HIP International最新文献

Introduction: Few studies have evaluated nonpharmacologic interventions, including preoperative psychotherapy, in patients who have depression. We studied whether psychotherapy visits prior to total hip arthroplasty (THA) in patients with depression were associated with lower: (1) readmissions; and (2) implant complications in patients who have depression.

Methods: A nationwide database was queried from 2010 to 2021. Patients who had depression were 1:1 propensity score matched based on those who had (n = 16,143) and did not have (n = 16,140) preoperative psychotherapy visits within 3 months of primary THA. These depression patients were 1:5 ratio-matched to a control cohort of patients without comorbid depression (n = 80,627). A 90-day and 2-year follow-up surveillance period was used to evaluate readmissions and implant complications, respectively. Logistic regression models computed the odds ratios (OR) of psychotherapy on readmissions and implant complications. Patients without comorbid depression served as the reference cohort. p-Values less than 0.001 were significant.

Results: Of patients who had depression, a stepwise increase in odds of readmissions occurred for patients who had psychotherapy (6.2 vs. 5.0%, OR 1.25; p < 0.0001) and did not have psychotherapy (6.7 vs. 5.0%, OR 1.36; p < 0.0001) compared to patients who did not have depression. Compared to patients who did not have depression, patients who had depression and did not have psychotherapy experienced greater odds of aseptic loosening (1.7 vs. 0.7%, OR 2.31; p < 0.0001), periprosthetic fractures (0.5 versus 0.2%, OR 2.44; p < 0.0001), dislocations (3.7 vs. 1.6%, OR 2.39; p < 0.0001), periprosthetic joint infections (PJIs) (3.1 vs. 1.7%, OR 1.93; p < 0.0001), and all-cause THA revisions (3.6 vs. 1.5%, OR 2.44; p < 0.0001).

Discussion: Preoperative psychotherapy may provide a modifiable benefit among patients who had depression for 2-year implant complications. This intervention may aid arthroplasty surgeons in optimising patients potentially at higher risk for adverse events.

Objectives: Total hip arthroplasty (THA) and resurfacing hip arthroplasty (RHA) offer promising therapeutic solutions to physically active patients with hip osteoarthritis (OA). The impact of physical activity on long-term implant integrity in this population remains unknown. This systematic review compares the impact of physical activity and sports participation on implant integrity in THA versus RHA.

Methods: A comprehensive search of Medline, Embase (both via Ovid), Scopus, and CINAHL was conducted from inception to May 2023 following the Cochrane Handbook for Systematic Reviews of Interventions. Data were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The quality of included studies was assessed using the Newcastle-Ottawa Scale. Implant integrity was measured either radiographically, via serum metal ion levels or revision rates.

Results: A total of 16 studies with 4676 patients (THA: 3146; RHA: 1530) met the inclusion criteria. The median age at surgery was 60 years (range 49 to 86) in THA and 54 (range 49-61) years in RHA. At a median follow-up of 7.1 (range 4.8-13.1) years in THA and 10 (range 2.8-11.7) years in RHA, 3 studies out of 12, including 65.7% of the patients who underwent THA, and 2 studies out of 5, including 30.1% of the patients who underwent RHA, demonstrated that increased physical activity was associated with poor implant survivorship.

Conclusions: Patients undergoing THA or RHA should be counselled to participate in moderate physical activity and may benefit from avoiding sports that exert an excessive load on their implants. On average, the quality of the studies was moderate. The outcome measures used to quantify physical activity and implant integrity are heterogenous.

Background: The posterior horizontal dislocation distance (PHDD) is a 3-dimensional jump distance measurement that is relevant to the risk of dislocation. There are a number of dual-mobility (DM) constructs with varying designs available. The present study identifies design factors associated with increased PHDD and evaluates the PHDD of 3 DM implants.

Methods: 3 different computer-aided implant designs were virtually implanted within a 3-dimensional CT-derived pelvic model. Each design represented an analogue of a DM system (MDM, OR3O, and G7) according to specific variations in acetabular liner rim build-up and femoral head centre location. The effective head diameters and PHDD values were calculated for each size acetabular shell and DM design.

Results: The positive rim build-up design (MDM) showed higher PHDD values as compared to the other 2 hemispherical rim designs with no build-up, across all studied shell sizes. Specifically, the MDM design analogue had 16.4-29.0% greater PHDD values than the OR3O design analog and 15.2-30.5% greater PHDD values than the G7 design analogue The effect of a sfemoral head centre location relative to the liner head centre (OR3O) was negated by a larger effective head diameter to shell diameter ratio of the G7 design, resulting in similar PHDD values.

Conclusions: Design parameters affect the PHDD values of DM cups. The use of an elevated rim was associated with greater PHDD values. A medialised femoral head centre should also improve PHDD values, but the effect was nullified due to consecutive lower effective head diameters.

Background: A population-based study delineating the epidemiologic, clinical, and treatment characteristics of femoral neck fractures (FNFs) in elderly patients has not yet been conducted in Turkey. In this nationwide study, the epidemiologic, clinical, and treatment characteristics of patients aged ⩾65 years with FNFs who underwent osteosynthesis, hemiarthroplasty (HA), or total hip arthroplasty (THA) were examined.

Methods: Patients aged ⩾65 years with FNFs were identified in this retrospective, nationwide study. Then, the patients who underwent osteosynthesis or total/hemiarthroplasty from 2016 to 2021 were included. All the outcome variables were collected from patient medical records stored in the e-health database of the Republic of Turkey Ministry of Health.

Results: A total of 83,789 FNFs treated surgically were analysed. Osteosynthesis was performed on 21,130 FNFs (25.2%), HA on 56,378 FNFs (67.3%), and THA on 6281 FNFs (7.5%). From 2016 to 2021, the overall revision rates for THA and HA were 14.6% (914/5367 patients) and 5.9% (3301/53,077 patients), respectively. The rate of revision prosthetic surgery was significantly higher after THA than after HA (p < 0.001). Mortality rates at 1 year were 25% (n = 5293) for osteosynthesis, 14.7% (n = 924) for THA, and 71.1% (n = 40,109) for HA (p = 0.001). The multivariate model of 1-year postoperative mortality revealed 7 independent predictors: male sex (odds ratio [OR] 1.694; 95% confidence interval [CI], 1.640-1.751), use of a cemented femoral stem (OR 1.182; 95% CI, 1.117-1.250), acute myocardial infarction (AMI) (OR 1.317; 95% CI, 1.240-1.400), cerebrovascular accident (CVA) (OR 1.379; 95% CI, 1.333-1.425), chronic liver disease (CLD) (OR 2.188; 95% CI, 1.802-2.489), diabetes mellitus (DM) (OR, 1.160; 95% CI, 1.122-1.200), and age >81.50 years (OR 2.654; 95% CI, 2.569-2.742).

Conclusions: Our study suggested that a hemiarthroplasty is the most common treatment modality for FNF followed by osteosynthesis (25.2%) and THA (7.5%) in Turkey. Revision rates after THA for FNF are concerning. The 1-year mortality rates are highest after HA, followed by osteosynthesis and THA. Male sex, cemented fixation, CVA, CLD, liver failure, DM, and age >81.50 are the independent predictive factors for postoperative 1-year mortality in this specific group of patients.

Introduction: When operating in lateral decubitus apparent operative inclination (AOI) is the angle between the handle of the acetabular cup introducer and the theatre floor. A digital inclinometer has demonstrated optimal control of AOI. This study aims to compare the deviation from a target AOI with a novel autoclavable ball-in-cage mechanical alignment guide (MAG) as compared to a digital inclinometer.

Methods: 90 primary total hip arthroplasty cases performed in lateral decubitus using a posterior approach were included. The ball-in-cage mechanical alignment guide on a standard Pinnacle cup introducer handle was used to achieve the target AOI of 35° ± 2.5°. Final AOI was measured with a digital inclinometer. These readings were compared to a published historical series of 90 patients using a digital inclinometer.

Results: The ball-in-cage MAG mean inclination was 35.0° (range 32.5-37.4°), with 100% falling within target. This compared to a mean inclination of 34.0° (range 27.5-37.5°), with the digital inclinometer where 87.8% fell within target. However, the range of postoperative radiographic inclination for the ball-in-cage MAG was 23.4-53.9° with 31.1% being outside a ±5° target.

Conclusions: These results indicate that this simple autoclavable ball-in-cage MAG consistently achieves an intraoperative AOI within target range. In isolation this does not guarantee a postoperative radiographic inclination within target range.

Background: The incorporation of spinopelvic alignment measurement in the planning of primary hip arthroplasties is a simple and low-cost method whose isolated impact on reducing dislocation rates has not been clearly established.

Aim: The objective was to estimate the probability of dislocation and its occurrence rate by comparing 2 demographically similar populations, 1 with the measurement incorporated and the other without it. Additionally, the modification and distribution of surgical practices and indications aimed at reducing the risk of dislocations were compared.

Methods: A before-and-after study with prospective registry and retrospective control group was designed. We compared 693 patients (prospective registry) with the incorporation of spinopelvic alignment measurement in preoperative planning versus 341 from a previous period who constituted the control group (retrospective registry). All had a minimum follow-up of 2 years.

Results: The dislocation rate significantly decreased from 3.2% to 0.7%, with an OR of 0.22 for dislocation in the intervention group. There was a significant increase in the use of dual-mobility components in patients with complete misalignment and stems with extended offset in patients with partial misalignment.

Conclusions: In conclusion, the incorporation of spinopelvic alignment measurement in preoperative planning is an accessible method for any medical centre that contributed to modifying surgical practices, ultimately leading to a significant reduction in the dislocation rate.

Background: Valgus osteotomy is a femoral head-preserving surgery to treat femoral neck non-union in young, active patients. The traditional approach, however, causes medialisation of the femoral shaft during valgus correction, which alters femoral anatomy and complicates conversion to total hip arthroplasty if head osteosynthesis fails. This study aims to outline a novel surgical technique, medial opening wedge valgus intertrochanteric osteotomy (VITO), and evaluate its clinical and radiographic outcomes, focusing on restoring hip biomechanics and improving union rates.

Methods: Between 2007 and 2022, this technique was used in 18 cases (mean age :39; range :16-51 years). There were 14 males and 4 females. In 10 cases,non-union was due to failed internal fixation, while in 8 cases, it was due to neglected fractures. Treatment outcomes were evaluated by assessing union, pre- and postoperative neck-shaft angle (NSA) correction, and functional outcomes by the Harris Hip Score (HHS).

Results: 16 out of 18 patients were available for follow-up. The average duration of non-union was 10.7 (range 1-60) months, and the mean follow-up was 64 (range 24-140) months. All achieved successful union, with an average neck shaft angle correction of 16°. 3 patients were converted to total hip arthroplasty (THA) due to implant failure. Complications included 3 cases of avascular necrosis (AVN). Despite these complications, 62% of patients had excellent HHS, while 19% had good HHS. The mean HHS improved from 46(preoperative) to 92 (postoperative).

Conclusions: The medial opening wedge VITO is an effective technique for restoring hip biomechanics and achieving high union rates in patients with femoral neck non-union. This technique preserves proximal femoral anatomy, facilitating easier conversion to THA when necessary.

Introduction: Hip hemiarthroplasties are performed in medically frail and/or comorbid patients who sustain a displaced intracapsular hip fracture. Dislocations occur in approximately 0.6-5.0% patients and are associated with worse outcomes, including mortality when compared against a similar cohort of patients who do not suffer a dislocation of their hemiarthroplasty.This study aimed to quantify the outcomes from the management of dislocated hip hemiarthroplasties in a cohort of contemporaneously used implants and the associated 1-year mortality.

Methods: A retrospective review of a prospectively collected database of 4116 consecutive patients treated with a cemented hip hemiarthroplasty, in which 63 dislocations were identified was performed.The outcomes of the management of each dislocation were quantified, including the number of dislocations sustained after a preceding successful closed reduction. 1-year mortality was ascertained and stratified for each treatment option.

Results: 63 patients with a dislocation of a cemented hip hemiarthroplasty performed for an intracapsular hip fracture were included. Closed reduction was unsuccessful in 72% of (31/43) patients who had a closed reduction of their first dislocation. Failure rates of a second closed reduction increased to 76.9% and 100.0% with a third closed reduction.1-year mortality rate after a dislocation was 46.0% for all patients and lowest in the cohort of patients who were treated with a revision arthroplasty (27.3%).

Conclusions: Closed reduction of dislocated hip hemiarthroplasty is associated with a high failure rate, especially after a second dislocation. Consideration should be made to perform a revision procedure after a second dislocation with a high suspicion for soft tissue repair failure and/or infection.

Introduction: Constrained acetabular liners (CALs) are predominantly used as a salvage procedure in patients with a severe risk for dislocation after total hip arthroplasty (THA). However, the constrained design of CALs bears the risk of impingement with subsequent loosening or failure of the integrity of the implant. We investigated the use and survival of CALs in primary and revision THA in the Dutch Arthroplasty Register (LROI).

Methods: Use of CAL in THAs was extracted from the LROI in the period 2007-2022. 423,773 primary THAs and 52,706 revision THAs have been registered, of which 29 CALs were implanted in primary THA and 236 CALs in revision THA. Patient characteristics and survival of the CAL placed in primary and revision THA were separately analysed.

Results: Of the CALs placed in primary THA, no revisions of the implant occurred during a median follow-up of 5.4 years (interquartile range [IQR] 4.0-12.4). The CALs in revision THA were most frequently used for cases with recurrent dislocation (183/236). Median follow-up was 4.8 (IQR 2.3-8.2) years. The re-revision rate was 10% (95% CI, 6.6-14) at 5-year follow-up and 12% (CI, 8.1-17) at 9-year follow-up. The most frequently registered reason for re-revision was dislocation (n = 19, 70%).

Conclusions: In the Netherlands there is a relatively low use of CALs in primary as well as revision THA. The survival rate of CALs is acceptable, with recurrent dislocation as the main reason for re-revision. The use of CALs should be reserved for specific cases with high risk for dislocation.

Introduction: The unnecessary over-ordering of routine pre-transfusion tests (blood typing, screening, and cross-matching) for surgical cases results in substantial avoidable costs and imposes an undue burden on transfusion services. This study specifically focuses on conducting a systematic review of the literature to assess the necessity of routine pre-transfusion tests before total hip arthroplasty (THA) and aims to provide a comprehensive summary of the outcomes associated with this practice.

Methods: A systematic review and meta-analysis were conducted to analyse the study's characteristics, assess the prevalence of over-ordering, defined as ordering more routine pre-transfusion tests than clinically necessary, examine transfusion rates, and evaluate potential cost savings to the healthcare system.

Results: The study included 12,178 patients. Pooled results revealed an 88.1% over-ordering pre-transfusion test rate (95% CI, 0.80-0.96; p < 0.001) among patients undergoing primary THA. The pooled prevalence of hospital transfusion rate was 11.9%, with a percentage of intraoperative transfusion of 0.4% (95% CI, 0.001-0.007; p = 0.007). There were statistically significant differences in preoperative haemoglobin (Hb) levels between patients not requiring 14.1 g/dl (95% CI, 13.2-14.9; p < 0.001) and those needing transfusion 11.9 g/dl (95% CI, 10.9-12.9; p < 0.001) (p < 0.001). The per-patient total cost savings ranged from 2.10 to 191.27 dollars.

Conclusions: Our findings indicate that routine pretransfusion testing for all patients undergoing primary THA may be unnecessary. We recommend restricting pre-transfusion test orders to patients with preoperative haemoglobin levels below 12 g/dl specifically in the context of unilateral primary THA, always considering individual patient and surgical risk factors. This focused approach has the potential to yield substantial cost savings for healthcare systems and transfusion services by mitigating the unnecessary over-ordering of pre-transfusion tests associated with these surgical procedures.