1
|
Oetojo W, Lawler P, Farooq H, Pierrepont J, Schmitt D, Brown N. Accuracy of intraoperative approximation of pelvic tilt using preoperative standing radiographs. J Orthop 2024; 54:120-123. [PMID: 38560587 PMCID: PMC10979016 DOI: 10.1016/j.jor.2024.03.026] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 04/04/2024] Open
Abstract
Background Anterior approach surgeons who utilize intraoperative fluoroscopy often try to match a preoperative radiograph as a reference for intraoperative cup position. Every degree of inaccuracy in tilt leads to a roughly 0.7° change in anteversion. This study aimed to determine how closely pelvic tilt (PT) is approximated intraoperatively when compared to preoperative anteroposterior (AP) radiographs. Methods This was a retrospective review of 193 primary THA's done by 2 surgeons at an academic tertiary referral center between September 2021-January 2023. There were 24 patients excluded for distorted anatomy, post-traumatic arthritis, insufficient x-rays, or a sacroiliac joint that could not be visualized on film. Data collected included age and BMI. PT was calculated using the formula, Tilt = -(ln((B/A) x (1/0.483)))/0.051. Value A is the distance from the base of the SI joint to the superior margin of the obturator foramen; value B is the height of the obturator foramen. Results Mean preoperative PT was 0.2° versus intraoperative PT was 3.4° (p < 0.001). Mean absolute difference was 6.5°. 48% of patients (n = 81) had an absolute difference less than 5°, 31% (n = 52) between 5° and 10°, 14% (n = 24) between 10° and 15°, and 7% (n = 12) greater than 15°. There was no correlation between BMI or age and PT discrepancy. Conclusion Of the patients, 21% had a discrepancy of 10° or greater between their preoperative radiographs and intraoperative fluoroscopic images. Surgeons should be aware of potential errors in cup positioning and be particularly diligent in high-risk cases.
Collapse
Affiliation(s)
- William Oetojo
- Stritch School of Medicine, Loyola University, Maywood, IL, 60153, USA
| | - Patrick Lawler
- Stritch School of Medicine, Loyola University, Maywood, IL, 60153, USA
| | - Hassan Farooq
- Loyola University Health System, Department of Orthopaedic Surgery and Rehabilitation, Maywood, IL, 60153, USA
| | | | - Daniel Schmitt
- Loyola University Health System, Department of Orthopaedic Surgery and Rehabilitation, Maywood, IL, 60153, USA
| | - Nicholas Brown
- Loyola University Health System, Department of Orthopaedic Surgery and Rehabilitation, Maywood, IL, 60153, USA
| |
Collapse
|
2
|
Coden G, Schoeller L, Miller JP, Talmo C. Increased arthroplasty surgeon energy consumption when performing primary total hip arthroplasty compared to total knee arthroplasty. J Orthop 2024; 53:147-149. [PMID: 38601891 PMCID: PMC11001624 DOI: 10.1016/j.jor.2024.03.005] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 03/03/2024] [Accepted: 03/06/2024] [Indexed: 04/12/2024] Open
Abstract
Introduction Previously published studies have hypothesized that total hip arthroplasty (THA) requires the surgeon to expend more energy that total knee arthroplasty (TKA). However, techniques for performing these procedures have evolved. Therefore, we sought to compare if primary THA had increased energy expenditure compared to primary TKA. Methods We prospectively recorded the heart rate, respiratory rate, minute ventilation, cadence, and energy expenditure of a single fellowship-trained arthroplasty surgeon while performing primary THA and TKA on 372 patients. Patient demographics and operative records were reviewed to evaluate differences in the physical demands of each surgical case. Age (64.3 versus 65.9 years, p = 0.1) and gender (54.8% versus 51.0% female, p = 0.5) were similar between THA and TKA, but TKAs had a higher body mass index (31.1 versus 28.7 kg/m2, p < 0.001). Chi-square and independent-samples t-tests were used to compare cohorts. Significance was set at p < 0.05. Results THA tended to have 1.1 times longer operative time than TKA (102.2 versus 88.9 min, p < 0.001). THA had a statistically higher heart rate compared to TKA, although this is unlikely to be clinically significant (82.5 versus 80.7 beats/minute, p < 0.001). Respiratory Rate was 1.1 times higher (15.9 versus 14.9 respirations/minute, p < 0.001) and minute ventilation was 1.2 times higher (19.6 versus 16.9 L/min, p < 0.001) when performing THA. Cadence was 1.5 times higher when performing TKA (4.2 versus 2.8 steps/minute, p < 0.001). THA had a 1.2 times higher energy expenditure/patient (378.8 versus 312.0 Calories/patient, p < 0.001) and a 1.1 times higher energy expenditure/minute (3.7 versus 3.5 Calories/minute, p = 0.01) compared to TKA. Discussion THA is associated with longer operative time and increased energy expenditure per compared to TKA. Despite THA and TKA procedures becoming more efficient, arthroplasty surgery continues to have heavy physical burden on the surgeon. Further research is needed to understand ways to decrease surgeon energy expenditure and promote career longevity.
Collapse
Affiliation(s)
- Gloria Coden
- Department of Orthopaedic Surgery, New England Baptist Hospital, 125 Parker Hill Ave., Boston, MA, 02120, USA
| | - Lauren Schoeller
- Department of Research, New England Baptist Hospital, 125 Parker Hill Ave., Boston, MA, 02120, USA
| | - James Penn Miller
- Tufts University School of Medicine, 145 Harrison Ave., Boston, MA, 02111, USA
| | - Carl Talmo
- Department of Orthopaedic Surgery, New England Baptist Hospital, 125 Parker Hill Ave., Boston, MA, 02120, USA
| |
Collapse
|
3
|
Bourget-Murray J, Biniam B, Bhullar RS, Kim P, Gofton W, Beaulé PE, Grammatopoulos G. Early- to mid-term outcome of a short, cementless, titanium, flat, tapered stem for primary total hip arthroplasty: an independent series. Hip Int 2024; 34:327-335. [PMID: 38073478 PMCID: PMC11071641 DOI: 10.1177/11207000231216421] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 10/10/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION This study aims to: (1) describe perioperative complications amongst patients who underwent primary total hip arthroplasty (THA) using a short cementless, titanium, flat, tapered stem; (2) estimate this stem's early- to mid-term survival; (3) identify factors associated with revision arthroplasty; and (4) describe femoral remodelling at minimum 6 years postoperatively. METHODS A retrospective review of consecutive patients who underwent THA using a Taperloc Microplasty stem (Zimmer-Biomet, Warsaw, Indiana, USA) with minimum 2-year follow-up was performed. Surgeries were performed by 1 of 6, non-designer, arthroplasty surgeons between 2014 and 2018. Outcomes included perioperative complications including revision arthroplasty, and survival. Cox analysis was used to analyse the effect of different factors on risk of revision arthroplasty. Radiographs with 6-year follow-up served to describe femoral remodelling. RESULTS In 1205 patients, followed for 5.1 ± 1.4 years, the incidence of perioperative complication was 5.2% for which 29 patients (2.4%) required revision arthroplasty. The 5- and 7-year survival rates were 97.8% (95% CI, 96.9-98.5) and 97.0% (95% CI, 95.6-98.0), respectively. The only factor associated with revision arthroplasty was proximal femur morphology, as per Dorr classification (HR 1.24 [95%CI, 1.09-1.41]; p = 0.005). During radiographic assessment, 12% of patients showed ⩾25% of relative change in cortical thickness in Gruen zones 3 or 5. We observed calcar remodelling in 50% of radiographs while 10% showed presence of a pedestal sign. CONCLUSIONS The 7-year survivorship of the Taperloc Microplasty stem is within National Institute for Health and Care Excellence (NICE) guidelines. Patients ⩽65 years with osteoarthritis and Dorr A/B femoral morphology may be ideal candidates for THA with this stem. Femoral remodelling is common and not associated with adverse outcome.
Collapse
Affiliation(s)
- Jonathan Bourget-Murray
- Department of Surgery, Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Brook Biniam
- Department of Surgery, Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Raman S Bhullar
- Department of Surgery, Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Paul Kim
- Department of Surgery, Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Wade Gofton
- Department of Surgery, Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Paul E Beaulé
- Department of Surgery, Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - George Grammatopoulos
- Department of Surgery, Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
4
|
Kußmaul AC, Bruder J, Greiner A, Woiczinski M, Thorwächter C, Dotzauer F, Rubenbauer B, Linhart C, Böcker W, Becker CA. Uncemented hip revision cup as an alternative for T-type acetabular fractures: A cadaveric study. Orthop Traumatol Surg Res 2024; 110:103797. [PMID: 38142779 DOI: 10.1016/j.otsr.2023.103797] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 11/12/2023] [Accepted: 12/07/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND The current rise in elderly patients with compromised bone quality complicates the surgical treatment of acetabular T-type fractures (AO type 62B2 fractures). There is on ongoing discussion about the treatment options, mostly consisting of an open reduction and internal fixation (ORIF) with or without primary or secondary total hip arthroplasty (THA). Yet, these patients are oftentimes unable to fulfil weight-bearing restrictions and mostly present with an unavailability of a stable anchor site. Consequently, this study investigates the feasibility of a cementless hip revision cup for acetabular T-type fractures and compares its biomechanical properties to ORIF. HYPOTHESIS The cementless hip revision cup provides sufficient biomechanical stability under the simulation of full weight-bearing. PATIENTS AND METHODS The study compared two groups of human cadaveric hip bones with T-type fractures, of whom 6 subjects were treated with ORIF (6 male; mean age: 62±17years; mean body weight: 75±15) versus 6 subjects treated with a cementless hip revision cup (2 male; 69±12 years; 73±15kg). The group-assignment was controlled for comparable BMD results (mean BMD: ORIF 110±37 mg Ca-Ha/mL versus hip revision cup 134±32 mg Ca-Ha/mL). To compare for biomechanical stability cyclic loading was applied measuring the force and dislocation of the fracture gap at standardized bone loci using an all-electric testing machine and a 3D-ultrasound measuring system. RESULTS Comparing superior pubic ramus versus iliac wing (cementless hip revision cup versus ORIF [mean±standard deviation]: 5.8±2.0 versus 7.0±3.2; p=0.032) as well as sacral ala versus iliac wing (4.6±2.2 versus 6.4±3.7; p=0.002), the cementless revision cup achieved a significantly higher stability than the plate osteosynthesis. CONCLUSION Revision cup and ORIF withstood biomechanical loading forces exceeding full weight-bearing in this biomechanical study. The results of our study suggest that the cementless hip revision cup might be promising alternative to the current standard care of ORIF with or without primary THA. LEVEL OF EVIDENCE III; case control experimental study.
Collapse
Affiliation(s)
- Adrian Cavalcanti Kußmaul
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Jan Bruder
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Axel Greiner
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Matthias Woiczinski
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Christoph Thorwächter
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Fabian Dotzauer
- Department for Trauma and Orthopaedic Surgery, Kreiskliniken Dillingen Wertingen, Wertingen, Germany
| | - Bianka Rubenbauer
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Christoph Linhart
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Wolfgang Böcker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Christopher A Becker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany.
| |
Collapse
|
5
|
Fabrizio GM, Cardillo C, Egol A, Rozell JC, Schwarzkopf R, Aggarwal VK. Factors influencing patient selection of orthopaedic surgeons for total hip (THA) and total knee arthroplasty (TKA). Arch Orthop Trauma Surg 2024; 144:2057-2066. [PMID: 38641682 DOI: 10.1007/s00402-024-05314-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 03/30/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION The importance of identifying how patients choose their healthcare providers has grown with the prevalence of consumer-centric health insurance plans. There is currently a lack of studies exploring the factors associated with how patients select their hip and knee joint arthroplasty surgeons. The purpose of this study was to determine how patients find their arthroplasty providers and the relative importance of various arthroplasty surgeon characteristics. METHODS An electronic mail survey was sent to 3522 patients who had visited our institution for an arthroplasty surgeon office visit between August 2022 and January 2023. The survey consisted of multiple-choice questions, which aimed to inquire about the patients' referral sources for their current arthroplasty surgeon. In addition, patients were requested to rate the significance of 22 surgeon-related factors, on a scale of 1 (Not Important At All) to 5 (Very Important), in choosing their arthroplasty surgeon. RESULTS Of the 3522 patients that received the survey, 538 patients responded (15.3%). The most common referral sources were physician referral (50.2%), family/friend referral (27.7%), and self-guided research (24.5%). Of those that were referred by a physician, 54.4% of respondents were referred by another orthopaedic provider. Patients rated board certification (4.72 ± 0.65), in-network insurance status (4.66 ± 0.71), fellowship training (4.50 ± 0.81), bedside manner/personality (4.32 ± 0.86), and facility appearance (4.26 ± 0.81) as the five most important factors in picking an arthroplasty surgeon. Television (1.42 ± 0.83), print (1.50 ± 0.88), and online (1.58 ± 0.93) advertisements, along with social media presence (1.83 ± 1.08), and practice group size (2.97 ± 1.13) were rated as the five least important factors. CONCLUSION Patients are most likely to select an arthroplasty surgeon based on referral from other physicians, namely orthopedic surgeons, in addition to board certification status, in-network insurance, and fellowship training. Overall, these findings highlight the importance of physician credentials and reputation within the orthopaedic community in order to attract and retain patients.
Collapse
Affiliation(s)
- Grant M Fabrizio
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17 Street, New York, NY, 10003, USA
| | - Casey Cardillo
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17 Street, New York, NY, 10003, USA
| | - Alexander Egol
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17 Street, New York, NY, 10003, USA
| | - Joshua C Rozell
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17 Street, New York, NY, 10003, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17 Street, New York, NY, 10003, USA
| | - Vinay K Aggarwal
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17 Street, New York, NY, 10003, USA.
| |
Collapse
|
6
|
Perez Alamino L, Garabano G, Rodriguez J, Lopreite F, Pesciallo C. Total hip arthroplasty in patients under 50 years old: Does cementless fixation have better results? Rev Esp Cir Ortop Traumatol (Engl Ed) 2024:S1888-4415(24)00079-1. [PMID: 38643855 DOI: 10.1016/j.recot.2024.04.005] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 03/20/2024] [Accepted: 04/14/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND Cementless fixation for hip arthroplasties has increased in the last decades, particularly in younger patients. The purpose of this study was to compare the long-term results three different types of fixations in patients under 50years old. METHODS Cemented, hybrid and cementless fixations were assessed in patients under 50years old with a minimum follow-up of 8years. Loosening, demarcation, complications, and prosthesis survival were assessed. Functional analysis was performed with the modified Harris Hip Score and Visual analogue scale was collected. RESULTS Final series consisted in 222 patients. Significant improvement was observed regarding mHHS and VAS score in each group. We observed statistically significant difference regarding demarcation between the groups (P<.001). The higher rate of acetabular and femoral stem loosening was observed in the cemented (20.0%) and hybrid (18.9%) group. The lowest prosthesis survival rate after 16 years was observed in hybrid group (P<.001). CONCLUSION Total hip replacement has good long-term clinical and functional outcomes. The lowest rate of prosthesis survival was observed in hybrid group with 84.2% after 16years.
Collapse
Affiliation(s)
- L Perez Alamino
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina.
| | - G Garabano
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - J Rodriguez
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - F Lopreite
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - C Pesciallo
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| |
Collapse
|
7
|
Gupta A, Jain VK. Effect of weight-adjusted antimicrobial antibiotic prophylaxis on postoperative dosage and surgical site infection incidence in total joint arthroplasty. World J Orthop 2024; 15:318-320. [PMID: 38680674 PMCID: PMC11045471 DOI: 10.5312/wjo.v15.i4.318] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/29/2024] [Accepted: 03/01/2024] [Indexed: 04/16/2024] Open
Abstract
Surgical site infections (SSI) following total joint arthroplasty pose a significant concern for both providers and patients across the globe. Currently, administration of antimicrobial antibiotic prophylaxis is used throughout the world to reduce the incidence of SSI. However, the correct dosage and frequency of administration remains debatable. In this editorial, we emphasized the determination of the effect of administration of weight-adjusted antimicrobial antibiotic prophylaxis regime on the incidence of SSI and postoperative dosage reduction compared to the conventionally used regime during total joint arthroplasty. The results demonstrated similar efficacy between both regimes with respect to the incidence of SSI. In addition, weight-adjustment led to reduced postoperative dosage and has the potential to reduce chances of achieving lower therapeutic concentration, drug resistance, drug toxicity, and costs.
Collapse
Affiliation(s)
- Ashim Gupta
- Department of Orthopaedics and Regenerative Medicine, Future Biologics, Lawrenceville, GA 30043, United States
- Department of Orthopaedics, South Texas Orthopaedic Research Institute (STORI Inc.), Laredo, TX 78045, United States
- Department of Regenerative Medicine, BioIntegrate, Lawrenceville, GA 30043, United States
- Department of Orthopaedics and Regenerative Medicine, Regenerative Orthopaedics, Noida 201301, India
| | - Vijay Kumar Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi 110001, India
| |
Collapse
|
8
|
Yoon D, Doyle Z, Lee P, Hargreaves B, Stevens K. Clinical evaluation of isotropic MAVRIC-SL for symptomatic hip arthroplasties at 3 T MRI. Magn Reson Imaging 2024:S0730-725X(24)00130-9. [PMID: 38621551 DOI: 10.1016/j.mri.2024.04.017] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/07/2024] [Accepted: 04/12/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND 3D multi-spectral imaging (MSI) of metal implants necessitates relatively long scan times. OBJECTIVE We implemented a fast isotropic 3D MSI technique at 3 T and compared its image quality and clinical utility to non-isotropic MSI in the evaluation of hip implants. METHODS Two musculoskeletal radiologists scored images from coronal proton density-weighted conventional MAVRIC-SL and an isotropic MAVRIC-SL sequence accelerated with robust-component-analysis on a 3-point scale (3: diagnostic, 2: moderately diagnostic, 1: non-diagnostic) for overall image quality, metal artifact, and visualization around femoral and acetabular components. Grades were compared using a signed Wilcoxon test. Images were evaluated for effusion, synovitis, osteolysis, loosening, pseudotumor, fracture, and gluteal tendon abnormalities. Reformatted axial and sagittal images for both sequences were subsequently generated and compared for image quality with the Wilcoxon test. Whether these reformats increased diagnostic confidence or revealed additional pathology, including findings unrelated to arthroplasty that may contribute to hip pain, was also compared using the McNemar test. Inter-rater agreement was measured by Cohen's kappa. RESULTS 39 symptomatic patients with a total of 59 hip prostheses were imaged (mean age, 70 years ±9, 14 males, 25 females). Comparison scores between coronal images showed no significant difference in image quality, metal artifact, or visualization of the femur and acetabulum. Except for loosening, reviewers identified more positive cases of pathology on the original coronally-acquired isotropic sequence. In comparison of reformatted axial and sagittal images, the isotropic sequence scored significantly (p < 0.01) higher for overall image quality (3.0 vs 2.0) and produced significantly (p < 0.01) more cases of increased diagnostic confidence (42.4% vs 7.6%) or additional diagnoses (50.8% vs 22.9%). Inter-rater agreement was substantial (k = 0.798) for image quality. Mean scan times were 4.2 mins (isotropic) and 7.1 mins (non-isotropic). CONCLUSION Compared to the non-isotropic sequence, isotropic 3D MSI was acquired in less time while maintaining diagnostically acceptable image quality. It identified more pathology, including postoperative complications and potential pain-generating pathology unrelated to arthroplasty. This fast isotropic 3D MSI sequence demonstrates promise for improving diagnostic evaluation of symptomatic hip prostheses at 3 T while simultaneously reducing scan time.
Collapse
Affiliation(s)
- Daehyun Yoon
- Department of Radiology, Stanford University, Lucas MRS Center, 1201 Welch Road, Stanford, CA 94305, USA.
| | - Zoe Doyle
- Department of Radiology, Stanford University, Lucas MRS Center, 1201 Welch Road, Stanford, CA 94305, USA; Department of Radiology, VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA.
| | - Philip Lee
- Department of Electrical Engineering, Stanford University, 350 Jane Stanford Way, Stanford, CA 94305, USA.
| | - Brian Hargreaves
- Department of Radiology, Stanford University, Lucas MRS Center, 1201 Welch Road, Stanford, CA 94305, USA; Department of Electrical Engineering, Stanford University, 350 Jane Stanford Way, Stanford, CA 94305, USA; Department of Bioengineering, Stanford University, 443 Via Ortega, Rm 119, Stanford, CA 94305, USA.
| | - Kathryn Stevens
- Department of Radiology, Stanford University, Lucas MRS Center, 1201 Welch Road, Stanford, CA 94305, USA; Department of Orthopaedic Surgery, Stanford University, 430 Broadway Street, MC: 6342 , Pavilion C, 4th Floor, Redwood City, CA 94063, USA.
| |
Collapse
|
9
|
Gounot A, Charlot A, Guillon P, Schaefer A, Moslemi A, Boutroux P, Sautet A. The use of uncemented stems in femoral neck fractures in elderly patients: A comparative study of 671 cases. Orthop Traumatol Surg Res 2024:103878. [PMID: 38582221 DOI: 10.1016/j.otsr.2024.103878] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 10/07/2023] [Accepted: 02/14/2024] [Indexed: 04/08/2024]
Abstract
INTRODUCTION The use of cemented stems in elderly patients is associated with the risk of intraoperative embolic complications. Uncemented stems eliminate this risk, but their use is controversial because of the risk of mechanical complications, with estimated subsidence between 3.6 and 30% and periprosthetic fractures between 2.1 and 11% at 6 weeks. A retrospective multicenter comparative study was conducted using a propensity score analysis to evaluate mechanical performances of uncemented stems in femoral neck fractures in elderly patients to (1) compare the risk of mechanical complications and (2) assess the use of metaphyseal-anchored stems for this indication. HYPOTHESIS There is no difference in the risk of mechanical complications, intraoperatively or postoperatively, between these stems. MATERIALS AND METHODS We conducted a multicenter retrospective comparative study including 358 uncemented and 313 cemented stems. The mean age was 84.5 years [83.9-85.1]. The inclusion criteria were patients 70 years and older and a follow-up of at least 6 weeks. The primary endpoint was a composite endpoint comprised of stem subsidence≥2mm or periprosthetic fracture (up to 3 months postoperatively). The secondary endpoints were infection, stem subsidence≥2mm, and operative time. These endpoints were analyzed using a propensity score to control confounding factors. A secondary analysis used the same endpoints to compare metaphyseal-anchored (short stems) versus Corail-like stems. RESULTS After adjusting for the propensity score, we found 11.17% mechanical complications in the uncemented group (n=40, 5.59% subsidence, and 5.59% fractures) versus 13.42% for the cemented group (n=42, 7.99% subsidence, and 5.43% fractures). There was no statistically significant difference between the 2 values (Odds Ratio [OR]=0.64 [95% Confidence Interval [CI]: 0.14-2.85] [p=0.7]). The mortality rate due to cement embolism was 1%. There was no difference in the rate of subsidence (OR=0.55 [95% CI: 0.02-12.5] [p=0.7]), periprosthetic fracture (OR=0.65 [95% CI: 0.13-3.12] [p=0.7]) or infection (OR=0.71 [95% CI: 0.32-1.55] [p=0.4]). However, the operative times were longer in the cemented group (p=0.03 for hemiarthroplasties [mean additional time 16minutes] and p=0.02 for total hip arthroplasties [mean additional time 22minutes]). No difference was observed between the metaphyseal-anchored (short stems) and Corail-like stems regarding operative time, rate of infection, and rate of stem subsidence or periprosthetic fractures. DISCUSSION This is one of the first studies to highlight cemented stem subsidence when used for femoral neck fractures in elderly patients. Using uncemented stems in this indication is still warranted, especially since they do not bring about more mechanical complications in the first few months. Metaphyseal-anchored short stems seem to give the same results as "standard" stems. However, these findings need to be assessed in the longer term. LEVEL OF EVIDENCE III; retrospective comparative study.
Collapse
Affiliation(s)
- Alexandre Gounot
- Département de chirurgie orthopédique et traumatologique, GHI Le Raincy Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France.
| | - Anahita Charlot
- Département de chirurgie orthopédique et traumatologique, GHI Le Raincy Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France
| | - Pascal Guillon
- Département de chirurgie orthopédique et traumatologique, GHI Le Raincy Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France
| | - Augustin Schaefer
- Département d'anesthésie, hôpital Ambroise-Paré, Assistance publique-Hôpitaux de Paris (AP-HP), 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - Aymane Moslemi
- Département de chirurgie orthopédique et traumatologique, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris (AP-HP), 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Pierre Boutroux
- Département de chirurgie orthopédique et traumatologique, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris (AP-HP), 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Alain Sautet
- Département de chirurgie orthopédique et traumatologique, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris (AP-HP), 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| |
Collapse
|
10
|
Nerys-Figueroa J, Parsa A, Curley A, Charif S, Domb BG, Schinsky MF. Slightly reduced early subsidence with similar outcomes and complications rate in collared stems - A systematic review of randomized clinical trials. J Orthop 2024; 50:170-176. [PMID: 38328796 PMCID: PMC10845209 DOI: 10.1016/j.jor.2024.01.013] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/05/2024] [Accepted: 01/24/2024] [Indexed: 02/09/2024] Open
Abstract
Background There is a growing trend towards using femoral stems with a medial calcar collar during total hip arthroplasty (THA). Purpose Systematically review the literature comparing a femoral collared stem and femoral collarless stem on subsidence, patient-reported outcomes (PROs), and revision rate. Study design Systematic Review, Level of Evidence 1. Methods A literature search of Pubmed and Medline was according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized controlled trials that evaluated collared and collarless stems, subsidence and PROs for adult patients undergoing total hip arthroplasty (THA) were included. Additional data collection included patient demographics, stem-calcar contact, canal-fill ratio (CFR), stem orientation, surgical approach, Dorr Type, complications, and revisions. Results Five studies met inclusion criteria. 674 patients (704 hips) were included. Mean patient ages ranged 58.5-72.4 years old, and mean BMI ranged 26.6-29.8 kg/m2. Mean reported follow-up of the included clinical trials ranged 1-9.6 years. Two studies reported mean early subsidence at two weeks postoperatively, which was 0.36, 0.99 mm for collared stems and 0.52, 3.22 mm for collarless stems, proving to be statistically significant (P = 0.023), (P = 0.05). All studies demonstrated improved PROs at most recent follow-up. Revision rates ranged from 4 to 11.3 %, but these were not statistically significant. Conclusions Implantation of collared stems compared to collarless may reduce early post-operative subsidence, while no substantial effect on aseptic loosening, thigh pain, proximal femoral fracture, and revision is seen. When measuring patient-reported outcomes, the collared femoral stem was not superior to the collarless femoral stem as both resulted in similar improvement preoperatively to postoperative state.
Collapse
Affiliation(s)
| | - Ali Parsa
- American Hip Institute Research Foundation, Chicago, IL, 60018, USA
| | - Andrew Curley
- American Hip Institute Research Foundation, Chicago, IL, 60018, USA
| | - Sam Charif
- American Hip Institute Research Foundation, Chicago, IL, 60018, USA
| | - Benjamin G. Domb
- American Hip Institute Research Foundation, Chicago, IL, 60018, USA
- American Hip Institute, Chicago, IL, 60018, USA
| | - Mark F. Schinsky
- American Hip Institute Research Foundation, Chicago, IL, 60018, USA
- American Hip Institute, Chicago, IL, 60018, USA
| |
Collapse
|
11
|
Siroros N, Merfort R, Migliorini F, Lecouturier S, Leven S, Praster M, Hildebrand F, Eschweiler J. Evaluation of an early-stage prototype polyurethane femoral head implant for hip arthroplasty. J Orthop 2024; 50:49-57. [PMID: 38162259 PMCID: PMC10755531 DOI: 10.1016/j.jor.2023.11.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 11/22/2023] [Accepted: 11/26/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction Thi study evalautes a new bone-preserving femoral head cover that mimics the articular cartilage of the femoral head. Methods A specially developed polyurethane (PU) was evaluated in biocompatibility (cytotoxicity test) and mechanical response to tensile loading. In the cytotoxicity test, steam sterilized (SS) and ethylene oxide sterilized (EtO) PU samples were incubated separately in a cell culture medium. The seeded cell line MG-63 was then added to these sample-incubated cell culture mediums. One negative control group and one positive control group were also evaluated. The cells in each group were cultured for seven days before being quantified using the alamarBlue assay. In the mechanical test, the femoral head cover implants were separated into three groups of three samples. Each group represented a different implant insertion idea: direct insertion (uc sample) and another two insertion modes (is and ss samples) representing implants with enclosure mechanisms. The test consisted of distance-controlled cyclic tensile loadings followed by a failure test. Results The cytotoxicity test results show no significant difference in fluorescence intensity between the negative control, the three SS groups, and one EtO group (P > 0.05). However, the other two EtO groups exhibit significantly lower fluorescence intensity compared with the negative control (P < 0.05). In the mechanical test, the is samples have the highest cyclic loading force at 559.50 ± 51.41 N, while the uc samples exhibit the highest force in the failure test at 632.16 ± 50.55 N. There are no significant differences (P > 0.05) among the uc, is, and ss groups in terms of stiffness. Conclusion The cytotoxicity test and the mechanical experiment provide initial assessments of the proposed PU femoral head cover implant. The evaluation outcomes of this study could serve as a foundation for developing more functional design and testing methods, utilizing numerical simulations, and developing animal/clinical trials in the future.
Collapse
Affiliation(s)
- Nad Siroros
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Medical Center RWTH Aachen, Germany
- Biomedical Engineering Institute, Chiang Mai University, Thailand
- Department of Mechanical Engineering, Faculty of Engineering, Chiang Mai University, Thailand
| | - Ricarda Merfort
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Medical Center RWTH Aachen, Germany
| | - Filippo Migliorini
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Medical Center RWTH Aachen, Germany
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, 39100, Bolzano, Italy
| | - Sophie Lecouturier
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Medical Center RWTH Aachen, Germany
| | - Sophia Leven
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Medical Center RWTH Aachen, Germany
| | - Maximilian Praster
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Medical Center RWTH Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Medical Center RWTH Aachen, Germany
| | - Jörg Eschweiler
- Department of Trauma and Reconstructive Surgery, BG Hospital Bergmannstrost, Halle (Saale), Germany
| |
Collapse
|
12
|
Barbier O, Rassat R, Caubère A, Dubreuil S, Estour G. Short-stem total hip arthroplasty is equivalent to a standard-length stem procedure in an unselected population at mid-term follow-up. Int Orthop 2024; 48:1017-1022. [PMID: 37934276 DOI: 10.1007/s00264-023-06020-4] [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: 10/05/2023] [Accepted: 10/18/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE Limitations of standard-length femoral stems persist, including proximal-distal mismatch, non-ideal load transfer, loss of bone tissue, and perioperative fracture. Symbol® (Dedienne Santé, France) is a metaphyseal-engaging short-stem implant designed to address these issues in total hip arthroplasty (THA). While short stems have been well studied in selected and younger patients, it is unclear whether they offer advantages in an unselected population. We hypothesized that short femoral stems offer similar mid-term survivorship at five year minimum follow-up and function score to standard-length femoral stems, in an unselected patient population. METHODS We retrospectively reviewed a continuous unselected cohort of patients who undergone THA by one surgeon with a standard-length stem between November 2013 and October 2015, and a short stem between November 2015 and March 2017. We compared modified Harris Hip Score and Oxford Scores with a minimum follow-up of five years and procedural factors that could be associated with worse results with a short stem design. RESULTS There was no difference in survival rate between the two groups. Average Harris Hip Score and Oxford Scores at the last follow-up were comparable. A multivariate linear regression was performed to assess the relationship between modified Harrys Hip Score at five years post-operatively and the explanatory variables: age, body mass index, physical status score ASA (American Society of Anesthesiologists), and HHS pre-op. None was associated with the standard-length stem but for the short stem. CONCLUSION Short-stem implants provide good survival rate at mid-term; nevertheless, a steep learning curve is necessary to optimize the metaphyseal filling of the implant, especially for osteoporotic bone.
Collapse
Affiliation(s)
- Olivier Barbier
- Service de chirurgie orthopédique, HIA Sainte Anne, 2 boulevard Sainte Anne, 83000, Toulon, France.
| | - Robin Rassat
- Service de chirurgie orthopédique, HIA Sainte Anne, 2 boulevard Sainte Anne, 83000, Toulon, France
| | - Alexandre Caubère
- Service de chirurgie orthopédique, HIA Sainte Anne, 2 boulevard Sainte Anne, 83000, Toulon, France
| | - Sonia Dubreuil
- MEDI'CONSULTING, 4 rue du Couvent, 73240, Saint-Genix-sur-Guier, France
| | - Gilles Estour
- Médipôle de Savoie, 300 Av. des Massettes, 73190, Challes-les-Eaux, France
| |
Collapse
|
13
|
Diranzo-García J, Estrems-Díaz V, Garrido-Ferrer JF, Castillo-Ruipérez L, Zarzuela-Sánchez VM, Hernández-Ferrando L. AVIP Project (Prosthetic Virtual Friend): Study of clinical-functional outcomes and satisfaction with a mobile application in the perioperative management and follow-up of hip arthroplasty. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024:S1888-4415(24)00065-1. [PMID: 38508376 DOI: 10.1016/j.recot.2024.03.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/15/2024] [Accepted: 03/09/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVE To analyze the clinical, quality of life, and healthcare quality outcomes obtained in a series of patients undergoing total hip arthroplasty (THA), who were empowered and monitored using the AVIP application. These results will be compared with a control group followed through a standard protocol. MATERIAL AND METHOD Randomized clinical trial with parallel groups involving patients with an indication for THA. Clinical variables were measured and compared using the WOMAC and mHHS, pain assessed by the VAS, quality of life with the SF-12 test. Walking capabilities were analyzed using the Functional Gait Assessment Scale, along with satisfaction levels assessed through the SUCE questionnaire, and perceived anxiety levels related to the process. RESULTS A total of 68 patients were evaluated, with 31 patients in the AVIP group and 33 in the Control group completing the follow-up. Both groups demonstrated improvement in clinical outcomes based on the WOMAC and mHHS hip tests, a reduction in perceived pain, and an enhancement in quality of life according to the SF-12 test. Patients in the AVIP study group exhibited non-inferiority in clinical outcomes and satisfaction compared to the control group, as well as lower anxiety levels and improved walking capabilities after the first month of follow-up. Notably, 82.25% of the follow-up visits for this group were conducted remotely. CONCLUSION The implementation of a mHealth application like AVIP can be safely offered to selected patients undergoing hip arthroplasty, enabling effective monitoring and providing continuous information and training.
Collapse
Affiliation(s)
- J Diranzo-García
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, España.
| | - V Estrems-Díaz
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - J F Garrido-Ferrer
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - L Castillo-Ruipérez
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - V M Zarzuela-Sánchez
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - L Hernández-Ferrando
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| |
Collapse
|
14
|
Daher M, Haykal G, Aoun M, Moussallem M, Ghoul A, Tarchichi J, Sebaaly A. Pulsed lavage in joint arthroplasty: A systematic review and meta-analysis. World J Orthop 2024; 15:293-301. [PMID: 38596185 PMCID: PMC10999965 DOI: 10.5312/wjo.v15.i3.293] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 12/26/2023] [Accepted: 02/08/2024] [Indexed: 03/15/2024] Open
Abstract
BACKGROUND Knee and hip osteoarthritis affects millions of people around the world and is expected to rise even more in frequency as the population ages. Joint arthroplasty is the surgical management of choice in these articulations. Heterotopic ossification and radiolucent lines formation are two frequent problems faced in hip and knee replacements respectively. Some studies show that the usage of pulsed lavage may prevent their formation. AIM To compare pulsed lavage to standard lavage in joint arthroplasty. METHODS PubMed, Cochrane, and Google Scholar (page 1-20) were searched till December 2023. Only comparative studies were included. The clinical outcomes evaluated were the heterotopic ossification formation in hip replacements, radiolucent lines formation, and functional knee scores in knee replacements. RESULTS Four studies met the inclusion criteria and were included in this meta-analysis. Pulsed lavage was shown to reduce the formation of radiolucent lines (P = 0.001). However, no difference was seen in the remaining outcomes. CONCLUSION Pulsed lavage reduced the formation of radiolucent lines in knee replacements. No difference was seen in the remaining outcomes. Furthermore, the clinical significance of these radiolucent lines is poorly understood. Better conducted randomized controlled studies and cost-effectivity studies are needed to reinforce these findings.
Collapse
Affiliation(s)
- Mohammad Daher
- Department of Orthopedics, Saint Joseph University, Beirut 1001, Lebanon
| | - Gaby Haykal
- Department of Orthopedics, Saint Joseph University, Beirut 1001, Lebanon
| | - Marven Aoun
- Department of Orthopedics, Saint Joseph University, Beirut 1001, Lebanon
| | - Marc Moussallem
- Department of Orthopedics, Saint Joseph University, Beirut 1001, Lebanon
| | - Ali Ghoul
- Department of Orthopedics, Saint Joseph University, Beirut 1001, Lebanon
| | - Jean Tarchichi
- Department of Orthopedics, Saint Joseph University, Beirut 1001, Lebanon
| | - Amer Sebaaly
- Department of Orthopedics, Saint Joseph University, Beirut 1001, Lebanon
| |
Collapse
|
15
|
Harris LK, Troelsen A, Terluin B, Gromov K, Ingelsrud LH. Minimal important change thresholds change over time after knee and hip arthroplasty. J Clin Epidemiol 2024:111316. [PMID: 38458544 DOI: 10.1016/j.jclinepi.2024.111316] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE The minimal important change (MIC) reflects what patients, on average, consider the smallest improvement in a score that is important to them. MIC thresholds may vary across patient populations, interventions used, post-treatment time points and derivation methods. We determine and compare MIC thresholds for the Oxford Knee and Hip Score (OKS/OHS) at 3 months postoperatively to 12- and 24-month thresholds in patients undergoing knee or hip arthroplasty. STUDY DESIGN AND SETTING This cohort study used data from patients undergoing total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA), or total hip arthroplasty (THA) at a public hospital between February 2016 and February 2023. At 3, 12, and 24 months postoperatively, patients responded to the OKS/OHS and a 7-point anchor question determining experienced changes in knee or hip pain and functional limitations. We used the adjusted predictive modeling method that accounts for the proportion improved and the reliability of the anchor question to determine MIC thresholds and their mean differences between time points. RESULTS Complete data were obtained from 695/957 (73%), 1179/1703 (69%), and 1080/1607 (67%) patients undergoing TKA, 474/610 (78%), 438/603 (73%), and 355/507 (70%) patients undergoing UKA, and 965/1315 (73%), 978/1409 (69%), and 1059/1536 (69%) patients undergoing THA at 3, 12, and 24 months, respectively. The median age ranged from 68 to 70 years, and 55% to 60% were females. The proportions improved ranged between 83% and 95%. The OKS/OHS MIC thresholds were 0.1, 4.2, and 5.1 for TKA, 1.8, 5.6, and 3.4 for UKA, and 1.3, 6.1, and 6.0 for THA at 3, 12, and 24 months postoperatively, respectively. The reliability ranged between 0.64 and 0.82, and the MIC values increased between 3 and 12 months but not between 12 and 24 months. CONCLUSION Any absence of deterioration in pain and function is considered important at 3 months after knee or hip arthroplasty. Increasing thresholds over time suggest patients raise their standards for what constitutes a minimal important improvement over the first postoperative year. Besides improving our understanding of patients' views on postoperative outcomes, these clinical thresholds may aid in interpreting registry-based treatment outcome evaluations.
Collapse
Affiliation(s)
- Lasse K Harris
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
| | - Anders Troelsen
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Berend Terluin
- Department of General Practice, Amsterdam UMC Location, Vrije Universiteit Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Kirill Gromov
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Lina H Ingelsrud
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| |
Collapse
|
16
|
Ciatti C, Maniscalco P, Bosio S, Puma Pagliarello C, Bianchi G, Quattrini F. Pseudotumor from ceramic-on-ceramic total hip arthroplasty. Int J Surg Case Rep 2024; 116:109374. [PMID: 38401324 PMCID: PMC10943669 DOI: 10.1016/j.ijscr.2024.109374] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/26/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Total hip arthroplasty is one of the most performed surgical interventions in the world. Adverse local tissue reactions and pseudotumors are infrequent but dangerous eventualities, which are often related with metal-on-metal or metal-on-polyethylene implants. This study wants to highlight how adverse local tissue reactions and pseudotumors must be taken into consideration during the diagnostic process. CASE PRESENTATION We report the case of a patient with ceramic-on-ceramic modular total hip arthroplasty with titanium neck. 12 years after surgery, he complained of pain and swelling on the hip. Diagnostic tests revealed the presence of a bulky pseudotumor. During the revision surgery biopsy samples were taken and microscopical analysis revealed the presence of fibrous tissue, fibrin hemorrhagic collections, histiocytes and chronic inflammation due to foreign body, with dark refractive material of an exogenous nature. CLINICAL DISCUSSION The possible formation of pseudotumor and metallosis reactions in hip prostheses with metal-on-metal coupling or in couplings with polyethylene is known. Many cases of pseudotumor are reported after revision of prostheses due to the breakage of ceramic components, but we did not observe any damage or corrosion of the prosthetic elements; on the other hand, we noticed an excessive retroversion of the femoral neck. It may be possible that an accurate microscopic analysis could clarify the failure of this implant. CONCLUSION To date ceramic-ceramic coupling remains the gold standard in terms of resistance and durability for hip arthroplasty but there is still a gap of knowledge in the field of tribology and individual immune response mechanisms.
Collapse
Affiliation(s)
- Corrado Ciatti
- U.O.C. Orthopedics and Traumatology, Guglielmo Da Saliceto Hospital, AUSL Piacenza, Italy; University of Parma
| | - Pietro Maniscalco
- U.O.C. Orthopedics and Traumatology, Guglielmo Da Saliceto Hospital, AUSL Piacenza, Italy; University of Parma.
| | - Silvia Bosio
- Pathology Unit, Onco-Hematologic Department, Guglielmo Da Saliceto Hospital, AUSL Piacenza, Piacenza, Italy
| | | | - Giuseppe Bianchi
- Clinica Ortopedica III, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Fabrizio Quattrini
- U.O.C. Orthopedics and Traumatology, Guglielmo Da Saliceto Hospital, AUSL Piacenza, Italy; University of Parma
| |
Collapse
|
17
|
Kenanidis E, Boutos P, Voulgaris G, Zgouridou A, Gkoura E, Gamie Z, Papagiannakis G, Tsiridis E. Effectiveness of virtual reality compared to video training on acetabular cup and femoral stem implantation accuracy in total hip arthroplasty among medical students: a randomised controlled trial. Int Orthop 2024; 48:625-633. [PMID: 37993676 PMCID: PMC10901922 DOI: 10.1007/s00264-023-06038-8] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/10/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE Virtual reality (VR) training effectiveness in improving hip arthroplasty surgical skills requires further evaluation. We hypothesised VR training could improve accuracy and the time taken by medical students compared to a control group with only video teaching. METHODS This single-centre randomized controlled clinical trial collected data from March to June 2023. Surgically naïve volunteer undergraduate medical students performed three sessions on a VR training platform, either cup (VR-Cup=Control-Stem) or stem (VR-Stem=Control-Cup) implantation. The primary outcome was the mean difference between predefined cup inclination (60°) and stem anteversion (20°) compared to the actual implanted values in sawbones between VR and control groups. Secondary outcomes were task completion time and mistake number between the groups. RESULTS A total of 101 students participated (VR-Cup 47, VR-Stem 54). Groups did not significantly differ concerning age (p = 0.879), gender (p = 0.408), study year (p = 0.938), previous VR use (p = 0.269) and baseline medical and procedural knowledge. The VR-Cup implanted the cup closer to the intended target (p < 0.001) and faster than the Control-Cup group (p = 0.113). The VR-Stem implanted the stem closer to the intended target (p = 0.008) but not faster than the Control-Cup group (p = 0.661). Stem retroversion was commoner in the Control-Stem than in the VR-Stem group (p = 0.016). CONCLUSIONS VR training resulted in higher rates of accurate procedure completion, reduced time and fewer errors compared to video teaching. VR training is an effective method for improving skill acquisition in THA. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05807828.
Collapse
Affiliation(s)
- Eustathios Kenanidis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece.
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, GR, Greece.
| | - Panagiotis Boutos
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, GR, Greece
| | - Grigorios Voulgaris
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, GR, Greece
| | - Aikaterini Zgouridou
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, GR, Greece
| | - Eleni Gkoura
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, GR, Greece
| | - Zakareya Gamie
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, GR, Greece
| | - George Papagiannakis
- Institute of Computer Science, Foundation for Research and Technology (FORTH), Heraklion, Greece
- Department of Computer Science, University of Crete, Heraklion, Greece
| | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, GR, Greece
| |
Collapse
|
18
|
Burdick GB, Maier LM, Kuhlmann NA, Ayoola AS, Fathima B, Muh SJ. Clinical characteristics and long-term outcomes of septic arthritis of the native hip joint: a 20-year retrospective review. Hip Int 2024; 34:194-200. [PMID: 37728010 DOI: 10.1177/11207000231200175] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND The primary purpose of this retrospective case series was to describe the prevalence and outcomes of single-stage hip arthroplasty in patients who were previously treated for septic arthritis of the native hip at our institution over a 20-year period. This study also examined rates of persistent or recurrent infection, reoperation, and mortality for septic arthritis of the native hip. METHODS Adult patients treated for septic arthritis of the native hip at our institution from 1995 to 2015 were retrospectively identified. Exclusion criteria included age <18 years, missing or incomplete medical records, treatment at an outside institution, and prior surgery of the hip. RESULTS 97 patients were included in this study. 3 patients (3.1%) who were previously treated for septic arthritis of the native hip underwent single-stage hip arthroplasty an average of 40 ± 25 months from the date of infection. 3 of the 18 (16.7%) patients who were treated with resection arthroplasty underwent second-stage joint reconstruction. There were no cases of periprosthetic joint infection (PJI). 1 patient who underwent single-stage arthroplasty experienced implant-induced metallosis, necessitating removal of the implant. There were no other cases of revision arthroplasty. CONCLUSIONS The prevalence of single-stage hip arthroplasty in patients with a history of septic arthritis of the native hip joint was 3.1%, which is higher than the prevalence of hip arthroplasty in the United States general population, suggesting that a history of septic arthritis may increase the risk of requiring hip arthroplasty. In the small number of patients who went on to receive a hip replacement, there were no reported cases of PJI. This study suggests that hip arthroplasty is a viable option for patients with symptomatic osteoarthritis and a history of septic arthritis of their hip.
Collapse
Affiliation(s)
- Gabriel B Burdick
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Lindsay M Maier
- Department of Orthopaedic Surgery, Henry Ford Health, Detroit, MI, USA
| | - Noah A Kuhlmann
- Department of Orthopaedic Surgery, Henry Ford Health, Detroit, MI, USA
| | - Ayooluwa S Ayoola
- Department of Orthopaedic Surgery, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | - Bushra Fathima
- Department of Orthopaedic Surgery, Henry Ford Health, Detroit, MI, USA
| | - Stephanie J Muh
- Department of Orthopaedic Surgery, Henry Ford Health, Detroit, MI, USA
| |
Collapse
|
19
|
Ramanath SK, Tribhuvan T, Chandran U, Shah RH, Kaushik A, Patil S. Mid-term Results of Total Hip Arthroplasty for Posttraumatic Osteoarthritis after Acetabular Fracture. Hip Pelvis 2024; 36:37-46. [PMID: 38432687 DOI: 10.5371/hp.2024.36.1.37] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 03/05/2024] Open
Abstract
Purpose The prognosis of total hip replacement (THR) after open reduction and internal fixation (ORIF) versus THR following non-operative treatment of acetabular fractures is unclear. Few studies have been conducted in this regard. Therefore, the purpose of the current study was to perform an assessment and compare the functional outcomes for study subjects in the ORIF and non-ORIF groups during the follow-up period compared to baseline. Materials and Methods This longitudinal comparative study, which included 40 patients who underwent THR for either posttraumatic arthritis after fixation of an acetabular fracture or arthritis following conservative management of a fracture, was conducted for 60 months. Twenty-four patients had undergone ORIF, and 16 patients had undergone nonoperative/conservative management for acetabular fractures. Following THR, the patients were followed up for monitoring of functional outcomes for the Harris hip score (HHS) and comparison between the ORIF and non-ORIF groups was performed. Results The HHS showed significant improvement in both ORIF and non-ORIF groups. At the end of the mean follow-up period, no significant variation in scores was observed between the groups, i.e., ORIF group (91.61±6.64) compared to non-ORIF group (85.74±11.56). A significantly higher number of re-interventions were required for medial wall fractures and combined fractures compared to posterior fractures (P<0.05). Conclusion THR resulted in improved functional outcome during follow-up in both the groups; however, the ORIF group was observed to have better functional outcome. Re-intervention was not required for any of the posterior fractures at the end of the mean follow-up period.
Collapse
Affiliation(s)
| | - Tejas Tribhuvan
- Department of Orthopedics, M S Ramaiah Medical College and Hospital, Bangalore, India
| | - Uday Chandran
- Department of Orthopedics, The Oxford Medical College, Hospital and Research Centre, Bangalore, India
| | - Rahul Hemant Shah
- Department of Orthopedics, M S Ramaiah Medical College and Hospital, Bangalore, India
| | - Ajay Kaushik
- Department of Orthopedics, M S Ramaiah Medical College and Hospital, Bangalore, India
| | - Sandesh Patil
- Department of Orthopedics, M S Ramaiah Medical College and Hospital, Bangalore, India
| |
Collapse
|
20
|
He M, Zhu Q, Yin D, Duan Y, Sun P, Fang Q. Changes in serum inflammatory factors after hip arthroplasty and analysis of risk factors for prosthesis loosening. Am J Transl Res 2024; 16:557-566. [PMID: 38463599 PMCID: PMC10918134] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/05/2023] [Indexed: 03/12/2024]
Abstract
OBJECTIVE To explore the relationship of serum levels of IL-1β, IL-6, and TNF-α with prosthesis loosening after hip arthroplasty, and to establish a predictive model for prosthesis loosening. METHODS We retrospectively analyzed the data of 501 patients who underwent hip arthroplasty in Xi'an International Medical Center Hospital from January 2020 to August 2022. Based on radiological diagnosis, the patients were divided into a prosthesis loosening group and a non-loosening group. Clinical data including postoperative serum levels of inflammatory cytokines were collected. Univariant analysis, Lasso regression, decision tree, and random forest models were used to screen feature variables. Based on the screening results, a nomogram model for predicting the risk of prosthesis loosening was established and then validated using ROC curve, and calibration curve, and other methods. RESULTS There were 50 cases in the loosening group and 451 cases in the non-loosening group. Postoperative levels of IL-1β, IL-6, and TNF-α were found to be significantly higher in the loosening group (P<0.0001). Univariant analysis showed that osteoporosis and postoperative infection were risk factors for prosthesis loosening (P<0.001). The machine learning algorithm identified osteoporosis, postoperative infection, IL-1β, IL-6, and TNF-α as 5 relevant variables. The predictive model based on these 5 variables exhibited an area under the ROC curve of 0.763. The calibration curve and DCA curve verified the accuracy and practicality of the model. CONCLUSION Serum levels of IL-1β, IL-6, and TNF-α were significantly elevated in patients with postoperative prosthesis loosening. Osteoporosis, postoperative infection, and inflammatory cytokines are independent risk factors for prosthesis loosening. The predictive model we established through machine learning can effectively determine the risk of prosthesis loosening. Monitoring inflammatory cytokines and postoperative infections, combined with prevention of osteoporosis, can help reduce the risk of prosthesis loosening.
Collapse
Affiliation(s)
- Ming He
- Department of Arthrology I, Xi'an International Medical Center Hospital No. 777 Xitai Road, Chang'an District, Xi'an 710100, Shaanxi, China
| | - Qingsheng Zhu
- Department of Arthrology I, Xi'an International Medical Center Hospital No. 777 Xitai Road, Chang'an District, Xi'an 710100, Shaanxi, China
| | - Dayu Yin
- Department of Arthrology I, Xi'an International Medical Center Hospital No. 777 Xitai Road, Chang'an District, Xi'an 710100, Shaanxi, China
| | - Yonghong Duan
- Department of Arthrology I, Xi'an International Medical Center Hospital No. 777 Xitai Road, Chang'an District, Xi'an 710100, Shaanxi, China
| | - Pengxiao Sun
- Department of Arthrology I, Xi'an International Medical Center Hospital No. 777 Xitai Road, Chang'an District, Xi'an 710100, Shaanxi, China
| | - Qing Fang
- Department of Arthrology I, Xi'an International Medical Center Hospital No. 777 Xitai Road, Chang'an District, Xi'an 710100, Shaanxi, China
| |
Collapse
|
21
|
Amin S, Hasanin A, Mansour R, Mostafa M, Zakaria D, Arafa AS, Yassin A, Ziada H. Oral midodrine for prophylaxis against post-spinal anesthesia hypotension during hip arthroplasty in elderly population: a randomized controlled trial. BMC Anesthesiol 2024; 24:64. [PMID: 38355397 PMCID: PMC10865567 DOI: 10.1186/s12871-024-02442-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/01/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND We aimed to evaluate the efficacy of midodrine as a prophylaxis against post-spinal hypotension in elderly patients undergoing hip arthroplasty. METHODS This randomized controlled trial included elderly patients undergoing hip arthroplasty under spinal anesthesia. Ninety minutes before the procedure, patients were randomized to receive either 5-mg midodrine or placebo (metoclopramide). After spinal anesthesia, mean arterial pressure (MAP) and heart rate were monitored every 2 min for 20 min then every 5 min until the end of the procedure. Post-spinal hypotension (MAP < 80% baseline) was treated with 10 mg ephedrine. The primary outcome was intraoperative ephedrine consumption. Secondary outcomes were the incidence of post-spinal hypotension, bradycardia, and hypertension (MAP increased by > 20% of the baseline reading). RESULTS We analyzed 29 patients in the midodrine group and 27 in the control group. The intraoperative ephedrine consumption was lower in the midodrine group than in the control group (median [quartiles]: 10 [0, 30] mg versus 30 [20, 43] mg, respectively, P-value: 0.002); and the incidence of intraoperative hypotension was lower in the midodrine group than that in the control group. The incidence of hypertension and bradycardia were comparable between the two groups. CONCLUSION The use of 5 mg oral midodrine decreased the vasopressor requirements and incidence of hypotension after spinal anesthesia for hip surgery in elderly patients. CLINICAL TRIAL REGISTRATION This study was registered on September 22, 2022 at clinicaltrials.gov registry, NCT05548985, URL: https://classic. CLINICALTRIALS gov/ct2/show/NCT05548985 .
Collapse
Affiliation(s)
- Sarah Amin
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Hasanin
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Rehab Mansour
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Maha Mostafa
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dina Zakaria
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amany S Arafa
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Akram Yassin
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hisham Ziada
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| |
Collapse
|
22
|
Bordino V, Vicentini C, Cornio AR, Gianino MM, Zotti CM. Hip prosthesis and colon surgery, a decade of surveillance on surgical site infections in Italy, a prospective cohort study: rates, trends, and disease burden in DALYs. Antimicrob Resist Infect Control 2024; 13:17. [PMID: 38347612 PMCID: PMC10863245 DOI: 10.1186/s13756-024-01377-6] [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: 09/21/2023] [Accepted: 02/06/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Surveillance programs are a key element of interventions aiming to reduce rates of surgical site infections (SSIs). The aim of this study was to evaluate rates and trends of SSIs following hip arthroplasty and colon surgery procedures in Piedmont, a region in North-western Italy, from 2010 to 2019. Further, we aimed to assess the burden of SSIs in terms of Disability-Adjusted Life-Years (DALYs). METHODS A prospective cohort study was conducted among 42 hospitals participating in the surveillance system. Procedure-specific SSI rates were calculated and the 2010 - 2019 trend was evaluated using Spearman's Rho test. Patients were stratified according to age, sex and infection risk index according to life expectancy in order to calculate DALYs, using a modified version of the ECDC's BCoDE toolkit: disease models for both procedure types were adapted to incorporate long-term disability associated with SSIs. RESULTS Overall, 20,356 hip arthroplasty and 11,011 colon surgery procedures were monitored over 10 years and were included in our analyses. Hip arthroplasty and colon surgery cumulative SSIs rates were 1.5% and 8% respectively. Using the Spearman's Rho test, we evaluated a significant downward trend from 2010 to 2019 for colon surgery interventions (Rs - 0.7, p < 0.05), while there was no difference for hip arthroplasty. (Rs - 0.04, p > 0.05). Regarding disease burden, a total of 955.3 (95%CI 837.7-1102.98) and 208.65 (95%CI 180.87-240.90) DALYs were calculated for SSIs following hip arthroplasty, whilst 76.58 (95%CI 67.15-90.71) and 38.62 (95% CI 33.09-45.36) DALYs for SSIs in colon surgery, in 2010 and 2019, respectively. CONCLUSIONS The significant decrease both in terms of incidence and DALYs found in this study for colon surgery and the stability for hip arthroplasty support the role of surveillance networks in improving quality of care. Despite the smaller SSI rate, the burden associated with SSIs following hip arthroplasty was higher, which is important to consider in light of the aging population in Italy.
Collapse
Affiliation(s)
- Valerio Bordino
- Paediatrics and Public Health Sciences Department, University of Turin, Via Santena 5bis, 10126, Turin, Italy.
| | - Costanza Vicentini
- Paediatrics and Public Health Sciences Department, University of Turin, Via Santena 5bis, 10126, Turin, Italy
| | - Alessandro Roberto Cornio
- Paediatrics and Public Health Sciences Department, University of Turin, Via Santena 5bis, 10126, Turin, Italy
| | - Maria Michela Gianino
- Paediatrics and Public Health Sciences Department, University of Turin, Via Santena 5bis, 10126, Turin, Italy
| | - Carla Maria Zotti
- Paediatrics and Public Health Sciences Department, University of Turin, Via Santena 5bis, 10126, Turin, Italy
| |
Collapse
|
23
|
Çakmak MF, Bayram S, Birişik F, Ayik Ö, Şahinkaya T, Ergin ÖN, Öztürk İ. The effects of modified hardinge approach on hip muscle strength in patients with primary hip arthroplasty: a patient evaluation with isokinetic strength test and gait analyses. Eur J Orthop Surg Traumatol 2024; 34:1209-1218. [PMID: 38010444 DOI: 10.1007/s00590-023-03778-6] [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: 08/16/2023] [Accepted: 11/01/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE Numerous factors affect abductor strength after Total hip arthroplasty (THA), including surgical technique, prosthesis type, postoperative rehabilitation program, and preoperative patient condition. We prospectively investigated the effects of the modified Hardinge approach on hip muscle strength, which was evaluated using the isokinetic test, functional results, and gait function of patients who underwent primary THA. METHODS The hip muscles strength were measured using an isokinetic dynamometer. The primary outcomes of the present study were measurement of isokinetic strength of hip abductor muscle strengths using an isokinetic evaluator and gait analyses preoperatively and at 6 months postoperatively in 27 patients. RESULTS Isokinetic muscle strength test, abductor and other hip circumference groups achieved the preoperative muscle strength at 3 months postoperatively, and the postoperative sixth month values showed a statistically significant improvement compared with the preoperative and third month values. In gait analyze, our temporospatial data showed a slight regression at postoperative 3 months but reached the same values at 6 months postoperatively. Kinematic data showed a significant regression, but the data were not compared with those in the preoperative period. CONCLUSIONS Adequate muscle strength and physiological gait pattern, similar to the preoperative status, can be achieved at 6 months postoperatively. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Mehmet Fevzi Çakmak
- Department of Orthopedics and Traumatology, Faculty of Medicine, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - Serkan Bayram
- Department of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, 34050, Çapa Fatih Istanbul, Turkey.
| | - Fevzi Birişik
- Department of Orthopaedics and Traumatology, Istanbul Research and Training Hospital University of Health Sciences, Istanbul, Turkey
| | - Ömer Ayik
- Department of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, 34050, Çapa Fatih Istanbul, Turkey
| | - Türker Şahinkaya
- Department of Sports Medicine, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ömer Naci Ergin
- Department of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, 34050, Çapa Fatih Istanbul, Turkey
| | - İrfan Öztürk
- Department of Orthopedics and Traumatology, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
| |
Collapse
|
24
|
Cantrell AJ, Forrester DA, Crawford AW, Morris C, Thakral R. Intraprosthetic Dislocation of a Modular Dual-Mobility Total Hip Arthroplasty With Posterior Migration of the Polyethylene Liner. Arthroplast Today 2024; 25:101290. [PMID: 38298810 PMCID: PMC10827604 DOI: 10.1016/j.artd.2023.101290] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/28/2023] [Accepted: 11/06/2023] [Indexed: 02/02/2024] Open
Abstract
Dual-mobility (DM) implants have been used in total hip arthroplasty since 1974. Modular DM implants have seen an increase in use in primary and revision total hip arthroplasties given the theoretical decreased dislocation rate. DM constructs have 2 articulation sites, one between the acetabular shell and a polyethylene liner, as well as one between the liner and the femoral head component. However, dislocations with modular DM implant dislocations can still occur. These dislocations occur via an extraprosthetic or intraprosthetic mechanism. Intraprosthetic dislocation is a phenomenon in which the smaller femoral head dissociates from the polyethylene liner. We present a case of intraprosthetic dislocation in an 81-year-old female with migration of the polyethylene liner into her gluteal muscles after 2 attempted closed reductions.
Collapse
Affiliation(s)
- Austin J. Cantrell
- Department of Orthopedic Surgery and Rehabilitation, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - D. Alex Forrester
- Department of Orthopedic Surgery and Rehabilitation, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Alexander W. Crawford
- Department of Orthopedic Surgery and Rehabilitation, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Cade Morris
- Department of Orthopedic Surgery and Rehabilitation, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Rishi Thakral
- Department of Orthopedic Surgery and Rehabilitation, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| |
Collapse
|
25
|
Moore MC, Dubin JA, Bains SS, Hameed D, Nace J, Delanois RE. Trends in deep vein thrombosis prophylaxis after total hip arthroplasty: 2016 to 2021. J Orthop 2024; 48:77-83. [PMID: 38059214 PMCID: PMC10696429 DOI: 10.1016/j.jor.2023.11.030] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/12/2023] [Indexed: 12/08/2023] Open
Abstract
Introduction Venous thromboembolism (VTE) has long been acknowledged as a potential complication of total hip arthroplasty (THA) contributing to heightened patient morbidity, mortality, and substantial healthcare costs. We aimed to: 1) assess trends in VTE prophylaxis utilization between 2016 and 2021; 2) determine the incidence of postoperative VTE and transfusions; and 3) identify independent risk factors for 90-day VTE and transfusion risks following THA in relation to the use of aspirin, dabigatran, enoxaparin, rivaroxaban, and warfarin. Methods A national, all-payer database was queried from January 1, 2016 and December 31, 2022. Use trends for aspirin, enoxaparin, rivaroxaban, dabigatran, and warfarin as thromboprophylaxis following THA was assessed. Incidence of ninety-day postoperative outcomes assessed included rates of 90-day postoperative VTE and transfusion. Results From 2016 to 2021, aspirin (n = 36,346) was the most used agent for VTE prophylaxis after THA, followed by dabigatran (n = 13,065), rivaroxaban (n = 11,790), enoxaparin (n = 11,380), and warfarin (n = 6326). Independent risk factors for 90-day VTE included CKD, COPD, CHF, obesity, dabigatran, enoxaparin, rivaroxaban, and warfarin (all p < 0.05). Conclusion Aspirin was used with increasing frequency and demonstrated lower rates of VTE and transfusion following THA, compared to dabigatran, enoxaparin, rivaroxaban, and warfarin. These findings seem to indicate that the increasing use of aspirin in VTE prophylaxis has been accomplished in appropriately selected patients.
Collapse
Affiliation(s)
- Mallory C. Moore
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Jeremy A. Dubin
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Sandeep S. Bains
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Daniel Hameed
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - James Nace
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Ronald E. Delanois
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| |
Collapse
|
26
|
Kappenschneider T, Bammert P, Maderbacher G, Greimel F, Parik L, Holzapfel DE, Schraag AD, Götz J, Michalk K, Grifka J, Meyer M. The impact of primary total hip and knee replacement on frailty: an observational prospective analysis. BMC Musculoskelet Disord 2024; 25:78. [PMID: 38245710 PMCID: PMC10799496 DOI: 10.1186/s12891-024-07210-w] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 01/16/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Osteoarthritis is a prevalent condition in frail older adults that requires hip or knee replacement in many patients. The aim of the study was to determine the impact of hip and knee arthroplasty on frailty. METHODS In this prospective short-term study, we used data from 101 participants of the ongoing Special Orthopaedic Geriatrics (SOG) trial, funded by the German Federal Joint Committee (GBA). Frailty, measured by Fried's Physical Frailty Phenotype (PFP), was assessed preoperatively, 7 days postoperatively, 4-6 weeks and 3 months after hip and knee arthroplasty. ANOVA with repeated measures and post-hoc tests for the subgroups were used for the statistical analysis. RESULTS Of the 101 participants, 50 were pre-frail (1-2 PFP criteria) and 51 were frail (≥ 3 PFP criteria) preoperatively. In the pre-frail group, the PFP score decreased from 1.56 ± 0.50 (median 2) preoperatively to 0.53 ± 0.73 (median 0) 3 months after surgery (p < 0.001). The PFP score in the frail cohort decreased from 3.39 ± 1.45 (median 3) preoperatively to 1.27 ± 1.14 (median 1) 3 months postoperatively (p < 0.001). While the PFP score of the pre-frail participants increased 7 days after surgery, the PFP score of the frail group decreased significantly. CONCLUSION Pre-frail individuals often regain robustness and patients with frailty are no longer assessed as frail after surgery. Joint replacement is an effective intervention to improve frailty in hip and knee osteoarthritis. TRIAL REGISTRATION This study is part of the Special Orthopaedic Geriatrics (SOG) trial, German Clinical Trials Register DRKS00024102. Registered on 19 January 2021.
Collapse
Affiliation(s)
- Tobias Kappenschneider
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany.
| | - Philip Bammert
- Department of Health Economics, Technical University of Munich, Munich, Germany
| | - Günther Maderbacher
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany
| | - Felix Greimel
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany
| | - Lukas Parik
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany
| | - Dominik Emanuel Holzapfel
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany
| | - Amadeus Dominik Schraag
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany
| | - Julia Götz
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany
| | - Katrin Michalk
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany
| | - Joachim Grifka
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany
| | - Matthias Meyer
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany
| |
Collapse
|
27
|
Scholes CJ, Fatima M, Schwagli T, Liu D. Imageless navigation system (Naviswiss) provides accurate component position in total hip arthroplasty with lateral decubitus position for end-stage hip osteoarthritis: a prospective cohort study with CT-validation. Arthroplasty 2024; 6:3. [PMID: 38191491 PMCID: PMC10773062 DOI: 10.1186/s42836-023-00224-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/12/2023] [Indexed: 01/10/2024] Open
Abstract
AIMS The Naviswiss system (Naviswiss AG, Brugg, Switzerland) is a handheld imageless navigation device used to improve the accuracy of implant positioning in total hip arthroplasty (THA). However, clinical data for leg length discrepancy and femoral offset is lacking, and the validity of the system has not been reported for patients undergoing THA in the lateral decubitus position. This study aimed to report the accuracy of the device in this patient population. METHODS Patients underwent THA in the lateral decubitus position performed by a single surgeon. Component position measured by the device intraoperatively was compared to postoperative measurements on computed tomography (CT) scans. Agreement between the navigation system and postoperative measurements was reported for acetabular cup inclination, acetabular cup version, femoral offset, and leg length discrepancy. RESULTS Thirty-three patients were included in the analysis. The mean difference between intraoperative and postoperative CT measurements was within 2° for angular measurements and 2 mm for leg length. Absolute differences in the two indices were up to 4° and 3 mm. The mean bias was 1°-2° overestimation for cup orientation and up to 2 mm overestimation for leg length change. However, 95% limits of agreement did not exceed absolute thresholds of 10° and 10 mm, especially after correction for bias. One case (3%) was declared intraoperatively for issues with fixation on the greater trochanter. CONCLUSIONS The accuracy of the Naviswiss system falls within clinically acceptable recommendations for acetabular cup placement, femoral offset, and leg length for total hip arthroplasty with a anterolateral approach in lateral decubitus position. The system could be further improved with regression-based bias correction.
Collapse
Affiliation(s)
| | | | | | - David Liu
- Gold Coast Centre for Bone and Joint Surgery, Palm Beach, QLD, 4221, Australia.
| |
Collapse
|
28
|
Zhuang Z, Li Q, Yao Y, Shen Y, Chen D, Jiang Q. Incidence and risk factors of perioperative deep vein thrombosis in patients undergoing primary hip arthroplasty via the direct anterior approach. J Orthop Surg Res 2024; 19:10. [PMID: 38167482 PMCID: PMC10763199 DOI: 10.1186/s13018-023-04443-8] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Deep vein thrombosis (DVT) is a frequent complication following hip arthroplasty. There still has been a lack of studies analyzing the perioperative risk factors of DVT following hip arthroplasty via direct anterior approach (DAA). METHODS Patients who underwent unilateral primary hip arthroplasty via DAA in our hospital from August 2015 to January 2022 were included. Patients' data, including demographic data, clinical features, past medical history, operative data, and laboratory data, were analyzed and compared between patients with and without DVT. Logistic regression analysis was conducted to identify the independent risk factors. Receiver operating characteristic (ROC) curve analysis was used to assess the best cutoff value of continuous variables with statistical significance. RESULT A total of 651 patients were included. The incidence of DVT before and after hip arthroplasty was 12.7% and 6.7%, respectively. Logistic regression analysis indicated that age ≥ 65 years (OR 4.594, 95% CI 1.994-10.587), women (OR 2.331, 95% CI 1.285-4.227), and cerebral infarction (OR 1.984, 95% CI 1.138-3.460) were independent risk factors for preoperative DVT. And age ≥ 65 years (OR 4.859, 95% CI 1.062-22.226), tumor (OR 3.622, 95% CI 1.108-11.841), and preoperative D-dimer (OR 1.040, 95% CI 1.004-1.078) were risk factors for postoperative DVT. The ROC curve analysis showed that the best cutoff value of preoperative D-dimer for the diagnosis of postoperative DVT is 1.44 mg/L. CONCLUSIONS The incidence of DVT in patients undergoing DAA hip arthroplasty was low and the occurrence of DVT before and after unilateral primary hip arthroplasty performed through DAA was related to multiple factors.
Collapse
Affiliation(s)
- Zaikai Zhuang
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China
- State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing, Jiangsu, People's Republic of China
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, People's Republic of China
| | - Qiangqiang Li
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China
- State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing, Jiangsu, People's Republic of China
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, People's Republic of China
| | - Yao Yao
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China
- State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing, Jiangsu, People's Republic of China
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, People's Republic of China
| | - Ying Shen
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China
- State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing, Jiangsu, People's Republic of China
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, People's Republic of China
| | - Dongyang Chen
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China.
- State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing, Jiangsu, People's Republic of China.
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, People's Republic of China.
| | - Qing Jiang
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China.
- State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing, Jiangsu, People's Republic of China.
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, People's Republic of China.
| |
Collapse
|
29
|
Serdysnki KC, Kaplan S, Oraham A, Mirgati S, Akili F, Allam E. Trunnionosis in total hip arthroplasty with accompanying amyloidosis and calcium pyrophosphate deposition disease. Radiol Case Rep 2024; 19:186-189. [PMID: 38028302 PMCID: PMC10630768 DOI: 10.1016/j.radcr.2023.10.002] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/05/2023] [Accepted: 10/01/2023] [Indexed: 12/01/2023] Open
Abstract
Metal-on-polyethylene (MoP) is a common type of total hip arthroplasty. Trunnionosis is a rare but concerning complication of this type of implant. Trunnionosis involves wear and corrosion at the femoral component's head-neck interface and may cause a local inflammatory response referred to as an adverse reaction to metal debris (ARMD). We present a rare case of trunnionosis with concurrent calcium pyrophosphate deposition disease (CPPD) and amyloidosis in a MoP implant. ARMD can be linked to crystalline arthropathy and amyloidosis, possibly due to metal ion-induced acidosis. Clinicians should consider trunnionosis in patients with persistent post-surgical hip pain, and order metal ion tests and synovial fluid analysis to aid in the diagnosis of this condition if suspected. Timely recognition enables appropriate surgical revision.
Collapse
Affiliation(s)
| | - Sam Kaplan
- Loyola University Medical Center and Loyola University Chicago, 2160 S 1st Ave, Maywood, IL 60153 USA
| | - Aaron Oraham
- Loyola University Medical Center and Loyola University Chicago, 2160 S 1st Ave, Maywood, IL 60153 USA
| | - Sidney Mirgati
- Loyola University Medical Center and Loyola University Chicago, 2160 S 1st Ave, Maywood, IL 60153 USA
| | - Fatima Akili
- Loyola University Medical Center and Loyola University Chicago, 2160 S 1st Ave, Maywood, IL 60153 USA
| | - Emad Allam
- Loyola University Medical Center and Loyola University Chicago, 2160 S 1st Ave, Maywood, IL 60153 USA
| |
Collapse
|
30
|
Kucukkarapinar I, Gozacan B, Ekhtiari S, Dasci MF, Gehrke T, Citak M. In-hospital outcomes following primary and revision total hip arthroplasty in nonagenarian patients. Arch Orthop Trauma Surg 2024; 144:475-481. [PMID: 37634168 DOI: 10.1007/s00402-023-05032-4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/09/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE The primary goal of this study was to assess the risk of postoperative surgical and medical complications and problems among nonagenarian patients operated with hip arthroplasty. METHODS Data from a specific high-volume arthroplasty clinic, were collected to evaluate postoperative morbidity and complication rates after hip arthroplasty in nonagenarians, compared with a control group of younger, but similar patients. Outcomes evaluated included length of stay, transfusion rate, and postoperative medical and surgical complication rates. RESULTS A total of 97 nonagenarian patients (mean age 91.4 years) were included, and compared with 89 control group patients (mean age 70.18 years). Nonagenarian patients had significantly longer length of stay (11.44 vs. 7.98 days, p < 0.01), significantly higher risk of needing a transfusion (11.30% vs. 3.40%, p = 0.04), and significantly higher risk of a postoperative medical complication (28.90% vs. 11.20%, p = 0.03). There was no difference in postoperative surgical complication rate (7.20% vs. 2.20%, p = 0.12). CONCLUSION Nonagenarian patients, when compared to a younger control group, experience significantly longer hospital stays, and risk of non-surgical complications. Arthroplasty in nonagenarian patients carries with it a high risk of complications, and thus careful pre-operative evaluation and the care of these patients at high volume, specialized clinics is important to optimize outcomes. LEVEL OF EVIDENCE Level III retrospective cohort analysis.
Collapse
Affiliation(s)
- Ibrahim Kucukkarapinar
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Beren Gozacan
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Seper Ekhtiari
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Mustafa Fatih Dasci
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
- Department of Orthopaedics and Traumatology, Istanbul Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Thorsten Gehrke
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Mustafa Citak
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany.
| |
Collapse
|
31
|
Chiari C, Schneider E, Stamm T, Peloschek P, Kotz R, Windhager R. Ultra-long-term results of the Chiari pelvic osteotomy in hip dysplasia patients: a minimum of thirty-five years follow-up. Int Orthop 2024; 48:291-299. [PMID: 37624407 PMCID: PMC10766777 DOI: 10.1007/s00264-023-05912-9] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE The Chiari pelvic osteotomy was the first surgical procedure to address hip dysplasia by changing the position of the acetabulum by medialization, thus creating a bony roof and improving biomechanical conditions. The aim of this retrospective cohort study was to report on the very long-term results of this technique. METHODS Out of a consecutive series of 1536 hips, 504 in 405 patients were available for follow-up. The patients were assessed by physical and radiological examination. A Kaplan-Meier survival analysis with total hip arthroplasty as an endpoint was performed and stratified for age groups, pre-operative diagnosis, sex and osteoarthritis stage. RESULTS The average follow-up was 36 ± 8.1 years (range, 35.2 to 54). The average pain level on the Visual Analogue Scale was 2.9 ± 2.6 (range 0 to 8.7). The average Harris Hip Score was 80.2 ± 17.4 (range 17.4 to 100). Correction of dysplasia was effective and remained stable over time. Osteoarthritis significantly increased over time with 53% Tönnis grade 3 at follow-up. The cumulative survivorship was 79.8% (95% confidence interval (CI), 76.1-83.2%) at 20 years, 57.1% (95% CI, 52.8-61.8%) at 30 years and 35% (95% CI, 30.3-40.3%) at 40 years. Young age, male sex and low osteoarthritis grade were positive prognostic factors. CONCLUSIONS Although the Chiari pelvic osteotomy is considered a salvage procedure nowadays, it achieved excellent long-term results even in indications, which would be treated differently today. Young patients without osteoarthritis had the best outcome.
Collapse
Affiliation(s)
- Catharina Chiari
- Division of Orthopaedics, Department of Orthopaedics and Trauma-Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Eleonora Schneider
- Division of Orthopaedics, Department of Orthopaedics and Trauma-Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Tanja Stamm
- Center for Medical Statistics, Informatics and Intelligent Systems, Institute of Outcomes Research, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | | | - Rainer Kotz
- Vienna Private Hospital, Pelikangasse 15, 1090, Vienna, Austria
| | - Reinhard Windhager
- Division of Orthopaedics, Department of Orthopaedics and Trauma-Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| |
Collapse
|
32
|
Ji CY, Yang LR. Perioperative nursing care for hip arthroplasty patients with concomitant hypertension: A minireview. World J Clin Cases 2023; 11:8440-8446. [PMID: 38188203 PMCID: PMC10768512 DOI: 10.12998/wjcc.v11.i36.8440] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/18/2023] [Accepted: 12/08/2023] [Indexed: 12/22/2023] Open
Abstract
Hip replacement (HA) is mainly indicated for the elderly, who generally suffer from various underlying diseases such as hypertension. This article provides a review of the key points of perioperative nursing care for patients with hypertension undergoing HA. It analyzes the key points of care during the perioperative period (preoperative, intraoperative, and postoperative) and proposes directions for the development of perioperative nursing care for HA. The prognosis for patients can be improved through the modification of traditional medical approaches and the application of new technologies and concepts.
Collapse
Affiliation(s)
- Chang-Yue Ji
- Department of Orthopedic Sports Medicine Joint Surgery, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Li-Ru Yang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| |
Collapse
|
33
|
Berkovic D, Vallance P, Harris IA, Naylor JM, Lewis PL, de Steiger R, Buchbinder R, Ademi Z, Soh SE, Ackerman IN. A systematic review and meta-analysis of short-stay programmes for total hip and knee replacement, focusing on safety and optimal patient selection. BMC Med 2023; 21:511. [PMID: 38129857 PMCID: PMC10740291 DOI: 10.1186/s12916-023-03219-5] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Short-stay joint replacement programmes are used in many countries but there has been little scrutiny of safety outcomes in the literature. We aimed to systematically review evidence on the safety of short-stay programmes versus usual care for total hip (THR) and knee replacement (KR), and optimal patient selection. METHODS A systematic review and meta-analysis. Randomised controlled trials (RCTs) and quasi-experimental studies including a comparator group reporting on 14 safety outcomes (hospital readmissions, reoperations, blood loss, emergency department visits, infection, mortality, neurovascular injury, other complications, periprosthetic fractures, postoperative falls, venous thromboembolism, wound complications, dislocation, stiffness) within 90 days postoperatively in adults ≥ 18 years undergoing primary THR or KR were included. Secondary outcomes were associations between patient demographics or clinical characteristics and patient outcomes. Four databases were searched between January 2000 and May 2023. Risk of bias and certainty of the evidence were assessed. RESULTS Forty-nine studies were included. Based upon low certainty RCT evidence, short-stay programmes may not reduce readmission (OR 0.95, 95% CI 0.12-7.43); blood transfusion requirements (OR 1.75, 95% CI 0.27-11.36); neurovascular injury (OR 0.31, 95% CI 0.01-7.92); other complications (OR 0.63, 95% CI 0.26-1.53); or stiffness (OR 1.04, 95% CI 0.53-2.05). For registry studies, there was no difference in readmission, infection, neurovascular injury, other complications, venous thromboembolism, or wound complications but there were reductions in mortality and dislocations. For interrupted time series studies, there was no difference in readmissions, reoperations, blood loss volume, emergency department visits, infection, mortality, or neurovascular injury; reduced odds of blood transfusion and other complications, but increased odds of periprosthetic fracture. For other observational studies, there was an increased risk of readmission, no difference in blood loss volume, infection, other complications, or wound complications, reduced odds of requiring blood transfusion, reduced mortality, and reduced venous thromboembolism. One study examined an outcome relevant to optimal patient selection; it reported comparable blood loss for short-stay male and female participants (p = 0.814). CONCLUSIONS There is low certainty evidence that short-stay programmes for THR and KR may have non-inferior 90-day safety outcomes. There is little evidence on factors informing optimal patient selection; this remains an important knowledge gap.
Collapse
Affiliation(s)
- Danielle Berkovic
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Patrick Vallance
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Ian A Harris
- School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Kensington, Australia
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Justine M Naylor
- School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Kensington, Australia
- Liverpool Hospital, Liverpool, NSW, Australia
| | - Peter L Lewis
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia and Faculty of Medicine, University of Adelaide, Adelaide, Australia
| | - Richard de Steiger
- Department of Surgery, Epworth HealthCare, University of Melbourne, Melbourne, Australia
| | - Rachelle Buchbinder
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Health Economics and Policy Evaluation Research (HEPER), Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Sze-Ee Soh
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Ilana N Ackerman
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| |
Collapse
|
34
|
Ackerman IN, Berkovic D, Soh SE, Naylor J, Lewis P, de Steiger R, Buchbinder R, Ademi Z, Vallance P, Harris IA. Stakeholder perspectives on short-stay joint replacement programs: results from a national cross-sectional study. BMC Health Serv Res 2023; 23:1436. [PMID: 38110962 PMCID: PMC10729344 DOI: 10.1186/s12913-023-10427-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/04/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND The capacity to meet anticipated growth in joint replacement demand requires safe, efficient models of care. While short-stay joint replacement programs are being used internationally, they have not been widely implemented in many countries. Importantly, the critical challenges that need to be addressed ahead of large-scale program implementation remain unclear. This study aimed to investigate stakeholder perspectives on short-stay joint replacement programs, including perceived barriers and enablers to implementation and sustainability, and understand current practices in Australia. METHODS Four key stakeholder groups were invited to participate in this national study: (1) health professionals who provide joint replacement care; (2) hospital administrators involved in joint replacement provision; (3) patients with recent joint replacement; and (4) carers of people with recent joint replacement. Data on perceived feasibility (0 (not at all feasible) - 10 (highly feasible), appeal (0 (not at all appealing) - 10 (highly appealing), current practices, and barriers and enablers were collected using visual analogue scales, multiple response option and open-ended questions, via an online platform. Descriptive analysis and free-text content analysis was undertaken. RESULTS Data were available from 1,445 participants including 360 health professionals, 20 hospital administrators, 1,034 patients, and 31 carers. Short-stay program implementation was considered moderately feasible by health professionals (median 6, interquartile range (IQR) 3-8) and hospital administrators (median 5, IQR 5-6). Short-stay programs were moderately appealing to patients (median 7, IQR 2-9) but of little appeal to carers (median 3, IQR 1-7). Prominent implementation barriers included perceived limited appropriateness of short-stay programs, inadequate home supports, and issues around reimbursement models or program funding. Not having daily physiotherapy access and concerns about pain and mobility at home were common barriers for patients. Concern about patients' ability to manage daily activities was the most common barrier for carers. Access to post-discharge services, better funding models, improved staffing, and consistent protocols and national care standards were prominent enablers. CONCLUSIONS This national study has uniquely captured multiple stakeholder perspectives on short-stay joint replacement programs. The findings can guide future quality improvement and implementation initiatives and the development of resources to best support patients, carers, clinicians, and hospitals.
Collapse
Affiliation(s)
- Ilana N Ackerman
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Danielle Berkovic
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sze-Ee Soh
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Justine Naylor
- Liverpool Hospital, Liverpool, Australia
- School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Peter Lewis
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia
- Faculty of Medicine, University of Adelaide, Adelaide, Australia
| | - Richard de Steiger
- Department of Surgery, Epworth HealthCare, University of Melbourne, Melbourne, Australia
| | - Rachelle Buchbinder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Health Economics and Policy Evaluation Research (HEPER) Group, Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Patrick Vallance
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Ian A Harris
- School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Sydney, Australia
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, Australia
| |
Collapse
|
35
|
Wignadasan W, Haddad FS. Day-case hip and knee arthroplasty: stages of care and the development of an institutional pathway. Br J Hosp Med (Lond) 2023; 84:1-11. [PMID: 38153017 DOI: 10.12968/hmed.2023.0037] [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] [Indexed: 12/29/2023]
Abstract
Day-case, or outpatient, arthroplasty is growing and has been adopted in healthcare systems because of its cost-effectiveness. A number of studies that reported on day-case total hip arthroplasty, total knee arthroplasty and unicompartmental knee arthroplasty have shown that they can be performed successfully in a select group of patients. However, safety remains a concern, as a clear pathway, including discharge criteria, is not well described in the literature. This article outlines the stages of care involved in day-case hip and knee arthroplasty and gives insights from University College London Hospital's own evidence-based day-case arthroplasty pathway.
Collapse
Affiliation(s)
- Warran Wignadasan
- Department of Trauma and Orthopaedic Surgery, University College London Hospital, London, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College London Hospital, London, UK
| |
Collapse
|
36
|
Cassuto J, Folestad A, Göthlin J, Malchau H, Kärrholm J. The importance of BMPs and TGF-βs for endochondral bone repair - A longitudinal study in hip arthroplasty patients. Bone Rep 2023; 19:101723. [PMID: 38047271 PMCID: PMC10690547 DOI: 10.1016/j.bonr.2023.101723] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 09/14/2023] [Accepted: 11/01/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction Osseointegration of hip implants, although a decade-long process, shows striking similarities with the four major phases of endochondral bone repair. In the current study we investigated the spatiotemporal involvement of bone morphogenic proteins (BMPs) and transforming growth factor betas (TGF-βs) throughout the process of bone repair leading to successfully osseointegrated hip implants. Materials and methods Twenty-four patients that had undergone primary total hip arthroplasty (THA) due to one-sided osteoarthritis (OA) were investigated during a period of 18 years (Y) with repeated measurements of plasma biomarkers as well as clinical and radiological variables. All implants were clinically and radiographically well anchored throughout the follow-up. Eighty-one healthy donors divided in three gender- and age-matched groups and twenty OA patients awaiting THA, served as controls. Plasma was analyzed for BMP-1, -2, -3, -4, -6, -7 -9 and TGF-β1, -β2, -β3 by use of a high-sensitivity and wide dynamic range electrochemiluminescence technique allowing for detection of minor changes. Results Spatiotemporal changes during the follow-up are presented in the context of the four phases of endochondral bone repair shown in earlier studies and transposed to the current study based on similarities in biomarker responses. Phase 1: Primary proinflammatory phase lasting from surgery until day 7, Phase 2: Chondrogenic phase from day 7 until 18 months postsurgery, Phase 3: Secondary proinflammatory and cartilage remodeling phase lasting from 18 months until 7Y, Phase 4: coupled bone remodeling from 7Y until 18Y postsurgery. BMP-1 increased sharply shortly after surgery and remained significantly above healthy during the chondrocyte recruitment, proliferation, and hypertrophy phases with a subsequent return to control level at 5Y postsurgery. BMP-2 was above healthy controls before surgery and 1 day after surgery before decreasing to control level and remaining there throughout the follow-up. BMP-3 was at control level from presurgery until 6M after surgery when it increased to a peak at 2Y during the cartilage hypertrophy phase followed by a gradual decrease to control level at 10Y during the phase of bone formation. In the following, BMP-3 decreased below controls to a nadir 15Y postsurgery during coupled bone remodeling. BMP-4 was at control level from presurgery until 10Y postsurgery when it increased to a sharp peak at 15Y after surgery followed by a return to the level of healthy at 18Y. BMP-6 did not differ from healthy during the follow-up. BMP-7 was at control level from presurgery until 1Y postsurgery before gradually increasing to a peak at 10Y during the early phase of osteogenesis with a gradual return to control level at 18Y during the phase of coupled bone remodeling. BMP-9 was above OA before surgery followed by a decrease to basal level on day 1 after surgery and a renewed increase to a plateau above controls lasting from 6 W until returning to the level of healthy at 18Y postsurgery, i.e., throughout the phases of cartilage formation, cartilage hypertrophy and remodeling, bone formation and coupled bone remodeling. TGF-β1 was above controls presurgery before decreasing to baseline shortly after surgery followed by a renewed increase at 6 M to a peak at 2Y during cartilage hypertrophy/remodeling followed by a gradual return to baseline at 10Y during early osteoblastogenesis. TGF-β2 was at control level from presurgery until the phase of cartilage remodeling at 5Y when it increased sharply to a peak at 7Y with a gradual return to baseline at 18Y postsurgery. TGF-β3 remained at control level throughout the study. Conclusion This study shows that the involvement of BMPs and TGF-βs in endochondral bone repair is a process of stepwise recruitment of individual biomarkers characterized by distinct, yet overlaping, spatiotemporal patterns that extend from the early phase of pre-chondrocyte recruitment until the late phase of coupled bone remodeling.
Collapse
Affiliation(s)
- Jean Cassuto
- Orthopedic Research Unit & Department of Orthopedic Surgery, Sahlgrenska University Hospital, Mölndal, Sweden
- Institution of Clinical Sciences, Göteborg University, Göteborg, Sweden
| | - Agnetha Folestad
- Department of Orthopedics, CapioLundby Hospital, Göteborg, Sweden
| | - Jan Göthlin
- Department of Radiology, Sahlgrenska University Hospital, Mölndal, Sweden
- Institution of Clinical Sciences, Göteborg University, Göteborg, Sweden
| | - Henrik Malchau
- Orthopedic Research Unit & Department of Orthopedic Surgery, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Orthopedic Surgery, Harvard Medical School, Boston, USA
| | - Johan Kärrholm
- Orthopedic Research Unit & Department of Orthopedic Surgery, Sahlgrenska University Hospital, Mölndal, Sweden
- Institution of Clinical Sciences, Göteborg University, Göteborg, Sweden
| |
Collapse
|
37
|
McCrosson M, Broadfoot J, Yeager M, Marquess B, Scheinberg M, Naranje S. Femoral stem taper geometry and porous coating in cementless direct anterior primary total hip arthroplasty. J Orthop 2023; 46:169-173. [PMID: 38031626 PMCID: PMC10682507 DOI: 10.1016/j.jor.2023.11.009] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Abstract
Objective This study aims to compare the clinical outcomes and complications between a fully coated, dual-tapered hip stem versus a proximally coated, triple-tapered hip stem in patients undergoing cementless direct anterior (DA) primary total hip arthroplasty (THA). Methods A retrospective analysis was conducted on patients who underwent primary THA with either a fully coated, dual-tapered hip stem or a proximally coated, triple-tapered stem with at least a 1-year follow up. Exclusion criteria included any patients that did not receive either femoral stem, those undergoing bilateral THA, those with a surgical approach other than DA, those with an indication other than osteoarthritis, avascular necrosis (AVN), or femoral neck fracture, and those that had a cemented femoral component. Complications and clinical outcomes were assessed. Statistical analyses were conducted to identify significant differences between the groups. Results A total of 95 patients were included in the study. The average ages for the dual-tapered and triple-tapered stem cohorts were 63.6 and 59.5, respectively (p = 0.168). At 1-year follow-up, no significant differences were seen between the groups in terms of ambulatory status, ROM, and patient satisfaction (p = 0.414, p = 0.106, and p = 0.126). 6 (18 %) of the patients receiving the dual-tapered, fully coated hip stem had at least one complication while 8 (13 %) of the triple-tapered, proximally coated hip stem patients did (p = 0.550). Conclusion Both hip stem cohorts demonstrated comparable clinical outcomes and complication rates in patients undergoing primary DA THA and we believe that either hip stem may be a reasonable choice for patients. Future studies with larger sample sizes and longer follow-up periods are warranted to validate these findings.
Collapse
Affiliation(s)
- Matthew McCrosson
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1313th Street S, Ste 226, Birmingham, AL, 35205, USA
| | - Jackson Broadfoot
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1313th Street S, Ste 226, Birmingham, AL, 35205, USA
| | - Matthew Yeager
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1313th Street S, Ste 226, Birmingham, AL, 35205, USA
| | - Ben Marquess
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1313th Street S, Ste 226, Birmingham, AL, 35205, USA
| | - Mila Scheinberg
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1313th Street S, Ste 226, Birmingham, AL, 35205, USA
| | - Sameer Naranje
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1313th Street S, Ste 226, Birmingham, AL, 35205, USA
| |
Collapse
|
38
|
Parperis K, Lampi M, Constantinou M, Bhattarai B. Outcomes of total hip arthroplasty in calcium pyrophosphate deposition disease patients. Semin Arthritis Rheum 2023; 63:152300. [PMID: 37931491 DOI: 10.1016/j.semarthrit.2023.152300] [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: 09/02/2023] [Revised: 10/22/2023] [Accepted: 10/26/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE We aim to examine the demographics, clinical characteristics, outcomes, and resource utilization following total hip arthroplasty (THA) in patients with and without calcium pyrophosphate deposition (CPPD) disease. METHODS We queried the National Inpatient Sample database to identify patients who underwent THA between 2006 and 2014. The ICD-9 code 81.51 was used to determine the patients who underwent THA, and of those, we classified 2 groups of patients: (i) those with ICD-9 codes defining CPPD and (ii) those without any CPPD code. Data collection included patient demographics and comorbidities. Outcomes post-THA were mortality, length of stay (LOS), and costs. Associations between CPPD and specific morbidity were evaluated with chi-square tests. T tests were used for continuous variables. RESULTS Among the 4,111,808 patients who underwent THA, 6198 (0.15 %) had CPPD, with a mean age of 77 years and 64.2 % were females. CPPD patients were more likely to be older (mean age 77 vs 72.7 years; p<0.001) than non-CPPD patients. The Charlson Comorbidity Index score ≥ 2 was more frequently seen in CPPD, however, the mortality post-THA was lower in the CPPD patients (0.7 % vs 1.7 %, OR 0.35, 95 % CI 0.26- 0.47). THA in CPPD patients was associated with a longer mean length of stay (LOS) (6.04 vs 5.15 days, OR 1.15, 95 % CI 1.09-1.22) while mean total charges were not statistically different between the 2 groups (p = 0.344). CPPD patients were more likely to be discharged to rehabilitation or other nursing facilities (42.5 % vs 35.3 %, p<0.001). The number of THA procedures increased in both CPPD and non-CPPD patients over time. CONCLUSIONS CPPD patients who underwent THA were more likely to be older, with a greater comorbidity burden, longer LOS and discharged to a non-home setting.
Collapse
Affiliation(s)
- Konstantinos Parperis
- Department of Medicine, Division of Rheumatology University of Arizona College of Medicine Phoenix, AZ, USA; University of Cyprus Medical School, Nicosia, Cyprus
| | - Marios Lampi
- University of Cyprus Medical School, Nicosia, Cyprus
| | | | - Bikash Bhattarai
- Department of Research, Valleywise Health, Department of Obstetrics and Gynecology, University of Arizona College of Medicine Phoenix, Department of Clinical Research and Public Health, Creighton University School of Medicine, Arizona, USA
| |
Collapse
|
39
|
Gu S, Chen YE, Lei M, Li J, Li W, Zhang M, Zhu H, Ma M, Kong D, Gao Y. Effect of different application duration of a venous foot pump on prevention of venous thromboembolism after hip and knee arthroplasty: a multicenter prospective clinical trial. BMC Musculoskelet Disord 2023; 24:931. [PMID: 38041039 PMCID: PMC10691185 DOI: 10.1186/s12891-023-06921-w] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/26/2023] [Indexed: 12/03/2023] Open
Abstract
OBJECTIVE To investigate the optimal duration of applying a venous foot pump (VFP) in the prevention of venous thromboembolism (VTE) following hip and knee arthroplasty. METHODS A total of 230 patients undergoing hip and knee arthroplasty between March 2021 and March 2022 in orthopaedic departments of four major teaching hospitals were prospectively enrolled. Patients were randomly divided into five groups based on the duration of the VFP application. Postoperative deep vein thromboses (DVT), including proximal, distal, and intermuscular DVT, were recorded for analysis. Postoperative blood coagulation examinations, such as D-dimer and active partial thromboplastin time (APTT), pain outcome, and degree of comfort were also collected. RESULTS Two of the 230 patients withdrew due to early discharge from the hospital, and 228 patients were included in the final analysis. The mean age was 60.38 ± 13.33 years. The baseline characteristics were comparable among the five groups. Compared with the other groups, patients treated with 6-hour VFP had the lowest incidence of DVT (8.7%, 4/46), followed by those treated with 1-hour VFP (15.2%, 7/46), 12-hour VFP (15.6%, 7/45), 18-hour VFP(17.8%, 8/45) and 20-hour VFP(21.7%, 10/46), but with no significant difference (P = 0.539). Regarding postoperative blood coagulation examinations, patients treated with 6-hour VFP had the lowest D-dimer (P = 0.658) and the highest APTT (P = 0.262) compared with the other four groups. 6-hour VFP also had the lowest pain score (P = 0.206) and the highest comfort score (P = 0.288) compared with the other four groups. CONCLUSIONS Six hours may be the optimal duration of applying VFP for the prevention of VTE in patients undergoing hip and knee arthroplasty in terms of VTE incidence, postoperative blood coagulation examinations, pain outcomes, and comfort scores.
Collapse
Affiliation(s)
- Siqi Gu
- Department of Orthopaedics, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Yu-E Chen
- Department of Orthopaedics, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Mingxing Lei
- Department of Orthopaedics, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Jiahui Li
- Department of Orthopaedics, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Wanying Li
- Department of Orthopaedics, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Meihong Zhang
- Department of Orthopaedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China
| | - Hongxia Zhu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Jiangsu, 215006, China
| | - Mengying Ma
- Department of Orthopaedics, Hainan Hospital, PLA General Hospital, Hainan, 572013, China
| | - Dan Kong
- Department of Orthopaedics, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.
| | - Yuan Gao
- Nursing Department, The First Medical Center of Chinese PLA General, Beijing, 100853, China.
| |
Collapse
|
40
|
Ganz R, Ulrich G, Kamineni S. Reinforcement Ring-Augmented Hip Arthroplasty: A 35-Year Follow-up. Arthroplast Today 2023; 24:101248. [PMID: 37964918 PMCID: PMC10641149 DOI: 10.1016/j.artd.2023.101248] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/09/2023] [Accepted: 09/13/2023] [Indexed: 11/16/2023] Open
Abstract
During the late 1980s, techniques were evolving to prevent acetabular component loosening. Inadequate acetabular bone stock further complicated this concern, which was traditionally addressed with cementation and bone grafting during this time period. However, one evolving tactic to address acetabular component loosening in the setting of inadequate acetabular bone stock was to augment bone graft with an acetabular reinforcement ring. In 1963, a 26-year-old, active male sustained a right-sided femoral neck fracture following a skiing accident. He ultimately developed a collapsed femoral head and varus deformity of the femoral neck requiring a total hip arthroplasty with a cemented monoblock femoral component and a polyethylene acetabular component cemented into a reinforcement ring. The initial procedure was performed in 1988, and this prosthesis is still functioning 35 years later and represents one of the longest follow-ups of a patient with a primary total hip arthroplasty with a reinforcement ring.
Collapse
Affiliation(s)
- Reinhold Ganz
- Department of Orthopedic Surgery, University of Bern, Bern, Switzerland
| | - Gary Ulrich
- Department of Orthopedic Surgery, Elbow Shoulder Research Center, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Srinath Kamineni
- Department of Orthopedic Surgery, Elbow Shoulder Research Center, University of Kentucky College of Medicine, Lexington, KY, USA
| |
Collapse
|
41
|
Kim SH, Jang SY, Cha Y, Kim BY, Lee HJ, Kim GO. Analysis of the effects of intraoperative warming devices on surgical site infection in elective hip arthroplasty using a large nationwide database. Arch Orthop Trauma Surg 2023; 143:7237-7244. [PMID: 37500931 DOI: 10.1007/s00402-023-04917-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/21/2023] [Indexed: 07/29/2023]
Abstract
INTRODUCTION The aim of our study is to analyze the association of usage and type of warming device with the risk of surgical site infection (SSI) in patients who underwent hip arthroplasty, and to analyze the factors that increase the risk of SSI if the warming device is not used. MATERIALS AND METHODS This retrospective cross-sectional study identified subjects from data of "Evaluation of the Appropriate Use of Prophylactic Antibiotics". Included patients were defined as those who underwent elective unilateral hip hemiarthroplasty or total hip arthroplasty (THA). Patients were classified into no intraoperative warming device, forced air warming devices, and devices using conduction. Multiple logistic regression analysis was conducted to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) to assess the association between warming devices and SSI. RESULTS A total of 3945 patients met the inclusion criteria. Compared to those who received an intraoperative warming device, the odds of developing SSI were 1.9 times higher in those who did not receive intraoperative warming devices (aOR 1.9; 95% CI 1.1-3.6). The risk of SSI was 2.2 times higher with forced air warming devices compared to devices using conduction but this difference was not statistically significant (aOR 2.2; 95% CI 0.7-6.8). The risk of SSI increased in males (aOR 2.8; 95% CI 1.1-7.2), in patients under 70 years of age (aOR 4.4; 95% CI 1.6-10.4), in patients with a Charlson`s comorbidity index of 2 or higher (aOR 3.3; 95% CI 1.3-8.7), and in patients who underwent THA (aOR 3.8; 95% CI 1.7-8.3) when intraoperative warming devices were not used. CONCLUSIONS The use of intraoperative active warming devices is highly recommended to prevent SSI during elective hip arthroplasty. In particular, male patients younger than 70 years, those with a high CCI, and those undergoing THA are at significantly increased risk of SSI if intraoperative active warming devices are not used. Intraoperative warming device using conduction is likely superior to forced air warming device, but further studies are needed to confirm this.
Collapse
Affiliation(s)
- Seung Hoon Kim
- Department of Preventive Medicine, Eulji University School of Medicine, Daejeon, South Korea
| | - Suk-Yong Jang
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, 95 Dunsan Seoro, Seo-Gu, Daejeon, 35233, South Korea.
| | - Bo-Yeon Kim
- Healthcare Review and Assessment Committee, Health Insurance Review and Assessment Service, Wonju, South Korea
| | - Hyo-Jung Lee
- Quality Assessment Department, Health Insurance Review and Assessment Service, Wonju, South Korea
| | - Gui-Ok Kim
- Quality Assessment Department, Health Insurance Review and Assessment Service, Wonju, South Korea
| |
Collapse
|
42
|
Kappenschneider T, Bammert P, Maderbacher G, Greimel F, Holzapfel DE, Schwarz T, Götz J, Pagano S, Scharf M, Michalk K, Grifka J, Meyer M. The impact of elective total hip and knee arthroplasty on physical performance in orthogeriatric patients: a prospective intervention study. BMC Geriatr 2023; 23:763. [PMID: 37990164 PMCID: PMC10664286 DOI: 10.1186/s12877-023-04460-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 11/06/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Osteoarthritis is a prevalent condition in older adults that leads to reduced physical function in many patients and ultimately requires hip or knee replacement. The aim of the study was to determine the impact of hip and knee arthroplasty on the physical performance of orthogeriatric patients with osteoarthritis. METHODS In this prospective study, we used data from 135 participants of the ongoing Special Orthopaedic Geriatrics (SOG) trial, funded by the German Federal Joint Committee (GBA). Physical function, measured by the Short Physical Performance Battery (SPPB), was assessed preoperatively, 3 and 7 days postoperatively, 4-6 weeks and 3 months after hip and knee arthroplasty. For the statistical analysis, the Friedman test and post-hoc tests were used. RESULTS Of the 135 participants with a mean age of 78.5 ± 4.6 years, 81 underwent total hip arthroplasty and 54 total knee arthroplasty. In the total population, SPPB improved by a median of 2 points 3 months after joint replacement (p < 0.001). In the hip replacement group, SPPB increased by a median of 2 points 3 months after surgery (p < 0.001). At 3 months postoperatively, the SPPB increased by a median of 1 point in the knee replacement group (p = 0.003). CONCLUSION Elective total hip and knee arthroplasty leads to a clinically meaningful improvement in physical performance in orthogeriatric patients with osteoarthritis after only a few weeks. TRIAL REGISTRATION This study is part of the Special Orthopaedic Geriatrics (SOG) trial, German Clinical Trials Register DRKS00024102. Registered on 19 January 2021.
Collapse
Affiliation(s)
- Tobias Kappenschneider
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany.
| | - Philip Bammert
- Department of Health Economics, Technical University of Munich, Munich, Germany
| | - Günther Maderbacher
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Felix Greimel
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | | | - Timo Schwarz
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Julia Götz
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Stefano Pagano
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Markus Scharf
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Katrin Michalk
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Joachim Grifka
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Matthias Meyer
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| |
Collapse
|
43
|
Osan J, Pabbruwe M, Kop A, Joyce A, Vlaskovsky P, Salasi M, Kuster M. The effect of trunnionosis on the risk of re-revision following femoral head exchange in hip arthroplasty. Hip Int 2023; 33:1072-1078. [PMID: 36357353 DOI: 10.1177/11207000221136204] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Fretting corrosion at modular junctions contributes to arthroplasty failure. Currently, no evidence-based guidelines are available regarding the acceptable level of trunnion corrosion that can occur in vivo. We aimed to examine the relationship between trunnion corrosion and risk of re-revision to assist surgeons with intraoperative decision making. METHOD Grading by 3 independent examiners of revised and re-revised head components was performed using a modified Goldberg corrosion scale. Samples were separated into low-grade (LG) and high-grade (HG) corrosion. Mechanical testing determined the relationship between corrosion severity and pull-off strength at the head-stem junction. RESULTS 529 retrieved femoral heads were analysed. A positive association was detected between males and HG corrosion (OR 2.07; 95% CI, 1.45-2.94; p < 0.001). No difference between the survivorship of LG and HG heads was detected (p-value = 0.247). In the re-revised sample, the first implant had a time in situ that was on average 7.97 years longer (95% CI, 5.4-10.6) than that of the subsequent re-revised femoral head. Severe corrosion on the first head was associated with a 37.5 (95% CI, 4.00-1944) fold increase of HG on the subsequent head (p < 0.001). Femoral disassembly force had a positive correlation with stem taper corrosion grade (p = 0.001). CONCLUSIONS A well-fixed stem with corrosion may remain in situ.
Collapse
Affiliation(s)
- Jessica Osan
- Department of Orthopaedic Surgery, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Moreica Pabbruwe
- Centre for Implant Retrieval and Analysis, Royal Perth Hospital, Perth, WA, Australia
| | - Alan Kop
- Centre for Implant Retrieval and Analysis, Royal Perth Hospital, Perth, WA, Australia
| | - Alex Joyce
- Curtin Corrosion Centre, Curtin University, Bentley, WA, Australia
| | - Phil Vlaskovsky
- Medical School, University of Western Australia, Nedlands, WA, Australia
| | - Mobin Salasi
- Curtin Corrosion Centre, Curtin University, Bentley, WA, Australia
| | - Markus Kuster
- Department of Orthopaedic Surgery, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| |
Collapse
|
44
|
Hummel A, Gaucher D, Wang P, Lawton DRY, Andrews SN, Nakasone CK. Higher intra-operative narcotic requirements and weakness with quadratus lumborum compared to paravertebral nerve block for total hip arthroplasty. Arch Orthop Trauma Surg 2023; 143:6849-6855. [PMID: 37269351 DOI: 10.1007/s00402-023-04925-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/21/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND This was a prospective single-blinded study comparing the peri-operative opioid consumption and motor weakness for patients undergoing total hip arthroplasty (THA) with either a Quadratus Lumborum Type 3 Nerve Block (QLB) or a Paravertebral Nerve Block (PVB). METHODS A consecutive cohort of patients undergoing elective anterior approach (AA) THA by a single high-volume surgeon were randomly assigned an anesthesiologist by the charge anesthesiologist. One anesthesiologist performed all QLBs, and the other six anesthesiologists performed the PVBs. Pertinent data include prospectively collected qualitative surveys from blinded medical personnel, floor nurses, and physical therapists as well as demographic information and post-operative complications. RESULTS Overall, 160 patients were included in the study divided equally between the QLB and PVB groups. The QLB group had a statistically higher peri-operative narcotic use (p < 0.001), greater intra-operative peak systolic blood pressure (p < 0.001) and respiratory rate (p < 0.001), and higher incidence of post-operative lower extremity muscle weakness (p = 0.040). There were no statistical group differences for floor narcotic use, post-operative hemoglobin levels or hospital length of stay. CONCLUSION The QLB required greater intraoperative narcotic use and resulted in greater post-operative weakness, however provided nearly equal post-operative pain management and did not adversely affect rapid discharge success. LEVEL OF EVIDENCE III, Non-randomized controlled cohort/follow-up study.
Collapse
Affiliation(s)
- Amelia Hummel
- John A Burns School of Medicine., University of Hawai'I, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - Donald Gaucher
- Department of Orthopedic Surgery, Straub Medical Center, 888 South King Street, Honolulu, HI, 96813, USA
| | - Peter Wang
- Department of Orthopedic Surgery, Straub Medical Center, 888 South King Street, Honolulu, HI, 96813, USA
| | - Dylan R Y Lawton
- John A Burns School of Medicine., University of Hawai'I, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - Samantha N Andrews
- Department of Orthopedic Surgery, Straub Medical Center, 888 South King Street, Honolulu, HI, 96813, USA
- Department of Kinesiology and Rehabilitation Science, University of Hawai'I, 1337 Lower Campus Road, Honolulu, HI, 96822, USA
| | - Cass K Nakasone
- Department of Orthopedic Surgery, Straub Medical Center, 888 South King Street, Honolulu, HI, 96813, USA.
- Department of Surgery, John A Burns School of Medicine, University of Hawai'I, 1356 Lusitana Street, Honolulu, HI, 96813, USA.
| |
Collapse
|
45
|
Thompson Z, Hothi H, Brillantes J, Khoshbin A, Atrey A. A Geometric Analysis of Polyethylene Liners Exposed to Acrylic-based Bone Cement. Arthroplast Today 2023; 23:101184. [PMID: 37745962 PMCID: PMC10517260 DOI: 10.1016/j.artd.2023.101184] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 05/29/2023] [Accepted: 07/03/2023] [Indexed: 09/26/2023] Open
Abstract
Background Acrylic-based bone cement (polymethyl methacrylate [PMMA]) is a material commonly used in orthopaedic surgeries; however, during PMMA polymerization, a highly exothermic reaction occurs. The heat released in polymerization can damage nearby materials including poorly heat-resistant cross-linked polyethylene (XLPE). Both PMMA and XLPE are used in total hip arthroplasty and could interact during femoral stem fixation. We sought to determine if the exothermic polymerization of PMMA could alter the surface characteristics of XLPE acetabular liners. Methods Six XLPE liners were assigned to one of 4 experimental categories with varying volumes of PMMA applied in a manner that mimicked how the 2 materials would come into contact intraoperatively. Measurements were taken both pre- and post-intervention using a coordinate measuring machine for geometric and gravimetric analysis. Light microscopy was conducted postintervention to examine the surface for damage. Results Coordinate measuring machine measurements showed minimal gross deformation in all 6 liners, but there were isolated surface deposits in 4 of 6 liners. The average maximal surface deviations, when compared to the control, for liners exposed to 1 cc of cement, 2 cc of cement, or 1 cc of cement with a femoral head implant attached were 26.6 μm, 77.2 μm, and 26.4 μm, respectively. All but one liner showed an increase in volume following intervention when compared to the control. Subtle scratches were identified using light microscopy on all 6 liners. Conclusions XLPE shows areas of isolated surface deformation in a dose-dependent manner but with minimal gross deformation after interacting with highly exothermic PMMA.
Collapse
Affiliation(s)
| | - Harry Hothi
- The Royal National Orthopaedic Hospital, Stanmore, UK
| | - Jacqueline Brillantes
- University of Toronto, Toronto, Canada
- St. Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Amir Khoshbin
- University of Toronto, Toronto, Canada
- St. Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Amit Atrey
- University of Toronto, Toronto, Canada
- St. Michael’s Hospital, University of Toronto, Toronto, Canada
| |
Collapse
|
46
|
Fraval A, Zappley N, Hozack WJ. The Use of Iodophor-Impregnated Drapes in Patients With Iodine-Related Allergies: A Case Series and Review of the Literature. Arthroplast Today 2023; 23:101201. [PMID: 37745955 PMCID: PMC10517272 DOI: 10.1016/j.artd.2023.101201] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 07/23/2023] [Indexed: 09/26/2023] Open
Abstract
Background The use of iodophor-impregnated adhesive drapes have become almost universally incorporated into standard practice of arthroplasty draping technique. Iodine-related allergies in patients planned for joint replacement present a challenge in terms of the best course of action to minimize complications and optimize outcomes. Methods This is a retrospective case series of patients that received an iodophor-impregnated drape as part of draping for a total hip or knee arthroplasty at a single orthopaedic-specific hospital with documented iodine-related allergies. From 2015 to 2023, 9816 total hip arthroplasty and total knee arthroplasty cases were reviewed, and 135 were documented to have an iodine-related allergy for a prevalence of 1.38%. Intraoperative and postoperative records were reviewed to screen for an allergic reaction or wound healing issues that may have been related to an adverse reaction to the use of the iodophor-impregnated drape. Results Of the 135 patients, 43 had iodine listed as an allergy, 85 had shellfish, 20 had iodinated contrast media, and 3 had povidone iodine. Sixteen patients had a cluster of iodine-related allergies. There were no intraoperative reports of an allergic reaction to this drape. There were four superficial wound problems, none of which were documented to relate to an allergic dermatitis reaction, and none required further surgery. Conclusions Patients reporting iodine-related allergies were present in 1.38% of patients undergoing hip or knee arthroplasty in our series. We encountered no allergic reactions or adverse outcomes that could be attributed to the use of iodiphor impregnated drapes in these patients.
Collapse
Affiliation(s)
- Andrew Fraval
- Rothman Institute Orthopaedics at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Nicolina Zappley
- Rothman Institute Orthopaedics at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - William J. Hozack
- Rothman Institute Orthopaedics at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| |
Collapse
|
47
|
Burke OC, Gibbons JAB, Do HT, Y. Lai E, Bradford L, Bass AR, Amen TB, Russell LA, Mehta B, Parks M, Figgie M, Goodman S. Racial Differences in Patient Satisfaction With the Hospital Experience Undergoing Primary Unilateral Hip and Knee Arthroplasty: A Retrospective Study. Arthroplast Today 2023; 23:101212. [PMID: 37745963 PMCID: PMC10511336 DOI: 10.1016/j.artd.2023.101212] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 09/26/2023] Open
Abstract
Background Press Ganey (PG) inpatient survey is widely used to track patient satisfaction with the hospital experience. Our aim was to use the PG survey to determine if there are racial differences in overall hospital experience and perception of nurses and surgeons following hip and knee arthroplasty. Methods We retrospectively analyzed Black and White patients from hip and knee arthroplasty registries from a single institution between July 2010 and February 2012. The overall assessment score for the hospital experience and perception of the nurse and surgeon questions from the PG inpatient survey were dichotomized as "not completely satisfied" or "completely satisfied". Multivariable logistic regression models were developed to determine the impact of race on the likelihood of being 'completely satisfied' in the hip and knee cohorts. Results There were 2517 hip and 2114 knee patients who underwent surgery and completed the PG survey, of whom 3.9% were Black and 96.0% were White. Black patients were less likely to be completely satisfied with their hospital experience compared to White patients in the hip (odds ratio 0.62, confidence interval 0.39-1.00, P = .049) and knee (odds ratio 0.52, confidence interval 0.33-0.82, P = .005) cohorts. Black patients were also less likely to be completely satisfied with multiple aspects of care they received from the nurse and surgeon in both cohorts. Conclusions We found that the PG Survey shows Black patients were less likely to be completely satisfied than White patients with the hospital experience, including their interactions with nurses and surgeons. More work is needed to understand this difference.
Collapse
Affiliation(s)
- Orett C. Burke
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - J. Alex B. Gibbons
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, USA
| | - Huong T. Do
- Division of Research Administration, Hospital for Special Surgery, New York, NY, USA
| | - Emily Y. Lai
- Division of Research Administration, Hospital for Special Surgery, New York, NY, USA
| | - Letitia Bradford
- Department of Orthopedics, University of Nevada, Reno, Reno, NV, USA
| | - Anne R. Bass
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, USA
- Division of Rheumatology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Troy B. Amen
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - Linda A. Russell
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, USA
- Division of Rheumatology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Bella Mehta
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, USA
- Division of Rheumatology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Michael Parks
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - Mark Figgie
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - Susan Goodman
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, USA
- Division of Rheumatology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
48
|
Lotito M, Jamison M, Howell C, Liimakka A, Lange J, Chen AF. Age, Sex, and Education Level Predict Telehealth Engagement in Total Joint Arthroplasty Patients. Arthroplast Today 2023; 23:101191. [PMID: 37766861 PMCID: PMC10520290 DOI: 10.1016/j.artd.2023.101191] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/17/2023] [Indexed: 09/29/2023] Open
Abstract
Background Racial and other demographic predictors of total joint arthroplasty (TJA) telehealth engagement since the onset of the COVID-19 pandemic remain unclear. The purpose of the current study was to elucidate this relationship. Methods A retrospective, cross-sectional study on 732 primary TJA patients was conducted within a single hospital system from March 2020-December 2021 (during the pandemic). Patients were excluded if their race or education level could not be determined. Patient demographics (age, sex, body mass index, language) and TJA information were obtained. The number of telehealth visits and telehealth engagement were assessed. Engagement (yes/no) and engagement frequency across all demographics and each measure of telehealth (telemedicine, patient-reported outcome measurements [PROMs], and electronic patient portal [EPP] messaging) were analyzed using multivariate logistic and linear regression, respectively. Results Our results demonstrated that non-White race was not a significant predictor of binomial engagement or engagement frequency across all telehealth measures. Older age was a negative predictor of binomial engagement and engagement frequency with telemedicine and EPPs. Male sex was shown to be a negative predictor of binomial engagement with EPPs as well as PROM engagement frequency. Educational attainment of less than a college degree was a negative predictor of binomial engagement and engagement frequency with PROMs and EPPs. Conclusions This study demonstrates that older age, male sex, and lower education level were negative predictors of various measures of telehealth engagement. Non-White race was not a significant predictor. This data informs providers on how to improve access to virtual orthopaedic care.
Collapse
Affiliation(s)
- Michael Lotito
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Matthew Jamison
- Department of Orthopedics, Brigham & Women’s Hospital, Boston, MA, USA
| | | | | | - Jeffrey Lange
- Department of Orthopedics, Brigham & Women’s Hospital, Boston, MA, USA
| | - Antonia F. Chen
- Department of Orthopedics, Brigham & Women’s Hospital, Boston, MA, USA
| |
Collapse
|
49
|
Nie L, Sun Z, Shan F, Li C, Ding X, Shen C. An artificial intelligence framework for the diagnosis of prosthetic joint infection based on 99mTc-MDP dynamic bone scintigraphy. Eur Radiol 2023; 33:6794-6803. [PMID: 37115217 DOI: 10.1007/s00330-023-09687-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 01/30/2023] [Accepted: 02/26/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVES Dynamic bone scintigraphy (DBS) is the first widely reliable and simple imaging modality in nuclear medicine that can be used to diagnose prosthetic joint infection (PJI). We aimed to apply artificial intelligence to diagnose PJI in patients after total hip or knee arthroplasty (THA or TKA) based on 99mTc-methylene diphosphonate (99mTc-MDP) DBS. METHODS A total of 449 patients (255 THAs and 194 TKAs) with a final diagnosis were retrospectively enrolled and analyzed. The dataset was divided into a training and validation set and an independent test set. A customized framework composed of two data preprocessing algorithms and a diagnosis model (dynamic bone scintigraphy effective neural network, DBS-eNet) was compared with mainstream modified classification models and experienced nuclear medicine specialists on corresponding datasets. RESULTS In the fivefold cross-validation test, diagnostic accuracies of 86.48% for prosthetic knee infection (PKI) and 86.33% for prosthetic hip infection (PHI) were obtained using the proposed framework. On the independent test set, the diagnostic accuracies and AUC values were 87.74% and 0.957 for PKI and 86.36% and 0.906 for PHI, respectively. The customized framework demonstrated better overall diagnostic performance compared to other classification models and showed superiority in diagnosing PKI and consistency in diagnosing PHI compared to specialists. CONCLUSION The customized framework can be used to effectively and accurately diagnose PJI based on 99mTc-MDP DBS. The excellent diagnostic performance of this method indicates its potential clinical practical value in the future. KEY POINTS • The proposed framework in the current study achieved high diagnostic performance for prosthetic knee infection (PKI) and prosthetic hip infection (PHI) with AUC values of 0.957 and 0.906, respectively. • The customized framework demonstrated better overall diagnostic performance compared to other classification models. • Compared to experienced nuclear medicine physicians, the customized framework showed superiority in diagnosing PKI and consistency in diagnosing PHI.
Collapse
Affiliation(s)
- Liangbing Nie
- School of Computer Engineering and Science, Shanghai University, Shanghai, 200444, China
| | - Zhenkui Sun
- Department of Nuclear Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
- Bone Nonunion & Bone Infection MDT, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Fengling Shan
- Department of Nuclear Medicine, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Chengfan Li
- School of Computer Engineering and Science, Shanghai University, Shanghai, 200444, China
| | - Xuehai Ding
- School of Computer Engineering and Science, Shanghai University, Shanghai, 200444, China
| | - Chentian Shen
- Department of Nuclear Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China.
- Bone Nonunion & Bone Infection MDT, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China.
| |
Collapse
|
50
|
Wang X, Zhang H, Chen Y, Xie Z, Chen M, Chen Y, Zhang J. The anesthetic efficacy of ultrasound-guided lumbar plexus combined with quadratus lumborum block with Shamrock approach in total hip arthroplasty: study protocol for a randomized controlled trial. Trials 2023; 24:596. [PMID: 37718446 PMCID: PMC10506336 DOI: 10.1186/s13063-023-07619-z] [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: 04/01/2023] [Accepted: 09/02/2023] [Indexed: 09/19/2023] Open
Abstract
INTRODUCTION The lumbar plexus originates from multiple segments of the spinal cord. Both single-level lumbar plexus block (LPB) and transmuscular quadratus lumborum block (TQLB) are commonly used to provide analgesia for the patients undergoing total hip arthroplasty (THA). However, neither of them can completely cover the lumbar plexus. Multiple-level LPB is also not recommended since this expert technique involves more potential risks. To achieve a better anesthetic effect and avoid risks, we propose to combine ultrasound-guided LPB with TQLB with Shamrock approach. We aim to assess the anesthetic efficacy of this combination technique and expect it will be an ideal alternative for conventional LPBs in THA. METHODS AND ANALYSIS In this prospective randomized controlled trial, 84 patients schedule for THA will be enrolled. The patients will be randomly assigned at a 1:1:1 ratio to receive LPB at L3 level (P group), T12 paravertebral block combined with LPB at L3 and L4 levels (TP group), or LPB combined with TQLB at L3 level (PQ group). Each method will be evaluated in terms of the successful rate of sensory blockade, postoperative pain, performance time of block, requirement for intraoperative sufentanil, cumulative doses of intraoperative vasoactive medications, and adverse events. ETHICS AND DISSEMINATION The study protocol has been approved by the institutional review board (IRB) at Shanghai Jiao Tong University Affiliated Sixth People's Hospital, China (No.2020-031). The results will be disseminated in a peer-reviewed journal and the ClinicalTrials.gov registry. TRIAL REGISTRATION ClinicalTrials.gov, NCT04266236 . Registered on 10 February 2020. CLINICALTRIALS gov PRS: Record Summary NCT04266236 .
Collapse
Affiliation(s)
- Xiaofeng Wang
- Department of Anesthesiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No.600 Yishan Road, Xuhui District, Shanghai, 200233, China
| | - Hui Zhang
- Department of Anesthesiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No.600 Yishan Road, Xuhui District, Shanghai, 200233, China
| | - Yongzhu Chen
- Department of Anesthesiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No.600 Yishan Road, Xuhui District, Shanghai, 200233, China
| | - Zhenwei Xie
- Department of Anesthesiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No.600 Yishan Road, Xuhui District, Shanghai, 200233, China
| | - Moxi Chen
- Department of Anesthesiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No.600 Yishan Road, Xuhui District, Shanghai, 200233, China
| | - Yonglin Chen
- Department of Anesthesiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No.600 Yishan Road, Xuhui District, Shanghai, 200233, China
| | - Junfeng Zhang
- Department of Anesthesiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No.600 Yishan Road, Xuhui District, Shanghai, 200233, China.
| |
Collapse
|