Pub Date : 2024-01-01Epub Date: 2023-03-08DOI: 10.1177/11207000231158722
Jeremy A Dubin, Geoffrey H Westrich
Introduction: The relationship between implant type, dual mobility (DM) or fixed bearing (FB), and postoperative groin pain remains unexplored. We examined the incidence of groin pain in DM implants and compare this to a cohort of FB THA patients.
Methods: From 2006 to 2018, a single surgeon performed 875 DM THA and 856 FB THA procedures with 2.8-year and 3.1-year follow-up, respectively. Each patient received a questionnaire postoperatively and was asked if they had any groin pain (yes/no). Secondary measurements were implant characteristics such as head size, head offset, cup size, and cup-to-head ratio. Additional PROMs that were collected included: Veterans RAND 12 (VR-12), University of California Los Angeles (UCLA) activity score, Pain visual analogue scale (Pain VAS), and range of motion (ROM).
Results: The incidence of groin pain was 2.3% in the DM THA cohort and 6.3% in the FB THA group (p< 0.001). Also, low head offset (⩽0 mm) had a significant odds ratio (1.61) for groin pain in both cohorts. There was no significant difference in terms of revision rate between the cohorts (2.5% vs. 3.3%, p = 0.39) at the latest follow up.
Conclusions: This study demonstrated a lower incidence of groin pain (2.3%) in patients with a DM bearing compared to a FB (6.3%) and a greater risk of groin pain with low head offset (<0 mm). As such, surgeons should try to recreate offset of the hip compared to the contralateral side to avoid groin pain.
{"title":"Less groin pain with dual-mobility bearings versus fixed bearings in total hip arthroplasty.","authors":"Jeremy A Dubin, Geoffrey H Westrich","doi":"10.1177/11207000231158722","DOIUrl":"10.1177/11207000231158722","url":null,"abstract":"<p><strong>Introduction: </strong>The relationship between implant type, dual mobility (DM) or fixed bearing (FB), and postoperative groin pain remains unexplored. We examined the incidence of groin pain in DM implants and compare this to a cohort of FB THA patients.</p><p><strong>Methods: </strong>From 2006 to 2018, a single surgeon performed 875 DM THA and 856 FB THA procedures with 2.8-year and 3.1-year follow-up, respectively. Each patient received a questionnaire postoperatively and was asked if they had any groin pain (yes/no). Secondary measurements were implant characteristics such as head size, head offset, cup size, and cup-to-head ratio. Additional PROMs that were collected included: Veterans RAND 12 (VR-12), University of California Los Angeles (UCLA) activity score, Pain visual analogue scale (Pain VAS), and range of motion (ROM).</p><p><strong>Results: </strong>The incidence of groin pain was 2.3% in the DM THA cohort and 6.3% in the FB THA group (<i>p</i> <i><</i> 0.001). Also, low head offset (⩽0 mm) had a significant odds ratio (1.61) for groin pain in both cohorts. There was no significant difference in terms of revision rate between the cohorts (2.5% vs. 3.3%, <i>p</i> = 0.39) at the latest follow up.</p><p><strong>Conclusions: </strong>This study demonstrated a lower incidence of groin pain (2.3%) in patients with a DM bearing compared to a FB (6.3%) and a greater risk of groin pain with low head offset (<0 mm). As such, surgeons should try to recreate offset of the hip compared to the contralateral side to avoid groin pain.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9430025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2023-09-08DOI: 10.1177/11207000231194582
David T Wallace, Karl Stoffel, Joe Baines
Acetabular augmentation is a challenge for complex primary and revision hip surgery. Several methods exist to recreate a supportive, hemispherical acetabulum where a defect exists, however, these can be complex, expensive, time consuming, and limited by available size and shape. We present a simple, inexpensive, quick and customisable method of acetabular augmentation using cementless polyethylene with titanium coating. The first case is presented with follow-up up to 8 years.
{"title":"Technical note: acetabular augmentation with customisable cementless all-polyethylene insert.","authors":"David T Wallace, Karl Stoffel, Joe Baines","doi":"10.1177/11207000231194582","DOIUrl":"10.1177/11207000231194582","url":null,"abstract":"<p><p>Acetabular augmentation is a challenge for complex primary and revision hip surgery. Several methods exist to recreate a supportive, hemispherical acetabulum where a defect exists, however, these can be complex, expensive, time consuming, and limited by available size and shape. We present a simple, inexpensive, quick and customisable method of acetabular augmentation using cementless polyethylene with titanium coating. The first case is presented with follow-up up to 8 years.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10185618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Although several reports have examined the association between preoperative function and postoperative outcomes in patients undergoing total hip arthroplasty (THA), it is unclear whether the ability of the affected or non-affected side particularly impacts on outcomes. We aimed to investigate the association between affected and non-affected side ability and walking independence.
Methods: We prospectively enrolled 721 consecutive patients who underwent THA. Preoperatively, quadriceps isometric strength (QIS) and one-leg standing time (OLST) were measured. The endpoints were walking independence within 3, 5, 7, 10, and 14 days postoperatively. The associations between preoperative abilities and outcomes were examined using multivariate Cox hazard model, and the area under the curves (AUCs) for outcomes were compared.
Results: We analysed 540 patients after excluding patients who met the exclusion criteria. Both affected and non-affected QIS predicted walking independence within 3 (p= 0.006 and 0.001, respectively), 5, 7, 10, and 14 (both p< 0.001) days postoperatively. For OLST, only the affected side did not predict walking independence within 3 days postoperatively (p= 0.154 and 0.012, respectively), and both sides did at days 5 (p= 0.019 and <0.001, respectively), 7, 10, and 14 (both p< 0.001). The AUCs of the non-affected side ability for walking independence were significantly greater than those of the affected side on postoperative days 3 (0.66 vs. 0.73; p= 0.021) and 5 (0.67 vs. 0.71; p= 0.040), with no significant difference after day 7.
Conclusions: Both sides abilities were associated with walking independence after THA, but non-affected side was found to be particularly crucial for early walking independence.
{"title":"Association of affected and non-affected side ability with postoperative outcomes in patients undergoing total hip arthroplasty.","authors":"Kohei Nozaki, Yuta Nanri, Masashi Kawabata, Manaka Shibuya, Manami Nihei, Takehiro Shirota, Hiroyoshi Masuma, Takuya Maeda, Kensuke Fukushima, Katsufumi Uchiyama, Naonobu Takahira, Masashi Takaso","doi":"10.1177/11207000231199169","DOIUrl":"10.1177/11207000231199169","url":null,"abstract":"<p><strong>Background: </strong>Although several reports have examined the association between preoperative function and postoperative outcomes in patients undergoing total hip arthroplasty (THA), it is unclear whether the ability of the affected or non-affected side particularly impacts on outcomes. We aimed to investigate the association between affected and non-affected side ability and walking independence.</p><p><strong>Methods: </strong>We prospectively enrolled 721 consecutive patients who underwent THA. Preoperatively, quadriceps isometric strength (QIS) and one-leg standing time (OLST) were measured. The endpoints were walking independence within 3, 5, 7, 10, and 14 days postoperatively. The associations between preoperative abilities and outcomes were examined using multivariate Cox hazard model, and the area under the curves (AUCs) for outcomes were compared.</p><p><strong>Results: </strong>We analysed 540 patients after excluding patients who met the exclusion criteria. Both affected and non-affected QIS predicted walking independence within 3 (<i>p</i> <i>=</i> 0.006 and 0.001, respectively), 5, 7, 10, and 14 (both <i>p</i> <i><</i> 0.001) days postoperatively. For OLST, only the affected side did not predict walking independence within 3 days postoperatively (<i>p</i> <i>=</i> 0.154 and 0.012, respectively), and both sides did at days 5 (<i>p</i> <i>=</i> 0.019 and <0.001, respectively), 7, 10, and 14 (both <i>p</i> <i><</i> 0.001). The AUCs of the non-affected side ability for walking independence were significantly greater than those of the affected side on postoperative days 3 (0.66 vs. 0.73; <i>p</i> <i>=</i> 0.021) and 5 (0.67 vs. 0.71; <i>p</i> <i>=</i> 0.040), with no significant difference after day 7.</p><p><strong>Conclusions: </strong>Both sides abilities were associated with walking independence after THA, but non-affected side was found to be particularly crucial for early walking independence.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10289896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2023-04-10DOI: 10.1177/11207000231167349
Alexandra Dimitrakopoulou, Bryan English, Christiana Kartsonaki, Adam Gledhill, Ernest Schilders
Background: The postoperative management of femoroacetabular impingement (FAI) is variable with favourable surgical outcomes. Yet there is no evidence on the efficacy of hydrotherapy in athletes undergoing hip arthroscopy for FAI. The purpose of this study was to evaluate the role and the impact of hydrotherapy on return to sports following hip arthroscopy for symptomatic FAI.
Methods: 2 cohorts of mixed level of athletes from various sports: a hydrotherapy group that followed land-based exercises in combination with hydrotherapy exercises and a control group that followed solely the same land-based exercises. Pre- and postoperative pain and hip-specific outcome scores were completed, and patient satisfaction was rated.
Results: A total of 88 hip arthroscopies were included with a minimum of 2 years follow-up; the hydrotherapy group comprised of 36 hips and the control group, 52 hips. There was a significant improvement in time to return to previous performance (HR 1.91, 95% CI, 1.21-3.01; p = 0.005) in the hydrotherapy group compared with the control. The hip-specific scores and patient satisfaction were considerably improved in the hydrotherapy group.
Conclusions: The analysis of our data indicates that the incorporation of hydrotherapy into postoperative rehabilitation for hip arthroscopy for FAI accelerates the return of athletes to their pre-injury performance, since recovery time decreased significantly.
背景:股骨髋臼撞击症(FAI)的术后治疗方法多种多样,手术效果良好。然而,目前还没有证据表明水疗对接受髋关节镜手术治疗股骨髋臼撞击症的运动员有疗效。本研究的目的是评估水疗对有症状的髋关节置换术后恢复运动的作用和影响。方法:由来自不同运动项目的两组不同水平的运动员组成:水疗组在进行陆上运动的同时进行水疗运动,对照组则只进行同样的陆上运动。术前和术后疼痛和髋关节特异性结果评分均已完成,患者满意度也已评定:共有88例髋关节镜手术接受了至少2年的随访;水疗组有36个髋关节,对照组有52个髋关节。与对照组相比,水疗组患者恢复到以往表现的时间明显缩短(HR 1.91,95% CI,1.21-3.01;P = 0.005)。水疗组的髋关节特异性评分和患者满意度均显著提高:我们的数据分析表明,在髋关节镜手术治疗 FAI 的术后康复中加入水疗可加快运动员恢复到受伤前的表现,因为恢复时间明显缩短。
{"title":"The effectiveness of hydrotherapy on return to play in sports following hip arthroscopic surgery: a comparative study.","authors":"Alexandra Dimitrakopoulou, Bryan English, Christiana Kartsonaki, Adam Gledhill, Ernest Schilders","doi":"10.1177/11207000231167349","DOIUrl":"10.1177/11207000231167349","url":null,"abstract":"<p><strong>Background: </strong>The postoperative management of femoroacetabular impingement (FAI) is variable with favourable surgical outcomes. Yet there is no evidence on the efficacy of hydrotherapy in athletes undergoing hip arthroscopy for FAI. The purpose of this study was to evaluate the role and the impact of hydrotherapy on return to sports following hip arthroscopy for symptomatic FAI.</p><p><strong>Methods: </strong>2 cohorts of mixed level of athletes from various sports: a hydrotherapy group that followed land-based exercises in combination with hydrotherapy exercises and a control group that followed solely the same land-based exercises. Pre- and postoperative pain and hip-specific outcome scores were completed, and patient satisfaction was rated.</p><p><strong>Results: </strong>A total of 88 hip arthroscopies were included with a minimum of 2 years follow-up; the hydrotherapy group comprised of 36 hips and the control group, 52 hips. There was a significant improvement in time to return to previous performance (HR 1.91, 95% CI, 1.21-3.01; <i>p</i> = 0.005) in the hydrotherapy group compared with the control. The hip-specific scores and patient satisfaction were considerably improved in the hydrotherapy group.</p><p><strong>Conclusions: </strong>The analysis of our data indicates that the incorporation of hydrotherapy into postoperative rehabilitation for hip arthroscopy for FAI accelerates the return of athletes to their pre-injury performance, since recovery time decreased significantly.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9279515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2023-06-09DOI: 10.1177/11207000231177588
Fernando Diaz-Dilernia, Carlos Lucero, Pablo A Slullitel, Gerardo Zanotti, Fernando Comba, Francisco Piccaluga, Martin Buttaro
Background: Short stems are designed with a bone preservation philosophy in mind. This study aims to compare the outcomes/complications and survival of a collarless fully hydroxyapatite (HA)-coated conventional tapered stem and a HA-coated partial neck-retaining uncemented short stem in patients ⩽55 years old at medium-term follow-up.
Methods: We retrospectively studied 247 uncemented THAs operated between 2010 and 2014, comparing 146 patients treated with the fully HA-coated collarless stem (Group A) with 101 patients treated with a partial neck preserving, HA-coated short stem (Group B). 87 and 62 males were in groups A and B, respectively (p= 0.11). The mean age of the series was 46 years (17-55) (p =0.16). The mean follow-up of groups A and B were 9.9 (7-12) years and 9.7 (7-12) years, respectively (p =0.21).
Results: Mean Harris Hip Score improved from 55 to 92 in group A (p <0.001) and from 54 to 95 in group B (p <0.001), without differences between groups. Mean femoral neck length preservation in groups A and B was 13.6 (0-28) mm and 26 (11-38) mm, respectively (p =0.001). 13 (8.9%) and 1 (1%) patients in groups A and B presented postoperative complications, respectively (p =0.008). The conventional stem group had more aseptic loosening (Group A 3.4% vs. Group B 0%, p =0.06) along with more Symptomatic radiolucent lines (Group A 3.4% vs. Group B 0%, p =0.06).
Conclusions: Both conventional and short stems showed excellent implant survival rates and functional outcomes at a mean follow-up of 9.8 years. However, complications and radiolucent lines were more frequent with a collarless conventional-length stem. Bone preservation of the femoral neck and diaphysis may be preferred in active young patients.
{"title":"Medium-term outcomes of conventional versus short uncemented femoral stems for primary total hip arthroplasty in patients younger than 55 years.","authors":"Fernando Diaz-Dilernia, Carlos Lucero, Pablo A Slullitel, Gerardo Zanotti, Fernando Comba, Francisco Piccaluga, Martin Buttaro","doi":"10.1177/11207000231177588","DOIUrl":"10.1177/11207000231177588","url":null,"abstract":"<p><strong>Background: </strong>Short stems are designed with a bone preservation philosophy in mind. This study aims to compare the outcomes/complications and survival of a collarless fully hydroxyapatite (HA)-coated conventional tapered stem and a HA-coated partial neck-retaining uncemented short stem in patients ⩽55 years old at medium-term follow-up.</p><p><strong>Methods: </strong>We retrospectively studied 247 uncemented THAs operated between 2010 and 2014, comparing 146 patients treated with the fully HA-coated collarless stem (Group A) with 101 patients treated with a partial neck preserving, HA-coated short stem (Group B). 87 and 62 males were in groups A and B, respectively (<i>p</i> <i>=</i> 0.11). The mean age of the series was 46 years (17-55) (<i>p =</i>0.16). The mean follow-up of groups A and B were 9.9 (7-12) years and 9.7 (7-12) years, respectively (<i>p =</i>0.21).</p><p><strong>Results: </strong>Mean Harris Hip Score improved from 55 to 92 in group A (<i>p <</i>0.001) and from 54 to 95 in group B (<i>p <</i>0.001), without differences between groups. Mean femoral neck length preservation in groups A and B was 13.6 (0-28) mm and 26 (11-38) mm, respectively (<i>p =</i>0.001). 13 (8.9%) and 1 (1%) patients in groups A and B presented postoperative complications, respectively (<i>p =</i>0.008). The conventional stem group had more aseptic loosening (Group A 3.4% vs. Group B 0%, <i>p =</i>0.06) along with more Symptomatic radiolucent lines (Group A 3.4% vs. Group B 0%, <i>p =</i>0.06).</p><p><strong>Conclusions: </strong>Both conventional and short stems showed excellent implant survival rates and functional outcomes at a mean follow-up of 9.8 years. However, complications and radiolucent lines were more frequent with a collarless conventional-length stem. Bone preservation of the femoral neck and diaphysis may be preferred in active young patients.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9593126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aim: This study aimed to assess the relationship between the three-dimensional (3D) alignment of short tapered-wedge cementless stems and bone mineral density (BMD) changes in patients followed up for 5 years after total hip arthroplasty (THA).
Methods: We retrospectively analysed the hips of 52 patients who underwent THA using short tapered-wedge cementless stems at our institution from 2013 to 2016 with complete 5-year follow-up data. We evaluated the relationship between stem alignment, measured using a 3D-templating software, and BMD changes in the 7 Gruen zones.
Results: After 1 year, significant negative correlations between varus insertion and a decrease in BMD in zone 7 and between flexed insertion and decreases in BMD in zones 3 and 4 were noted. After 5 years, significant negative correlations between varus insertion and a decrease in BMD in zone 7 and between flexed insertion and decreases in BMD zones 2, 3, and 4 were observed. With increased amounts of varus/flexion stem alignment, the amount of BMD loss decreased. There was no correlation between anteverted stem insertion and changes in BMD levels.
Conclusions: Our data showed that stem alignment affects BMD based on 5-year follow-up data after surgery. Careful observation is necessary, especially when using short tapered-wedge cementless stems, as stem alignment may affect changes in BMD levels more than 5 years after surgery.
{"title":"Stem alignment with short tapered-wedge cementless stems affects bone mineral density continuously for at least 5 years after primary total hip arthroplasty.","authors":"Sho Masuda, Kentaro Iwakiri, Yoichi Ohta, Yukihide Minoda, Akio Kobayashi, Hiroaki Nakamura","doi":"10.1177/11207000231178984","DOIUrl":"10.1177/11207000231178984","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to assess the relationship between the three-dimensional (3D) alignment of short tapered-wedge cementless stems and bone mineral density (BMD) changes in patients followed up for 5 years after total hip arthroplasty (THA).</p><p><strong>Methods: </strong>We retrospectively analysed the hips of 52 patients who underwent THA using short tapered-wedge cementless stems at our institution from 2013 to 2016 with complete 5-year follow-up data. We evaluated the relationship between stem alignment, measured using a 3D-templating software, and BMD changes in the 7 Gruen zones.</p><p><strong>Results: </strong>After 1 year, significant negative correlations between varus insertion and a decrease in BMD in zone 7 and between flexed insertion and decreases in BMD in zones 3 and 4 were noted. After 5 years, significant negative correlations between varus insertion and a decrease in BMD in zone 7 and between flexed insertion and decreases in BMD zones 2, 3, and 4 were observed. With increased amounts of varus/flexion stem alignment, the amount of BMD loss decreased. There was no correlation between anteverted stem insertion and changes in BMD levels.</p><p><strong>Conclusions: </strong>Our data showed that stem alignment affects BMD based on 5-year follow-up data after surgery. Careful observation is necessary, especially when using short tapered-wedge cementless stems, as stem alignment may affect changes in BMD levels more than 5 years after surgery.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9593132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2023-01-27DOI: 10.1177/11207000231151235
Oguz Turan, Xuankang Pan, Kyle N Kunze, Pedro J Rullan, Ahmed K Emara, Robert M Molloy, Nicolas S Piuzzi
Background: Mortality after total hip arthroplasty (THA) is a rare but devastating complication. This meta-analysis aimed to: (1) determine the mortality rates at 30 days, 90 days, 1 year, 5 years and 10 years after THA; (2) identify risk factors and causes of mortality after THA.
Methods: Pubmed, MEDLINE, Cochrane, EBSCO Host, and Google Scholar databases were queried for studies reporting mortality rates after primary elective, unilateral THA. Inverse-proportion models were constructed to quantify the incidence of all-cause mortality at 30 days, 90 days, 1 year, 5 years and 10 years after THA. Random-effects multiple regression was performed to investigate the potential effect modifiers of age (at time of THA), body mass index, and gender.
Results: A total of 53 studies (3,297,363 patients) were included. The overall mortality rate was 3.9%. The 30-day mortality was 0.49% (95% CI; 0.23-0.84). Mortality at 90 days was 0.47% (95% CI, 0.38-0.57). Mortality increased exponentially between 90 days and 5 years, with a 1-year mortality rate of 1.90% (95% CI, 1.22-2.73) and a 5-year mortality rate of 9.85% (95% CI, 5.53-15.22). At 10-year follow-up, the mortality rate was 16.43% (95% CI, 1.17-22.48). Increasing comorbidity indices, socioeconomic disadvantage, age, anaemia, and smoking were found to be risk factors for mortality. The most commonly reported causes of death were ischaemic heart disease, malignancy, and pulmonary disease.
Conclusions: All-cause mortality remains low after contemporary THA. However, 1 out of 10 patients and 1 out of 6 patients were deceased after 5 years and 10 years of THA, respectively. As expected, age, but not BMI or gender, was significantly associated with mortality.
{"title":"30-day to 10-year mortality rates following total hip arthroplasty: a meta-analysis of the last decade (2011-2021).","authors":"Oguz Turan, Xuankang Pan, Kyle N Kunze, Pedro J Rullan, Ahmed K Emara, Robert M Molloy, Nicolas S Piuzzi","doi":"10.1177/11207000231151235","DOIUrl":"10.1177/11207000231151235","url":null,"abstract":"<p><strong>Background: </strong>Mortality after total hip arthroplasty (THA) is a rare but devastating complication. This meta-analysis aimed to: (1) determine the mortality rates at 30 days, 90 days, 1 year, 5 years and 10 years after THA; (2) identify risk factors and causes of mortality after THA.</p><p><strong>Methods: </strong>Pubmed, MEDLINE, Cochrane, EBSCO Host, and Google Scholar databases were queried for studies reporting mortality rates after primary elective, unilateral THA. Inverse-proportion models were constructed to quantify the incidence of all-cause mortality at 30 days, 90 days, 1 year, 5 years and 10 years after THA. Random-effects multiple regression was performed to investigate the potential effect modifiers of age (at time of THA), body mass index, and gender.</p><p><strong>Results: </strong>A total of 53 studies (3,297,363 patients) were included. The overall mortality rate was 3.9%. The 30-day mortality was 0.49% (95% CI; 0.23-0.84). Mortality at 90 days was 0.47% (95% CI, 0.38-0.57). Mortality increased exponentially between 90 days and 5 years, with a 1-year mortality rate of 1.90% (95% CI, 1.22-2.73) and a 5-year mortality rate of 9.85% (95% CI, 5.53-15.22). At 10-year follow-up, the mortality rate was 16.43% (95% CI, 1.17-22.48). Increasing comorbidity indices, socioeconomic disadvantage, age, anaemia, and smoking were found to be risk factors for mortality. The most commonly reported causes of death were ischaemic heart disease, malignancy, and pulmonary disease.</p><p><strong>Conclusions: </strong>All-cause mortality remains low after contemporary THA. However, 1 out of 10 patients and 1 out of 6 patients were deceased after 5 years and 10 years of THA, respectively. As expected, age, but not BMI or gender, was significantly associated with mortality.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10624951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2023-06-12DOI: 10.1177/11207000231178269
Zachary P Berliner, Muhammad Umar Jawad, Chelsea Matzko, H John Cooper, Jose A Rodriguez, Matthew S Hepinstall
Introduction: Radiolucent lines occasionally develop around the proximal aspect of fully hydroxyapatite (HA)-coated tapered femoral stems after total hip arthroplasty (THA). It was hypothesised that distal wedging of stems may predispose to proximal radiolucent line formation, which may negatively impact clinical outcome.
Methods: All primary THA performed with a collarless fully HA-coated stem that had a minimum of 1 year of radiographic follow-up were identified in a surgical database (n = 244). Radiographic measures of proximal femoral morphology and femoral canal fill at the middle and distal thirds of the stem were analysed for association with the presence of proximal radiolucent lines. Linear regression was used to explore any association between radiolucent lines and patient reported outcome measures (PROMs), available in 61% of patients.
Results: Proximal radiolucent lines developed in 31 cases (12.7%) at final follow-up. Dorr A femoral morphology and increased canal-fill at the distal ⅓ of the stem correlated with the development of radiolucent lines (p < 0.001). No correlation was observed between pain or PROMs and the presence of proximal radiolucent lines.
Discussion: We observed an unexpectedly high incidence of proximal femoral radiolucent lines about collarless fully HA coated stems. Distal-only implant wedging in Dorr A bone may compromise proximal fixation. Although this finding did not correlate with short-term outcomes, the long-term clinical impact requires further study.
{"title":"Proximal radiolucent lines around fully hydroxyapatite-coated tapered femoral stems: should we be concerned?","authors":"Zachary P Berliner, Muhammad Umar Jawad, Chelsea Matzko, H John Cooper, Jose A Rodriguez, Matthew S Hepinstall","doi":"10.1177/11207000231178269","DOIUrl":"10.1177/11207000231178269","url":null,"abstract":"<p><strong>Introduction: </strong>Radiolucent lines occasionally develop around the proximal aspect of fully hydroxyapatite (HA)-coated tapered femoral stems after total hip arthroplasty (THA). It was hypothesised that distal wedging of stems may predispose to proximal radiolucent line formation, which may negatively impact clinical outcome.</p><p><strong>Methods: </strong>All primary THA performed with a collarless fully HA-coated stem that had a minimum of 1 year of radiographic follow-up were identified in a surgical database (<i>n =</i> 244). Radiographic measures of proximal femoral morphology and femoral canal fill at the middle and distal thirds of the stem were analysed for association with the presence of proximal radiolucent lines. Linear regression was used to explore any association between radiolucent lines and patient reported outcome measures (PROMs), available in 61% of patients.</p><p><strong>Results: </strong>Proximal radiolucent lines developed in 31 cases (12.7%) at final follow-up. Dorr A femoral morphology and increased canal-fill at the distal ⅓ of the stem correlated with the development of radiolucent lines (<i>p <</i> 0.001). No correlation was observed between pain or PROMs and the presence of proximal radiolucent lines.</p><p><strong>Discussion: </strong>We observed an unexpectedly high incidence of proximal femoral radiolucent lines about collarless fully HA coated stems. Distal-only implant wedging in Dorr A bone may compromise proximal fixation. Although this finding did not correlate with short-term outcomes, the long-term clinical impact requires further study.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9668000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2023-06-14DOI: 10.1177/11207000231177642
Peter P Schmitz, Matthijs P Somford, Simon S Jameson, B Willem Schreurs, Job L C van Susante
Purpose: Several controversies in the optimal treatment of femoral neck fractures persist, together with large variations in clinical practice.
Methods: A narrative literature review covering 4 current controversies in the surgical management of femoral neck fractures (total hip arthroplasty (THA) versus hemiarthroplasty (HA), cemented versus uncemented HA, internal fixation versus arthroplasty, operative versus non-operative) was performed. Available literature was balanced against annual trends in the management of femoral neck fractures from the public domain of several national registries (Sweden, Norway, The Netherlands, Australia and New Zealand).
Results: For most controversies, the literature provides stronger evidence than is reflected by variations encountered in daily practice. Implementation of clinical evidence tends to lag behind and important differences exist between countries.
Conclusions: Trends of clinical practice from national registries indicate that implementation of available clinical evidence needs to be improved.
{"title":"Controversies around hip fracture treatment: clinical evidence versus trends from national registries.","authors":"Peter P Schmitz, Matthijs P Somford, Simon S Jameson, B Willem Schreurs, Job L C van Susante","doi":"10.1177/11207000231177642","DOIUrl":"10.1177/11207000231177642","url":null,"abstract":"<p><strong>Purpose: </strong>Several controversies in the optimal treatment of femoral neck fractures persist, together with large variations in clinical practice.</p><p><strong>Methods: </strong>A narrative literature review covering 4 current controversies in the surgical management of femoral neck fractures (total hip arthroplasty (THA) versus hemiarthroplasty (HA), cemented versus uncemented HA, internal fixation versus arthroplasty, operative versus non-operative) was performed. Available literature was balanced against annual trends in the management of femoral neck fractures from the public domain of several national registries (Sweden, Norway, The Netherlands, Australia and New Zealand).</p><p><strong>Results: </strong>For most controversies, the literature provides stronger evidence than is reflected by variations encountered in daily practice. Implementation of clinical evidence tends to lag behind and important differences exist between countries.</p><p><strong>Conclusions: </strong>Trends of clinical practice from national registries indicate that implementation of available clinical evidence needs to be improved.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9627853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Despite the overall success of THA, between 5 and 20% report unsatisfactory results. Several factors may cause this variable outcome. 1 of them might be ethnicity which, because of its potential social impact on living conditions, may influence quality of life too. It should be studied whether patients born and being operated in their home country Bosnia and Herzegovina (BH) had similar results as immigrants being operated in Sweden (IS).
Methods: Data of 280 patients were collected prospectively from questionnaires in the BH group. Patients of the IS group were eligible if both of their parents were born outside the Nordic countries, not having Swedish as their native language. Data were gained from the Swedish Arthroplasty Registry (SAR), 449 patients were included. Outcomes were pain VAS, satisfaction VAS, EQ-VAS, and the EQ-5D. Logistic and linear regression models including age, sex, diagnosis, type of fixation, surgical incision, marital status and educational level were analysed to compare those 2 groups.
Results: There were considerable differences in patient demographics between the 2 groups. Before the operation, patients in the BH group reported more problems with self-care and usual activities, even after adjustment for confounding factors (p< 0.0005). Patients in the IS group reported a higher EQ-VAS and more pain VAS (p< 0.0005), the difference in the EQ-VAS was not significant after adjustment for confounding factors (p = 0.41). After 1 year patients in the BH group reported better scores in all dimensions of the EQ-5D (p ⩽ 0.005) apart from self-care. After adjustment for confounding factors, patients in the BH group were more satisfied too (p< 0.0005).
Conclusions: Immigrated patients (IS group) seemed to experience less benefit from THA 1 year after the operation despite more symptoms preoperatively. There were considerable limitations affecting the results. Nevertheless, the data are a point of concern, and it is suggested to take more multidimensional care of immigrant patients.
{"title":"Influence of immigrant background on the outcome of total hip arthroplasty: better outcome in 280 native patients in Bosnia and Herzegovina than in 449 immigrants living in Sweden.","authors":"Ferid Krupic, Slavko Manojlovic, Svemir Custovic, Mirsad Fazlic, Sahmir Sadic, Johan Kärrholm","doi":"10.1177/11207000231182321","DOIUrl":"10.1177/11207000231182321","url":null,"abstract":"<p><strong>Background: </strong>Despite the overall success of THA, between 5 and 20% report unsatisfactory results. Several factors may cause this variable outcome. 1 of them might be ethnicity which, because of its potential social impact on living conditions, may influence quality of life too. It should be studied whether patients born and being operated in their home country Bosnia and Herzegovina (BH) had similar results as immigrants being operated in Sweden (IS).</p><p><strong>Methods: </strong>Data of 280 patients were collected prospectively from questionnaires in the BH group. Patients of the IS group were eligible if both of their parents were born outside the Nordic countries, not having Swedish as their native language. Data were gained from the Swedish Arthroplasty Registry (SAR), 449 patients were included. Outcomes were pain VAS, satisfaction VAS, EQ-VAS, and the EQ-5D. Logistic and linear regression models including age, sex, diagnosis, type of fixation, surgical incision, marital status and educational level were analysed to compare those 2 groups.</p><p><strong>Results: </strong>There were considerable differences in patient demographics between the 2 groups. Before the operation, patients in the BH group reported more problems with self-care and usual activities, even after adjustment for confounding factors (<i>p</i> <i><</i> 0.0005). Patients in the IS group reported a higher EQ-VAS and more pain VAS (<i>p</i> <i><</i> 0.0005), the difference in the EQ-VAS was not significant after adjustment for confounding factors (<i>p</i> = 0.41). After 1 year patients in the BH group reported better scores in all dimensions of the EQ-5D (<i>p</i> ⩽ 0.005) apart from self-care. After adjustment for confounding factors, patients in the BH group were more satisfied too (<i>p</i> <i><</i> 0.0005).</p><p><strong>Conclusions: </strong>Immigrated patients (IS group) seemed to experience less benefit from THA 1 year after the operation despite more symptoms preoperatively. There were considerable limitations affecting the results. Nevertheless, the data are a point of concern, and it is suggested to take more multidimensional care of immigrant patients.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10787385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41113415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}