HIP International最新文献

Background and purpose: This prospective observational study aimed to investigate the occurrence of avascular necrosis (AVN) of the femoral head in COVID-19 patients through MRI scans. The study examined the patterns of AVN in 110 individuals who had undergone conventional COVID-19 therapy and reported hip discomfort. This study highlights the importance of considering AVN as a potential complication of COVID-19 therapy, particularly in younger patients who experience hip discomfort.

Methods: Individuals who had corticosteroid treatment for COVID-19 and experienced hip discomfort during 6 months between January 2022 and August 2022 were included in this study, and an MRI scan was done to observe changes in the hip joint.

Results: The results were classified using the Ficat and Arlet classification system. The analysis revealed that AVN was not present in 91.81% of cases. However, Stage I AVN was detected in 4.54% of cases, Stage II AVN in 2.72% of cases, and Stage III AVN in 1.1% of cases. No cases of Stage IV AVN were observed.

Conclusions: The study concludes that AVN occurred in 6% of individuals who underwent conventional therapy for COVID-19 and experienced hip discomfort. In these settings (post COVID-19), normal MRI results were more typical, and mild AVN (Stage I) was a frequent finding in MRI scans that were positive.

Objectives: To evaluate the efficiency and tolerability of pericapsular nerve group block (PENG) for the treatment of chronic hip pain.

Methods: This is a retrospective, single-centre, 4-group study conducted over a 3-month period to find out the most typical cause of chronic hip pain. A total of 112 patients with symptomatic hip osteoarthritis (OA), Stage 2-3, greater trochanteric pain (GTPS) and chronic pain after total hip arthroplasty (cTHA), who had an ultrasound-guided PENG block, were selected. To assess the effectiveness of the treatment, the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and visual analogue scale (VAS) scores of the patients prior to treatment were compared with their scores after the 1st week, 1st month, and 3rd month of treatment. The study also aimed to analyse the patients' initial feelings of alleviation following the block (1st VAS/2) and problems experienced both during and after the block.

Results: The parameters studied included pain, stiffness, and results of physical activity in the 1st week, 1st month, and 3rd month following PENG block application. At the beginning of the 1st week, of the 112 patients who were administered a PENG block for hip pain, we reported a 62% improvement in pain, a 52% reduction in stiffness, and a 53% increase in physical activity. Even though these results slightly declined in the 1st and 3rd months, the rates were still higher than 45%.

Conclusions: Overall, the PENG block was well-tolerated by the patients in our study. No treatment-related infections or any other serious complications were observed.

Background: The growing adoption of robotic-assistance during total hip arthroplasty (THA) has provided novel means through which a patient's anatomy and dynamic spinopelvic relationship can be incorporated into surgical planning. However, the impact of enhanced technologies on intraoperative decision-making and changes to component positioning has not yet been described.

Methods: A multicentre, prospective study included 105 patients (52% women) patients who underwent robotic-assisted THA with the integration of software that incorporates a patient's pelvic tilt (PT) and virtual range-of-motion (VROM) for impingement modeling. The primary outcome of the study was the percentage of patients who underwent changes to the preoperative plan for cup position after incorporating the data from the software.

Results: Utilising the intraoperative VROM information, the preoperative plan for cup position was changed from the default (40° inclination and 20° anteversion) in 82/105 (78%) cases. When stratifying by spinopelvic mobility, 64% were considered normal (change ⩾ 10° and ⩽30°), 27% were stiff (change < 10°), and 9% were hypermobile (change > 30°). For all cohorts, the majority of cases (78%) deviated from the 40° inclination and 20° version target. When evaluating the proportion of cases within the Lewinnek and Callanan safe zones based on spinopelvic mobility, 19% of cases within the normal group were planned outside of both zones compared to 39% of stiff cases and 10% of hypermobile cases.

Conclusions: Utilising the latest version of robotic-assisted THA software, the preoperative plan for cup position was changed in the vast majority (78%) of patients, causing substantial deviations from traditional, generic cup targets.

Background: Operative treatment of acetabular fractures generally yields good results, but several authors report up to 15-20% of patients developing post-traumatic osteoarthritis (OA). Previous studies have shown that total hip arthroplasty (THA) following post-traumatic OA have inferior results compared to THA for primary OA. The aim of this study was to report on long-term outcome of THA following acetabular fracture, compared to primary OA.

Materials and methods: We performed a matched cohort study with data from the Norwegian Arthroplasty Register (NAR). All patients receiving THA following an acetabular fracture between 1987 and 2018 were identified. A 3:1 matched cohort consisting of patients treated for primary OA with THA was selected using propensity scores and matched for age, gender and year of surgery. Survival analysis was performed with revision of any cause as endpoint. Cox regression was used to identify factors associated with risk of revision surgery.

Results: 552 cases were identified, 397 men and 155 women. Mean age was 58.8 (11-91) years. 224 had previously been operated for the acetabular fracture, 328 had been treated non-operatively. Mean follow up time was 8.7 (1-29) years. Implant survival at 10 years was 79.7% (75.6-83.3) and at 20 years 62.4% (55.5-69.3). The hazard ratio for revision was 1.38 (1.07-1.77, p < 0.001) compared to the OA cohort, regardless of operative or non-operative treatment of the index acetabular fracture. Uncemented acetabular components had an increased risk of revision with hazard ratio for revision 1.61 (p = 0.012).

Conclusions: THA following an acetabular fracture can be performed with acceptable results regarding implant survival, however, we report an increased risk for revision when compared to primary OA. Our results indicate that previous operative fracture treatment does not increase the risk for THA revision compared to cases treated non-operatively.

Background: Inflammatory bowel disease (IBD) is a systemic inflammatory disorder of the gut. Few studies have evaluated whether patients with a history of IBD have worse outcomes following primary total hip arthroplasty (THA). Therefore, the purpose of this study was to evaluate whether IBD is associated with increased: (1) medical complications; (2) readmissions; and (3) emergency department (ED) visits.

Methods: Using a nationwide claims database, patients with IBD undergoing primary THA were identified and matched to a comparison group according to age, sex and the Charlson Comorbidity Index. Outcomes assessed included the development of 90-day medical complications, 90-day re-admissions and 90-day ED visit rates. A p-value <0.0001 was considered statistically significant.

Results: Patients with IBD had a greater incidence and odds ratio of total medical complications (31.90% vs. 11.47%; OR 2.89; p < 0.0001) compared with matched controls. IBD patients had significantly higher incidence and odds ratio of developing acute kidney injury (5.46 vs. 1.46%; OR 3.92; p < 0.0001), cerebrovascular accident (1.32 vs. 0.35%; OR 3.79; p < 0.0001), pneumonia (4.02 vs. 1.30%; OR 3.19; p < 0.0001), respiratory failure (1.21 vs. 0.41%; OR 2.94; p < 0.0001), deep vein thrombosis (0.89% vs. 0.30%; OR 2.93; p < 0.0001), and other adverse events. IBD patients also had higher incidence and odds ratio of 90-day re-admissions (4.20% vs. 3.23%; OR 1.31; p < 0.0001) and ED visits (6.56% vs. 3.99%; OR 1.69; p < 0.0001).

Conclusions: This study found that patients with IBD are at increased risk of 90-day medical complications, re-admissions, and ED visits. Due to its systemic nature, surgeons operating on these patients should be aware of the disease's extra-intestinal manifestations, and the potential postoperative risks in IBD patients. Providers should use this investigation when educating patients on potential risks of elective THA.

Background: Multimodal analgesia for total hip arthroplasty (THA) is increasingly employed to reduce early postoperative pain and promote fast patient discharge. The aim of this study was to compare the efficacy and tolerability of tramadol/dexketoprofen (TRAM/DKP, Group A) versus paracetamol + tramadol (PARA+TRAM, Group B) in patients undergoing THA using minimally invasive direct anterior approach (DAA).

Methods: A single-centre, randomised, single-blind, parallel, interventional study conducted in 323 patients undergoing primary THA with DAA was performed. Group A consisted of 188 patients and Group B of 135. The primary endpoints were the change from baseline (measured 2 hours postoperatively) in pain intensity (PI) during the treatment period (48 hours), assessed by visual analogue scale (VAS) at pre-specified postoperative time-points (2, 8, 24, 48 hours) and the total rescue medication (RM) use during the first 24 hours postoperatively.

Results: As early as 2 hours after baseline, Group A showed a greater PI reduction from baseline compared to Group B (-26.24% vs. -6.87%; p < 0.001). A lower mean PI (VAS) score was consistently found over the entire observation period following treatment with TRAM/DKP than with PARA+TRAM as well as more than 2-fold higher proportion of responders at the end of treatment period. More patients in Group B required RM in comparison to those in Group A (15.6% vs. 3.7%, p < 0.001). Both treatments were well tolerated.

Conclusions: After THA, oral TRAM/DKP provides faster and greater pain relief when compared to intravenous PARA+TRAM with limited consumption of RM and favourable tolerability profile. Our study expands the use of TRAM/DKP in the setting of major orthopaedic surgeries.

Clinical trial registration: clinicaltrials.gov (NCT04178109).

Background: The Hueter-Anterior Approach (HAA) with its limited soft tissue and internervous dissection has been shown to be an effective approach for primary total hip and hip resurfacing arthroplasty (HRA). The purpose of this study is to evaluate the clinical outcome of patients requiring revision of HRA to total hip replacement using the HAA, assessing function and complications.

Methods: We performed a retrospective review of a prospectively maintained research database. Between 2006 and 2015, 555 primary metal-on-metal (MoM) HRAs were performed via the HAA; we identified 33 hips in 30 patients that required revisions for aseptic causes to THA: aseptic loosening of acetabulum in 12 and femoral in 7, 10 for pseudotumour/ALTR, 4 for femoral neck fracture. All revision surgeries were performed through a HAA by a single surgeon who had also performed the index operation. PROMs were collected preoperatively and yearly at various timepoints postoperatively.

Results: The mean age at time of revision was 48.9 years (±5.3 SD) for 22 males (67%) and 11 females (33%). The mean time to revision surgery/failure of hip resurfacing was 3.3 years (±2.4 SD). There were 5 major reoperations with 3 infections, 1 acetabular loosening and 1 trunnionosis. There were significant improvements in multiple PROMs.

Conclusions: The HAA is a viable surgical approach for revision of HRA with smaller initial HRA acetabular components generally requiring a relatively larger acetabular compoent at time of revision. Patients reported improvement in symptoms and function and a lower risk of subsequent reoperation than what has previously been reported for failed MoM bearings.

Introduction: External beam radiation therapy (EBRT) has known effects on bone health. No large database studies have looked at the effects of pelvic EBRT on total hip arthroplasty (THA) outcomes. The purpose of this study was to evaluate 90-day and long-term (>2 years) complication rates following THA in patients with a history of pelvic malignancy and EBRT.

Methods: Patients were retrospectively identified using a national insurance claims database. Subjects who underwent THA for osteoarthritis or avascular necrosis were included if they had at least 2-year follow-up and were stratified into 3 cohorts: (1) prior pelvic malignancy diagnosis (prostate, cervical, uterine, ovarian, or rectal) and EBRT (Group A); (2) prior malignancy diagnosis but no EBRT (Group B); and (3) neither prior malignancy diagnosis nor EBRT (Group C). Univariate and multivariate analyses were conducted to evaluate for an association between prior EBRT and the incidence of 90-day and 2-year complication rates using chi-square, student t-tests, and logistic regression analyses where appropriate.

Results: 671,554 patients met the inclusion criteria. Group A had higher odds of all-cause revision, septic revision, and loosening with revision after 2 years when compared to Group C and Group B (p < 0.001). Group A subjects had higher rates of 90-day deep vein thrombosis, sepsis, and stroke (p < 0.001) than groups B and C.

Conclusions: Prior EBRT for pelvic malignancy was associated with significantly increased rates of all-cause revision, septic revision, and loosening as well as 90-day medical complications.