Bilateral Total Hip Replacement Research Articles

Bilateral pericapsular end nerve blocks for steroid-induced avascular necrosis following COVID-19 infection requiring bilateral total hip replacement

BACKGROUND Osteonecrosis or avascular necrosis (AVN) of the hip was one of the dreaded complications of coronavirus disease 2019 (COVID-19), which emerged in patients who received steroid therapy. Corticosteroids have been a mainstay in the treatment protocol of COVID-19 patients. Popular corticosteroid drugs used in patients suffering from COVID-19 were intravenous (IV) or oral dexamethasone, methylprednisolone or hydrocortisone. The use of such high doses of corticosteroids has shown very positive results and has been lifesaving in many cases. Still, long-term consequences were drug-induced diabetes, osteoporosis, Cushing syndrome, muscle wasting, peripheral fat mobilization, AVN, hirsutism, sleep disturbances and poor wound healing. A significant number of young patients were admitted for bilateral total hip replacements (THR) secondary to AVN following steroid use for COVID-19 treatment. AIM To assess the efficacy of bilateral pericapsular end nerve group (PENG) blocks in patients posted for bilateral THR post-steroid therapy after COVID-19 infection and assess the time taken to first ambulate after surgery. METHODS This prospective observational study was conducted between January 2023 and August 2023 at Care Hospitals, Hyderabad, India. Twenty young patients 30-35 years of age who underwent bilateral THR were studied after due consent over 8 months. All the patients received spinal anaesthesia for surgery and bilateral PENG blocks for postoperative analgesia. RESULTS The duration of surgery was 2.5 h on average. Seventeen out of twenty patients (85%) had a Visual Analog Score (VAS) of less than 2 and did not require any supplementation. One patient was removed from the study, as he required re-exploration. The remaining two patients had a VAS of more than 8 and received IV morphine post-operatively as a rescue analgesic drug. Fifteen out of seventeen patients (88.2%) could be mobilized 12 h after the procedure. CONCLUSION Osteonecrosis or AVN of the hip was one of the dreaded complications of COVID-19, which surfaced in patients who received steroid therapy requiring surgical intervention. Bilateral PENG block is an effective technique to provide post-operative analgesia resulting in early mobilization and enhanced recovery after surgery.

Effect of a PNF Intervention Strategy with the ICF Tool Applied to a Patient with Bilateral Total Hip Replacement Walking a Crosswalk

Effect of a PNF Intervention Strategy with the ICF Tool Applied to a Patient with Bilateral Total Hip Replacement Walking a Crosswalk

Ten-year clinical outcome of recent-onset axial spondyloarthritis: Results from the DESIR inception Cohort

ObjectivesThis study aimed to evaluate the 10-year clinical outcome of patients with recent-onset axial spondyloarthritis (axSpA). Methods study designThe DESIR cohort is an inception cohort of axSpA patients. Methods diagnosis and managementThe diagnosis and management of patients were based on the decision of the treating rheumatologist. Methods statistical analysisBoth complete cases and imputed data analyses were conducted. ResultsOf the 708 enrolled patients, 45 were excluded due to a change in the baseline diagnosis, 3 patients died, and 300 were lost to follow-up over the 10years. In the completer population, one patient required bilateral total hip replacement, and 56 patients received a pension due to invalidity. The prevalence of main extra-musculoskeletal features increased from baseline to year 10: psoriasis from 18% to 30%, acute anterior uveitis from 10% to 18%, and inflammatory bowel disease from 5% to 10%. The most frequent comorbidity was hypertension, with an increase from 5% to 15% from baseline to year 10. In the imputed data analysis the estimated proportions of patients with an acceptable status at year 10 were 70% [95% CI: 63; 77] for acceptable PASS, 43% [95% CI: 37; 49] for BASDAI<3, and 48% [95% CI: 41; 56] for ASDAS<2.1. ConclusionThese findings suggest that despite a quite favorable 10-year outcome exists for severe outcomes, a large proportion of patients present with an important disease burden reflected by patient-reported outcomes. This information can be valuable for providing patients with information at the time of diagnosis.

Outcomes following staged bilateral total hip replacement: does first-side surgery predict the second?

Patient-reported outcome measures (PROMs) for bilateral staged total hip replacements (THRs) were reviewed to determine whether first-side surgery can predict second-side outcomes. A retrospective review was undertaken of a consecutive cohort of staged bilateral THRs using the same approach, implant and technique, from August 2009 to February 2020. Minimal important change (MIC) in PROMs was set at ≥5. A total of 296 consecutive staged bilateral THRs were performed in 148 patients. Mean time interval between sides was 25 months (range 2-102). Mean age was 63.2 years for the first side and 65.3 years for the second; 62.8% of patients were female. Mean body mass index was 31.08 for the first side, increasing to 31.57 for the second side (p = 0.248). One-year follow-up PROMs were available for 96.6% and 92.5% of the first and second side, respectively. Mean PROMs improvement at 1 year was 26.4 for the first side and 25.1 for the second side (p = 0.207). Some 97.9% of patients achieved MIC for the first side and 96.3% for the second side (p = 0.092). Eight patients failed to reach an MIC on one side, all were female (p < 0.001); however, MIC was achieved for the contralateral side. Seven of eight patients (87.5%) achieved MIC by 2 years. This study identified no significant difference between first- and second-side PROMs improvements following staged bilateral THRs at 1-year follow-up. Failure to reach MIC on one side does not preclude success on the other. Female patients were more prone to not reach MIC at 1 year, but improvement was still subsequently achieved in the majority of cases. The informed consent process is able to reflect this expectation.

FUNCTIONAL OUTCOME OF BILATERAL CEMENTLESS TOTAL HIP ARTHROPLASTY IN DEGENERATIVE ARTHRITIS

Introduction : Bilateral hip degenerative arthritis is a frequent nding in 42% population with osteoarthritis. Unbearable pain restrict daily activities of living to a great extent. Bilateral total hip arthroplasty is an well established reconstructive procedure for advanced arthritis. The objective of this study was to evaluate functional outcome of bilateral cementless total hip arthroplasty using Harris Hip Score. A prospective study conducted in 20 patients with 40 hips w Materials And Methods : ere analyzed for clinical and functional outcome. Age, sex , operative indication and preoperative Harris Hip Score were documented. Operative time and complications were noted. Patients were evaluated immediate post operative period ,3 month and at 6 months . Harris Hip Score , Visual Analogue score , range of movement evaluation was done and documented. Mean preoperative Harris hip score w Results : as 38.6 on left side and 39.3 on right side . This score improved to 88.04 on left and 86.03 on right side immediate post operative period and 94 on left and 93 on right side on 6 month followup. A signicant improvement in Visual analogue score (VAS ) and range of movements were observed in post operative follow up. The outcome after bilateral total hip replacement was excellent in 95% and good in 5% of cases. Current generation of prosthesis used in cement less Conclusion : bilateral total hip arthroplasty for degenerative arthritis of hip, provides satisfactory functional and radiological outcomes . It is an effective and safe procedure and improves the quality of life by relieving pain and improving functional disability

Comparative Study of Pre-operative, Operative, and Post-operative Parameters of Single and Staged Bilateral Total Hip Replacement

Objectives Total Hip replacement (THR) is now emerging as the most successful surgery that can drastically improve the quality of life of an arthritis patient. Bilateral (B/L) hip involvement is seen in many cases where there is a treatment option of operation on both hips in a single operation under single anesthesia or a staged operation. The present study aims to compare the pre-operative, operative, and post-operative parameters of single operation Bilateral Total Hip Replacement (B/L THR) and staged B/L THR (two operations in stages; second operation done after 6–7 days). Material and Methods 97 B/L THR cases were included in a retrospective cohort study operated Delete conducted 2017–2021 under a single surgeon in a tertiary care hospital. The age, sex, and Body Mass Index (BMI) - matched cases were divided into Group 1-single B/L THR and Group 2-staged B/L THR. The patients were assessed on blood loss during surgery and post-surgery up to 24 h, time to reach visual pain analog score of baseline 3, pre and post-operative Harris Hip score, post-operative hemoglobin (Hb) level, infection, dislocation, deep vein thrombosis and duration of hospital stay. Results Thirty-seven cases of Group 1 Single B/L THR and 60 cases of Group 2-Staged B/L THR were analyzed. The time taken for pain to decrease was more in Single B/L THR which was statistically significant. Even though the intra-operative and post operative blood loss was not statistically significant, still more number of cases showed greater blood loss in Staged B/L THR. The pre-operative and post-operative hip functionality outcome was statistically same in both groups. Complications like deep vein thrombosis (DVT) showed lower incidence in Single B/L THR; and equal incidence of infection in both groups. The duration of hospital stay was more in Staged B/L THR. The statistical significance of longer duration of pain in Staged B/L THR can be explained on basis of two injuries inflicted by two operations 6–7 days apart. Harris Hip score for assessing hip functionality did not show statistical significance indicating that both single and staged show similar improvement of hip function. Lower incidence of DVT in Staged B/L THR can be attributed to early mobilization and physiotherapy. Conclusion On the basis of the above study, we conclude that Single B/L THR is feasible, safe and cost-effective with similar functional outcomes and early return to the society. Therefore, it should be encouraged in tertiary care hospitals.

Perioperative safety assessment of patients undergoing unilateral or bilateral hip replacements.

Due to the aging of the world population and the increase of obesity rate, it is expected that the number of joint replacement surgery will continue to increase in the next few years. This study evaluated the safety differences between unilateral and bilateral hip replacement surgeries. The data for patients who underwent hip arthroplasty in 2021 and 2022 were examined. The data set included 68 patients who were grouped according to the type of hip replacement needed, sex, age, and body mass index. Total blood loss and operative time were the safety-related indicators used to compare the groups. Regardless of whether the unilateral replacement group was compared with the overall bilateral replacement group or separately with the staged and simultaneous bilateral replacement groups, simultaneous bilateral replacement surgeries were equally safe as the other types of hip replacements. The total blood loss and operative time for the simultaneous bilateral replacement group were not significantly different from those in the unilateral and staged bilateral replacement groups. For overweight patients, the operative time for simultaneous bilateral replacements was significantly shorter than that for unilateral replacements. These findings suggest that for patients requiring bilateral hip replacements, the blood loss risk for patients undergoing simultaneous bilateral hip replacements was similar to that for patients undergoing either unilateral or staged bilateral hip replacements. Thus, simultaneous bilateral total hip replacement (THR) are safe and should be considered for candidate patients.

Evaluation of a stepped, fixed-height magnification marker stand for use with a 100-mm marker in implant sizing prediction in 52 total hip replacement procedures in dogs.

To describe the use of a 100-millimeter marker placed on a stepped, fixed-height magnification marker stand to measure radiographic magnification on accuracy of implant size prediction when used for canine total hip replacement (THR) implant size selection. Retrospective study. Fifty-two hips in 45 dogs. This study evaluated 52 consecutive canine total hip replacement surgery pre-planning procedures involving 45 dogs with 7 undergoing staged bilateral THRs. Data collected included demographic information, measured radiographic magnification for magnification recalibration, implant size prediction of the cups (52) and the stems (52) based on digital templates superimposed on digital radiographs, and the actual implant sizes used during surgery. Use of the magnification marker stand (MMS) and template application system resulted in an accurate prediction of implant size of 98/104 implants (94.2%) implants. A 100-mm marker placed on a magnification marker stand was a viable method to measure and recalibrate for magnification on digital radiographs during the template process to predict the THR implant sizes that should be available when the surgery begins. This stepped calibration marker stand is helpful in determination of an accurate preoperative THR implant size prediction, lowering implant stock thresholds, operating time, and associated complications. Additionally, the radiographic documentation of the marker's step height allows for indefinite confirmation of the magnification marker height used and for accurate repeatability for all follow-up imaging examinations and contralateral procedure planning.

Re-revision hip replacement in peri prosthesis shaft femur fracture in operated case of cemented total hip replacement

Introduction: Revision surgery differs from original total hip replacement surgery, which is a lengthier and more difficult process. To get a satisfactory result, substantial preparation is required, as well as the use of specialised implants and instruments. Periprosthetic fractures are most commonly caused by a fall and frequently necessitate revision surgery. Most modifications will include the use of customised implants intended to compensate for compromised bone and soft tissue. Case Report: 68-year-old male with bilateral cemented total hip replacement presents with peri prosthetic shaft femur fracture in left side without DNVD which was van-couver type B2 managed with ORIF + Platting + TBW loop which eventually failed, impairing the patient's routine activity, so he came to SMIMER hospital. Management: We performed implant removal + revision total hip replacement with long stem femoral component, which failed post-operatively, therefore the patient underwent Re-revision surgery with inter locking nail femoral long stem component. During repeated follow-ups, the patient expressed satisfaction with his everyday activities. Discussion: Complication are common in revision surgery. Early management is key to rectify intra operative and post-operative complication. Periprosthetic femoral fractures after total hip replacement is a rare but feared complication. Peri prosthetic fracture is managed based on fracture pattern and stem and bone stock. Conclusion: Surgical treatment of periprosthetic fractures, thanks to the introduction of new implants for osteosynthesis and development of new stems for revision endoprostheses, helps achieve ever better results. Of major importance for choosing the treatment method is correct classification of fracture and stem stability.

The clinical and radiological outcome of uncemented primary total hip arthroplasty in case of AVN of femoral head in middle age group

Background: The appropriate treatment of avascular necrosis (AVN) of the femoral head has become a serious problem around the world, particularly in adult instances. Objective was to evaluate the clinical and radiological outcome of uncemented primary total hip arthroplasty in case of AVN of femoral head in terms of pain relief, functional capacity, range of motion, absence of deformity, radiological assessment and comparing pre-operative and post-operative functional status.Methods: This was a prospective observational study of 44 hips of 37 patients at the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh.Results: Here, majority (70%) belong to 30-35 years age group, and 75% were male. The affected site of arthroplasty among patients where highest (51.35%) patients had been affected on right side and right side number of hip was (40.42%). Among all, 30 patients underwent unilateral total hip replacement (THR), 7 patients who were affected bilaterally underwent staged bilateral THR at an interval of 6-12 weeks. According to the position of the acetabular component, anteverted in 70% patients, retroverted in 0% patients, neutral in 25% patient, &lt;35º inclined in 0% patients, 35º-50º inclined in 65% patients, and &gt;50º inclined in 20% patients at follow-up cases. Based on modified Harris hip score (HHS), 92% cases rated this treatment as excellent.Conclusions: Uncemented total hip arthroplasty in individuals, who have arthritis of the hip joint secondary to AVN, provides satisfactory clinical and radiographic outcome. Though the procedure is not free of complications, the overall functional and clinical outcome had shown excellent result.

Efficacy of Dry Needling in Treating Scars following Total Hip Arthroplasty: A Case Report.

Background: In this case report of a 31-year-old female, we describe the effects of dry needling on scar tissue following total hip arthroplasty. Case report: A 31-year-old woman underwent an elective bilateral total hip replacement due to a motor vehicle accident. Based on physical examination, the patient had burning pain at the incision site at the time of menstruation and limited hip range of motion worse on the right side. The treatment program consisted of six sessions of dry needling over a three-week period alongside infrared radiation for 20 minutes during each session. The needles were spaced along the entire length of the scar tissue and rotation was performed back and forth across the scar region to release the adhesion between the scar line and the underlying tissue, focusing more on the painful-to-touch spots and adhesive points. Following the completion of the dry needling treatments hip range of motion and the patient's functional outcome improved. Dry needling may be an effective and rapid treatment for scar tissue adhesion after surgical procedures. High-quality randomized-controlled studies are needed to verify the efficacy of this method.

Outcome analysis of bilateral total hip replacement in patients of avascular necrosis of femoral head

Avascular necrosis (AVN) of the femoral head is one of the common causes of painful hip in a young adult. Bilateral presentation is frequently seen and males are more commonly affected. Total hip replacement (THR) is one of the most successful surgical procedures for AVN. THR is a time tested surgery giving good outcome in terms of relieving pain, restoring function &amp; improving quality of life in patients of AVN. The purpose of the study was to analyse the outcome of bilateral THR &amp; comparing the outcome of one stage THR with Two stage THR. In this study, 40 patients with AVN of bilateral femoral head who were presented in the Department of Orthopaedics, Hamidia Hospital, Bhopal from April 2016 to April 2020 who fulfilled the inclusion criteria were included in the study. THR of all the patients was done on elective basis by senior surgeons of the department. All patients were followed up clinically and radiologically for a period of 6 months after the surgery. Any complications if present were also noted. This study concludes that in patients of AVN of bilateral femoral head, THR gives excellent functional outcome with early walking &amp; early return to work. As compared to Two stage bilateral THR, One stage bilateral THR has advantage of less blood loss, less need of parenteral analgesics &amp; antibiotics &amp; less hospital stay. However, there is no significant advantage in terms of functional outcome, walking capability &amp; return to work.

Outcomes and complications reported from a multiuser canine hip replacement registry over a 10-year period.

To report outcomes and complications associated with total hip replacements (THR) using a multiuser canine hip registry (CHR) and owner-administered questionnaire. Prospective longitudinal clinical study. Dogs (n = 1852). Total hip replacement cases submitted to a CHR were reviewed. An online questionnaire including an adapted "Liverpool Osteoarthritis in Dogs" (LOAD) score was e-mailed to owners. Data were analyzed to determine associations between clinical variables and the agreement by veterinary surgeons and owners for complications. A group of 1329 (72%) dogs had unilateral THRs and another group of 523 (28%) dogs had bilateral THRs, resulting in 2375 THRs. Indications included hip dysplasia and osteoarthritis (n=2028/2375, 85%). Implants were manufactured by Kyon (n =1087, 46%), BioMedtrix CFX (n=514, 22%), BioMedtrix hybrid (n=264, 11%), BioMedtrix BFX (n=221, 9%), and Helica (n=107, 4.5%). Median veterinary surgeon and owner follow up were 1328 and 900 days respectively. Postoperative LOAD scores (21 ± 9) reported by 461 owners improved compared to preoperative scores (11 ± 9) (P < .001). Veterinary surgeons reported complications in 201/2375 (8.5%) THRs and owners in 107/461 (23%) THRs, with moderate agreement (weighted kappa=0.44). No associations were identified between complications and weight, age, sex, or breed. BioMedtrix BFX and Helica implants were associated with increased complications (P=.031) when used for revisions of femoral head and neck excisions. Excellent outcomes, including improved canine mobility, were reported after THRs. Complications were underreported by veterinary surgeons compared to owners in this first multiuser CHR. Canine THRs are safe, effective procedures but THR implants should be carefully selected when revising femoral head and neck excisions.

INDISCRIMINATE COAGULATION TESTING FOR BLEEDING RISK ASSESSMENT PRIOR TO ORTHOPEDIC SURGERY. IS IT A RATIONAL APPROACH?

Abstract Objective: Indiscriminative preoperative coagulation testing to identify patients at risk of bleeding is commonly practiced. However, this practice is no longer supported by current recommendations. We conducted this study with an aim to evaluate the advantage of doing screening testing for coagulation and hemostasis in unselected patients prior to elective orthopedic surgeries in our setting. Material and Methods: It was a retrospective, cross sectional study carried out at Medicare Cardiac and General Hospital, Jinnah Medical and Dental College, Karachi. All the patients admitted for elective orthopedic bilateral total knee replacement and Hip replacement surgeries from March 2016 to December 2018 were included in the study. Electronic data of patients’ pre-operative test results for Prothrombin time, activated partial Thromboplastin time was retrieved. Frequency of patients with deranged coagulation screening was calculated. Results: A total of 367 patients underwent pre-surgical coagulation testing. Male to female ratio was 1:3. Median age of patients was 61±5 years. A total of 2.9% (n=11) patients were found to have deranged coagulation profile. Out of which 3 patients did not undergo surgery and were loss to follow up. Out of total 0.54% (n=2) patients had both prolonged PT and APTT, 1.6% (n=6) patients had prolonged APTT and 0.3% (n=1) patient experienced intraoperative bleeding requiring one unit of packed cell transfusion. Only 0.3% (n=1) patient experienced post-operative bleeding and dropped her Hemoglobin and received transfusion. Conclusion: The overall results of the study suggest that indiscriminate coagulation screening does not provide any additional information unless further detailed hemostatic evaluation is carried out. It is suggested that routine screening tests should not be performed unless a medical history is indicative of bleeding tendency. Key Words: Coagulation screening, Bleeding risk, Orthopedic surgery.

Short-term outcomes of one-stage bilateral total hip arthroplasty in a South African setting

BACKGROUND: Total hip arthroplasty (THA) is one of the most successful orthopaedic surgical procedures that dramatically improves function, pain relief and quality of life for the patient. In South Africa, we have a high prevalence of osteonecrosis of the femoral head (ONFH) and inflammatory arthropathy affecting a young population. This subgroup of patients is usually between the ages of 30 and 50 years (young) and they require bilateral total hip replacements (BTHA) to allow them to return to their previous level of function and employment. The study aimed to assess the short-term outcomes and complications in patients with bilateral hip pathology managed surgically with a one-stage BTHA METHODS: We retrospectively reviewed a series of 33 patients who underwent a one-stage BTHA at a high-volume arthroplasty unit in a central hospital in South Africa between January 2016 and December 2018. The mean age was 38 years (standard deviation [SD] 9 years), and the most common diagnosis was ONFH (76%). In this cohort, 12 patients (36%) tested HIV positive. We assessed patient folders for diagnosis, perioperative details, postoperative follow-up and complications. Radiographic analysis was also performed RESULTS: There were no revisions or planned surgical interventions for any of the patients at a median follow-up of 22 months (interquartile range [IQR] 11-45 months). Thirty patients reported no hip pain and walked unaided at their most recent follow-up visit. Two patients reported groin pain and continued to walk with a single crutch. One patient demised from unrelated causes approximately one year post-surgery. The only perioperative complication was a urinary tract infection (UTI) in one patient. The median postoperative length of stay was six days (IQR 4-7 days), and no other medical or surgical complications were reported. Radiographic analysis revealed four patients (12%) with Brooker grade 1 heterotopic ossification in six hips CONCLUSION: Our results suggest that surgical treatment with a one-stage BTHA is a good alternative to a two-stage BTHA when performed in a high-volume arthroplasty centre and carefully selected patients. The 30-day mortality rate was 0%, and the complication rate was low Level of evidence: Level 4

Risk Factors and Outcomes Associated with Intraoperative Fractures during Short-Stem Total Hip Arthroplasty for Osteonecrosis of the Femoral Head.

BackgroundYoung age in osteonecrosis of the femoral head (ONFH) demands bone-preserving, short-stem arthroplasty. Several designs including neck-preserving stems and neck-resecting, shortened, standard stems are classified as short stems. There is a paucity of literature investigating risk factors and outcomes of intraoperative complications of neck preserving, short-stem arthroplasty in ONFH.MethodsA total of 107 hips operated with METHA short-stem arthroplasty for ONFH were retrospectively evaluated. The mean age of patients was 43.7 years (range, 27–60 years). Nine patients had an intraoperative fracture. Seven hips received prophylactic cerclage wiring for poor bone quality. Patients were invited for clinical and radiological evaluation at the latest follow-up.ResultsThe mean follow-up of patients was 47.2 months. Significant association with intraoperative fractures and the need for prophylactic cerclage wiring were found in steroids-, alcohol-, and chronic renal failure-induced ONFH. However, patient sex, body mass index, traumatic/idiopathic ONFH, previous implant in situ, prosthesis size, and single-sitting bilateral total hip replacement (THA) were not the risk factors. All hips showed signs of osteointegration at final follow-up. No revision was done during the study period for any cause.ConclusionsMETHA short-stem THA offers excellent functional and radiological outcomes in ONFH. However, precaution must be exercised in patients with steroids-, alcohol-, and renal disorders-induced ONFN due to poor bone quality and higher chances of intraoperative fractures. Also, additional measures such as the use of a high-speed burr and prophylactic cerclage wiring in ONFH may allow predictable and safe use of short stems.

Pedicle Subtraction Osteotomy in Lateral Position: A New Strategy for Correcting Severe Thoracolumbar Kyphosis Combined with Hip Flexion Contracture in Ankylosing Spondylitis.

ObjectiveTo describe spinal osteotomy in lateral position, which might be a new strategy for correcting thoracolumbar kyphotic deformity combined with severe hip flexion contracture, and to present two cases in which this method was successfully performed.MethodsSpinal osteotomies in lateral position were performed in two patients with severe thoracolumbar kyphosis combined with hip flexion contracture, which was not suitable for operation in the prone position. Case 1: a 33‐year‐old female AS patient still had severe hip flexion contracture due to poor rehabilitation after total hip replacement (THR). The range of movement of the hip was only about 15° in right and 10° in left. Pre‐operativethoracic kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL), and sagittal vertical axis (SVA) were 52.4°, 49.1°, 42.7°, and 315 mm, respectively. Pedicle subtraction osteotomy (PSO) at L3 was performed in the lateral position. The eggshell procedure was used during osteotomy. Case 2: a 45‐year‐old male AS patient presented coexisting rigid thoracolumbar kyphosis and hip flexion contracture. The range of movement of the hip was only about 20° in right and 25° in left. Pre‐operativeTK, TLK, LL and SVA were 34.9°, 66.8°, 58.8° and 290.8 mm, respectively. PSO at L2 was performed in lateral position. The eggshell procedure was also used.ResultsSagittal malalignments of both patients were greatly improved. For case 1, the total operation time was 5.5 h. The blood loss was 1500 mL and the amount of allogeneic blood transfusion was 1580 mL during the operation. SVA was reduced to 127 mm and LL decreased from preoperative 42.7° to −28.4°. The correction angle through L3 was 34.7° and the correction angle through the osteotomy segment was 62.9°. For case 2, the duration of surgery was 6.5 h. The operative blood loss was 2000 mL and the total amount of blood transfusion was 2020 mL. SVA was reduced to 209.8 mm and LL decreased from preoperative 58.8° to 9.2°.The correction angle through L2 was 37.1° and the correction angle through the osteotomy segment was 55°. No intra‐operative or post‐operative complications were observed. Six months after PSO, case 1 had good posture for standing and sitting. The case 2 underwent bilateral THRs nine months after PSO.ConclusionPSO could be performed in the lateral position successfully. For AS patients who cannot be placed in the prone position due to coexisting severe thoracolumbar kyphosis and hip flexion contracture, performing spinal osteotomy in the lateral position as the first step is an alternative.

Is Bilateral Sequential Total Hip Replacement as Safe an Option as Staged Replacement? A Matched Pair Analysis of 108 Cases at a Tertiary Care Centre.

Rationale for symptomatic severe bilateral arthritis of the hip is sequential bilateral THR completed under the same anaesthesia. The rarity of procedures and apprehension of complications preclude the widespread use. Retrospective analysis of prospectively collected data from 108 patients (216 hips) with bilateral arthritis who underwent total hip arthroplasties was done: out of which 54 patients (108 hips) underwent a single-stage sequential procedure (sequential group) and a matched group of 54 patients (108 hips) underwent a two-stage procedure at different admissions (staged group). Patients were matched according to age (± 2years), gender, American Society of Anaesthesiologists classification, perioperative management protocol and diagnosis. The mean duration of follow-up for sequential group was 5.1years while that of staged group was 5.3years. Most patients (88.88%) were operated with uncemented implants having ceramic on ceramic bearing surfaces under spinal or general anaesthesia. The operating time, post-op limb length and functional outcomes of both groups were comparable. Although the total estimated blood loss was significantly less in the sequential group (502ml) as compared to the staged group (570ml), the mean blood transfusion requirement was significantly higher (1.6units) in the sequential group as compared to that in the staged group (0.9units). The mean cumulative length of hospital stay was significantly longer in the staged group (23days) compared with the sequential group (16days). Single-stage bilateral total hip arthroplasty is a safe and viable option when performed with expertise in appropriately selected patients without any surge in complications.

Comparison and prediction of artefact severity due to total hip replacement in 1.5 T versus 3 T MRI of the prostate

PurposeTo evaluate image quality and diagnostic value of multiparametric prostate MRI (mpMRI) in patients with total hip replacement (THR) at 1.5 and 3 Tesla. MethodsIn this retrospective multicenter cohort study patients with uni- or bilateral THR and 1.5 T or 3 T mpMRI were included. Seventy consecutive, standard-of-care examinations per field strength were evaluated regarding their diagnostic value. The overall diagnostic value and prostate imaging quality score (PI-QUAL) were assessed. Artifact severity in the localizer and mpMRI sequences (T2w, DWI, DCE) was scored on a 3-point scale. Correlation between diagnostic value and artifacts was analysed. Moreover, a subgroup analysis focussed on image quality at different 3 T scanner generations. Results140 consecutive patients (mean age 72, median PSA value 8.3 ng/ml) were included. When comparing 1.5 T to 3 T examinations, no significant differences were observed regarding the artifact severity of DWI and the localizer and the overall diagnostic value of the images. There was a strong correlation between the diagnostic value, PI-QUAL score, and artifact severity in the localizer and DWI. T2w and DCE sequences showed overall low artifacts. Significant improvement in image quality for 3 T at the latest scanner generation was observed, especially for DWI (p < 0.03). ConclusionsMpMRI of patients with THR can be conducted at both field strengths without significant differences in artifacts. The localizer might be useful as an early forecasting feature for diagnostic value and particularly for contrast medium application decision. Patients with THR could benefit from technically advanced scanner generation and rs/ptx-EPI DWI sequences.

The Symmetry and Predictive Factors in Two-Stage Bilateral Hip Replacement Procedures

Background: Approximately 10–25% of total hip replacement patients undergo a bilateral procedure. The purpose of this study was to compare selected parameters associated with the first and second hip arthroplasty in patients undergoing two-stage treatment due to bilateral hip osteoarthritis and establish the predictive factors for the second procedure. Methods: This study compared the data on bilateral total hip replacement surgeries conducted in the period between 2017 and 2021 (42 patients). The following parameters from the first and second procedure were compared: the prosthetic stem, head, and insert cup size; type of cup insert; duration of anesthesia; duration of hospitalization; and the number of complications. Results: The mean duration of hospital stay at the time of the first total hip arthroplasty was 5.83 days and 5.4 days during the second stay. The mean stem sizes used during the first and second total hip replacement procedures were 7.11 and 7.09, respectively. The mean sizes of endoprosthetic cups used at the first and second total hip replacement procedures were 52.64 and 53.04, respectively. There were no significant differences between the mean prosthetic head size at the first and second surgery. The cup type used during the first and second surgery showed no difference. The mean duration of anesthesia used during the first and second total hip replacement surgery was 108.09 min and 104.52 min, respectively. We recorded a mean of 0.07 complications per patient at the first surgery and 0.02 at the second surgery. Conclusions: Our study results showed symmetry duration of anesthesia, length of hospital stay, number of complications per patient, stem size, prosthetic head size, cup insert size, and cup insert type at the first and second surgery in patients with two-stage bilateral total hip arthroplasty. We observed a strong correlation between the stem sizes of the first and second hip endoprostheses. There was also a strong correlation between the cup sizes used during the first and second surgery.