Hip Replacement Research Articles

Morphometric study of normal acetabulum on computed tomography scan in adults at a tertiary care center.

The introduction provides an in-depth understanding of the acetabulum's anatomical structure and its significance in hip joint biomechanics. It highlights the variability in acetabular morphology among normal individuals, emphasizing the importance of establishing normal ranges for accurate diagnosis of acetabular deformities. The section also underscores the role of geographical, racial, and anatomical factors in influencing acetabular parameters, crucial for orthopedic interventions and surgical outcomes like total hip arthroplasty. Furthermore, it discusses the limitations of traditional imaging methods and the necessity of advanced techniques like computed tomography (CT) scans for precise evaluation and preoperative planning in hip surgeries. The study adopted a cross-sectional design at a tertiary care center, enrolling 94 participants using purposive sampling for CT evaluation of acetabular morphology. Morphometric parameters including center edge angle of Wiberg, acetabular angle of Sharp, acetabular version, acetabular depth, and joint space width were measured using CT scans, while BMI categorization and statistical analyses were conducted to explore gender-based and side-based differences and correlations with BMI and age. The study included 94 patients with ages ranging from 20 to 82 years (mean age: 49±15years), predominantly in the 41-50 years age group. Female participants slightly outnumbered males. The mean BMI was 23.5±3.2kg/m2, with variations across different age and BMI categories. Most morphometric parameters showed no significant differences between sexes or sides but did correlate with age and BMI, notably the center edge angle positively correlating with BMI in males. The study found correlations between morphometric parameters of the acetabulum and both age and BMI. Specifically, the center edge angle demonstrated a positive correlation with BMI in males and a weak positive correlation with age. Acetabular angle showed a negative correlation with BMI, highlighting potential implications for understanding hip joint health and conditions related to BMI changes.

How Does the New Australian EQ-5D-5L Value Set Impact Utility Scores? Analysis of Data from the Australian Orthopaedic Association National Joint Replacement Registry.

With advances in health state valuation methods, new value sets may be developed for some countries. Quantifying the impact of moving between existing and new value sets is critical for guiding decisions around utility score interpretation, reporting and comparison with published scores. The aim of this study is to examine, using large-scale national registry data, how the new Australian EQ-5D-5L value set impacts utility scores for patients undergoing joint replacement. Data from the Australian Orthopaedic Association National Joint Replacement Registry were used for this analysis. All primary total hip (THR), knee (TKR), and shoulder replacement (TSR) procedures between 2018 and 2022 with pre-operative and 6-month post-operative EQ-5D-5L data were included. Utility scores were generated using the 2013 and 2023 Australian value sets ('previous' and 'new' value sets, respectively) and analysed descriptively for each joint replacement cohort. Agreement between the two utility score sets was evaluated using concordance correlation coefficients and Bland-Altman plots. EQ-5D-5L data were available for 17,576 THR, 23,010 TKR, and 1667 TSR procedures. The new value set produced a lowest possible EQ-5D-5L utility score of -0.30 (compared with -0.68 previously) and fewer patients had 'worse-than-dead' quality of life (score < 0.00) before surgery. Mean pre-operative scores were 0.21 (THR), 0.19 (TKR), and 0.17 (TSR) units higher with the new value set, and mean post-operative scores were 0.11-0.14 units higher. The new value set resulted in smaller effect sizes for the THR (1.08 versus 1.23) and TKR cohorts (0.86 versus 0.92). There was moderate-to-good overall agreement (coefficients: 0.70-0.80), but concordance varied by time point. Although acceptable agreement was evident, the new Australian value set produces less extreme negative utility scores and markedly higher group-level scores. Transition to reporting new EQ-5D-5L utility scores will require accompanying explanation to signal measurement modifications rather than better quality of life.

Is a patient self-recorded 6 minute walk test equivalent to a formally recorded 6 minute walk test.

Functional tests such as the 6-minute walk test (6MWT) are used in many areas of medicine to monitor disease progression and outcomes of treatment. They are particularly helpful in Orthopaedic surgery as the outcomes have been shown to be responsive to recovery over time. The 6MWT is typically performed in a controlled supervised environment which may limit its widespread use (Terwee et al., Rheumatology (Oxford), 2006, 45, 890-902). The primary aim is to investigate if a patient measured 6MWT is comparable to a 6MWT performed under formal testing conditions (Täger et al., Int. J. Cardiol. 2014, 176, 94-98). A total of 55 patients undergoing elective primary hip or knee replacement were instructed to use a smart watch to record a 6MWT in their home community environment (C-6MWT). These measurements were compared to a formally tested 6MWT (F-6MWT) at 2 separate time periods-6 and 12 weeks post-surgery. At 6 weeks post operation the Intraclass Correlation Coefficient between a formally tested and a patient self-administered 6MWT was 0.928 (95% CI 0.832-0.970) and at 12 weeks it was 0.831 (0594-0.935). A patient recorded 6 minute walk test shows high agreement with a formally recorded one under research conditions. This makes this test a suitable way to monitor rehabilitation progression and research outcomes at multiple time periods and in remote situations.

Weight changes following Achilles debridement with flexor hallucis longus transfer: A retrospective analysis

Obesity poses a growing concern, with global predictions estimating over half the population to be overweight or obese by 2030 (1). While prior research has extensively explored the impact of obesity on hip and knee surgeries, a notable gap persists in understanding weight changes following foot and ankle procedures. This retrospective study focuses on the relationship between Body Mass Index (BMI) and Achilles debridement with flexor hallucis longus (FHL) transfer. Despite prevailing research on the adverse effects of obesity on orthopedic outcomes, few studies examine the reciprocal influence of surgeries on weight. A retrospective analysis of 136 patients undergoing primary Achilles debridement with FHL transfer was conducted. Data encompassing BMI, demographic information, and medical comorbidities were extracted from electronic medical records (EMRs). A clinically meaningful BMI change was considered as a 5 % variation. Inferential statistics in the form of analysis of variance, t-test, and linear regression were employed for data analysis. Among the 136 patients in the study, no statistically significant BMI changes were noted up to two years after surgery (p = 0.9967). While obesity remains a significant factor in foot and ankle surgery complications, our study suggests that Achilles debridement with FHL transfer does not induce significant weight changes. Further research exploring factors influencing weight changes and varying outcomes across demographics is warranted. Level of evidenceIII.

An improved analytical solution on viscous dissipation effect in extended Stokes’ second problem in microchannel with isothermal boundaries

In this analytical study, the fluid motion within a microchannel is induced by the oscillation of one surface parallel to the other stationary surface, termed the extended Stokes’ problem. The novelty and research gap are acquiring the thermal effect of such motion due to the viscous dissipation or fluid friction, subject to symmetric isothermal boundary conditions. The study may shed light on the role of viscous dissipation in temperature rise in the synovial fluid of an artificial hip joint, or in the fluid layer of a mechanical bearing. The full exact analytical temperature field, until now, has been unsolved, as it involves unsteady flow with manipulation of a complicated velocity field. The assumptions in the model are one-dimensional, incompressible, laminar, Newtonian flow with constant properties in a microchannel. Through the methodology of partial differential equation analysis, the temperature field is obtained in terms of Brinkman number, Prandtl number and a dimensionless angular frequency, and results are verified with a reported numerical solution, for specified range of the variables. Results complement recent approximate solutions which are valid only for the limited condition of the dimensionless angular frequency being less than or equal to unity, whereby suggesting a new Stokes number.

Assessment of Daily Living Activities for Older Adults Post Hip Joint Replacement

Assessment of Daily Living Activities for Older Adults Post Hip Joint Replacement

Femoroacetabular impingement syndrome in middle-aged individuals is strongly associated with the development of hip osteoarthritis within 10-year follow-up: a prospective cohort study (CHECK)

ObjectiveThe objective is to determine the association and absolute risk of femoroacetabular impingement syndrome (FAIS) for the development of radiographic hip osteoarthritis (RHOA).MethodsThis is a nationwide, multicentre prospective cohort study...

Exploring heterogeneity in coxarthrosis medication use patterns before total hip replacement: a State Sequence Analysis

ObjectiveEvidence of geographical variation in total hip replacement (THR) and deviations from treatment guidelines persists. In this exploratory study, we aim to gain an in-depth understanding of patients’ healthcare trajectories...

Geriatric Pharmacotherapy Case Series: Clotting and Gender-Affirming Care.

Background A transfeminine patient is a 79-year-old with past medical history significant for type 2 diabetes mellitus, hypertension, gender dysphoria, chronic kidney disease, dyslipidemia, total left hip replacement, and recent provoked deep venous thromboembolism (DVT). She was seen by a pharmacist in a primary care clinic after her discharge from a skilled nursing facility. The patient was experiencing symptoms of gender dysphoria after discontinuation of her estradiol in setting of her DVT. Assessment Her renal function was calculated to ensure she was on appropriate dosing of her medications. Because her DVT was provoked, providers determined she would require only 3 months of anticoagulation. Her laboratory test results showed a subtherapeutic estradiol level and her estradiol was restarted. Additionally, aspirin was being prescribed for primary prevention of atherosclerotic cardiovascular disease and was discontinued. Outcome She has significant improvement in her gender dysphoria symptoms with resuming her estradiol and now has a therapeutic estradiol level. She is tolerating her direct oral coagulant well and reports good quality of life. Conclusion When reviewing medications for patients it is important to take several factors into account, including dose, appropriate indication, and patient preference. Pharmacists play a key role, through collaboration with providers, in assessing these medication-specific factors. Estradiol was stopped in this patient because of her DVT, but given her DVT was provoked after a recent surgery, it was unlikely that estradiol was the cause of her clot. Weighing the risks and benefits for any patient is important when determining what medications are appropriate to continue. Additionally, calculating renal function appropriately in a gender-non-conforming patients ensures appropriate and safe dosing.

Effectiveness of Rehabilitation Program on Functional Ability among Patients Undergoing Total Hip Replacement Surgery

Effectiveness of Rehabilitation Program on Functional Ability among Patients Undergoing Total Hip Replacement Surgery

Total Hip Arthroplasty for Osteonecrosis of the Femoral Head: A Mid-term Follow-Up in Patients From Northern India.

Osteonecrosis of femoral head (ONFH) is a disabling condition of the hip joint with multifactorial etiology and is associated with genetic predilection and exposure to certain risk factors most commonly being chronic alcohol or steroid intake. Total hip arthroplasty (THA) remains the gold standard for end-stage femoral head osteonecrosis. The outcome after the surgery is mainly affected by age, activity levels and other factors that affect the development of ONFH. Through this study we aimed to evaluate the clinical and radiological outcomes in the patients who have undergone uncemented THA for ONFH. We included 111 uncemented THA on 84 patients with ONFH done by a single surgeon in our institution. The patients were followed up postoperatively and were evaluated based on their functional outcome using Harris hip scores (HHS) and the radiological outcome by serial radiographs on every follow-up. The mean preoperative HHSwas 49.30 which showed significant improvement inthe final follow-up to96.17. The mean acetabular inclination and anteversion at final follow-up radiographs were 47.70 and 18.67 degrees respectively. Fifteen patients had complications which included post-operative surgical site infection (three), hip pain (six) and thigh pain (six). Complications like osteolysis, poly wear and femoral subsidence were recorded in a total of six patients at the final follow-up. Three patients underwent revision THA due to increased femoral subsidence, accelerated poly wear, and aseptic loosening due to osteolysis. Our current observational study, which included 84 patients and 111 hips affected by osteonecrosis of the femoral head, examined the outcomes of total hip arthroplasty using metal on ultra-high molecular weight polyethylene liners. The results showed excellent clinical and radiological outcomes at a mean follow-up period of 4.8 years, particularly in younger patients with a mean age of 37.05 years.

Characterisation of 3D-printed acetabular hip implants.

Three-dimensional printing is a rapidly growing manufacturing method for orthopaedic implants and it is currently thriving in several other engineering industries. It enables the variation of implant design and the construction of complex structures which can be exploited in orthopaedics and other medical sectors. In this review, we develop the vocabulary to characterise 3D printing in orthopaedics from terms defined by industries employing 3D printing, and by fully examining a 3D-printed off-the-shelf acetabular cup (Fig. 1). This is a commonly used 3D-printed implant in orthopaedics, and it exhibits a range of prominent features brought about by 3D printing. The key features and defects of the porous and dense regions of the implant are clarified and discussed in depth to determine reliable definitions and a common understanding of characteristics of 3D printing between engineers and medical experts in orthopaedics. Despite the extensive list of terminology derived here, it is clear significant gaps exist in the knowledge of this field. Therefore, it is necessary for continued investigations of unused implants, but perhaps more significantly, examining those in vivo and retrieved to understand their long-term impact on patients and the effects of certain features (e.g. surface-adhered particles). Analyses of this kind will establish an understanding of 3D printing in orthopaedics and additionally it will help to update the regulatory approach to this new technology.

Patients Undergoing Revision Hip Arthroscopy With Labral Reconstruction or Labral Repair and Patient-Reported Outcomes: A Systematic Review.

Compromise of the acetabular labrum can lead to pain and loss of critical intra-articular fluid pressure. Revision labral preservation poses unique challenges due to adhesions and compromised tissue quality. The purpose of the study was to evaluate patient-reported outcome (PRO) measures (PROMs) in patients undergoing revision hip arthroscopy with either labral reconstruction or labral repair after primary hip arthroscopy for labral tear. It was hypothesized that both procedures would lead to improved PROs. Systematic review; Level of evidence, 4. A systematic review of the literature was conducted with the following keywords: (revision) AND (hip OR femoroacetabular impingement) AND (arthroscop*) AND (reconstruction OR repair) in PubMed, Cochrane, and Scopus in August 2023 using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria, yielding 2002 initial records. Only studies comparing PROMs between revision labral reconstruction or revision labral repair after primary hip arthroscopy for labral tear were included. Background article information was recorded, including article title, author, study design, level of evidence, patient demographics, radiographic information, intraoperative data, PROMs, psychometric thresholds, and secondary surgeries. Secondary surgery in our study was defined as any open or arthroscopic hip surgery secondary to the initial revision surgery. Forest plots were created for pre- and postoperative outcomes present in ≥3 studies. Heterogeneity was calculated using I 2 values. Four studies, including 215 revision labral reconstructions and 115 revision labral repairs of the hips, were included in this systematic review. All studies were level 3 evidence, and study periods ranged between 2009 and 2019. Mean follow-up for the reconstruction and repair groups ranged from 26.3 to 36.6 months and 30.7 to 56.4 months, respectively. The mean age for the reconstruction and repair groups varied between 27 to 34.6 years and 27.5 to 30 years, respectively. Mean postoperative modified Harris Hip Scores for the reconstruction and repair cohorts ranged from 72.0 to 81.2 and 70.8 to 84.1, respectively (I 2 = 0%). Mean visual analog scale for pain scores for the reconstruction and repair cohorts ranged from 3 to 3.5 and 2.3 to 3.9 (I 2 = 33%). Overall secondary surgery rates ranged from 10.0% to 26.7% in the labral reconstruction cohort, compared with 10.0% to 50.0% in the labral repair cohort. One study reported superior outcomes in the revision labral repair group, with 3 studies finding no statistically significant difference in outcomes between the groups. Our systematic review showed that patients undergoing revision hip arthroscopy with labral reconstruction demonstrated significant improvement in postoperative outcome measures. Postoperative outcomes were similar to those of a benchmark control group of patients undergoing revision hip arthroscopy and labral repair. Labral reconstruction in the revision setting appears to be an effective treatment in clinically indicated patients.

Stress-shielding in aseptic loosening on the 3D printed acetabular cup in hip arthroplasty: review article

The increasing number of prosthetic hip replacement surgeries and their growing indication have led to a growing interest in understanding the factors that influence their long-term success. Total hip arthroplasty (THA) failure is mainly due to aseptic loosening. More rarely septic mobilization may occur. In the first case, many variables influence the bone-implant relationship and periprosthetic bone remodeling. Stress-shielding is the most evident but not fully explained manifestation of the bone implant interaction. Recently, three-dimensional (3D) printed titanium orthopedic implants have offered new perspectives in the field of hip prosthetics, enabling the customization and production of acetabular cups with enhanced biocompatibility. This review aims to evaluate the efficacy and reliability of 3D printed acetabular cups from the perspective of aseptic failure particularly related to the stress-shielding. The most recent clinical and preclinical studies will be reviewed, exploring the benefits and challenges associated with the use of these emerging technologies. Key factors, such as biocompatibility, mechanical stability, osseointegration, and wear resistance.

Comparison of the efficacy and safety of different puncture routes for ultrasound-guided fascia iliaca compartment block for early analgesia after hip arthroplasty: A meta-analysis.

This study aimed to compare the effect of ultrasound-guided fascia iliaca compartment block with different puncture sites on postoperative analgesia in patients undergoing hip arthroplasty. We searched the PubMed, Web of Science, EBSCO, Wiley Library, Embase, China National Knowledge Infrastructure, and Wanfang databases for literature on ultrasound-guided fascia iliaca compartment block through different puncture sites in hip replacement patients. The software package R (4.2.1) was used in the meta-analysis. The meta results showed the suprainguinal approach (SA) puncture pathway had a significantly longer operative time than the infrainguinal approach (IA) pathway (mean deviation [MD] = 0.97, 95% confidence interval [CI] [0.09, 1.84], P < .01) when performing orthopedic surgery. In terms of nerve block efficacy, only the block rates of the obturator nerve, lateral femoral cutaneous nerve, and femoral nerve groups did not show significant differences between the SA and IA pathways. In contrast, the results of the Meta combined effect size of visual analogue scale scores during postoperative activity showed that the SA puncture pathway significantly reduced patients' pain scores compared with the IA pathway at the T1 (3-6 h) and T2 (8 h) time points (MD = -0.39, 95% CI [-0.77, -0.01], P = .04 in the T1 group; MD = -0.58, 95% CI [-0.95, -0.21], P < .01). The differences in pain scores at the T3 (12 h) and T4 (24 h) time points were not significant, and in terms of adverse reaction rates, the differences in the incidence of pruritus, sedation, urinary retention, and nausea and vomiting were not significant. This study demonstrates that the SA puncture pathway has a significant advantage over the IA pathway in reducing active pain in early postoperative pain management without increasing the risk of adverse events. This finding supports the prioritization of SA pathway in clinical practice where postoperative pain control is considered. Future research should continue to explore the use of SA pathway in different patient populations and types of surgery, as well as their impact on long-term postoperative recovery, with the aim of optimizing individualized postoperative pain management strategies.

A holonic approach to clinical pathway data analysis

BackgroundHealthcare faces challenges due to the advancements of Industry 4.0 as large volumes of data are generated within healthcare facilities that, combined with the complex nature of healthcare environments, make it difficult to utilise and interpret this data effectively. PurposeA novel holonic approach to clinical pathway data analysis is presented and implemented as a clinical pathway digital twin. A holon is here taken to be an autonomous and co-operative building block of a software system for transforming, transporting, storing and/or validating information. The digital twin's aim is to ingest, structure and analyse the information associated with a clinical pathway to support healthcare professionals in making informed decisions, for example monitoring and predicting the duration from admission to discharge for individual patients. MethodReal world observations and a review of literature led to the identification of a generic set of clinical pathway analysis needs and, derived therefrom, a set of design requirements. A proof-of-concept clinical pathway analysis digital twin was implemented using a holonic approach derived from the ARTI reference architecture. The holonic approach is evaluated in a hip and knee replacement pathway case study. The evaluation includes automated statistical analyses and machine learning predictions. ResultsThe evaluation demonstrates that the holonic approach provides an intuitive and extensible means to aggregate and disaggregate information tactically, and to derive context-tailored analysis features. The holonic approach enhances checking for data completion and handling data anomalies. The evaluation also demonstrates on-demand report generation, which reduces repetitive manual tasks for healthcare professionals. ConclusionThe novel holonic data analysis approach facilitates context-rich analyses tailored to specific clinical pathway activities, with effective tailoring of data ingestion and analysis. Healthcare professionals can use the data analysis approach to extract valuable insights for decision-making related to clinical pathways.

Recovery of Muscular Strength Following Total Hip Replacement: A Narrative Review.

This narrative review analyzes muscle strength recovery following total hip replacement (THR) and looks at various factors affecting postoperative muscle function restoration. The review synthesizes evidence from various studies regarding the timing and degree of muscular strength recovery, different rehabilitation protocols, and patient-specific variables such as age, preoperative physical condition, and comorbidities, among others. Overall, it appears that THR is associated with improved hip function and quality of life, but this usually takes a long time due to individualized physical therapy interventions. In addition, postoperative rehabilitation has been found not to exist without any personal factors involved such as age or gender whereby for instance senior citizens have no alternative but to go for THR surgery, making their lower limbs weaker than those who are younger. Based on the findings in this review on muscle recovery after THR surgeries, one may conclude that this endeavor should begin as early as possible and include regular resistance training programswith performance-focused functional training after surgery. In addition, more longitudinal studies should be conducted regarding post-surgical outcomes comparing other traditional medical practices.

The median effective concentration of ropivacaine for ultrasound-guided anterior iliopsoas muscle space block in the elderly undergoing hip surgery: a dose-finding study.

In order to improve perioperative pain and reduce the adverse outcome of severe pain in elderly hip fractures, anterior iliopsoas muscle space block (AIMSB) can be used clinically to reduce pain. The aim of the study is to investigate the 50% effective concentration (EC50) of ropivacaine for ultrasound-guided anterior iliopsoas space block in elderly with hip fracture. A total of 27 patients were enrolled with aged ≥65 years, American society of Anesthesiologists (ASA) physical status classification II-III and undergoing Total Hip Arthroplasty (THA). We measured the EC50 using Dixon's up-and-down method. Ultrasound-guided AIMSB was performed preoperatively with an initial concentration of 0.2% in the first patient. After a successful or unsuccessful postoperative analgesia, the concentration of local anesthetic was decreased or increased 0.05%, respectively in the next patient. The successful block effect was defined as no sensation to pinprick in the area with femoral nerve, obturator nerve, and lateral femoral cutaneous nerve in 30 min. Meanwhile, the EC50 of ropivacaine was determined by using linear model, linear-logarithmic model, probit regression model, and centered isotonic regression. A total of 12 patients (48%) had a successful block. All patients with a successful block had a postoperative visual analog scale score of <4 in the 12 h. The estimated EC50 values in linear model, linear-logarithmic model, probit regression model, and centered isotonic regression (a nonparametric method) were 0.268%, 0.259%, 0.277%, and 0.289%. The residual standard error of linear model was the smallest (0.1245). The EC50 of ropivacaine in anterior iliopsoas space block under ultrasound guidance is 0.259-0.289%.

Elastic resistance exercise effects in gait kinematic characteristics and lower limb functional rehabilitation

Background: Elastic resistance exercise is a popular type of exercise. Elastic bands are widely used in pre-competition preparation and for sports performance improvement. Purpose: The purpose of the present review is the study of the effect using exercise with elastic resistance bands, in walking kinematics and functionality level after surgical repair of low extremity degenerative diseases. Methodology: A systematic literature review was carried out at Advanced Scholar Google, Cochrane, PubMed and Embase databases, a chronological range from 1999 to 2022. Terms used in the search were as follows: “elastic resistance exercise”, “elastic resistance bands”, “Thera-band”, “arthropathy”, “hip replacement”. Results: Systematic elastic resistance exercise in the frame of a rehabilitation program lasting 8-12 weeks, provides results comparable to an isotonic exercise program, using free weights or constant resistance devices. Elastic resistance bands are commonly used for increasing muscle strength and range of motion and also for static and dynamic balance, walking ability and functionality level improvement. Important benefits observed in metabolic biochemical health biomarkers in the elderly.

Managing the Hip in Supraphysiologic Motion Athletes

The supraphysiologic hip in artistic athletes poses a unique challenge to the discerning sports medicine practitioner. Through stretching and repetitive microtraumatic motions, a cascade of soft tissue laxity, increased strain on surrounding soft tissue structures, and microinstability can develop, resulting in both soft tissue and bony injury. In addition, extra-articular pathology can predominantly affect the artistic athlete. Thus, a thorough understanding of the anatomy and pathophysiology as the hip is ranged to the extremes is paramount to establishing an adequate diagnosis and developing a treatment plan. Through a careful history along with a targeted and thorough physical exam in addition to diagnostic imaging, one can accurately identify the sources of pain and dysfunction. Treatment can range from conservative and interventional non-operative modalities to open and/or arthroscopic hip surgery. Surgical techniques should not only address the identified pathology but also take care to not limit the extremes of hip motion required by the artistic athlete's sport. Despite the high demands of hip motion and function (supraphysiologic motion and function) the artistic athlete can return to high levels of performance if one pays attention to these factors.