Hip Arthroplasty Research Articles

Comprehensive Pain Management in Total Joint Arthroplasty: A Review of Contemporary Approaches

Background: Total hip and knee arthroplasties are among the most effective and widely performed procedures in modern medicine, providing substantial benefits to patients with end-stage osteoarthritis. These surgeries have transformed the treatment of degenerative joint disease, significantly enhancing functionality and quality of life for patients. Despite considerable advancements in surgical techniques and postoperative care, managing postoperative pain remains a major challenge, impacting both clinical recovery and patient satisfaction. The persistence of postoperative pain as a barrier to recovery underscores the need for improved pain management strategies. Methods: A comprehensive narrative review of the literature was conducted, focusing on the physiological mechanisms underlying surgical pain, the role of anesthesia techniques, and the development of multimodal pain management approaches used in total joint arthroplasty. This review emphasizes the components of modern multimodal strategies, which combine multiple pharmacologic and non-pharmacologic methods to address the various mechanisms of postoperative pain. Results: Current pain management strategies employ a dynamic, multimodal approach that covers the perioperative period. These strategies aim to optimize pain control while minimizing side effects. They incorporate a range of methods, including nerve blocks, non-opioid analgesics, opioids, and non-pharmacologic techniques such as physical therapy. However, evidence regarding the efficacy and optimal combinations of these interventions varies widely across studies. Conclusions: This variation has led to inconsistent pain management practices across institutions. To standardize and improve care, this paper presents the authors’ institutional pain management model, offering a potential framework for broader application and adaptation in the field of joint arthroplasty.

Beyond the Hip: Clinical Phenotypes of Hip Osteoarthritis Across the Biopsychosocial Spectrum

Background/Objectives: To identify clinical phenotypes of hip osteoarthritis (OA) within a biopsychosocial framework. Methods: A cross-sectional analysis of 143 individuals with hip OA awaiting total hip arthroplasty (THA) was performed. Phenotyping features included sociodemographic and biomedical information, pain-related cognitions and emotions, mental disorders, traumatic experiences, self-efficacy, social support, perceived stress, and somatosensory function. Outcome measures included the hip disability and osteoarthritis outcome score and the numeric pain-rating scale. Decision tree learning was used to select the most important phenotyping features. K-means clustering analyses were performed to identify clinical phenotypes and a decision tree algorithm was trained to classify individuals in the identified clinical phenotypes. Results: Selected phenotyping features associated with pain and disability included a combination of biomedical, psychological, and social variables. Two distinct clinical phenotypes were identified. Individuals within the maladaptive phenotype (34%) reported more comorbidities, less self-efficacy and higher levels of anxiety, depression, pain-related fear-avoidance, and feelings of injustice. No differences were found regarding social support and somatosensory function. Regarding the outcome measures, individuals within the maladaptive phenotype reported higher levels of pain and disability. Finally, based on the Fear-Avoidance Components Scale (FACS) and the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A), individuals could be classified into the clinical phenotypes with 87.8% accuracy. Conclusions: Two clinical phenotypes, an adaptive and a maladaptive phenotype, can be identified in individuals with hip OA using the FACS and HADS-A. The identification of these clinical phenotypes represents a crucial step toward precision medicine, enabling the development of targeted treatment pathways tailored to the distinct biomedical and psychological features of each phenotype.

Utilization of preoperative EOS imaging to prevent adverse events following total hip arthroplasty

Utilization of preoperative EOS imaging to prevent adverse events following total hip arthroplasty

An overview of cell salvage in orthopaedic hip and knee arthroplasty surgery

Blood management is a critical aspect of patient care during surgical procedures. In the United Kingdom, there is a growing recognition of the need to integrate intraoperative cell salvage into blood management protocols, especially for invasive surgeries where significant blood loss is anticipated. While donated blood (allogeneic blood) is traditionally used in such cases, it carries risks and potential complications. Consequently, intraoperative cell salvage presents itself as an appealing alternative, particularly in hip and knee arthroplasty procedures. Intraoperative cell salvage involves the collection and reinfusion of a patient’s own blood (autologous blood) lost during surgery. Studies have consistently shown that autologous blood collected via intraoperative cell salvage has fewer complications and greater benefits compared to donated blood. However, despite these advantages, the widespread adoption of intraoperative cell salvage in UK hospitals remains limited, primarily due to associated costs. While the integration of intraoperative cell salvage into blood management services may incur initial expenses, research suggests that it could ultimately prove to be cost-effective. This is because improved patient outcomes associated with intraoperative cell salvage may lead to reduced postoperative complications and shorter hospital stays. Thus, there is a growing imperative to overcome financial barriers and promote the implementation of intraopertive cell salvage as a standard practice in perioperative care across UK health care settings. The purpose of this scoping literature review is to consolidate the available information on the current use of intraoperative cell salvage and to identify intraoperative cell salvage techniques and devices described for use in an arthroplasty setting.

Early insights from the routine use of patient reported outcome measures in elective hip and knee arthroplasty at a public teaching hospital in South Australia

Abstract Introduction For advanced osteoarthritis of the knee and hip, the most clinically effective treatment remains total-knee arthroplasty (TKA) and total-hip arthroplasty (THA). Success of these surgeries have traditionally been appraised by economic and volume-based measures. There has been a shift towards the use of patient reported outcome measures (PROMs) to quantify success and guide treatment. The present study provides analysis of three PROMS which have been validated for use in orthopaedic settings; the Oxford Knee Score (OKS), Oxford Hip Score (OHS), Forgotten Joint Score (FJS), and the EuroQol-Visual Analogue Scale (EQ-VAS) - a non-disease specific measure of health. PROMs were completed pre-operatively, 6-weeks, and 1-year after elective TKA and THA undertaken in 2018 in a public teaching hospital in South Australia. Post-operative satisfaction/dissatisfaction was measured using a 5-point Likert scale and was collected at the same 6-week and 1-year points. Results PROMs were collected from 285 eligible elective knee-arthroplasty, and 205 elective hip-arthroplasty patients. There was significant average improvement, greater than minimal clinical important differences between pre-operative and 1-year post-operative scores for all three PROMs tools. Inter-PROM correlation was strongest between FJS and OKS at 1-year post TKA (rs = 0.722), and between FJS and OHS in post-THA at the same interval (rs = 0.609). TKA patients with higher pre-surgical 10-year mortality were weakly associated with lower pre-operative OKS score (rs = 0.169). BMI was weakly negatively associated with pre-operative and 6-week post-operative EQ-VAS scores (rs = -0.291 and rs = -0.149 respectively). Post-TKA satisfaction was 77.2% at 1-year, and THA 88.5% at the same interval. Conclusion This study provides an early insight from the use of the OKS, OHS, the EQ-VAS and the FJS as PROMs in primary TKA and THA at our centre. All PROMs demonstrate significant increase (improvement) at both 6-week and 1-year post-operative intervals, relative to pre-operative scores. The FJS demonstrated good sensitivity. Pre-existing co-morbidities do not appear to have any significant relation with post-operative PROMs collected in this study.

Effects of pericapsular nerve group block on early postoperative cognitive function in older people undergoing hip arthroplasty: a randomized controlled clinical trial

Effects of pericapsular nerve group block on early postoperative cognitive function in older people undergoing hip arthroplasty: a randomized controlled clinical trial

Total hip arthroplasty in patients under 35 years: a systematic review of the last 2 decades studies

Background: Patients with total hip arthroplasty (THA) under the age of 35 represent a small and heterogeneous group of 1% of all THA performed. This systematic review aims to analyse the diagnosis, implant type, complications, and long-term results in these patients. Methods: A search was performed on PubMed, Scopus, and Cochrane Library up to 31 July 2023. We included observational prospective and retrospective studies published in the last 20 years, which evaluated diagnosis, implant types, long-term results, and return to sports in patients ⩽35 years who underwent THA. We excluded case reports, case series, and studies with <35 patients. We extracted age, diagnosis, surgical information, follow-up, complications, revision rate, implant survival, and clinical outcomes for each study. The methodology of the included studies was evaluated using the MINORS score. Results: 18 studies with 1955 patients and 2383 THAs were included. Osteonecrosis (40.6%), posterior approach (81%), the uncemented press-fit implants (73.4%), metal-polyethylene bearings (31.3%) were the most frequently found items. All the clinical outcomes reported improvement from the preoperative to postoperative. The most frequent complication was aseptic loosening (4.3%). The survival rate was 92.4% at a mean follow-up of 10 years. Conclusions: THA is a good option for specific hip diseases in the young, but aseptic loosening still is the major point of concern.

Hounsfield unit values are useful for predicting early outcomes after acetabular fractures: a retrospective study

Background: Acetabular fractures are among the most challenging orthopaedic fractures, and a high total hip arthroplasty (THA) conversion rate has been reported in older patients with acetabular fractures. Bone quality is a poor prognostic factor after acetabular fracture fixation and has been assessed using computed tomography (CT). However, the relationship between Hounsfield unit (HU) values measured using CT and early acetabular fracture outcomes remains unknown. This study aimed to elucidate the effect of HUs on early acetabular fracture outcomes. Methods: 50 consecutive patients who underwent open reduction and internal fixation for acetabular fractures were included. The mean follow-up duration was 24 months. 27 hips had elementary fractures and 23 had associated fractures. The reduction quality assessed using CT was as follows: anatomical, 13 hips; imperfect, 10 hips; and poor, 27 hips. Secondary hip osteoarthritis was observed in 5 patients (10%), and the surgery was converted to THA in 1 patient (2%). The HU values of the fifth vertebral body and the unaffected side of the femoral head were measured. The fracture type, radiological secondary hip osteoarthritis, conversion to THA, and postoperative displacement gap were recorded. Results: The unaffected femoral head HU values in elementary fractures (250.5 ± 50.5) were significantly higher than those in associated fractures (221.5 ± 48) ( p < 0.047). The HU values of the fifth vertebral body and the unaffected femoral head were significantly correlated with the postoperative residual displacement gap and were significantly lower in those with secondary osteoarthritis than in those without it. The cut-off value for predicting early osteoarthritic change after an acetabular fracture was approximately 180. Conclusions: The HU values were correlated with the fracture type, postoperative displacement gap, and early osteoarthritic change after acetabular fractures and are clinically useful prognostic factors for early acetabular fracture outcomes.

Pain Control and Opioid Consumption in Patients Undergoing Total Hip or Knee Arthroplasty Receiving a Preoperative Low Dose of Gabapentin

Background: Meta-analyses and randomized controlled trials were inconclusive regarding the role of gabapentinoids in patients undergoing joint arthroplasties. The aim of the present study was to investigate the effect of a preoperative low dose of gabapentin in patients undergoing total hip (THA) and knee arthroplasties (TKA). Methods: A retrospective observational study was conducted on 135 patients undergoing THA and TKA at the National Orthopedic Hospital Cappagh, Dublin, from July to December 2022. The primary outcome was the assessment of numerical rating scores (NRS) for postoperative pain at various time intervals. Results: During the observation period, 55 patients received a preoperative dose of gabapentin, while 80 patients did not. Statistically significant differences in numerical rating scores (NRS) were found at 6 (3 vs. 0, p < 0.001), 12 (4 vs. 2, p < 0.001), 18 (4 vs. 3, p < 0.001), and 24 h (4 vs. 3, p = 0.010) after surgery, in favor of the group receiving gabapentin. A reduction in opioid consumption, measured as morphine equivalents, was also noted in the gabapentin group (40 vs. 30 mg, p = 0.040). Conclusions: A low preoperative dose of gabapentin was associated with reduced postoperative pain and opioid consumption in patients undergoing TKA and THA, without impacting hospital stay. Prospectively designed trials are encouraged to assess the safety and effect on pain control of a preoperative low dose of gabapentin.

The use of multipotent mesenchymal cells in the complex treatment of osteonecrosis of the femoral head.

Background. Avascular necrosis of the femoral head (ANFH) is a disabling disease that often leads to hip replacement. However, due to the increasing incidence among the young population, various methods of organ-preserving treatment have been proposed aimed at slowing the progression of ANFH and preserving the function of the hip joint. Today, the procedure for introducing mesenchymal cells into the focus of osteonecrosis causes a lot of controversy and disagreement, which is the subject of discussion in our review. Aim of the study: a non-systematic analysis of the accumulated literature data on the effectiveness, safety, advantages and disadvantages of treating patients with early stages of avascular necrosis of the femoral head using the tunneling method using multipotent mesenchymal cells, as well as their impact on reducing the risk of disease progression and long-term treatment results. Material and Methods. A 10-year literature search (2013-2023) was conducted in the PubMed, Scopus and eLIBRARY databases. According to our inclusion criteria, the review included 8 high-quality studies that used mesenchymal cells to treat ANFH. Results. We analyzed 548 hips from 8 studies based on our inclusion and non-inclusion criteria. The mean follow-up period was from 24 to 360 months. In most cases, functional indicators improved. Radiological progression to the next stage occurred in 31.25% of cases and the need for hip arthroplasty was 30.6% in the group where mesenchymal cells were used. Conclusion. The use of multipotent mesenchymal cells in the complex treatment of ANFH in the early (I, II according to ARCO) stages of ANFH can improve the function of the hip joint, slow down the progression of the disease and reduce the need for hip arthroplasty.

Successful experience of hip arthroplasty with a unipolar endoprosthesis

Introduction. Fractures of the femoral neck occupy a significant place in traumatology and orthopedics and represent a serious pathological problem. Without surgical treatment, this pathology leads to complications and death of the patient within a year. Hip replacement is the choice of treatment method that allows the injured patient to be mobilized as early as possible. This promotes and has a positive effect on the timing and effectiveness of rehabilitation measures and minimizes the risk of developing possible complications. The purpose of this publication is to demonstrate the successful experience of treating a patient with a fracture of the right femoral neck with displacement of fragments using endoprosthetics. Materials and methods. To write the article, we used medical documentation data from a trauma hospital, the results of instrumental research and dynamic observation of the patient. A search was also carried out in the open electronic scientific databases PubMed of the US National Electronic Medical Library and the databases of the Russian scientific electronic library elibrary, using keywords and phrases: Results. Endoprosthesis replacement of the hip joint with a unipolar endoprosthesis was performed. On the sixth day after the surgical intervention, the patient was discharged in satisfactory condition for outpatient treatment by a traumatologist at his place of residence. The wound and sutures have no signs of inflammation, sensitivity and blood supply to the limb are preserved. The patient moves independently using a walker. Discussion. Analyzing the results of surgical treatment in the described clinical case, we can conclude that the method of hip replacement is highly effective in elderly people. Conclusion. Endoprosthesis replacement surgery is low-traumatic and allows the patient to be mobilized early. Our experience allows us to believe that treatment with endoprosthetics is effective for fractures of the femoral neck and allows us to achieve positive results in the early stages.

Symptomatic Acetabular Erosion After Hip Hemiarthroplasty: Is It a Major Concern? A Retrospective Analysis of 2477 Hemiarthroplasty Cases

Background/Objectives: Acetabular erosion is a postoperative condition that can occur after hip hemiarthroplasty (HA), potentially leading to pain and requiring conversion to total hip arthroplasty (THA). Given the discrepancy in its incidence and impact in the literature, this study aims to report the incidence of symptomatic acetabular erosion and the subsequent conversion to THA in all HA cases performed in a single health system. Methods: A total of 2477 HA cases had their clinical notes and serial radiographs examined for this retrospective study. Outcome measures included any records of hip or groin pain and conversion to THA that were attributed to acetabular erosion as documented in the clinical notes. Results: Two thousand four hundred and seventy-seven HA cases were reviewed in this study. The mean age for all patients in the study was 81.5 years and the mean follow up was 3.7 years. Out of the 2477 HA cases, only 12 HA cases (0.48%) in 12 patients had data records of chronic hip pain, attributable to acetabular wear in the clinical notes, of variable severity and presentations. The mean duration until the clinical documentation of acetabular wear-induced pain was 25.6 months (range, 1.4–146.4 months), with most symptomatic hip erosion cases presented within the first year (50% presented within the first 6 months) after the index HA surgery. Despite that, only five cases underwent conversion to THA (0.2%) while seven patients received conservative management. Conclusions: In patients older than 65 years of age who are candidates for HA, the incidence of symptomatic hip erosion and the subsequent conversion to THA is low and hence HA remains a viable treatment option. Based on the duration until clinical presentation of acetabular erosion, this study suggests that the state of acetabular cartilage during surgery may influence the development of early acetabular wear in most symptomatic patients. On the other hand, hip hemiarthroplasty is a rare treatment option for displaced femoral neck fractures in patients younger than 65 years of age, and its use in this patient subset depends on conditional and patient-related factors such as the activity level, cognitive function, and medical comorbidities.

Revision total hip arthroplasty with medial wall defect using bone graft with or without porous metal restrictor

When a severe medial wall defect is present in revision total hip arthroplasty (THA), simple bone grafting (BG) may not be sufficient, and trabecular metal (TM) augmentation is often necessary. We aimed to evaluate whether there were differences in outcomes of revision THA with medial wall defects depending on the use of TM augmentation. Between 2009–2021, 130 patients were classified into two groups: 80 patients undergoing bone grafting (BG group) and 50 patients undergoing both bone grafting and TM augmentation (BG/TM group). We evaluated the postoperative center of rotation (COR) position and changes in vertical and horizontal COR at last follow-up. Additionally, we categorized the fate of the transplanted bone graft into four groups: unchanged, initially changed, resorption-no further intervention, and resorption-revision. The mean horizontal COR changes were −3.50 mm in the BG group and −1.07 mm in the BG/TM group (p = 0.005). In the BG/TM group, a higher proportion of the patients showed unchanged or only initial changes when compared to the BG group (88.0% and 65.0%, respectively). The BG/TM group showed more favorable results regarding horizontal changes in the COR and fate of the bone graft. Therefore, for revision THA in patients with severe medial wall defects, the combined use of bone graft and TM augmentation can be a suitable option.

The cemented stem in hip arthroplasty - state of the art technique and recommendations.

The indication for femoral stem cementation should be made on a patient-specific basis, taking physical activity, femoral geometry, and bone tissue quality into account. Age alone should not be the sole justification for cementation. The Dorr classification can serve as decision support for whether a cemented fixation should be used. Femoral neck fractures should generally be cemented. Familiarize yourself with the applied stem philosophy. Force-closed stems typically have a polished surface that allows for subsidence, especially in the first 2 years postoperatively. Stems following the shape-closed philosophy have rougher surfaces and do not allow subsidence. There are various types of cement that differ in viscosity and can be categorized accordingly. These cement types go through four temperature-dependent phases: mixing phase, waiting phase, working phase, and curing phase. Rough implants should be implanted quickly, using wetter cement. For a polished stem, the cement should be slightly firmer. To avoid complications like bone cement implantation syndrome, it is essential to adhere to the state-of-the-art retrograde cementation technique, which recommends pulsatile lavage and vacuum mixing of the cement. Additionally, cement restrictors and pressurizers are used. A thorough understanding of cementation techniques is crucial to ensure a favorable outcome with a uniformly thick cement mantle that encompasses the entire stem. Incorrect cementing can lead to the premature failure of the endoprosthesis.

Development and accuracy of an artificial intelligence model for predicting the progression of hip osteoarthritis using plain radiographs and clinical data: a retrospective study

BackgroundPredicting the progression of hip osteoarthritis (OA) remains challenging, and no reliable predictive method has been established. This study aimed to develop an artificial intelligence (AI) model to predict hip OA progression via plain radiographs and patient data and to determine its accuracy.MethodsThis retrospective study utilized anteroposterior pelvic radiographs of consecutive patients with hip OA who underwent primary unilateral total hip arthroplasty. Radiographs diagnosed with Kellgren–Lawrence (KL) grade 0–2 were extracted from 361 patients and 1697 images. This AI model was developed to predict whether OA would progress from KL grade 0–2 to KL grade ≥ 3 within n years (n = 3, 4, 5). A gradient-boosting decision tree approach was utilized according to feature extractions obtained by a convolutional neural network from radiographs and patient data (height, body weight, sex, age, and KL grade given by an orthopedic surgeon) with five-fold cross-validation. The model performance was assessed using accuracy, specificity, sensitivity, and the area under the receiver operating characteristic curve (AUC).ResultsThe mean accuracy, specificity, sensitivity, and AUC of our prediction model were, respectively, 81.8%, 88.0%, 66.7%, and 0.836 for 3 years; 79.8%, 85.0%, 71.6%, and 0.836 for 4 years; and 78.5%, 80.4%, 76.9%, and 0.846 for 5 years.ConclusionsThe proposed AI model performed adequately in predicting hip OA progression and may be clinically applicable with additional datasets and validation.

Application of ultrasound-guided inferior vena cava collapsibility measurement in volume assessment for patients undergoing single-shot spinal anesthesia in total hip arthroplasty

To explore the value of ultrasound in volume assessment during the perioperative period of single-shot spinal anesthesia for total hip arthroplasty. A total of 100 patients undergoing elective surgery under spinal anesthesia at our hospital from January 2022 to January 2024 were selected. Transthoracic echocardiography was used to measure the diameter of the abdominal aorta (Ao) before anesthesia (T1), 10 minutes after anesthesia (T2), and 30 minutes after anesthesia (T3). The inferior vena cava collapsibility index (IVC-CI) and the ratio of IVCe to Ao (IVCe/Ao) were calculated. A volume load test was performed 10 minutes after anesthesia. Based on the increase in stroke volume (ΔSV) after the volume load test, patients were divided into a volume-responsive group (ΔSV ≥ 15%) and a volume-nonresponsive group (ΔSV < 15%). The reliability of inferior vena cava parameters in predicting hypotension after spinal anesthesia and the value in predicting volume responsiveness postanesthesia were evaluated using ROC curves. A total of 100 patients were enrolled, 18 were withdrawn, and a total of 82 patients were included. After the volume load test, the parameters of the volume response group and the volume nonresponse group were basically consistent, and the difference was not statistically significant (P > .05). The SV of volume reaction group was significantly higher than that of volume no reaction group (P < .05). The incidence of hypotension in the volume response group was higher than that in the non-volume response group (51.28% vs 11.63%, χ 2 = 15.174, P < .01). The AUC for volume reactivity prediction using IVCe, IVCi, IVC-CI, and IVCe/Ao were 0.62, 0.71, 0.70, and 0.72, respectively. IVCi, IVC-CI, and IVCe/Ao were significant predictors of volume reactivity (P < .05). The AUC predicting persistent hypotension after spinal anesthesia using IVCe, IVCi, IVC-CI, and IVCe/Ao were 0.78, 0.79, 0.70, and 0.84, respectively. IVCe, IVCi, IVC-CI, and IVCe/Ao can predict volume reactivity before anesthesia. IVCi, IVC-CI, and IVCe/Ao predicted persistent hypotension in patients with spinal anesthesia after anesthesia, and IVCe/Ao showed the best predictive effect. Thus, IVCe/Ao is a reliable parameter for predicting persistent hypotension and assessing volumetric reactivity.

Preoperative Consultations and Their Effect on Surgical Delays and Mortality in Hip Fracture Surgery.

The impact of preoperative consultations on mortality and morbidity rates, and their association with delays and hospital stays for surgery, remains a topic of discussion. This study aims to elucidate the necessity of consultations for those undergoing femoral neck fracture surgery, examining their influence on delays, hospital durations, and their correlation with mortality rates. The study examined data from 320 emergency department patients with femoral neck fractures undergoing hip arthroplasty surgery at our hospital between 2011 and 2021, using digital medical records. Patients were consulted in relevant departments for risk optimization. They were categorized into two groups based on the time of surgery: Group 1 (operated within 48 h) and Group 2 (delayed surgery). The analysis included days from admission to surgery, total hospital stay, and time from surgery to discharge. Mortality rates, with a minimum 2-year follow-up, were assessed using digital records, patient contact, or a death notification system. Statistical analyses involved Mann-Whitney U, Kruskal-Wallis, post hoc analysis, Pearson's chi-squared, and Fisher-Freeman-Halton tests (α = 0.05). SPSS v25.0 software was used. Patients with consultation requests experience significantly delayed surgery compared to those without (p < 0.001). Statistically significant differences were observed between consulted and nonconsulted groups in time until surgery (p < 0.001), time from surgery to discharge (p < 0.001), and overall length of hospital stay (p < 0.001). However, there is no statistically significant difference in 30-day and 1-year mortality between consulted and nonconsulted patients, both departmentally and overall. This study found that advanced age and high ASA scores were the main factors causing surgical delays in hip fracture patients. While modifiable comorbidities could reduce hospital stays, they did not significantly affect postoperative mortality. Streamlining elective consultations and reducing organizational delays could help prevent delayed surgeries and improve outcomes.

Patients with multiple sclerosis have higher rates of worsening following total hip arthroplasty: a propensity-matched analysis.

The progressive nature of multiple sclerosis (MS) may adversely affect outcomes following total hip arthroplasty (THA). As patient-reported outcome measures (PROMs) in this specific group are not well defined, this study aimed to compare the clinical outcomes and the rates of achieving the minimal clinically important difference for improvement (MCID-I) and worsening (MCID-W) between patients with MS and those without MS undergoing THA. We conducted a retrospective analysis of 375 THAs, including 75 MS patients and 300 propensity-matched non-MS patients (4:1), performed between 2016 and 2022. Collected PROMs included Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health Mental and Physical, PROMIS Physical Function short form 10-a (PF-10a), and Hip disability and Osteoarthritis Outcome Score-Physical Function Short-form (HOOS-PS). Preoperative and postoperative PROMs and MCID-I/MCID-W rates were compared. A total of 375 THAs, including 75 MS and 300 matched non-MS patients, were analysed. MS patients had higher 90-day postoperative complication rates (9.3% vs. 2.3%, p = 0.012) and infection rates (4.0% vs. 0.3%, p = 0.006). The rates of achieving MCID-I and MCID-W were similar for PROMIS Global Mental, PROMIS Global Physical, and HOOS-PS, but MS patients had a higher rate of experiencing MCID-W for PROMIS PF-10a compared to non-MS patients (16.7% vs. 6.5%, p = 0.022). Additionally, MS patients had a longer mean hospital stay (2.4 vs. 1.9 days, p = 0.005) and lower rates of being discharged home (82.7% vs. 94.3%, p < 0.001). The present study found that MS patients experience similar rates of MCID-I and MCID-W in most PROMs but have a higher rate of MCID-W for PROMIS PF-10a and increased postoperative complications. These findings highlight the need for careful consideration of postoperative risks despite potential improvements. Further research is needed to explore the impact of MS progression on PROMs and perioperative outcomes.

Effects of Predictive Nursing Process on Elderly Patients with Total Hip Arthroplasty

Effects of Predictive Nursing Process on Elderly Patients with Total Hip Arthroplasty

Efficacy of the inferior vena cava collapsibility index in predicting anaesthesia-induced hypotension in elderly patients undergoing hip arthroplasty

The inferior vena cava collapsibility index (IVCCI) has been used to predict fluid responsiveness. This study aimed to evaluate the accuracy of the perioperative IVCCI to predict postinduction hypotension (PIH) under general anaesthesia (GA) combined with lumbar plexus sacral plexus block (LSPB) in elderly patients undergoing hip arthroplasty. A total of forty patients aged over 65 years were recruited for this prospective observational study. The diameters of the inferior vena cava (IVC), common iliac vein (CIV) and IVCCI were measured at baseline and 15 min post-LSPB. PIH was defined as a systolic blood pressure less than 90 mmHg or a ≥ 30% drop from baseline; patients were divided into hypotensive and nonhypotensive groups. The primary objective of this study was to evaluate the ability of the IVCCI to predict PIH via receiver operating characteristic (ROC) analysis. The secondary objective was to observe the change in CIV diameter. Eighteen patients (45%) developed PIH during GA. No statistically significant differences in baseline or post-LSPB IVCCI were detected between hypotensive and nonhypotensive patients (p > 0.05), whereas a significant expansion of the CIV (0.83 cm to 1.10 cm) was observed 15 min post-LSPB in all patients (p < 0.0001). According to the ROC curve analysis, the IVCCI cannot accurately predict severe PIH: the area under the ROC curve for the IVCCI was 0.54 (95% confidence interval: 0.35–0.72, P = 0.69). Thus, the IVCCI is not an effective predictor of PIH during GA combined with LSPB in elderly patients undergoing hip arthroplasty. Additionally, significant expansion of the CIV was observed 15 min after LSPB, indicating sympathetic blockade of the unilateral lower extremity.