HIP International最新文献

Background: Dual-taper modular stems have been linked to implant failure due to aseptic lymphocytic vasculitis-associated lesions (ALVAL), yet data on revision outcomes remain limited. This study assessed the survival rate of modular stems revised for ALVAL and compared outcomes with a non-revised control group.

Methods: A retrospective analysis of 233 total hip arthroplasties (THA) with ABGII dual-taper modular stems (2007-2011) was conducted, with follow-up until 2024. 39 THA (16.7%) underwent revision for ALVAL, confirmed by intraoperative histology. The control group included unrevised patients with ⩾1-year follow-up. Pre-revision assessments included Harris Hip Score (HHS), radiographs, MARS-MRI, and cobalt/chromium ion levels. Revision was indicated for disabling pain, cobalt >5 µg/L, or progressive effusion/pseudotumours. Outcomes included HHS, complications, and Kaplan-Meier survival analysis.

Results: Revisions for ALVAL (39 THA, 16.7%) were primarily due to groin pain (64.1%), MRI effusion (79.5%), and elevated cobalt levels (46.2%). The median time to revision was 4 years postoperatively, with a mean time to revision of 2.4 years. Of 21 unipolar revisions 10 hips (27.1%) had a had a dislocation, bipolar revisions (18 hips) had none (p <0.001).At 5, 10, and 15 years, overall revision-free survival was 88.8%, 80.3%, and 75.2%, respectively, while survival free from revision specifically due to ALVAL, confirmed by histological findings, was 91.4%, 83.7%, and 83.1%. 3 hips were re-revised for periprosthetic fractures. After ALVAL revision the HHS improved from 77.6 to 87.7 (p <0.001) but remained lower than in the non-revised controls (p = 0.002). 25.6% of the revised patients had persistent pain.

Conclusions: ALVAL-related revisions led to improvement in the HHS but did not reach the levels of non-revied control. Revision with dual-mobility cups reduced the dislocation risk.

Purpose: The long-term success of total hip arthroplasty (THA) is dependent on support from the periprosthetic bone bed. We present a randomised study using 18F-fluoride Positron Emission Tomography/Computerised Tomography (F-PET/CT) to analyse bone metabolism in periprosthetic bone adjacent to femoral stems following THA surgery. To compare bone metabolism to cemented Exeter and uncemented SP-CL stems, patients with hip osteoarthritis were randomly assigned for THA with either cemented or uncemented femoral components. The results were analysed with F-PET/CT.

Patients and methods: In 28 patients (28 cases) with hip osteoarthritis, a THA was performed. The patients received either an uncemented or a cemented femoral stem. The contralateral healthy femur was used as reference for normal bone metabolism. Patients' clinical scores, radiography and F-PET/CT were analysed at 4, 16 and 36 weeks postoperatively. PET results were analysed and presented in 13 regions of interest (ROI) adjacent to the whole stem-bone interface.

Results: Clinical results were good in all patients, and no major complications were recorded. At radiography, all stems were stable. PET analyses after 4 weeks showed that bone mineralising activity was significantly higher around the SP-CL stems, both compared to the Exeter group and to the contralateral healthy reference femur group. The SP-CL also had prolonged raised activity compared to the Exeter group.

Conclusions: A detailed analysis of bone formation patterns on the implant surface shows that early healing is associated with higher mineral deposition using the uncemented SP-CL stem.

Clinical trial registration: The study was registered at ClinicalTrials.gov (identifier NCT02320682).

Introduction: Same-day discharge (SDD) has gained increasing importance in orthopaedic surgery, particularly for hip and knee procedures. Despite initial concerns about the lack of extended hospital care, growing evidence demonstrates its benefits, including reduced in-hospital infections and significant financial and psychosocial advantages for patients and healthcare systems. This study examines the adoption and outcomes of SDD in total hip arthroplasty (THA).

Method: A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database from 2016 to 2021 was conducted to identify trends, predictors, and outcomes of SDD in THA.

Results: In this study, a multicentre database analysis was performed on 235,393 patients, including 25,388 who were discharged on the same day following total hip arthroplasty. Patients undergoing same-day discharge THA were generally younger, with females comprising 48.3% of SDD cases compared to 55.6% in hospitalised patients. Operative times were shorter for SDD patients (83.9 minutes vs. 92.3 minutes). Postoperatively, SDD patients experienced significantly lower rates of 30-day readmissions (1.7% vs. 3.5%), procedure-related readmissions (1.0% vs. 2.1%), reoperations (1.1% vs. 1.9%), and mortality (0.02% vs. 0.04%). Predictors of unplanned readmissions in the SDD group included age >65 years (OR 2.0), hypertension (OR 1.6), chronic steroid use (OR 2.2), and severe COPD (OR 2.0), while gender, emergent surgery indication, and smoking were not significant predictors. The adoption of SDD increased markedly, rising from 1.5% in 2016 to 25.6% in 2021.

Conclusions: Same-day discharge is a safe and effective option for appropriately selected THA patients, offering reduced readmission and reoperation rates, shorter operative times, and increased healthcare efficiency. This trend highlights a paradigm shift in perioperative care, improving patient outcomes and satisfaction.

Background: The most cost-effective intravenous antibiotic prophylaxis for preventing prosthetic joint infection (PJI) in total hip arthroplasty (THA) has been a matter of debate. The aim of this study was to compare the cost differential between cefazolin and vancomycin as prophylactic options with a particular focus on costs associated with PJI management.

Methods: Using previously published data on PJI rates associated with cefazolin and vancomycin, we modelled the cost of each prophylactic option. This model included unit prices for each drug obtained from our hospital's pharmacy service, as well as the labor costs associated with the hour-long period required for vancomycin administration. Cost of PJI accounted for the price of a 2-stage septic THA revision procedure. National projections were obtained to account for future THA volume.

Results: The average per-patient cost associated with cefazolin PJI prophylaxis was $1025.59, accounting for a PJI rate of 0.75%. The average per-patient cost associated with vancomycin PJI prophylaxis was $2710.82, accounting for a 1.47% PJI rate. The annual cost difference could amount to $2.4 billion by 2040 given projections of THA incidence.

Conclusions: The per-patient cost associated with vancomycin PJI prophylaxis is 164% higher than that associated with cefazolin due to increased cost of primary treatment, labor costs associated with prolonged infusion time, and most importantly differential PJI rates (number needed to treat = 1.39). In an era of value-based care, the use of cefazolin has been consistently shown to be the gold standard for THA PJI prophylaxis and is associated with significant cost advantages.

Background: Evaluation of patients with hip arthritis for total hip arthroplasty (THA) may be confounded by concomitant low back pain (LBP).

Purpose: To study the prevalence and outcome of LBP in THA patients. To evaluate the outcome of THA in patients with dysfunctional low back pain (DLBP).

Methods: In patients undergoing THA, low back pain was assessed with the Roland Morris Disability Questionnaire (RMDQ) and Numerical Pain Rating Scale (NPRS) scores preoperatively and 1 year postoperatively. Patients were categorised as suffering from DLBP if their RMDQ score was >4. Hip function was assessed using the modified Harris Hip Score (mHHS).

Results: 26 of 79 (33%) patients had DLBP before THA. At 1 year follow-up, 19 of them either no longer suffered from DLBP (RMDQ ⩽ 4) or at least had improvement in their RMDQ scores ⩾ 5 suggesting discerning clinical improvement. The mean NPRS scores for LBP at one year also improved (1.5 vs. 0.7, p < 0.01). The mean mHHS at 1 year in patients without DLBP was significantly higher than those with DLBP (85.15 vs. 75.81, p = 0.003) implying that patients without DLBP had better hip outcomes following THA.

Conclusions: DLBP improves considerably after THA. The outcome of THA may be adversely affected by the presence of DLBP.

Background: Gluteus maximus (GMax) tenotomy is a well described technique to improve femoral and/or acetabular exposure during the Kocher Langenbeck approach. Branches of the first femoral perforator artery (1FPA) are frequently encountered and may be injured during the tenotomy, causing bleeding and obscuration of surgical field. The understanding of vascular anatomy around GMax insertion is poor. This study aims to identify the origin, size, course, and consistency of these vessels, and a safe technique for GMax tenotomy.

Methods: 100 eligible computed-tomography angiograms (CTA) of the lower-limbs were identified between January 2019 and July 2021 with 200 limbs studied. The gluteal tuberosity (GTu) was set as the origin of GMax tendon insertion. CTAs were reconstructed in multiplanar reformats, including 3D reconstructions. The 1FPA and its branches were mapped, their anatomical course, size, and relationship with GTu and posterior femoral cortex were recorded.

Results: Average age of cohort was 66.5years. Out of 200 limbs, 2 anatomical arterial variants of the 1FPA were identified near the gluteal tubercle. 23 limbs (11.5%) had a proximal (high) take-off of the 1FPA. 177 (88.5%) had a long ascending vessel originating from the 1FPA. The courses of both arteries are consistent. The average luminal size of these vessels was 2.1 mm. In terms of vertical distance, 12 (6%) limbs had an artery within 15 mm from the GTu, the assumed top of GMax tendon insertion. All 200 vessels were seen within 10 mm of the posterior cortex. The combination of these findings make up the "safe-zone" of GMax tenotomy.

Conclusions: This is the first to detail the origin, course, and size of the ascending artery in relation to GMax tendon. The "Safe zone" of GMax tenotomy is a 15-mm partial release, at least 10 mm off the posterior femoral cortex.

Background: The relationship between total hip arthroplasty (THA) surgeon volume and outcomes is informative in this era of health care value optimisation. The purpose of this study was to evaluate outcomes based on modern-day surgeon practice volumes.

Methods: The SPARCS database was queried for patients undergoing primary THA from 2010 to 2020. Annual case volume thresholds were 30 and 150, differentiating high-volume (HV), intermediate-volume (IV), and low-volume (LV) groups. Perioperative outcomes and all-cause cumulative revision rates were evaluated.

Results: There were 88,411, 142,201, and 53,276 in the HV, IV, and LV groups, respectively. HV surgeons had significantly lower 3-month prosthetic joint infection (PJI) rates (0.5 vs. 0.8 vs. 1.0%, p < 0.001). While controlling for confounders, multivariate regression revealed increased odds of PJI for IV (1.5) and LV (1.87) and increased all-cause revision hazard ratio for IV (1.1) and LV (1.3). Cumulative revision rates were lower for HV at 1 and 2 years, but rates converged with IV group at 9 years.

Conclusions: HV surgeons have the most favourable short-term outcomes. However, in the long-term the difference in all-cause revision event rates becomes less apparent.

Background: There have been few reports of long stem cemented revision arthroplasty in the treatment of periprosthetic fractures (PPFs). The purpose of this study was to retrospectively compare the clinical and radiological outcomes between osteosynthesis and long stem cemented revision arthroplasty for PPFs.

Methods: This study retrospectively evaluated 29 femurs who underwent surgical treatment for PPF following total or bipolar hip arthroplasty. The mean duration of clinical follow-up was 5.0 (range 2-12) years. Surgical options included osteosynthesis only in 7 femurs (Group O) and long stem cemented revision arthroplasty in 22 femurs (Group R).

Results: Repeat surgeries due to implant failure were performed in 2 (29%) and 1 (5%) in groups O and R, respectively. In the walking component of the mean Merle d'Aubigné clinical score at the last follow-up, there were significant differences between the groups. Mean time to independent cane walking was 24.0 (13.1-42.3) weeks and 7.2 (2.0-15.6) weeks in groups O and R, respectively (p < 0.05). Bone union rates were 71% and 95% in groups O and R, respectively (p = 0.14). Where bone union was successfully achieved, the mean time to bone union was 12.2 (6.1-22.2) months in group O and 6.6 (1.7-12.5) months in group R (p < 0.05).

Conclusions: The time to independent cane walking and bone union was significantly shorter for long stem cemented revision arthroplasty. This procedure offers considerable advantages for patients, despite the difficulty of the procedure for surgeons.

Objective: This study aimed to evaluate the efficacy of interdisciplinary nursing care based on the concept of enhanced recovery after surgery (ERAS) during the perioperative period of geriatric hip arthroplasty.

Methods: A prospective, single-centre, randomised, evaluator-blinded, case-control study was conducted involving 80 patients diagnosed with femoral neck fractures who underwent total hip arthroplasty from October 2021 to May 2023. Patients were randomly assigned to a control or experimental group (40 patients each). Clinical and surgery-related data were collected and compared between the 2 groups. Critical assessments included the Harris Hip Score (HHS), Barthel Index (BI), Berg Balance Scale (BBS), Numeric Rating Scale (NRS) for pain, Beck Anxiety Inventory (BAI), and Caprini thrombosis risk scale.

Results: No significant differences between the 2 groups in baseline characteristics such as age, gender, BMI, surgery time, and complication rates (p > 0.05). The experimental group had shorter durations for catheter removal and postoperative ambulation (p < 0.05). Preoperative HHS and BI scores were similar in both groups, but at 1 week, 1 month, and 6 months postoperatively, the experimental group showed significantly higher HHS, BI, and BBS scores (p < 0.05). Anxiety levels (BAI) and thrombosis risk scores were comparable at all time points, except for significantly lower Caprini thrombosis and NRS pain scores in the experimental group at 1 month (p < 0.05).

Conclusions: Interdisciplinary nursing care based on the ERAS concept improves joint function recovery and self-care abilities and shortens mobilisation time in geriatric hip arthroplasty patients, promoting enhanced overall recovery.