduced total blood loss (p = 0.000) and the need for transfusion (p = 0.000) compared with placebo. Total blood loss and the need for allogenic blood transfusion were statistically significantly reduced in the combined + group compared with placebo, and also compared with all other groups. Post-operative thromboembolic vascular incidents were not reported. The cost-benefit of using TXA in THR is associated with reduction of transfusion costs. CONCLUSIONS None of the TXA administration routes are superior to others, but multiple doses could statistically significantly reduce blood loss and transfusion requirements, which should be the subject of future researches.
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Affiliation(s)
- Stanislav Palija
- Orthopedic Department, Institute for Physical Medicine and Rehabilitation "Dr Miroslav Zotovic", Slatinska 11, 78000, Banja Luka, Bosnia and Herzegovina.
| | - Sinisa Bijeljac
- Orthopedic Department, Institute for Physical Medicine and Rehabilitation "Dr Miroslav Zotovic", Slatinska 11, 78000, Banja Luka, Bosnia and Herzegovina
| | - Slavko Manojlovic
- Medical Faculty, Department of Surgery, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Zeljko Jovicic
- Orthopedic Department, Institute for Physical Medicine and Rehabilitation "Dr Miroslav Zotovic", Slatinska 11, 78000, Banja Luka, Bosnia and Herzegovina
| | - Milan Jovanovic
- Orthopedic Department, Institute for Physical Medicine and Rehabilitation "Dr Miroslav Zotovic", Slatinska 11, 78000, Banja Luka, Bosnia and Herzegovina
| | - Petar Cvijic
- Orthopedic Department, Institute for Physical Medicine and Rehabilitation "Dr Miroslav Zotovic", Slatinska 11, 78000, Banja Luka, Bosnia and Herzegovina
| | - Dragana Dragicevic-Cvjetkovic
- Orthopedic Department, Institute for Physical Medicine and Rehabilitation "Dr Miroslav Zotovic", Slatinska 11, 78000, Banja Luka, Bosnia and Herzegovina
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23
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Fu X, Wang W, Li X, Gao Y, Li H, Shen Y. The effect of trace elements on BMP-2, BMP-7 and STRO-1 + cells in hip replacement. Saudi J Biol Sci 2020; 27:1352-1362. [PMID: 32346345 PMCID: PMC7182999 DOI: 10.1016/j.sjbs.2020.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/28/2020] [Accepted: 03/08/2020] [Indexed: 11/16/2022] Open
Abstract
To explore the correlation between the trace elements in the proximal femur and BMP-2, BMP-7 and STRO-1+ cells in hip replacement, and analyze the therapeutic effect of prosthesis loosening in clinic. Fifty-one patients undergone the first hip replacement in xxx hospital from August 2016 to August 2019 were selected as the study subjects, including 26 females and 25 males, aged 52-89 years. The bone marrow mesenchymal stem cells (BMSCs) were cultured in vitro for flow cytometry, and the string-1+ in BMSCs was detected and analyzed. After that, the expression of bone morphogenetic protein 2 (BMP-2) and bone morphogenetic protein 7 (BMP-7) in the cells were detected by enzyme-linked immunosorbent assay, the content of trace elements in the supernatant was detected by radioimmunoassay, and the collected data were analyzed statistically. In the analysis of the content of trace elements, it was found that the correlation between trace elements was dependent on the separation area, and all trace elements had no correlation with BMP2. Ca2+, Mg2+ were correlated with the level of BMP7 and Ca2+, VD3 was correlated with the percentage of STOR-1+ cells. Further analysis showed that the correlation between trace elements was dependent on bone mineral density (BMD) area, and there was a positive correlation between vitamin D3 (VD3), parathyroid hormone (PTH), zinc, and BMD in zone 7. To sum up, it is found that trace elements may be related to prosthesis loosening, which provides experimental basis for the treatment of prosthesis loosening later.
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Affiliation(s)
- Xiaodong Fu
- Department of Orthopedics, School of Medicine, South Campus, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Weili Wang
- Department of Orthopedics, School of Medicine, South Campus, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Xiaomiao Li
- Department of Orthopedics, School of Medicine, South Campus, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yingjian Gao
- Department of Orthopedics, School of Medicine, South Campus, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Hao Li
- Department of Orthopedics, School of Medicine, South Campus, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yi Shen
- Department of Orthopedics, School of Medicine, South Campus, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
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Undén A, Jehpsson L, Kamrad I, Carlsson Å, Henricson A, Karlsson MK, Rosengren BE. Better implant survival with modern ankle prosthetic designs: 1,226 total ankle prostheses followed for up to 20 years in the Swedish Ankle Registry. Acta Orthop 2020; 91:191-196. [PMID: 31928101 PMCID: PMC7144194 DOI: 10.1080/17453674.2019.1709312] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [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 - We have previously reported on the prosthetic survival of total ankle replacements (TAR) in Sweden performed between 1993 and 2010. Few other reports have been published on 5- and 10-year survival rates. Furthermore, there is a lack of long-term outcome data on modern prosthetic designs. Therefore, we compared early and current prosthetic designs after a mean 7-year follow-up.Patients and methods - On December 31, 2016, 1,230 primary TARs had been reported to the Swedish Ankle Registry. We analyzed prosthetic survival, using exchange or permanent extraction of components as endpoint for 1,226 protheses with mean follow-up of 7 years (0-24). Differences between current (Hintegra, Mobility, CCI, Rebalance, and TM Ankle) and early prosthetic designs (STAR, BP, and AES) were examined by log rank test.Results - 267/1,226 prostheses (22%) had been revised by December 31, 2016. We found an overall prosthetic survival rate at 5 years of 0.85 (95% CI 0.83-0.87), at 10 years 0.74 (CI 0.70-0.77), at 15 years 0.63 (CI 0.58-0.67), and at 20 years 0.58 (CI 0.52-0.65). For early prosthetic designs the 5- and 10-year survival rates were 0.81 (CI 0.78-0.84) and 0.69 (CI 0.64-0.73) respectively, while the corresponding rates for current designs were 0.88 (CI 0.85-0.91) and 0.84 (CI 0.79-0.88). Current prosthetic designs had better survival (log rank test p < 0.001).Interpretation - Our results point to a positive time trend of prosthetic survival in Sweden; use of current prosthetic designs was associated with better prosthetic survival. Improved designs and instrumentation, more experienced surgeons, and improved patient selection may all have contributed to the better outcome.
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Affiliation(s)
- Alexandra Undén
- Department of Radiology, Skåne University Hospital, Malmö; ,Department of Clinical Sciences Malmo (IKVM), Lund University; ,Correspondence:
| | - Lars Jehpsson
- Department of Clinical Sciences Malmo (IKVM), Lund University; ,Department of Orthopedics, Skåne University Hospital, Malmö;
| | - Ilka Kamrad
- Department of Clinical Sciences Malmo (IKVM), Lund University; ,Department of Orthopedics, Skåne University Hospital, Malmö;
| | - Åke Carlsson
- Department of Clinical Sciences Malmo (IKVM), Lund University; ,Department of Orthopedics, Skåne University Hospital, Malmö;
| | - Anders Henricson
- Department of Orthopedics, Falu Central Hospital and Center of Clinical Research Dalarna, Falun, Sweden
| | - Magnus K Karlsson
- Department of Clinical Sciences Malmo (IKVM), Lund University; ,Department of Orthopedics, Skåne University Hospital, Malmö;
| | - Björn E Rosengren
- Department of Clinical Sciences Malmo (IKVM), Lund University; ,Department of Orthopedics, Skåne University Hospital, Malmö;
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25
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Morosato F, Traina F, Cristofolini L. Effect of different motor tasks on hip cup primary stability and on the strains in the periacetabular bone: An in vitro study. Clin Biomech (Bristol, Avon) 2019; 70:137-145. [PMID: 31491739 DOI: 10.1016/j.clinbiomech.2019.08.005] [Citation(s) in RCA: 4] [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: 08/03/2019] [Accepted: 08/11/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Excessive prosthesis/bone motions and the bone strains around the acetabulum may prevent osteointegration and lead to cup loosening. These two factors depend on post-operative joint loading. We investigated how Walking (which is often simulated) and Standing-Up from seated (possibly more critical) influence the cup primary stability and periacetabular strains. METHODS Twelve composite hemipelvises were used in two test campaigns. Simplified loading conditions were adopted to simulate Walking and Standing-Up. For each motor task, a single-direction force was applied in load packages of increasing amplitude. Stable and unstable uncemented cups were implanted. Digital image correlation was used to measure implant/bone motions (three-dimensional translations and rotations, both permanent and inducible), and the strain distribution around the acetabulum. FINDINGS When stable implants were tested, higher permanent cranial translations were found during Walking (however the resultant migrations were comparable with Standing-Up); higher rotations were found for Standing-Up. When unstable implants were tested, motions were 1-2 order of magnitude higher. Strains increased significantly from stable to unstable implants. The peak strains were in the superior aspect of the acetabulum during Walking and in the superior-posterior aspect of the acetabulum and at the bottom of the posterior column during Standing-Up. INTERPRETATION Different cup migration trends were caused by simulated Walking and Standing-Up, both similar to those observed clinically. The cup mobilization pattern depended on the different simulated motor tasks. Pre-clinical testing of new uncemented cups could include simulation of both motor tasks. Our study could also translate to indication of what tasks should be avoided.
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Affiliation(s)
- Federico Morosato
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Francesco Traina
- Second Clinic of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Luca Cristofolini
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum - Università di Bologna, Bologna, Italy.
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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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27
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Homco J, Rodriguez K, Bardach DR, Hahn EA, Morton S, Anderson D, Kendrick D, Scholle SH. Variation and Change Over Time in PROMIS-29 Survey Results Among Primary Care Patients With Type 2 Diabetes. J Patient Cent Res Rev 2019; 6:135-147. [PMID: 31414025 DOI: 10.17294/2330-0698.1694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose We sought to describe results of patient-reported outcome measures implemented among primary care patients with diabetes and explore factors associated with changes in scores over time. Methods Two organizations serving diverse patient populations collected the PROMIS-29 survey at baseline and 3-month follow-up for patients with type 2 diabetes. Bayesian regression analysis was used to examine the relationship between patient characteristics and changes in PROMIS-29 scores. Exploratory analyses assessed relationships between goal-setting and changes in scores. Results The study population reported substantially more problems with physical functioning (mean: 42.5 at Site 1 and 38.9 at Site 2) and pain interference (mean: 58.0 at Site 1 and 61.1 at Site 2) compared to the general population (mean: 50; standard deviation: 10). At least 33% of patients had a clinically meaningful change (ie, at least half the standard deviation, or 5 points) in each PROMIS domain. For pain interference, 55% had no change, 22% improved by 5 or more points, and 23% worsened by 5 or more points. Bayesian regression analyses suggest that chronic conditions, insurance status, and Hispanic ethnicity are likely associated with decreased functioning over time. Exploratory analyses found that setting a mental health goal did not appear to be associated with improvement for anxiety or depression. Conclusions Use of patient-reported outcome measures in routine clinical care identified areas of functional limitations among people with diabetes. However, changes in participants' PROMIS-29 scores over time were minimal. Research is needed to understand patterns of change in global and domain-specific functioning, particularly among racial/ethnic minorities.
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Affiliation(s)
- Juell Homco
- University of Oklahoma-University of Tulsa School of Community Medicine, Tulsa, OK
| | - Kristin Rodriguez
- University of Oklahoma-University of Tulsa School of Community Medicine, Tulsa, OK
| | | | - Elizabeth A Hahn
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Suzanne Morton
- National Committee for Quality Assurance, Washington, DC
| | | | - David Kendrick
- University of Oklahoma-University of Tulsa School of Community Medicine, Tulsa, OK
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28
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Perioperative complications and causes of 30- and 90-day readmission after direct anterior approach primary total hip arthroplasty. J Orthop 2019; 17:69-72. [PMID: 31879477 DOI: 10.1016/j.jor.2019.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 08/09/2019] [Indexed: 01/03/2023] Open
Abstract
We aimed to report causes of readmission 30 and 90 days following a total hip arthroplasty (THA) using the direct anterior approach (DAA). METHODS Three hundred and two patients (335 hips) underwent a DAA-THA for primary osteoarthritis. RESULTS The main reasons for 30 and 90-day readmission were wound related problems, dislocation (rate: 0.9%) and deep infection. The readmission rates at 30 and 90 days were 1.8% and 2.7%, respectively. Age over 60 years and morbidly obese patients were at risk for complications. CONCLUSION The DAA-THA was associated with low readmission rates. Obesity should be adressed preoperatively.
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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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30
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Bartz-Johannessen C, Furnes O, Fenstad AM, Lie SA, Pedersen AB, Overgaard S, Kärrholm J, Malchau H, Mäkelä K, Eskelinen A, Wilkinson JM. Homogeneity in prediction of survival probabilities for subcategories of hipprosthesis data: the Nordic Arthroplasty Register Association, 2000-2013. Clin Epidemiol 2019; 11:519-524. [PMID: 31402836 PMCID: PMC6637139 DOI: 10.2147/clep.s199227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 04/08/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction: The four countries in the Nordic Arthroplasty Register Association (NARA) share geographic proximity, culture, and ethnicity. Pooling data from different sources in order to obtain higher precision and accuracy of survival-probability estimates is appealing. Nevertheless, survival probabilities of hip replacements vary between the countries. As such, risk prediction for individual patients within countries may be problematic if data are merged. In this study, our primary question was to address when data merging for estimating prosthesis survival in subcategories of patients is advantageous for survival prediction of individual patients, and at what sample sizes this may be advised. Methods: Patients undergoing total hip replacements for osteoarthritis between January 1, 2000 and December 31, 2013 in the four Nordic countries were studied. A total of 184,507 patients were stratified into 360 patient subcategories based on country, age-group, sex, fixation, head size, and articulation. For each patient category, we determined the sample size needed from a single country to obtain a more accurate and precise estimate of prosthesis-survival probability at 5 and 10 years compared to an estimate using data from all countries. The comparison was done using mean-square error. Results: We found large variations in the sample size needed, ranging from 40 to 2,060 hips, before an estimate from a single Nordic country was more accurate and precise than estimates based on the NARA data. Conclusion: Using pooled survival-probability estimates for individual risk prediction may be imprecise if there is heterogeneity in the pooled data sources. By applying mean-square error, we demonstrate that for small sample sizes, applying the larger NARA database may provide a more accurate and precise estimate; however, this effect is not consistent and varies with the characteristics of the subcategory.
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Affiliation(s)
| | - Ove Furnes
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Anne Marie Fenstad
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Stein Atle Lie
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Alma Becic Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Overgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Orthopaedic Surgery and Traumatology Odense University Hospital and Institute of Clinical Research, University of Southern Denmark, Odense Denmark
| | - Johan Kärrholm
- Swedish Hip Arthroplasty Register, Department of Orthopaedics, Institute of Surgical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Henrik Malchau
- Swedish Hip Arthroplasty Register, Department of Orthopaedics, Institute of Surgical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden.,Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, USA.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Keijo Mäkelä
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland.,Finnish Arthroplasty Register, Finnish Institute of Health, Helsinki, Finland
| | - Antti Eskelinen
- Finnish Arthroplasty Register, Finnish Institute of Health, Helsinki, Finland.,Department of Orthopaedics Surgery, Coxa Hospital for Joint Replacement, Tampere, Finland
| | - Jeremy M Wilkinson
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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Mäkelä KT, Furnes O, Hallan G, Fenstad AM, Rolfson O, Kärrholm J, Rogmark C, Pedersen AB, Robertsson O, W-Dahl A, Eskelinen A, Schrøder HM, Äärimaa V, Rasmussen JV, Salomonsson B, Hole R, Overgaard S. The benefits of collaboration: the Nordic Arthroplasty Register Association. EFORT Open Rev 2019; 4:391-400. [PMID: 31312523 PMCID: PMC6598612 DOI: 10.1302/2058-5241.4.180058] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The Nordic Arthroplasty Register Association (NARA) was established in 2007 by arthroplasty register representatives from Sweden, Norway and Denmark with the overall aim to improve the quality of research and thereby enhance the possibility for quality improvement with arthroplasty surgery. Finland joined the NARA collaboration in 2010. NARA minimal hip, knee and shoulder datasets were created with variables that all countries can deliver. They are dynamic datasets, currently with 25 variables for hip arthroplasty, 20 for knee arthroplasty and 20 for shoulder arthroplasty. NARA has published statistical guidelines for the analysis of arthroplasty register data. The association is continuously working on the improvement of statistical methods and the application of new ones. There are 31 published peer-reviewed papers based on the NARA databases and 20 ongoing projects in different phases. Several NARA publications have significantly affected clinical practice. For example, metal-on-metal total hip arthroplasty and resurfacing arthroplasty have been abandoned due to increased revision risk based on i.a. NARA reports. Further, the use of uncemented total hip arthroplasty in elderly patients has decreased significantly, especially in Finland, based on the NARA data. The NARA collaboration has been successful because the countries were able to agree on a common dataset and variable definitions. The collaboration was also successful because the group was able to initiate a number of research projects and provide answers to clinically relevant questions. A number of specific goals, set up in 2007, have been achieved and new one has emerged in the process.
Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180058
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Affiliation(s)
- Keijo T Mäkelä
- Turku University Hospital and University of Turku, Finland, and the Finnish Arthroplasty Register
| | - Ove Furnes
- Haukeland University Hospital, Bergen, Norway, and the Norwegian Arthroplasty Register
| | - Geir Hallan
- Haukeland University Hospital, Bergen, Norway, and the Norwegian Arthroplasty Register
| | - Anne Marie Fenstad
- Haukeland University Hospital, Bergen, Norway, and the Norwegian Arthroplasty Register
| | - Ola Rolfson
- Sahlgrenska University Hospital and University of Gothenburg, Sweden, and the Swedish Hip Arthroplasty Register
| | - Johan Kärrholm
- Sahlgrenska University Hospital and University of Gothenburg, Sweden, and the Swedish Hip Arthroplasty Register
| | - Cecilia Rogmark
- Department of Orthopedics, Skåne University Hospital, Department of Clinical Sciences Malmö, Lund University, and the Swedish Hip Arthroplasty Register, Sweden
| | - Alma Becic Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark, and the Danish Hip Arthroplasty Register
| | - Otto Robertsson
- The Swedish Knee Arthroplasty Register, Department of Orthopedics, Skåne University Hospital, and Department of Clinical Sciences, Orthopedics, Lund University, Sweden
| | - Annette W-Dahl
- The Swedish Knee Arthroplasty Register, Department of Orthopedics, Skåne University Hospital, and Department of Clinical Sciences, Orthopedics, Lund University, Sweden
| | - Antti Eskelinen
- Coxa Hospital for Joint Replacement, Tampere, Finland, and the Finnish Arthroplasty Register
| | - Henrik M Schrøder
- Department of Orthopaedic Surgery, Naestved Hospital, Denmark, and the Danish Knee Arthroplasty Register
| | - Ville Äärimaa
- Turku University Hospital and University of Turku, Finland, and the Finnish Arthroplasty Register
| | - Jeppe V Rasmussen
- Department of Orthopaedic Surgery, Herlev Hospital, University of Copenhagen, Denmark, and the Danish Shoulder Arthroplasty Register
| | - Björn Salomonsson
- Department of Orthopedics, Karolinska Institutet, Danderyds Sjukhus AB, Sweden, and the Swedish Shoulder Arthroplasty Register
| | - Randi Hole
- Haukeland University Hospital, Bergen, Norway, and the Norwegian Arthroplasty Register
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, and the Danish Hip Arthroplasty Register
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Are Hooded, Crosslinked Polyethylene Liners Associated with a Reduced Risk of Revision After THA? Clin Orthop Relat Res 2019; 477:1315-1321. [PMID: 31136427 PMCID: PMC6554106 DOI: 10.1097/corr.0000000000000710] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hooded acetabular liners and head sizes ≥ 32 mm have both shown to have a beneficial effect on the revision rate for dislocation in THA. Experience with noncrosslinked polyethylene (nonXLPE) raised concerns regarding the risk of impingement damage, loosening, and osteolysis with hooded liners; however, the evidence for this in crosslinked polyethylene (XLPE) is inconclusive. The interaction between different femoral head sizes and hooded liners is not well understood, and it is unclear whether hooded XLPE liners have a beneficial effect on overall long-term survivorship. QUESTIONS/PURPOSES We analyzed a large national joint registry to ask: (1) Is the use of hooded XLPE liners associated with a reduced revision rate for dislocation compared with nonhooded liners? (2) Is there a difference in the revision rate for aseptic loosening/osteolysis? (3) Is head size associated with any difference in the revision rate between hooded and nonhooded liners? METHODS The Australian Orthopaedic Association National Joint Replacement Registry longitudinally maintains data on all primary and revision joint arthroplasties with nearly 100% capture. We analyzed all conventional primary THAs performed from registry inception in September 1999 until December 31, 2016 in patients with a diagnosis of osteoarthritis who had nonhooded or hooded XLPE bearings in a cementless acetabular shell. The study group included 192,659 THA procedures with XLPE liners, of which 67,904 were nonhooded and 124,755 were hooded. The mean age of patients receiving nonhooded liners was 70 years (range, 11-100 years); 44% were males. This was similar to the patients with hooded liners, who had a mean age of 70 years (range, 16-100 years); 45% were males. The main outcome measure was the cumulative percent revision at 15 years of the THA using Kaplan-Meier estimates of survivorship. We examined reasons for revision and and performed multivariable analysis to control for the confounding factors of three head size groups (< 32mm, 32mm, and > 32mm) and for the method of femoral fixation. RESULTS There was a higher revision rate for dislocation for patients with nonhooded liners at all times to 15 years (HR, 1.31; 95% CI, 1.17-1.47; p < 0.001). There was a higher revision rate for the diagnosis of aseptic loosening/osteolysis with patients with nonhooded liners compared with hooded liners (HR, 1.19; 95% CI, 1.05-1.34; p = 0.006). Head sizes of 32 mm or larger were independently associated with a lower comparative revision rate between hooded and nonhooded liners, but this was not apparent for head sizes smaller than 32 mm. It appeared that the main driver of the finding in larger heads was a reduced dislocation risk with hooded liners for 32 mm heads (HR, 1.50; 95% CI, 1.23-1.80; p < 0.001) and for heads larger than 32 mm (HR, 1.50; 95% CI, 1.20-1.89; p < 0.001). CONCLUSIONS Prior research has suggested that hooded acetabular liners may be associated with impingement, loosening, and osteolysis; however, in this large, registry-based report we found that XLPE hooded liners are not associated with an increased revision rate for aseptic loosening/osteolysis. Although there are many potential confounding variables in this registry analysis, if anything, surgeons using larger femoral heads and hooded liners likely did so in patients with a higher perceived dislocation risk. Patients with larger heads and XLPE hooded liners were, however, less likely to experience revision for dislocation. These liners therefore appear reasonable to use in primary THA at the surgeon's discretion. LEVEL OF EVIDENCE Level III, therapeutic study.
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Varnum C, Pedersen AB, Rolfson O, Rogmark C, Furnes O, Hallan G, Mäkelä K, de Steiger R, Porter M, Overgaard S. Impact of hip arthroplasty registers on orthopaedic practice and perspectives for the future. EFORT Open Rev 2019; 4:368-376. [PMID: 31210974 PMCID: PMC6549115 DOI: 10.1302/2058-5241.4.180091] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Total hip arthroplasty (THA) registers are established in several countries to collect data aiming to improve the results after THA. Monitoring of adverse outcomes after THA has focused mainly on revision surgery, but patient-reported outcomes have also been investigated.Several surgery-related factors influencing the survival of the THA have been thoroughly investigated and have changed clinical practice. These factors include surgical approach, specific implants, the size of the components, type of fixation and different bone cements.Register data have been used to examine the risk of venous thromboembolism and bleeding after THA. These investigations have resulted in shorter duration of thromboprophylaxis and a reduced frequency of blood transfusion.Registers may provide specific information to surgeons on the outcome of all THAs that they have performed with a detailed analysis of revisions rates and reasons for the revisions.A number of other stakeholders can use register data to provide benchmarks. The National Joint Registry for England, Wales, Northern Ireland and the Isle of Man supplies data to the Orthopaedic Device Evaluation Panel (ODEP), which provides benchmarks at 3, 5, 7, 10, and 13 years graded from A*, A, B and C.Future perspectives: National registers have to play a major role in documenting the quality of THA in order to describe best practice and report implant outliers. The registers have to be used for research and post-market surveillance and register data may be a source for intelligent decision tools. Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180091.
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Affiliation(s)
- Claus Varnum
- The Danish Hip Arthroplasty Register
- Department of Orthopaedic Surgery, Vejle Hospital, Vejle, Denmark
| | - Alma Bečić Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Ola Rolfson
- The Swedish Hip Arthroplasty Register
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Cecilia Rogmark
- The Swedish Hip Arthroplasty Register
- Lund University, Skåne University Hospital, Department of Orthopedics, Malmö, Sweden
| | - Ove Furnes
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Geir Hallan
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Keijo Mäkelä
- The Finnish Arthroplasty Register
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland
| | - Richard de Steiger
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, Australia
- Department of Surgery, Epworth HealthCare, University of Melbourne, Melbourne, Australia
| | - Martyn Porter
- The National Joint Registry of England, Wales, Northern Ireland and Isle of Man
- Centre for Hip Surgery, Wrightington Hospital, Wrightington, Wigan and Leigh NHS Trust, Lancashire, United Kingdom
| | - Søren Overgaard
- The Danish Hip Arthroplasty Register
- Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
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Paxton EW, Cafri G, Nemes S, Lorimer M, Kärrholm J, Malchau H, Graves SE, Namba RS, Rolfson O. An international comparison of THA patients, implants, techniques, and survivorship in Sweden, Australia, and the United States. Acta Orthop 2019; 90:148-152. [PMID: 30739548 PMCID: PMC6461092 DOI: 10.1080/17453674.2019.1574395] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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 - International comparisons of total hip arthroplasty (THA) practices and outcomes provide an opportunity to enhance the quality of care worldwide. We compared THA patients, implants, techniques, and survivorship in Sweden, Australia, and the United States. Patients and methods - Primary THAs due to osteoarthritis were identified using Swedish (n = 159,695), Australian (n = 279,693), and US registries (n = 69,641) (2003-2015). We compared patients, practices, and implant usage across the countries using descriptive statistics. We evaluated time to all-cause revision using Kaplan-Meier survival curves. We assessed differences in countries' THA survival using chi-square tests of survival probabilities. Results - Sweden had fewer comorbidities than the United States and Australia. Cement fixation was used predominantly in Sweden and cementless in the United States and Australia. The direct anterior approach was used more frequently in the United States and Australia. Smaller head sizes (≤ 32 mm vs. ≥ 36 mm) were used more often in Sweden than the United States and Australia. Metal-on-highly cross-linked polyethylene was used more frequently in the United States and Australia than in Sweden. Sweden's 5- (97.8%) and 10-year THA survival (95.8%) was higher than the United States' (5-year: 97.0%; 10-year: 95.2%) and Australia (5-year: 96.3%; 10-year: 93.5%). Interpretation - Patient characteristics, surgical techniques, and implants differed across the 3 countries, emphasizing the need to adjust for demographics, surgical techniques, and implants and the need for global standardized definitions to compare THA survivorship internationally.
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Affiliation(s)
- Elizabeth W Paxton
- Department of Clinical Analysis, Surgical Outcomes and Analysis, Southern California Permanente Medical Group, San Diego, CA, USA; ,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; ,Correspondence:
| | - Guy Cafri
- Department of Clinical Analysis, Surgical Outcomes and Analysis, Southern California Permanente Medical Group, San Diego, CA, USA;
| | - Szilard Nemes
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden; ,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;
| | - Michelle Lorimer
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia;
| | - Johan Kärrholm
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden; ,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; ,Sahlgrenska University Hospital, Gothenburg, Sweden;
| | - Henrik Malchau
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden; ,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; ,Sahlgrenska University Hospital, Gothenburg, Sweden;
| | - Stephen E Graves
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia;
| | - Robert S Namba
- Southern California Permanente Medical Group, Irvine, CA, USA
| | - Ola Rolfson
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden; ,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; ,Sahlgrenska University Hospital, Gothenburg, Sweden;
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Evans JT, Evans JP, Walker RW, Blom AW, Whitehouse MR, Sayers A. How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. Lancet 2019; 393:647-654. [PMID: 30782340 PMCID: PMC6376618 DOI: 10.1016/s0140-6736(18)31665-9] [Citation(s) in RCA: 288] [Impact Index Per Article: 57.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/13/2018] [Accepted: 07/17/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Total hip replacement is a common and highly effective operation. All hip replacements would eventually fail if in situ long enough and it is important that patients understand when this might happen. We aimed to answer the question: how long does a hip replacement last? METHODS We did a systematic review and meta-analysis with a search of MEDLINE and Embase from the start of records to Sept 12, 2017. We included articles reporting 15-year survival of primary, conventional total hip replacement constructs in patients with osteoarthritis. We extracted survival and implant data and used all-cause construct survival as the primary outcome. We also reviewed reports of national joint replacement registries, and extracted data for a separate analysis. In the meta-analyses, we weighted each series and calculated a pooled survival estimate for each source of data. This study was registered with PROSPERO (CRD42018085642). FINDINGS We identified 140 eligible articles reporting 150 series, and included 44 of these series (13 212 total hip placements). National joint replacement registries from Australia and Finland provided data for 92 series (215 676 total hip replacements). The 25-year pooled survival of hip replacements from case series was 77·6% (95% CI 76·0-79·2) and from joint replacement registries was 57·9% (95% CI 57·1-58·7). INTERPRETATION Assuming that estimates from national registries are less likely to be biased, patients and surgeons can expect a hip replacement to last 25 years in around 58% of patients. FUNDING National Institute for Health Research, National Joint Registry for England, Wales, Northern Ireland and Isle of Man, and The Royal College of Surgeons of England.
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Affiliation(s)
- Jonathan T Evans
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, Bristol, UK.
| | - Jonathan P Evans
- Health and Policy Research Group, University of Exeter, Exeter, UK
| | - Robert W Walker
- Department of Trauma and Orthopaedics, Derriford Hospital, Plymouth, UK
| | - Ashley W Blom
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, Bristol, UK; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals, Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Michael R Whitehouse
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, Bristol, UK; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals, Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Adrian Sayers
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, Bristol, UK
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Evans JT, Evans JP, Walker RW, Blom AW, Whitehouse MR, Sayers A. How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. Lancet 2019. [PMID: 30782340 DOI: 10.1016/s0140-6736(18)31665-9/attachment/14b424e0-004d-4903-8960-c00543bdca68/mmc2.mp4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Total hip replacement is a common and highly effective operation. All hip replacements would eventually fail if in situ long enough and it is important that patients understand when this might happen. We aimed to answer the question: how long does a hip replacement last? METHODS We did a systematic review and meta-analysis with a search of MEDLINE and Embase from the start of records to Sept 12, 2017. We included articles reporting 15-year survival of primary, conventional total hip replacement constructs in patients with osteoarthritis. We extracted survival and implant data and used all-cause construct survival as the primary outcome. We also reviewed reports of national joint replacement registries, and extracted data for a separate analysis. In the meta-analyses, we weighted each series and calculated a pooled survival estimate for each source of data. This study was registered with PROSPERO (CRD42018085642). FINDINGS We identified 140 eligible articles reporting 150 series, and included 44 of these series (13 212 total hip placements). National joint replacement registries from Australia and Finland provided data for 92 series (215 676 total hip replacements). The 25-year pooled survival of hip replacements from case series was 77·6% (95% CI 76·0-79·2) and from joint replacement registries was 57·9% (95% CI 57·1-58·7). INTERPRETATION Assuming that estimates from national registries are less likely to be biased, patients and surgeons can expect a hip replacement to last 25 years in around 58% of patients. FUNDING National Institute for Health Research, National Joint Registry for England, Wales, Northern Ireland and Isle of Man, and The Royal College of Surgeons of England.
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Affiliation(s)
- Jonathan T Evans
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, Bristol, UK.
| | - Jonathan P Evans
- Health and Policy Research Group, University of Exeter, Exeter, UK
| | - Robert W Walker
- Department of Trauma and Orthopaedics, Derriford Hospital, Plymouth, UK
| | - Ashley W Blom
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, Bristol, UK; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals, Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Michael R Whitehouse
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, Bristol, UK; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals, Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Adrian Sayers
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, Bristol, UK
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Ekman E, Palomäki A, Laaksonen I, Peltola M, Häkkinen U, Mäkelä K. Early postoperative mortality similar between cemented and uncemented hip arthroplasty: a register study based on Finnish national data. Acta Orthop 2019; 90:6-10. [PMID: 30712498 PMCID: PMC6366465 DOI: 10.1080/17453674.2018.1558500] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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 - Implant survival of cemented total hip arthroplasty (THA) in elderly patients is higher than that of uncemented THA. However, a higher mortality rate in patients undergoing cemented THA compared with uncemented or hybrid THA has been reported. We assessed whether cemented fixation increases peri- or early postoperative mortality compared with uncemented and hybrid THA. Patients and methods - Patients with osteoarthritis who received a primary THA in Finland between 1998 and 2013 were identified from the PERFECT database of the National Institute for Health and Welfare in Finland. Definitive data on fixation method and comorbidities were available for 62,221 THAs. Mortality adjusted for fixation method, sex, age group, and comorbidities among the cemented, uncemented, and hybrid THA was examined using logistic regression analysis. Reasons for cardiovascular death within 90 days since the index procedure were extracted from the national Causes of Death Statistics and assessed separately. Results - 1- to 2-day adjusted mortality after cemented THA was comparable to that of the uncemented THA group (OR 1.2; 95% CI 0.24-6.5). 3- to 10-day mortality in the cemented THA group was comparable to that in the uncemented THA group (OR 0.54; CI 0.26-1.1), and in the hybrid THA group (OR 0.64, CI 0.25-1.6). Pulmonary embolism or cardiovascular reasons as a cause of death were not over-represented in the cemented THA group. Interpretation - Early peri- and postoperative mortality in the cemented THA group was similar compared with that of the hybrid and uncemented groups.
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Affiliation(s)
- Elina Ekman
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland; ,Correspondence:
| | - Antton Palomäki
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland;
| | - Inari Laaksonen
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland;
| | - Mikko Peltola
- National Institute for Health and Welfare, Helsinki, Finland
| | - Unto Häkkinen
- National Institute for Health and Welfare, Helsinki, Finland
| | - Keijo Mäkelä
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland;
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Klasan A, Sen A, Dworschak P, El-Zayat BF, Ruchholtz S, Schuettler KF, Schmitt J, Heyse TJ. Ten-year follow-up of a cemented tapered stem. Arch Orthop Trauma Surg 2018; 138:1317-1322. [PMID: 30043147 DOI: 10.1007/s00402-018-3002-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION This stem was cleared by the FDA in 2002 and has been implanted in cementless and cemented versions. Despite its long history, there are no long-term clinical results available for the cemented version of this implant. The aim of this study was to provide such data. It was hypothesized that this implant delivers clinical success comparable to other tapered cemented stems. MATERIALS AND METHODS A total of 113 hip replacements were performed in 106 patients between October 2007 and December 2009 using the cemented version of this stem. The mean age of the patients at operation was 74.8 years (range 50-91 years). The mean follow-up was 8.9 years with only two patients lost to follow-up. Implant survival was determined using the Kaplan-Meier analysis. RESULTS Stem survival with revision for any reason as the endpoint was 96.4% after 10 years. Survival for stem aseptic loosening was 100%. There were no cases of osteolysis. Clinical outcomes, as shown by Harris Hip Scores, were in line with previous investigations and the rate of adverse events was very low. CONCLUSIONS This is a modern cemented stem with an excellent survival rate and satisfactory functional outcomes. In this cohort, there were no failures related to the stem through the first decade.
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Affiliation(s)
- Antonio Klasan
- Center for Orthopedics and Traumatology, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany.
| | - Ahmet Sen
- Department for Trauma, Clinic Jung-Stilling, Wichernstraße 40, 57074, Siegen, Germany
| | - Philipp Dworschak
- Center for Orthopedics and Traumatology, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Bilal Farouk El-Zayat
- Center for Orthopedics and Traumatology, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Steffen Ruchholtz
- Center for Orthopedics and Traumatology, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Karl F Schuettler
- Center for Orthopedics and Traumatology, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Jan Schmitt
- Department for Orthopedics, Clinic Wetzlar, Forsthausstraße 1, 35578, Wetzlar, Germany
| | - Thomas J Heyse
- ORTHOmedic Frankfurt Offenbach, Herrnstr. 57, 63065, Offenbach, Germany
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Cnudde P, Rolfson O, Timperley AJ, Garland A, Kärrholm J, Garellick G, Nemes S. Do Patients Live Longer After THA and Is the Relative Survival Diagnosis-specific? Clin Orthop Relat Res 2018; 476:1166-1175. [PMID: 29489471 PMCID: PMC6263594 DOI: 10.1007/s11999.0000000000000097] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hip replacements are successful in restoring mobility, reducing pain, and improving quality of life. However, the association between THA and the potential for increased life expectancy (as expressed by mortality rate) is less clear, and any such association could well be influenced by diagnosis and patient-related, socioeconomic, and surgical factors, which have not been well studied. QUESTIONS/PURPOSES (1) After controlling for birth year and sex, are Swedish patients who underwent THA likely to survive longer than individuals in the general population? (2) After controlling for relevant patient-related, socioeconomic/demographic factors and surgical factors, does relative survival differ across the various diagnoses for which THAs were performed in Sweden? METHODS Data from the Swedish Hip Arthroplasty Register, linked to administrative health databases, were used for this study. We identified 131,808 patients who underwent THA between January 1, 1999, and December 31, 2012. Of these, 21,755 had died by the end of followup. Patient- and surgery-specific data in combination with socioeconomic data were available for analysis. We compared patient survival (relative survival) with age- and sex-matched survival data in the entire Swedish population according to Statistics Sweden. We used multivariable modeling proceeded with a Cox proportional hazards model in transformed time. RESULTS Patients undergoing elective THA had a slightly improved survival rate compared with the general population for approximately 10 years after surgery. At 1 year after surgery, the survival in patients undergoing THA was 1% better than the expected survival (r = 1.01; 95% confidence interval [CI], 1.01-1.02; p < 0.001); at 5 years, this increased to 3% (r = 1.03; 95% CI, 1.03-1.03; p < 0.001); at 10 years, the difference was 2% (r = 1.02; 95% CI, 1.02-1.03; p < 0.001); and by 12 years, there was no difference between patients undergoing THA and the general population (r = 1.01; 95% CI, 0.99-1.02; p = 0.13). Using the diagnosis of primary osteoarthritis as a reference, hip arthroplasties performed for sequelae of childhood hip diseases had a similar survival rate (hazard ratio [HR], 1.02; 95% CI, 0.88-1.18; p = 0.77). Patients undergoing surgery for osteonecrosis of the femoral head (HR, 1.69; 95% CI, 1.60-1.79; p < 0.001), inflammatory arthritis (HR, 1.49; 95% CI, 1.38-1.61; p < 0.001), and secondary osteoarthritis (HR, 2.46; 95% CI, 2.03-2.99; p < 0.001) all had poorer relative survival. Comorbidities and the Elixhauser comorbidity index had a negative association with relative survival. Level of achieved education (middle level of education: HR, 0.90, 95% CI, 0.87-0.93, p < 0.001; high level: 0.76, 95% CI, 0.73-0.80, p < 0.001) and marital status (single status: HR, 1.33; 95% CI, 1.28-1.38; p < 0.001) were also negatively associated with survival. CONCLUSIONS Whereas it has been known that in most patients, THA improves quality of life, this study demonstrates that it also is associated with a slightly increased life expectancy that lasts for approximately 10 years after surgery, especially among patients whose diagnosis was primary osteoarthritis. This adds further proof of a health-economic value for this surgical intervention. The reasons for the increase in relative survival are unknown but are probably multifactorial. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Peter Cnudde
- P. Cnudde, O. Rolfson, A. Garland, J. Kärrholm, G. Garellick, S. Nemes, Swedish Hip Arthroplasty Register, Centre of Registers Västra Götaland, Gothenburg, Sweden A. J. Timperley, Hip Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon & Exeter Hospital, Exeter, UK P. Cnudde, O. Rolfson, J. Kärrholm, G. Garellick, S. Nemes, Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden A. Garland, Department of Orthopaedics, Institute of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
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Miller LE, Gondusky JS, Kamath AF, Boettner F, Wright J, Bhattacharyya S. Influence of surgical approach on complication risk in primary total hip arthroplasty. Acta Orthop 2018; 89:289-294. [PMID: 29451051 PMCID: PMC6055783 DOI: 10.1080/17453674.2018.1438694] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 01/18/2018] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Systematic comparisons of anterior approach (A) versus posterior approach (P) in primary total hip arthroplasty (THA) have largely focused on perioperative outcomes. In this systematic review with meta-analysis, we compared complication risk of A versus P in studies of primary THA with at least 1-year mean follow-up. Patients and methods - We performed a systematic review of prospective and retrospective studies with at least 1-year mean follow-up that reported complications of A and P primary THA. Complications included infection, dislocation, reoperation, thromboembolic event, heterotopic ossification, wound complication, fracture, and nerve injury. Random effects meta-analysis was used for all outcomes. Complication risk was reported as rate ratio (RR) to account for differential follow-up durations; values >1 indicated higher complication risk with A and values <1 indicated lower risk with A. Results - 19 studies were included; 15 single-center comparative studies with 6,620 patients (2,278 A; 4,342 P) and 4 multicenter registries with 157,687 patients (18,735 A; 138,952 P). Median follow-up was 16 (12-64) months) with A and 18 (12-110) months with P. Anterior approach was associated with lower rate of infection (RR =0.55, p = 0.002), dislocation (RR =0.65, p = 0.03), and reoperation (RR =0.84, p < 0.001). No statistically significant differences were observed in rate of thromboembolic event (RR =0.59, p = 0.5), heterotopic ossification (RR =0.63, p = 0.1), wound complication (RR =0.93, p = 0.8), or fracture (RR =1.0, p = 0.9). There was a higher rate of patient-reported nerve injury with A (RR =2.3, p = 0.01). Interpretation - Comparing A with P in primary THA, A was associated with lower risk of reoperation, dislocation, and infection, but higher risk of patient-reported nerve injury.
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Affiliation(s)
| | | | - Atul F Kamath
- Penn Medicine, Department of Orthopedic Surgery, Leonard Davis Institute of Health Economics, Philadelphia
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Angerame MR, Fehring TK, Masonis JL, Mason JB, Odum SM, Springer BD. Early Failure of Primary Total Hip Arthroplasty: Is Surgical Approach a Risk Factor? J Arthroplasty 2018; 33:1780-1785. [PMID: 29439894 DOI: 10.1016/j.arth.2018.01.014] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/19/2017] [Accepted: 01/08/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND In an era of innovation in surgical approaches for total hip arthroplasty (THA), there is concern for increasing trends of early failure. The purpose of this study is to evaluate the incidence of early failure of primary THA stratified by surgical approach. METHODS A retrospective review was performed on consecutive primary THAs completed from 2007 to 2014 at a high-volume center. THAs were stratified by surgical approach. Only the direct anterior (DAA) and posterior approaches (PA) were included. The primary outcome measure was early revision (<5 years). Descriptive statistics were performed using SAS software. RESULTS In total, 6894 primary THAs performed between 2007 and 2014 were included. Across 2431 DAA THAs and 4463 PA THAs, there were 103 revisions overall. There was no difference in the overall revision rate for DAA THAs (1.69%) compared to PA THAs (1.39%) (P = .33). The DAA had a higher rate of early revisions for femoral component loosening compared to the PA (P = .0003). About 35.7% of DAA THAs were revised for femoral loosening compared to 8% for the PA (P = .0003). Early failure by femoral loosening occurred more often via the DAA in Dorr A bone (P = .03). The PA had a higher incidence of revision for instability (P = .04). There was no difference in modes of failure with regards to time to failure, acetabular loosening, early periprosthetic fracture, or infection. CONCLUSION The DAA had a higher incidence of femoral loosening while PA had a higher mode of failure due to instability. Overall revision rates were not statistically different between approaches.
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Long WJ, Nayyar S, Chen KK, Novikov D, Davidovitch RI, Vigdorchik JM. Early aseptic loosening of the Tritanium primary acetabular component with screw fixation. Arthroplast Today 2018; 4:169-174. [PMID: 29896547 PMCID: PMC5994600 DOI: 10.1016/j.artd.2017.11.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 11/21/2017] [Accepted: 11/28/2017] [Indexed: 10/31/2022] Open
Abstract
Ultraporous acetabular components were developed to improve osseointegration and fit for increased longevity and better outcomes after total hip arthroplasty. There is a paucity of literature detailing this acetabular component's clinical performance, with even less detailing those with screw fixation. We identify 5 patients at our institution who underwent revision total hip arthroplasty for early aseptic acetabular cup loosening of an ultraporous acetabular component known as the Tritanium primary cup with secondary screw fixation. They all presented with groin and hip pain after index surgery and underwent follow-up radiographic examination consistent with component loosening requiring revision surgery. This case series reports on the risk of early acetabular cup loosening and its associated clinical presentation, workup, and surgical management in patients with the Tritanium primary cup augmented with screws.
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Affiliation(s)
- William J. Long
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
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Girard J, Lons A, Ramdane N, Putman S. Hip resurfacing before 50years of age: A prospective study of 979 hips with a mean follow-up of 5.1years. Orthop Traumatol Surg Res 2018; 104:295-299. [PMID: 29277514 DOI: 10.1016/j.otsr.2017.10.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 10/11/2017] [Accepted: 10/27/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hip resurfacing arthroplasty (HRA) is an alternative to total hip arthroplasty (THA) for the treatment of hip osteoarthritis in patients younger than 50 years. Data on revision rates after HRA are conflicting. The National Institute for Health and Care Excellence (NICE) recommends performing only those hip arthroplasty procedures associated with 10-year revision rates no greater than 5% (0.5% per year). Follow-up studies can rapidly determine whether this criterion is met. The uncertainties surrounding revision rates after HRA prompted us to design a study of prospectively enrolled patients aiming (1) to determine the revision rate after HRA performed before 50years of age and (2) to assess the functional, radiological, and biological outcomes of HRA. HYPOTHESIS The revision rate after HRA performed before 50years of age meets the NICE criterion. MATERIAL AND METHODS Consecutive patients undergoing HRA before 50years of age were enrolled prospectively. The same implant was used in all patients. Functional outcomes were assessed based on the Harris Hip Score (HHS), Postel-Merle d'Aubigné (PMA) score, 12-item Oxford Hip Score (OHS), and UCLA activity score. Radiographic outcomes were assessed, and blood levels of chromium and cobalt were assayed. RESULTS The study included 936 patients (979 HRAs) with a mean age of 42.7years (16.4-50.0years) at surgery and a mean follow-up of 5.1years (range: 3.1-9.0 years). All four mean functional scores were significantly improved at last follow-up vs. baseline: HHS, 95.9 (39.0-100) vs. 44.3 (18.0-83.0); PMA score, 17.6 (6.0-18.0) vs. 11.7 (3.0-16.0); OHS, 14.3 (12.0-37.0) vs. 40.6 (25.0-60.0); and UCLA activity score, 7.8 (2.0-10.0) vs. 5.6 (1.0-10.0) (p<0.0001). Mean cup inclination in the coronal plane was 42.1° (25.0°-68.0°). Mean blood cobalt level was significantly higher at last follow-up than at baseline (1.36μg/L [0.05-8.2μg/L] vs. 0.61μg/L [0.01-3.6]) (p<0.001). No patient experienced dislocation. Revision was required for 17 hips and involved changing the implant in 12 (1.2%). The 10-year survival rate with implant change, as the endpoint was 98.7% (95%CI, 97.6%-99.3%), indicating that the NICE criterion was easily met. DISCUSSION The NICE criterion allows the rapid identification of prostheses with insufficient survival. HRA is theoretically associated with a high risk of aseptic mechanical loosening, as it is performed in young patients who have a high level of physical activity. Nevertheless, our study showed that implant survival after HRA was better than required by the NICE criterion. Thus, HRA is a valid alterative to THA in patients younger than 50years. LEVEL OF EVIDENCE IV, prospective study with no control group.
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Affiliation(s)
- J Girard
- Université Lille Nord de France, 59000 Lille, France; Département de médecine du sport, faculté de médecine de Lille, université de Lille 2, 59000 Lille, France; Service d'orthopédie, hôpital salengro, CHU Lille, place de Verdun, 59000 Lille, France.
| | - A Lons
- Université Lille Nord de France, 59000 Lille, France; Service d'orthopédie, hôpital salengro, CHU Lille, place de Verdun, 59000 Lille, France
| | - N Ramdane
- Unité de biostatistiques, EA 2694, Santé publique : épidémiologie et qualité des soins, centre hospitalier universitaire Lille, université Lille, 59000 Lille, France
| | - S Putman
- Université Lille Nord de France, 59000 Lille, France; Service d'orthopédie, hôpital salengro, CHU Lille, place de Verdun, 59000 Lille, France
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Assi C, Kheir N, Samaha C, Kouyoumjian P, Yammine K. Early results of total hip arthroplasty using dual-mobility cup in patients with osteonecrosis of the femoral head. SICOT J 2018; 4:4. [PMID: 29469804 PMCID: PMC5822877 DOI: 10.1051/sicotj/2018001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 12/28/2017] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Osteonecrosis of the femoral head (ONFH) remains a therapeutic challenge for patients undergoing total hip arthroplasty (THA). The majority of these patients are young with high functional demand, and show an increased risk of dislocation following surgery than patients with osteoarthritis. The use of double mobility cup (DMC) has been linked with lower rates of complications when compared to conservative cups; however, the literature is scarce over DMC results in patients with ONFH. The aim of the study is to report the early outcomes of patients with ONFH treated with THA-DMC. MATERIALS A retrospective analysis of patients suffering from ONFH who underwent THA using DMC (THA-DMC) from 2006 to 2015 were evaluated for functional status and risk of post-operative complications. Thirty THA-DMC in 26 patients with a mean follow-up of 51 months were evaluated clinically (modified Hip Harris Score) and radiologically. RESULTS The mean age of the included patients was 54.9 years. At final follow-up, the mean modified Hip Harris score was 98.7 ± 2.7 and no dislocation episodes or revision surgeries were recorded. The radiological assessment revealed no signs of migration/tilting, radiolucent lines, periprosthetic osteolysis or heterotopic ossification over the DMC component and the femoral stem. The survival rate over 51 months of follow-up was 100%. DISCUSSION The use of the new generation of dual mobility cup in patients with ONFH showed excellent functional early results with no major complications such as dislocation.
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Affiliation(s)
- Chahine Assi
- Department of Orthopedic Surgery, Lebanese American University-Rizk Hospital, Beirut, Lebanon
| | - Nadim Kheir
- Department of Orthopedic Surgery, Lebanese American University-Rizk Hospital, Beirut, Lebanon
| | - Camille Samaha
- Department of Orthopedic Surgery, Lebanese American University-Rizk Hospital, Beirut, Lebanon - Department of Orthopedic Surgery, Middle East Institute of Health, Bsalim, Lebanon
| | - Pascal Kouyoumjian
- Department of orthopedic Surgery, Centre Hospitalier Universitaire de Nîmes, Nîmes, France
| | - Kaissar Yammine
- Department of Orthopedic Surgery, Lebanese American University-Rizk Hospital, Beirut, Lebanon - Center for Evidence-based Anatomy, Sports & Orthopedic Research, Jdeideh, Lebanon
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Cnudde P, Nemes S, Bülow E, Timperley J, Malchau H, Kärrholm J, Garellick G, Rolfson O. Trends in hip replacements between 1999 and 2012 in Sweden. J Orthop Res 2018; 36:432-442. [PMID: 28845900 PMCID: PMC5873269 DOI: 10.1002/jor.23711] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 08/19/2017] [Indexed: 02/04/2023]
Abstract
National Registers document changes in the circumstance, practice, and outcome of surgery with the passage of time. In the context of total hip replacement (THR), registers can help elucidate the relevant factors that affect the clinical outcome. We evaluated the evolution of factors related to patient, surgical procedure, socio-economy, and various outcome parameters after merging databases of the Swedish Hip Arthroplasty Register, Statistics Sweden and the National Board of Health and Welfare. Data on 193,253 THRs (164,113 patients) operated between 1999 and 2012 were merged. We studied the evolution of surgical volume, patient demographics, socio-economic factors, surgical factors, length-of-stay, mortality rate, adverse events, re-operation and revision rates, and Patient Reported Outcome Measures (PROMs). Throughout this time period the majority of patients were operated on with a diagnosis of primary osteoarthritis. Comorbidity indices increased each year observed. The share of all-cemented implants has dropped from 92% to 68%. More than 88% of the bearings were metal-on-polyethylene. Length-of-stay decreased by 50%. There was a reduction in 30- and 90-day mortality. Re-operation and revision rates at 2 years are decreasing. The post-operative PROMs improved despite the observation of worse pre-operative pain scores getting over time. The demographics of patients receiving a THR, their comorbidities, and their primary diagnosis are changing. Notwithstanding these changes, outcomes like mortality, re-operations, revisions, and PROMs have improved. The practice of hip arthroplasty has evolved, even in a country such as Sweden that is considered to be conservative with regard taking on new surgical practices. © 2017 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 36:432-442, 2018.
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Affiliation(s)
- Peter Cnudde
- Swedish Hip Arthroplasty RegisterCentre of Registers Västra GötalandMedicinargatan 18GGothenburgSE 41345Sweden,Department of OrthopaedicsSahlgrenska AcademyInstitute of Clinical SciencesUniversity of GothenburgGothenburgSE 41345Sweden,Department of OrthopaedicsHywel Dda University HealthboardPrince Philip HospitalBryngwynmawrLlanelliSA14 8QFUnited Kingdom
| | - Szilard Nemes
- Swedish Hip Arthroplasty RegisterCentre of Registers Västra GötalandMedicinargatan 18GGothenburgSE 41345Sweden,Department of OrthopaedicsSahlgrenska AcademyInstitute of Clinical SciencesUniversity of GothenburgGothenburgSE 41345Sweden
| | - Erik Bülow
- Swedish Hip Arthroplasty RegisterCentre of Registers Västra GötalandMedicinargatan 18GGothenburgSE 41345Sweden,Department of OrthopaedicsSahlgrenska AcademyInstitute of Clinical SciencesUniversity of GothenburgGothenburgSE 41345Sweden
| | - John Timperley
- Hip UnitPrincess Elizabeth Orthopaedic CentreRoyal Devon & Exeter Hospital Barrack RoadExeterEX2 5DWUnited Kingdom
| | - Henrik Malchau
- Swedish Hip Arthroplasty RegisterCentre of Registers Västra GötalandMedicinargatan 18GGothenburgSE 41345Sweden,Department of OrthopaedicsSahlgrenska AcademyInstitute of Clinical SciencesUniversity of GothenburgGothenburgSE 41345Sweden,Harris Orthopaedic LaboratoryMassachusetts General Hospital 55 Fruit street, GRJ 1126Boston02114Massachusetts,Department of OrthopaedicsMassachusetts General Hospital55 Fruit street, GRJ 1126Boston02114Massachusetts
| | - Johan Kärrholm
- Swedish Hip Arthroplasty RegisterCentre of Registers Västra GötalandMedicinargatan 18GGothenburgSE 41345Sweden,Department of OrthopaedicsSahlgrenska AcademyInstitute of Clinical SciencesUniversity of GothenburgGothenburgSE 41345Sweden
| | - Göran Garellick
- Swedish Hip Arthroplasty RegisterCentre of Registers Västra GötalandMedicinargatan 18GGothenburgSE 41345Sweden,Department of OrthopaedicsSahlgrenska AcademyInstitute of Clinical SciencesUniversity of GothenburgGothenburgSE 41345Sweden
| | - Ola Rolfson
- Swedish Hip Arthroplasty RegisterCentre of Registers Västra GötalandMedicinargatan 18GGothenburgSE 41345Sweden,Department of OrthopaedicsSahlgrenska AcademyInstitute of Clinical SciencesUniversity of GothenburgGothenburgSE 41345Sweden
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Lübbeke A, Silman AJ, Prieto-Alhambra D, Adler AI, Barea C, Carr AJ. The role of national registries in improving patient safety for hip and knee replacements. BMC Musculoskelet Disord 2017; 18:414. [PMID: 29037237 PMCID: PMC5644143 DOI: 10.1186/s12891-017-1773-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 10/04/2017] [Indexed: 12/12/2022] Open
Abstract
Background The serious adverse events associated with metal on metal hip replacements have highlighted the importance of improving methods for monitoring surgical implants. The new European Union (EU) device regulation will enforce post-marketing surveillance based on registries among other surveillance tools. Europe has a common regulatory environment, a common market for medical devices, and extensive experience with joint replacement registries. In this context, we elaborate how joint replacement registries, while building on existing structure and data, can better ensure safety and balance risks and benefits. Main text Actions to improve registry-based implant surveillance include: enriching baseline and diversifying outcomes data collection; improving methodology to limit bias; speeding-up failure detection by active real-time monitoring; implementing risk-benefit analysis; coordinating collaboration between registries; and translating knowledge gained from the data into clinical decision-making and public health policy. Conclusions The changes proposed here will improve patient safety, enforce the application of the new legal EU requirements, augment evidence, improve clinical decision-making, facilitate value-based health-care delivery, and provide up-to-date guidance for public health.
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Affiliation(s)
- Anne Lübbeke
- Division of Orthopaedic Surgery and Traumatology, Geneva University Hospitals and Geneva University, Geneva, Switzerland. .,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| | - Alan J Silman
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Daniel Prieto-Alhambra
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Amanda I Adler
- Wolfson Diabetes and Endocrine Clinic, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,National Institute for Health and Care Excellence, 10 Spring Gardens, London, UK
| | - Christophe Barea
- Division of Orthopaedic Surgery and Traumatology, Geneva University Hospitals and Geneva University, Geneva, Switzerland
| | - Andrew J Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Ackerman IN, Bohensky MA, de Steiger R, Brand CA, Eskelinen A, Fenstad AM, Furnes O, Graves SE, Haapakoski J, Mäkelä K, Mehnert F, Nemes S, Overgaard S, Pedersen AB, Garellick G. Lifetime Risk of Primary Total Hip Replacement Surgery for Osteoarthritis From 2003 to 2013: A Multinational Analysis Using National Registry Data. Arthritis Care Res (Hoboken) 2017; 69:1659-1667. [DOI: 10.1002/acr.23197] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 01/17/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Ilana N. Ackerman
- Monash University and University of Melbourne; Melbourne Victoria Australia
| | | | - Richard de Steiger
- Epworth HealthCare and University of Melbourne, Melbourne, Victoria, and Australian Orthopaedic Association National Joint Replacement Registry; Adelaide South Australia Australia
| | | | | | | | - Ove Furnes
- The Norwegian Arthroplasty Register and University of Bergen; Bergen Norway
| | - Stephen E. Graves
- Australian Orthopaedic Association National Joint Replacement Registry; Adelaide South Australia Australia
| | | | - Keijo Mäkelä
- Turku University Hospital, Turku, and Finnish Arthroplasty Register; Helsinki Finland
| | - Frank Mehnert
- Aarhus University Hospital and Danish Hip Arthroplasty Register; Aarhus Denmark
| | - Szilard Nemes
- Swedish Hip Arthroplasty Register; Gothenburg Sweden
| | - Søren Overgaard
- Danish Hip Arthroplasty Register, Aarhus, and Odense University Hospital and University of Southern Denmark; Odense Denmark
| | - Alma B. Pedersen
- Aarhus University Hospital and Danish Hip Arthroplasty Register; Aarhus Denmark
| | - Göran Garellick
- University of Gothenburg and Swedish Hip Arthroplasty Register; Gothenburg Sweden
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Johanson PE, Furnes O, Ivar Havelin L, Fenstad AM, Pedersen AB, Overgaard S, Garellick G, Mäkelä K, Kärrholm J. Outcome in design-specific comparisons between highly crosslinked and conventional polyethylene in total hip arthroplasty. Acta Orthop 2017; 88:363-369. [PMID: 28375671 PMCID: PMC5499325 DOI: 10.1080/17453674.2017.1307676] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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 - Most registry studies regarding highly crosslinked polyethylene (XLPE) have focused on the overall revision risk. We compared the risk of cup and/or liner revision for specific cup and liner designs made of either XLPE or conventional polyethylene (CPE), regarding revision for any reason and revision due to aseptic loosening and/or osteolysis. Patients and methods - Using the Nordic Arthroplasty Register Association (NARA) database, we identified cup and liner designs where either XLPE or CPE had been used in more than 500 THAs performed for primary hip osteoarthritis. We assessed risk of revision for any reason and for aseptic loosening using Cox regression adjusted for age, sex, femoral head material and size, surgical approach, stem fixation, and presence of hydroxyapatite coating (uncemented cups). Results - The CPE version of the ZCA cup had a risk of revision for any reason similar to that of the XLPE version (p = 0.09), but showed a 6-fold higher risk of revision for aseptic loosening (p < 0.001). The CPE version of the Reflection All Poly cup had an 8-fold elevated risk of revision for any reason (p < 0.001) and a 5-fold increased risk of revision for aseptic loosening (p < 0.001). The Charnley Elite Ogee/Marathon cup and the Trilogy cup did not show such differences. Interpretation - Whether XLPE has any advantage over CPE regarding revision risk may depend on the properties of the polyethylene materials being compared, as well as the respective cup designs, fixation type, and follow-up times. Further research is needed to elucidate how cup design factors interact with polyethylene type to affect the risk of revision.
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Affiliation(s)
- Per-Erik Johanson
- The Swedish Hip Arthroplasty Register;,Department of Orthopaedics, Institute of Surgical Sciences, Sahlgrenska University Hospital, Göteborg, Sweden;,Correspondence:
| | - Ove Furnes
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen;,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Leif Ivar Havelin
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen;,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Anne Marie Fenstad
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
| | - Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus;,Danish Hip Arthroplasty Register, Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Overgaard
- Department of Orthopaedic Surgery, Traumatology and Clinical Institute, Odense University Hospital, and University of Southern Denmark, Odense;,Danish Hip Arthroplasty Register, Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Göran Garellick
- The Swedish Hip Arthroplasty Register;,Department of Orthopaedics, Institute of Surgical Sciences, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Keijo Mäkelä
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku;,The Finnish Arthroplasty Register, Finland
| | - Johan Kärrholm
- The Swedish Hip Arthroplasty Register;,Department of Orthopaedics, Institute of Surgical Sciences, Sahlgrenska University Hospital, Göteborg, Sweden
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Mussmann B, Overgaard S, Torfing T, Bøgehøj M, Gerke O, Andersen PE. Intra- and inter-observer agreement and reliability of bone mineral density measurements around acetabular cup: a porcine ex-vivo study using single- and dual-energy computed tomography. Acta Radiol Open 2017; 6:2058460117719746. [PMID: 28785480 PMCID: PMC5521355 DOI: 10.1177/2058460117719746] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 06/17/2017] [Indexed: 11/25/2022] Open
Abstract
Background Periprosthetic bone loss is considered to be a potentially contributing factor in aseptic loosening of acetabular hip components, but no studies have shown this association. The lack of association might be caused by insufficient image quality because of metal artifacts and challenges in measuring bone density (BMD) in complex anatomic structures which might be overcome using dual-energy computed tomography (DECT). Purpose To test inter- and intra-observer agreement and reliability of in-house segmentation software measuring BMD adjacent to acetabular cup and to compare measurements performed with single-energy CT (SECT) and DECT in cemented and cementless cups. Material and Methods Twenty-four acetabular cups inserted in porcine hip specimens were scanned with SECT and DECT. Bone density was measured in a three-dimensional volume adjacent to the cup. Double measurements were performed. Results BMD derived from SECT was approximately four times higher than that of DECT. In both scan modes, intraclass correlation coefficient (ICC) was >0.90 with no differences between repeated measurements, except for uncemented cups where a statistically significant difference of 11 mg/cm3 was found with DECT. DECT showed narrower limits of agreement than SECT. Inter-observer analysis showed small differences. Conclusion BMD can be estimated with high intra- and inter-observer reliability with SECT and DECT around acetabular cups using custom software. The intra- and inter-observer agreement of DECT is superior to that of SECT and better in the cementless concept. Good intra- and inter-observer reliability can be obtained in both cemented and cementless cups using the segmentation software. SECT and DECT cannot be used interchangeably.
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Affiliation(s)
- Bo Mussmann
- Department of Radiology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Søren Overgaard
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| | - Trine Torfing
- Department of Radiology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Morten Bøgehøj
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.,Centre of Health Economics Research, University of Southern Denmark, Odense, Denmark
| | - Poul Erik Andersen
- Department of Radiology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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50
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Gaillard MD, Gross TP. Metal-on-metal hip resurfacing in patients younger than 50 years: a retrospective analysis : 1285 cases, 12-year survivorship. J Orthop Surg Res 2017; 12:79. [PMID: 28578684 PMCID: PMC5455178 DOI: 10.1186/s13018-017-0579-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 05/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Nordic registry reports patients under 50 years old with total hip replacements realize only 83% 10-year implant survivorship. These results do not meet the 95% 10-year survivorship guideline posed by the UK's National Institute for Health and Care Excellence (NICE) in 2014. METHODS The purpose of this study is threefold: First, we evaluate if metal-on-metal hip resurfacing arthroplasty meets these high standards in younger patients. Next, we compare outcomes between age groups to determine if younger patients are at higher risk for revision or complication. Lastly, we assess how outcomes between sexes changed over time. From January 2001 to August 2013, a single surgeon performed 1285 metal-on-metal hip resurfacings in patients younger than 50 years old. We compared these to an older cohort matched by sex and BMI. RESULTS Kaplan-Meier implant survivorship was 96.5% at 10 years and 96.3% at 12 years; this did not differ from implant survivorship for older patients. Implant survivorship at 12 years was 98 and 93% for younger men and women, respectively; survivorship for women improved from 93 to 97% by using exclusively Biomet implants. There were four (0.3%) adverse wear-related failures, with no instances of wear or problematic ion levels since 2009. Activity scores improved from 5.4 ± 2.3 preoperatively to 7.6 ± 1.9 postoperatively (p < 0.0001), with 43% of patients reporting a UCLA activity score of 9 or 10. CONCLUSIONS Hip resurfacing exceeds the stricter 2014 NICE survivorship criteria independently in men and women even when performed on patients under 50 years old.
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Affiliation(s)
- Melissa D Gaillard
- Midlands Orthopaedics & Neurosurgery, 1910 Blanding Street, Columbia, SC, 29201, USA.
| | - Thomas P Gross
- Midlands Orthopaedics & Neurosurgery, 1910 Blanding Street, Columbia, SC, 29201, USA
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