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Robbins SM, Tyrpenou E, Lee S, Ippersiel P, Antoniou J. Impact of combined lumbar spine fusion and total hip arthroplasty on spine, pelvis, and hip kinematics during a sit to stand task. J Electromyogr Kinesiol 2024; 75:102871. [PMID: 38460219 DOI: 10.1016/j.jelekin.2024.102871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/29/2024] [Accepted: 03/02/2024] [Indexed: 03/11/2024] Open
Abstract
Lumbar fusion is a risk factor for hip dislocation following total hip arthroplasty (THA). The objective was to compare joint/segment angles during sit-stand-sit in participants that had a THA with and without a lumbar fusion. The secondary objective was to compare pain, physical function, disability, and quality of life. This cross-sectional study includes participants that had THA and lumbar fusion (THA-fusion; n = 12) or THA only (THA-only; n = 12). Participants completed sit-stand-sit trials. Joint/segment angles were measured using electromagnetic motion capture. Angle characteristics were determined using principal component analysis. Hierarchical linear models examined relationships between angle characteristics and groups. Pain, physical function, and disability were compared using Mann-Whitney U tests. Upper lumbar spine was more extended during sit-stand-sit in the THA-fusion group (b = 42.41, P = 0.04). The pelvis was more posteriorly and anteriorly tilted during down and end sit-stand-sit phases, respectively, in the THA-fusion group (b = 12.21, P = 0.03). There were no significant associations between group and other angles. THA-fusion group had worse pain, physical function, disability, and quality of life. Although differences in spine joint, pelvis segment, and hip joint angles existed, these findings are unlikely to account for the increased incidence of hip dislocation after total hip arthroplasty in patients that had spine fusion.
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Affiliation(s)
- Shawn M Robbins
- Centre for Interdisciplinary Research in Rehabilitation, Lethbridge-Layton-MacKay Rehabilitation Centre, and the School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.
| | - Evangelos Tyrpenou
- Division of Orthopaedic Surgery, SMBD-Jewish General Hospital and McGill University, Montreal, Quebec, Canada
| | - Soomin Lee
- Centre for Interdisciplinary Research in Rehabilitation, Lethbridge-Layton-MacKay Rehabilitation Centre, and the School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Patrick Ippersiel
- Centre for Interdisciplinary Research in Rehabilitation, Lethbridge-Layton-MacKay Rehabilitation Centre, and the School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - John Antoniou
- Division of Orthopaedic Surgery, SMBD-Jewish General Hospital and McGill University, Montreal, Quebec, Canada
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Tyrpenou E, Megaloikonomos PD, Epure L, Huk-Papanastassiou O, Zukor D, Antoniou J. Similar complication and readmission rates following simultaneous versus staged bilateral total hip arthroplasty. Eur J Orthop Surg Traumatol 2024; 34:863-867. [PMID: 37743391 DOI: 10.1007/s00590-023-03734-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/10/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE To compare short-term complications and readmission rates, in patients treated with simultaneous versus staged bilateral total hip arthroplasty (THA) within a year from the index procedure. METHODS We reviewed the charts of patients that underwent simultaneous and staged-within a year-bilateral THA, between 2016 and 2020. Preoperative baseline characteristics were evaluated, while differences in terms of 30-day major and 30-day minor complications and readmission rates were compared between the groups. RESULTS One-hundred-sixty patients (mean age, 64.3 years; SD, ± 11.7) were identified. Seventy-nine patients were treated with simultaneous (Group A) and eighty-one patients with staged (Group B) THA. There were no differences in baseline characteristic between the two groups (p > 0.050). Group A was more likely to receive general anesthesia (43% vs. 9.9%, p < 0.001) and had longer total operative time (182.8 vs. 128.0 min, p < 0.001). Group A had an overall shorter total length of hospital stay (5.8 vs. 8.6 days, p < 0.001). No differences in transfusion rates (p = 0.229) and no differences in major and minor complications (p > 0.05) were identified. Postoperative visits at the emergency department or readmissions were similar between the two groups (p > 0.050). CONCLUSION This study shows that similar complication and readmission rates are expected after simultaneous and staged THA. Simultaneous bilateral THA is a safe and effective procedure, that should be considered for patients that present with radiologic and clinical bilateral hip disease.
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Affiliation(s)
- Evangelos Tyrpenou
- Department of Orthopaedic Surgery, SMBD-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | | | - Laura Epure
- Department of Orthopaedic Surgery, SMBD-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Olga Huk-Papanastassiou
- Department of Orthopaedic Surgery, SMBD-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - David Zukor
- Department of Orthopaedic Surgery, SMBD-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - John Antoniou
- Department of Orthopaedic Surgery, SMBD-Jewish General Hospital, McGill University, Montreal, QC, Canada
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Malahias MA, Roumeliotis L, Tyrpenou E, Kazas ST, Sourlas I, Kaseta MK. Ultrasound-Guided Partial Plantar Fascia Release with the Use of a Fine Cutting Device for the Treatment of Persistent Plantar Fasciitis: A Case Series. J Am Podiatr Med Assoc 2022; 112:20-244. [PMID: 36115031 DOI: 10.7547/20-244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Plantar fasciitis is a common cause of musculoskeletal discomfort. Minimally invasive interventions are preferred as second-line treatments following failure of conservative management. We report on a novel technique of ultrasound-guided percutaneous release of the medial third of the plantar fascia with the use of a fine cutting device for the treatment of persistent plantar fasciitis. METHODS This is a retrospective case series of all patients treated with the technique between 2013 and 2015. Patients had failed conservative management for a minimum of 6 months. The procedure was performed in an outpatient setting under local anesthesia. Under continuous ultrasound guidance, release of the medial third of the plantar fascia from the calcaneus was performed using an ophthalmic V-Lance knife through a medial stab wound entry point. RESULTS Fifteen patients (six men and nine women) with an average age of 54.7 years were included. The mean (standard deviation [SD]) visual analogue scale score for pain improved significantly, from 66.0 (SD, 18.8) preoperatively to each consecutive follow-up point: 29.3 (SD, 25.2) at 2 weeks, 30.0 (SD, 27.8) at 4 weeks, and 34.0 (SD, 26.1) at 12 weeks (P < .001). The mild increase in visual analogue scale score between 4 and 12 weeks was statistically significant (P = .018). Average duration of required analgesia was 5.5 days and average time required to return to usual activities was 5.7 days. Two patients suffered with refractory neuropathic pain over the lateral border of the foot without any obvious abnormality. CONCLUSIONS Ultrasound-guided percutaneous release with the use of a fine cutting device could be an alternative option for the treatment of persistent plantar fasciitis. The technique is not without complications, and a mild but statistically significant decline in pain levels from early to short term has been detected. Therefore, the long-term outcomes of this technique need to be investigated before we can advocate its routine use.
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Affiliation(s)
- Michael-Alexander Malahias
- *Stavros Niarchos Foundation, Hospital for Special Surgery, Complex Joint Reconstruction Center, New York, NY.,†Second Orthopaedic Department, School of Medicine, National and Kapodistrian University of Athens, Konstantopouleio General Hospital, Athens, Greece
| | - Leonidas Roumeliotis
- †Second Orthopaedic Department, School of Medicine, National and Kapodistrian University of Athens, Konstantopouleio General Hospital, Athens, Greece.,‡Department of Trauma and Orthopaedics, Basingstoke and North Hampshire Hospital, Basingstoke, Hampshire, United Kingdom
| | - Evangelos Tyrpenou
- †Second Orthopaedic Department, School of Medicine, National and Kapodistrian University of Athens, Konstantopouleio General Hospital, Athens, Greece.,§Department of Orthopaedic Surgery, McGill University, Jewish General Hospital, Montreal, Quebec, Canada
| | - Sotirios-Tsambikos Kazas
- †Second Orthopaedic Department, School of Medicine, National and Kapodistrian University of Athens, Konstantopouleio General Hospital, Athens, Greece
| | - Ioannis Sourlas
- †Second Orthopaedic Department, School of Medicine, National and Kapodistrian University of Athens, Konstantopouleio General Hospital, Athens, Greece
| | - Maria-Kyriaki Kaseta
- †Second Orthopaedic Department, School of Medicine, National and Kapodistrian University of Athens, Konstantopouleio General Hospital, Athens, Greece
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Tyrpenou E, Khoshbin A, Mohammad S, Schemitsch EH, Waddell JP, Atrey A. A Large-Scale Fifteen-Year Minimum Survivorship of a Cementless Triple Tapered Femoral Stem. J Arthroplasty 2020; 35:2161-2166. [PMID: 32284208 DOI: 10.1016/j.arth.2020.03.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/12/2020] [Accepted: 03/15/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND This study reports the long-term outcomes of a metaphyseal fit-and-fill cementless femoral component in total hip arthroplasty (THA) with a follow-up of 15-19 years. METHODS We conducted a retrospective review of 376 consecutive THAs (345 patients), using a triple tapered stem performed between 2000 and 2003 with a view to assessing survivorship and radiological and functional outcomes. Images were assessed for initial alignment, terminal osteolysis, or subsidence, while clinical outcomes were assessed using the St Michael's Hip Score. RESULTS Forty-five (11.9%) hips were lost to follow-up, 20 (5.31%) had died before our 15-year cutoff follow-up, and 4 (1.06%) had declined follow-up early on, leaving 307 hips (81.64%, 276 patients) available for both clinical and radiological follow-up at a minimum of 15 years (range 15-19). The mean age at the time of operation was 49.6 years (range 19-71) and the cohort included 131 (42.67%) male and 145 (47.23%) female patients. Seven stems (2.28%) were revised: 4 due to periprosthetic fractures, 2 for periprosthetic joint infection, and 1 for adverse reaction to metal debris at the trunnion. The St Michael's Hip Score improved from 14.2 (range 9-23) preoperatively to 22.3 (range 13 to 25) at the last documented follow-up (P = .000). Kaplan-Meier survivorship with stem revision for any reason as the end point was 97.70%. Worst-case scenario Kaplan-Meier survivorship, where all lost to follow-up are considered as failures, was 85.3%. No stem was revised for aseptic loosening. CONCLUSION This triple tapered stem in THA shows excellent survivorship beyond a minimum of 15 years.
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Affiliation(s)
- Evangelos Tyrpenou
- Division of Orthopaedics, University of Toronto, Saint Michael's Hospital, Toronto, Ontario, Canada
| | - Amir Khoshbin
- Division of Orthopaedics, University of Toronto, Saint Michael's Hospital, Toronto, Ontario, Canada
| | - Shoaib Mohammad
- School of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Emil H Schemitsch
- Department of Surgery, University of Western Ontario, London Health Sciences Centre - University Hospital, London, Ontario, Canada
| | - James P Waddell
- Division of Orthopaedics, University of Toronto, Saint Michael's Hospital, Toronto, Ontario, Canada
| | - Amit Atrey
- Division of Orthopaedics, University of Toronto, Saint Michael's Hospital, Toronto, Ontario, Canada
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Tyrpenou E, Malahias MA, Nikolaou V, Babis GC. Nontraumatic Fracture of a Custom-Made Wagner Cone Prosthesis Hip Stem: A Case Report. J Long Term Eff Med Implants 2017; 27:77-83. [PMID: 29604952 DOI: 10.1615/jlongtermeffmedimplants.2018022196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Fractures of modern cementless stems are almost extinct. However, extra small stems used for cases of developmental dysplasia of the hip (DDH) are still at risk for this complication. We review the fracture of a small size 11, custom-made Wagner cone prosthesis in a 70 year old female patient. The patient had a body-mass index (BMI) of 22.2, 7 yrs after undergoing a total hip arthroplasty. The procedure was undertaken to correct extreme high-riding congenital hip dysplasia. She presented with sudden pain due to a non-traumatic fracture of the stem, just below the proximal third region. At revision, it was apparent that the stem had a concrete distal fixation, whereas the proximal part was loose and probably failed due to cantilever bending fatigue, although the patient had small stature and a low BMI. We trephined out the distal portion, and the patient was successfully revised with a cemented DDH Co-Cr stem. It is our belief that care should be taken when choosing extra small, cementless implants with distal fixation. Cemented prostheses may offer a safe alternative in such cases.
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Affiliation(s)
- Evangelos Tyrpenou
- University of Toronto, Division of Orthopaedic Surgery, Saint Michael's Hospital, Toronto, Canada
| | - Michael-Alexander Malahias
- National & Kapodistrian University of Athens, School of Medicine, 2nd Orthopaedic Department, Konstantopouleio Hospital, Nea Ionia, 14233, Athens, Greece
| | - Vassilios Nikolaou
- National & Kapodistrian University of Athens, School of Medicine, 2nd Orthopaedic Department, Konstantopouleio Hospital, Nea Ionia, 14233, Athens, Greece
| | - George C Babis
- National & Kapodistrian University of Athens, School of Medicine, 2nd Orthopaedic Department, Konstantopouleio Hospital, Nea Ionia, 14233, Athens, Greece
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Nikolaou VS, Chytas D, Tyrpenou E, Babis GC. Two-level reconstruction of isolated fracture of the lesser tuberosity of the humerus. World J Clin Cases 2014; 2:219-223. [PMID: 24945011 PMCID: PMC4061313 DOI: 10.12998/wjcc.v2.i6.219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 03/16/2014] [Accepted: 05/14/2014] [Indexed: 02/05/2023] Open
Abstract
Fractures of the lesser tuberosity of the humerus are typically met in combination with other injuries of the shoulder. Case reports of isolated lesser tuberosity fractures are particularly rare and, consequently, therapeutic protocols have not yet been completely clarified. Conservative as well as surgical treatment has been recommended, while several operative techniques have been applied. We present a case of a 39-year-old man with an isolated lesser tuberosity fracture who was treated surgically in our institution. Due to fracture comminution, a two-level reconstruction technique with headless screws and buttress plate was applied. As far as we know, this method of fixation of this type of fracture has not been previously described in the literature. The patient tolerated the procedure well and excellent results were obtained at the latest follow-up.
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