Hip Replacement Surgery Research Articles

Persistent elevation of plasma markers of cellular senescence after hip fracture: a pilot longitudinal study

IntroductionHip fractures may result from and contribute to accelerated biological aging. We aimed to evaluate the impact of hip fracture and its surgery on the senescence-associated secretory phenotype (SASP) index, a composite of peripheral protein markers where higher scores are thought to indicate greater levels of cellular senescence and accelerated aging.MethodsWe examined the SASP index in plasma over 12 weeks post-surgery and its prediction of long-term post-surgical functional outcomes. We included 60 older adults: 20 recruited immediately after hip fracture surgery, and 40 comparison individuals who were either healthy or suffering chronic psychosocial stress (caregiving). We assessed 22 SASP biomarkers and calculated the SASP index score for each hip fracture participant immediately following fracture surgery and 4 and 12 weeks later. Functional recovery was assessed at 12, 26, and 52 weeks after hip replacement surgery.ResultsThe hip fracture group had higher SASP index scores than the comparison groups, after adjusting for potential confounding variables (p = 0.021). SASP index scores in hip fracture patients increased further by week 4 after surgery (p < 0.001), declining by week 12 but remaining elevated overall. However, the SASP index scores were not significantly associated with functional recovery after hip replacement surgery at 26 or 52 weeks after surgery. In conclusion, after hip fracture surgery SASP scores are elevated, continue to rise over time, and do not return to normal by 12 weeks post-surgery.DiscussionOur findings support the need to investigate this phenomenon of post-operative senescence, including whether novel interventions such as senolytics would help older adults facing major surgery.

COMPARISON OF ULTRASOUND-GUIDED LUMBAR ERECTOR SPINAE PLANE BLOCK AND TRANSMUSCULAR QUADRATUS LUMBORUM BLOCK FOR POST-OPERATIVE ANALGESIA IN TOTAL HIP REPLACEMENT SURGERIES: A PROSPECTIVE RANDOMIZED STUDY

Objectives: The objective of the study is to compare the efficacy of ultrasound-guided lumbar erector spinae plane block (ESPB) and transmuscular quadratus lumborum block (QLB) in providing post-operative analgesia for patients undergoing total hip replacement (THR) surgeries. Methods: This prospective, randomized, double-blind study compared the efficacy of ultrasound-guided lumbar ESPB and transmuscular QLB (QLB-t) for post-operative analgesia in THR surgeries. Ninety patients were randomized into three groups: ESPB, QLB, and a control group. Primary outcomes included the duration of analgesia, measured by numeric rating scale scores, and secondary outcomes assessed total analgesic consumption and the incidence of post-operative nausea and vomiting (PONV) within 24 h. For statistical purposes, p<0.05 was taken as statistically significant. Results: This study compared lumbar ESPB and QLB for post-operative analgesia in THR surgeries. At the 1st h, pain scores were significantly lower in the ESPB (1.30) and QLB (1.05) groups compared to the control group (2.15) (p<0.001). Tramadol consumption in the first 12 h was significantly lower in the ESPB (52.3 mg) and QLB (50.1 mg) groups compared to the control group (135.20 mg) (p<0.001). PONV was absent in 60% of ESPB and 63% of QLB patients, compared to only 33% in the control group (p=0.038). Conclusion: Lumbar-ESPB and QLB-t blocks effectively reduce post-operative pain and analgesic requirements in THR surgeries, showing comparable benefits. Both techniques also lower the incidence of PONV.

Feasibility of a Multimodal Prehabilitation Program Before Elective Knee and Hip Arthroplasty in Older Adults

ObjectivesHip osteoarthritis and knee osteoarthritis cause significant disability and pain in older adults, often leading to hip or knee replacement surgery. Prehabilitation programs have been established for these surgeries, but there are few programs for orthogeriatrics. We evaluated the feasibility of a new multimodal prehabilitation program (MPP) for older adults before hip or knee replacement due to arthrosis: the Prehabilitation for Os (PRE4OS) study. DesignWe conducted a multicenter feasibility study in the Greater Paris area. Setting and ParticipantsEligible adults were ≥75 years old awaiting hip or knee replacement with at least a 6-week delay before surgery and able to participate in the MPP follow-up. The MPP included weekly hospital sessions providing nutritional, psychological, functional, and cognitive support, along with weekly home sessions featuring physiotherapist visits. MethodsThe primary outcome was at least 80% of 1-day hospital (ODH) sessions performed by 80% of participants. Secondary outcomes included intervention achievement, quality of life, and nutritional and functional status changes. Participant's satisfaction was qualitatively assessed via structured phone interviews presurgery and at 30 days postsurgery. ResultsFrom September 2021 to September 2023, a total of 27 individuals participated in the PRE4OS study. The mean (SD) age was 83 (4.3) years, with 7 males (26%) and median baseline Activities of Daily Living score 5.5 (interquartile range 5.5–6.0). Surgeries were for insertion of hip prosthesis in 17 participants (63%) and knee prosthesis in 10 (37%). The primary outcome was achieved in 89% of participants, with comparable rates for hip and knee prostheses. In total, 60% of participants rated the MPP as “excellent” presurgery and 100% at 30 days postsurgery, expressing a willingness to recommend the protocol to a friend or family. Conclusion and ImplicationsThe MPP was feasible for individuals before hip or knee replacement and was well received. Further randomized trials are needed to assess its clinical impact.

Effects of Small-Dose Esketamine on Postoperative Analgaesia and Sleep Quality in Patients with Total Hip Replacement.

To determine the effect of esketamine in patient-controlled analgaesia after hip replacement on postoperative pain and improve sleep quality in patients. Randomised double-blind study. Place and Duration of the Study: Department of Anaesthesiology, The First Affiliated Hospital of Guangxi Medical University, from March 2021 to May 2022. The research enrolled 72 patients who were subjected to unilateral complete hip replacement surgery utilising jointly administered universal and peripheral nerve-obstructing anaesthetics. A randomised numeric table method was used to allocate patients to either the F-D group (fentanyl combined with dexmedetomidine, n = 34) or the Es-D group (esketamine combined with dexmedetomidine, n = 38). The key outcome indicators included the time to first administration of rescue analgaesic, the dose of rescue analgaesics, and postoperative sleep quality. Baseline characteristics did not differ between the two groups. The time until postoperative analgaesic rescue medication was considerably shorter for those in the Es-D group (p <0.05). In addition, the Es-D group used significantly fewer rescue analgaesics (p = 0.01). The PSQI score and unpleasant responses (PONV, dizziness, nightmare) did not significantly differ between the two groups (p <0.05). Nevertheless, urine retention occurred in four patients in group F-D but not in group Es-D (p <0.05). Esketamine produced better analgaesia than fentanyl with fewer side effects after surgery. However, no improvement was observed in sleep quality. Arthroplasty, Postoperative analgaesia, Esketamine, Sleep quality, Patient-controlled analgaesia.

Effects of Small-Dose Esketamine on Postoperative Analgaesia and Sleep Quality in Patients with Total Hip Replacement.

To determine the effect of esketamine in patient-controlled analgaesia after hip replacement on postoperative pain and improve sleep quality in patients. Randomised double-blind study. Place and Duration of the Study: Department of Anaesthesiology, The First Affiliated Hospital of Guangxi Medical University, from March 2021 to May 2022. The research enrolled 72 patients who were subjected to unilateral complete hip replacement surgery utilising jointly administered universal and peripheral nerve-obstructing anaesthetics. A randomised numeric table method was used to allocate patients to either the F-D group (fentanyl combined with dexmedetomidine, n = 34) or the Es-D group (esketamine combined with dexmedetomidine, n = 38). The key outcome indicators included the time to first administration of rescue analgaesic, the dose of rescue analgaesics, and postoperative sleep quality. Baseline characteristics did not differ between the two groups. The time until postoperative analgaesic rescue medication was considerably shorter for those in the Es-D group (p <0.05). In addition, the Es-D group used significantly fewer rescue analgaesics (p = 0.01). The PSQI score and unpleasant responses (PONV, dizziness, nightmare) did not significantly differ between the two groups (p <0.05). Nevertheless, urine retention occurred in four patients in group F-D but not in group Es-D (p <0.05). Esketamine produced better analgaesia than fentanyl with fewer side effects after surgery. However, no improvement was observed in sleep quality. Arthroplasty, Postoperative analgaesia, Esketamine, Sleep quality, Patient-controlled analgaesia.

Surveillance of surgical site infections using artificial intelligence

Abstract Background Surgical site infection (SSI) is a major health problem associated with high morbidity and mortality, the consequences of which can be very serious for the patient and costly for the organisation. Surveillance systems provide insight into the incidence of SSI, the analysis of which enables improvement plans to be established to reduce it. Traditionally, surveillance systems have been based on manual medical record review for evidence of the presence of surgical infection. Objectives To create and validate a global SSI diagnostic algorithm and to optimise the SSI workload of Preventive Medicine services. Methods The study population included patients undergoing surgical procedures of rectal surgery, colon surgery, knee replacement surgery, hip replacement surgery, coronary bypass and valve surgery, at the Hospital Universitario Vinalopó in Elche (n = 1240). Data mining was used to collect clinical, microbiological and postoperative follow-up values from the electronic medical record. Machine Learning techniques were used to train (n = 1054) and validate the model (n = 186). Time spent on SSI surveillance of the preventive medicine service was measured. Results Model performance after validation was: sensitivity of 0.83 specificity of 0.87, accuracy of 0.87, an F1 score of 0.45, and an area under the curve of 0.87. The time spent by preventive medicine staff in identifying patients with surgical site infection decreased from 168 person-hours per procedure per quarter to 34 person-hours, a 77% reduction in the workload allocated to this task. Conclusions This project not only improves surveillance efficiency, but also optimises the workload in Preventive Medicine services very significantly. Key messages • This project improves the efficiency of surgical site infection surveillance and significantly optimises the workload in preventive medicine departments. • It makes it possible to extend surveillance to new surgical procedures and to work more intensively on preventive measures.

Personalized Stem Length Optimization in Hip Replacement: A Microscopic Perspective on Bone—Implant Interaction

Total hip replacement (THR) surgery involves the removal of necrotic tissue and the replacement of the natural joint with an artificial hip joint. The demand for THR is increasing due to population aging and prolonged life expectancies. However, the uniform length and shape of artificial hip joints can cause stress shielding, leading to implant loosening and femoral fractures. These issues arise because these designs fail to account for the unique anatomical and biomechanical characteristics of individual patients. Therefore, this study proposes and validates a method to optimize stem length by considering bone microstructure and daily load. The results demonstrated that the optimal stem length varies with loading conditions and significantly reduces stress in the cortical bone while maintaining an appropriate strain energy in the cancellous bone, thereby preventing bone loss. These findings underscore the importance of patient-specific stem design for improving implant stability and clinical outcomes.

Readiness for hospital discharge on people after hip replacement surgery in Vietnam: A cross-sectional study

Background &amp; Aim: Readiness for hospital discharge is closely linked to post-operative complications, readmission rates, and the post-discharge health status of patients after hip replacement surgery. This study aimed to assess discharge readiness and identify the factors that predict it in patients undergoing hip replacement surgery. Methods &amp; Materials: This cross-sectional descriptive study included 112 patients who had undergone hip replacement surgery at Hospital X in Middle Vietnam. Participants were selected using a convenience sampling method, and data were collected within 4 hours before hospital discharge. The Readiness for Discharge Scale, developed by Weiss et al. was used to measure discharge readiness. Data analysis was conducted using SPSS 20.0 statistical software. Results: The average discharge readiness score was 6.06± 2.10, indicating a low discharge readiness level. Multivariable linear regression analysis revealed that age, living conditions, planned admission, previous admission for the same diagnosis, and length of hospital stay significantly predicted 78.5% of the variance in discharge readiness (F= 77.626, p&lt; 0.001). Among these factors, the strongest predictor was previous admission for the same diagnosis (β= 0.341, p&lt; 0.001), followed by planned admission (β= 0.324, p&lt; 0.001). Conclusion: The findings indicate that patients' readiness for discharge after hip replacement surgery remains low, with various factors influencing their readiness. Nurses caring for these patients should consider these factors to improve discharge readiness and patient outcomes.

Bone allograft impregnated with tobramycin and vancomycin delivers antibiotics in high concentrations for prophylaxis against bacteria commonly associated with prosthetic joint infections.

Local delivery of antibiotics as prophylaxis for prosthetic joint infections (PJIs) is frequently used during total hip replacement surgery. Morselized bone allograft impregnated with vancomycin and tobramycin (TobraVanc) could provide effective prophylaxis against bacteria commonly associated with PJIs. In this study, the concentrations of antibiotics released by bone allograft impregnated with TobraVanc were determined by using an in vitro bioassay system entailing measuring inhibition zone diameters caused by antibiotic-impregnated bone chips cast in agar against standard curves. The concentrations were determined in samples of TobraVanc-impregnated bone graft taken before and after the application of the bone graft in the patients undergoing acetabular revision surgery. Antibiotic-impregnated bone grafts, sampled prior to application in the patient, delivered antibiotics in the concentration ranges of 730-9,800 mg/L for tobramycin and 1,300-11,000 mg/L for vancomycin. Samples taken after application in the patient released lower concentrations of tobramycin (490-1,900 mg/L; P < 0.01) and vancomycin (3,000-5,100 mg/L; P < 0.05); however, these concentrations remained well above the tobramycin minimum inhibitory concentrations (MICs) for investigated, highly tobramycin-resistant Staphylococcus epidermidis strains (MICs > 256 mg/L). At the tested concentrations, bone graft material mixed with TobraVanc delivered antibiotics in potent concentrations above the MICs for bacteria causing PJIs. Clinical trials are needed to evaluate the efficacy and risk of TobraVanc-impregnated bone graft as a prophylactic agent for patients undergoing hip replacement surgery.IMPORTANCEAntibiotic prophylaxis is the cornerstone of successful joint replacement surgery, reducing the risk for the dreaded complication of prosthetic joint infection (PJI) to roughly 0.5%-2% in standard total hip replacement (THR). In addition to systemic antibiotics, antibiotics added locally have the potential to reduce the PJI risk even further, because of the high concentrations that can be achieved in the joint with limited risk for systemic toxicity. The results in the current study show that bone chips impregnated with a combination of tobramycin and vancomycin (TobraVanc) release antibiotics in concentrations that are potent against common bacteria causing PJIs. Especially in high-risk patients, our results support the prophylactic use of TobraVanc in hip replacement surgery requiring the use of a bone graft. A clinical study testing the efficacy of TobraVanc-impregnated bone graft in reducing the incidence of PJI in hip replacement surgery is currently ongoing (EudraCT: 2021-001708-14).

Evaluation of transcutaneous electrical acupoint stimulation for improving pain and cognitive function in elderly patients around the perioperative period of hip replacement surgery: A meta-analysis.

We aim to evaluate the efficacy and safety of transcutaneous electrical acupoint stimulation(TEAS) in elderly patients around the perioperative period of hip replacement surgery. The China National Knowledge Infrastructure(CNKI), Wangfang Data, VIP database, SinoMed, PubMed, and Embase databases were searched for relevant publications until August 2024. All randomized controlled studies evaluating the efficacy and safety of TEAS in patients around the perioperative period of hip replacement surgery. We calculated pooled risk ratio (RR) with 95% CIs for binary outcomes and standardized mean difference (SMD) for continuous outcomes. The Cochrane's Risk of Bias Tool were used to evaluate the quality of studies. A total of 13 studies with 946 patients were included in this analysis. 1-day visual analogue scale (VAS) scores and 2-day VAS scores were significantly lower in the TEAS group compared to the control group (SMD: -0.78, 95% CI: -1.47, -0.09, P = 0.02 and SMD:-0.54, 95% CI:-1.00,-0.09,P = 0.02). Furthermore, 1-day mini-mental state examination (MMSE) scores and 3-day MMSE scores were significantly higher in the TEAS group compared to the control group (SMD: 1.60, 95% CI: 0.68, 2.51,P<0.001 and SMD:1.31, 95% CI:1.03,1.59,P<0.001), along with a lower postoperative cognitive dysfunction rate (RR: 0.55, 95% CI: 0.41, 0.73, P<0.001). Our meta-analysis demonstrated that TEAS significantly reduces pain and improves cognitive function in patients undergoing hip replacement surgery. Future studies should further investigate the optimal TEAS protocols to maximize these benefits across different population and surgical settings.

Systematisation of the causes that required revision hip replacement, methods of their solution, treatment results in Ukraine

BackgroundThe objective of this study is to organise data on complications following total hip replacement (THA) over a span of 10 years, specifically focussing on cases that necessitated revision endoprosthetic surgeries. The objective is to create a recommendation for an All-Ukrainian registry of initial and repeated hip arthroplasty (HA) and standardise the terminology used to define “revision of total hip replacement surgery”.MethodsThe retrospective analysis examined 236 instances of revision hip arthroplasty (rTHA) performed at the Institute of Traumatology and Orthopaedics Centre between January 2005 and December 2021. The primary factors for revision were identified through an analysis of the patient’s medical records, laboratory results, visual inspection, and the state of the previously implanted prosthesis. Demographic information, primary and revision HA dates, diagnoses, and causes of complications were recorded. The statistical analysis was conducted using the Statistica package (StatSoft), version 12.6 (2015), with a significance level of p < 0.05.ResultsOut of the 364 patients who were diagnosed with complications, 236 of them (55.17%) needed a procedure called 1rTHA. Among these cases, 152 (41.76%) were specifically diagnosed with aseptic component instability. Significant factors for mechanical loosening were a high body mass index (BMI ≥ 30) and older age, with respective t-values of 2.08 (p = 0.004) and 2.59 (p = 0.045). Osteoporosis significantly contributed to aseptic loosening and fractures around the implant. The occurrence of infectious complications was frequently linked to chronic infectious diseases (t = 3.37, p = 0.001). The overall percentage of need for 2rTHA was 27.22% (43 cases), with one case of infectious lesion following the revision.ConclusionsThe study emphasises the urgent requirement for standardised terminology and a comprehensive registry for hip arthroplasty procedures. Primary results indicate that cement-free fixation is more effective than cement-based fixation for revision in patients with aseptic instability and that two-stage arthroplasty is effective for treating infectious inflammation. Furthermore, the most effective treatment for femoral fractures with periprosthetic involvement was determined to be open repositioning and osteosynthesis with metal retainers. The aforementioned observations emphasise the need to create a comprehensive registry across Ukraine to support patient care, enable evidence-based practices, and enhance the overall effectiveness of hip arthroplasty operations.Clinical trial numberNot applicable.

Postoperative Harris Hip Score Versus Harris Hip Score Difference in Hip Replacement: What to Report?

Reliable scientific information is crucial for assessing hip function and evaluating the success of hip surgery. The Harris Hip Score (HHS) is the most widely used tool for measuring hip function and, in particular, the outcomes of hip surgery. The aim of this study was to conduct a systematic review of the literature to identify randomized controlled trials (RCTs) that reported the HHS for hip replacement treatment groups and to test whether there was a substantial difference between reporting only the postoperative HHS or the HHS difference (HHSdiff). PubMed, CNKI, and Epistemonikos were searched until March 1, 2024. The risk of bias, level of evidence, and publication bias were assessed. As HHS is a continuous outcome, mean difference (MD) with 95% confidence intervals (CIs) was calculated using the Hartung-Knapp-Sidik-Jonkman method and a common-effect/random-effects model. The same approach was used for both postoperative HHS and HHSdiff. The effect of the two treatment groups studied (minimally invasive vs. conventional approach) on postoperative HHS was then compared with the effect of the two groups studied on the difference in HHS. A total of 41 RCTs, involving 3572 patients, with a low to high risk of bias and a low to moderate publication bias were included. The measured outcome parameters showed a low to moderate level of evidence. There was no relevant difference in the reporting of HHS only postoperatively or HHSdiff when comparing two hip replacement treatment groups in RCTs, measured at 0-0.5, 3, 6, and 12 months postoperatively. The present study showed that there is no relevant difference between reporting of the HHS only postoperatively or HHSdiff when comparing two hip replacement treatment groups in RCTs. Both methods of HHS reporting produced comparable results in an identical cohort of 3765 patients undergoing hip replacement surgery.

POSSIBILITIES FOR MEDICAL REHABILITATION IN PATIENTS AFTER HIP ENDOPROSTHETICS

Hip replacement surgery is currently the only effective surgical treatment option for patients with severe forms of degenerative-dystrophic diseases of the hip joint, so the problem of medical rehabilitation of such patients remains very relevant. One of the problems that arise after hip replacement surgery is a violation of the biomechanics of the artificial joint. The leading role in this process is played by the functional state of muscle tissue, which determines the problem of adaptation of the endoprosthesis components and can subsequently cause complications. The solution to this problem lies in timely comprehensive medical rehabilitation, individually selected for each patient, taking into account the characteristics of the postoperative period. Traditional methods of medical rehabilitation, including various methods of therapeutic exercise, natural and preformed physical factors, are undoubtedly effective, as indicated by an extensive scientific evidence base, but despite the proven effectiveness, these methods are time-consuming and require the presence of specialists. Along with traditional methods of medical rehabilitation, new technologies are currently used, including telerehabilitation, digital products based on virtual reality and artificial intelligence, robotic mechanotherapy, the effectiveness of which has been proven by scientific works of domestic and foreign colleagues and is in no way inferior to classical methods of rehabilitation treatment.

Clinical, functional and neuropsychological status of joint replacement patients

Introduction The number of hip and knee replacement surgeries is increasing annually in Russia and worldwide. The majority of patients receiving joint arthroplasties are elderly women.The objective was to assess the clinical, functional and neuropsychological status of patients undergoing total knee or hip replacement.Material and methods The study included 448 patients admitted for elective surgery of total knee or hip replacement at the Department of Traumatology and Orthopedics of the Federal Center for High Medical Technologies (CHMT, Kaliningrad Region). Anthropometric parameters of the patients were measured, the medical history and concomitant diseases recorded. Common blood count and biochemistry test were evaluated preoperatively. Neuropsychological examination included assessment of cognitive and executive functions, levels of distress, depression, anxiety and somatization.Results Almost all patients studied were found to have varying degrees of obesity. A typical combination of concomitant pathology in volunteers was stage 2 hypertension, risk degree 2–3, and chronic gastritis in remission. Half of the volunteers showed moderate and high levels of distress, depression, anxiety and somatization. A significant number of volunteers showed moderate to high levels of cognitive decline. Age- and sex-related blood counts were slightly different from the normal ranges for a CBC and biochemistry. Changes in leukocyte count were detected.Discussion Leukocyte counts indicated the osteoarthritis induced inflammatory process in most patients. Mitochondrial dysfunction and aging of the immune system contributed to the “proinflammatory status.” The high rate of cognitive impairment in volunteers was associated with age and comorbidity, cardiovascular conditions, in particular. Distress and anxiety were associated with emotional reactions to surgery.Conclusion The factors reported can affect the duration and course of rehabilitation. The “pro-inflammatory status” of patients can complicate the healing of a postoperative wound. Neuropsychological disorders noted during postoperative rehabilitation can have a significant impact on physical recovery, social and professional adaptation.

Does the utilization of fluoroscopy affect the accuracy of prosthesis position in patients undergoing hip replacement surgery via the direct anterior approach compared to the posterolateral approach for an experienced surgeon? A single-center retrospective study

BackgroundThe direct anterior approach (DAA) for total hip arthroplasty (THA) has gained popularity due to perceived advantages in achieving better early outcomes. However, the theoretical benefits such as precise implant positioning and accurate leg length restoration are still inconsistent. In this study, we compared implant position and leg length discrepancy (LLD) of the DAA and posterolateral approach (PLA) conducted by a single surgeon who had mastered both approaches.MethodsThis study retrospectively reviewed the medical records and radiographic images of 244 patients who underwent THA between 2012 and 2021 by a single experienced surgeon using either the DAA (n = 120) or PLA (n = 124). Postoperative pelvic anteroposterior radiographs at 6 months follow-up were used to assess acetabular component inclination and anteversion, as well as LLD. Mann-Whitney U tests and Chi-squared test were performed to compare outcomes between the two approaches.ResultsNo significant differences were observed in patient demographics between the two groups. The DAA group demonstrated significantly lower postoperative LLD (0.00 mm) compared to the PLA group (5.00 mm, p < 0.0001). No significant difference was observed in the Lewinnek zone for cup anteversion and inclination angles between the two groups.ConclusionsFor experienced surgeons in other approaches, our findings suggest transferring to the DAA may not substantially improve cup positioning, but it might slightly enhance limb length measurement. For surgeons already proficient in other approaches and deciding to maintain those approaches, their primary concern for optimal THA outcome should be striving for leg length equivalence.

Open-Label Randomized Clinical Trial to Assess the Effects of Preoperative Acupuncture in High Anxiety Patients Undergoing Total Knee or Hip Arthroplasty.

Background: Preoperative state anxiety is a known predisposing factor for enhanced postoperative pain and hindered recovery following total knee or hip replacement. Acupuncture administered preoperatively has been associated with reduced anxiety in surgical studies, yet evidence of its efficacy in the orthopedic surgical setting is limited. Objective: This study investigated the effects of preoperative acupuncture on preoperative anxiety and pain and compared acute postoperative pain between acupuncture and control patient groups. Design: Parallel-arm, open-label, randomized controlled trial. Setting: Bone and Joint Institute, Hartford Hospital, Hartford, CT. Participants: Sixty middle-aged and elderly men and women with clinically validated preoperative anxiety undergoing elective total hip or knee replacement. Intervention: One-to-one randomization to preoperative acupuncture (n = 30) or no acupuncture treatment (n = 30) on the day of surgery. Coprimary outcomes: Anxiety before and after preoperative acupuncture using the visual analog scale and postsurgical pain using the numeric pain scale. Secondary outcomes: Incidence of acupuncture-related complications, pain before and after acupuncture, nausea and vomiting incidence, opioid consumption, anxiolytics and antiemetics use, and patient satisfaction. Results: Patients reported lower anxiety and pain preoperatively following acupuncture compared with before treatment (both p < 0.001). Postoperatively, the acupuncture group reported lower pain in the first 3 h than the control group, although this difference was not statistically significant. No significant differences in postoperative complications or patient satisfaction were observed between the study groups. Most patients were satisfied with the acupuncture treatment and reported a likelihood of considering preoperative acupuncture for future surgeries. Conclusions: These preliminary findings support that preoperative acupuncture is a safe and effective means to reduce perioperative anxiety and pain in patients undergoing total hip or knee replacement surgery. Additional studies should be conducted to best determine the value of preoperative acupuncture in total hip or knee patients presenting with surgically related anxiety. Clinical Trial Registration: ClinicalTrials.gov (10/31/2023, NCT06099223).

Comparison of Biomechanical, Clinical Indicators, and Quality of Life in People Undergoing Hip Replacement Surgery with Anterior and Posterior Approaches

Background: There are ongoing debates among surgeons regarding the most effective surgical method for hip replacement, with varying preferences for the anterior and posterior approaches. Both methods have demonstrated excellent long-term outcomes, with clinical differences primarily observed in the early postoperative period. Objectives: This study aimed to compare the anterior and posterior methods of hip replacement after six months of surgery in terms of biomechanical and clinical indicators, as well as quality of life. Methods: In this cross-sectional observational study, 42 patients who underwent hip replacement surgery using either the anterior (n = 22) or posterior method (n = 20) at least six months (and a maximum of 12 months) post-surgery, along with 20 healthy individuals, were evaluated. Biomechanical indices of the center of pressure (COP) were measured using a force plate during two-leg standing with eyes open and closed. Functional balance, independence, self-perception of performance, satisfaction, and quality of life were assessed using the timed up and go test (TUG), Barthel Index, Canadian Occupational Performance Measure (COPM), and the SF-36, respectively. Results: No significant differences were found between the anterior and posterior groups in terms of COP, clinical variables, and quality of life (P &gt; 0.05). However, when compared to the control group, the anterior replacement group exhibited significantly higher COP displacement in the medial-lateral direction (P = 0.03) and COP velocity in the anterior-posterior direction (P = 0.02) during two-leg standing with eyes open. No significant differences in COP variables were observed in the posterior replacement group compared to the control group (P &gt; 0.05). Conclusions: The findings indicate no significant differences between the anterior and posterior approaches to hip replacement in terms of biomechanical and clinical indicators, as well as quality of life after six months. Therefore, the choice of surgical method can be based on the patient's condition and the surgeon’s expertise in the respective approach.

Diagnostic Accuracy of Hip Joint Ultrasound for Detection of Calcium Pyrophosphate Deposition.

Calcium Pyrophosphate Crystal Deposition (CPPD) disease is a chronic and disabling arthropathy. Ultrasound (US) has been shown to be a tool with high sensitivity and specificity for the diagnosis of CPPD disease, but its value at the hip joint has not yet been determined. Therefore, our objective was to evaluate the diagnostic accuracy of US for the identification of calcium pyrophosphate (CPP) crystals in the hip joint as compared with histopathology. Diagnostic test study involving patients over 50 years of age with osteoarthritis, scheduled for hip replacement surgery. US was performed on the affected hip. Acetabular fibrocartilage (FC) and hyaline cartilage (HC) of the femoral head were assessed, and a dichotomous score was used for the presence/absence of CPP crystals. Synovial fluid (SF) was obtained from the affected hip and examined using polarized light microscopy. Histopathological examination was performed by an experienced pathologist in search for CPP crystals in FC and HC samples. One hundred patients were enrolled, of whom 62% were found to have hyperechoic areas suggestive of CPP deposition on US examination. Pathological evaluation revealed a prevalence of 61% of CPP crystals. The sensitivity, specificity and the positive predictive and the negative predictive values were 90%, 82%, 89%, and 84%, respectively. The area under the curve for US compared with histopathology for the diagnosis of hip CPPD was 0.86 (CI 95% 0.78-0.94). US is a valid imaging modality with good diagnostic accuracy for the detection of hip CPPD.

Assessment of Cup Placement Impact on Functional Outcomes in Total Hip Replacement: A Retrospective Analysis of 20 Patients

Introduction:Total hip replacement surgery is gaining popularity as a treatment for hip disorders, replacing alternative treatments like excisional arthroplasty, osteotomy, arthrodesis, and hemiarthroplasty. This research aims to evaluate the effect of the acetabular cup on functional outcomes, particularly in younger patients with hip arthritis and femur neck fractures.Materials And Methods:This study aimed to evaluate the placement of the acetabular cup and its association with functional outcomes in total hip replacement (THR). 20 patients were randomly selected from the MRD department and underwent pelvic CT scans postoperatively. Functional results have been analyzed using the Harris Hip Score. The acceptable cup version range was 15 ± 10 degrees, and patients outside this range were closely examined for rotational movements. Results: A study of 20 patients with a neck or femur fracture found that 11 patients had a right knee injury, while 9 had a left knee injury. After a year postoperatively, 18 patients reported no pain, while 2 had mild pain. Functional assessment depicted better outcomes in 17 patients, good outcomes in 2 patients, and fair outcomes in 1 patient. Radiological analysis revealed a mean cup version of 17.77 degrees, with complications including one dislocation and three limb length discrepancies. None of the patients developed an infection.Conclusion:The study found that 90% of patients had excellent functional outcomes, with only 10% exhibiting excessive anteversion. CT scan-based measurements of cup placement provided reliable predictions, consistent with intraoperative assessment of cup positioning.

A systematic review of crosswalks for converting patient-reported outcome measure scores in hip, knee, and shoulder replacement surgery.

We aimed to systematically review studies of crosswalks for converting patient-reported outcome measure (PROM) scores used in joint replacement, and develop a database of published crosswalks. 4 electronic databases were searched from January 2000 to May 2023 to identify studies reporting the development and/or validation of crosswalks to convert PROM scores in patients undergoing elective hip, knee, or shoulder replacement surgery. Data on study and sample characteristics, source and target PROMs, and crosswalk development and validation methods were extracted from eligible studies. Study reporting was evaluated using the Mapping onto Preference-based measures reporting Standards (MAPS) checklist. 17 studies describing 35 crosswalks were eligible for inclusion. Unidirectional crosswalks were available to convert hip-specific (Oxford Hip Score [OHS]) and knee-specific (Oxford Knee Score [OKS]) scores to the EQ-5D-3L/EQ-5D-5L. Similar crosswalks to convert disease-specific scores (WOMAC) to the EQ-5D-3L, EQ-5D-5L, and ICECAP-O Capability Index were identified. Bidirectional crosswalks for converting OHS and OKS to the HOOS-JR/HOOS-12 and KOOS-JR/KOOS-12, for converting WOMAC to the HOOS-JR/KOOS-JR, and for converting HOOS-Function/KOOS-Function to the PROMIS-Physical Function were also available. Additionally, crosswalks to convert generic PROM scores from the UCLA Activity Scale to the Lower Extremity Activity Scale in both directions were available. No crosswalks were identified for converting scores in shoulder replacement. Development methods varied with the type of target score; most studies used regression, item response theory, or equipercentile equating approaches. Reporting quality was variable, particularly for methods and results items, impacting crosswalk application. This is the first synthesis of published crosswalks for converting joint-specific (OHS, OKS, HOOS, KOOS), disease-specific (WOMAC), and generic PROMs scores (PROMIS-Physical Function, UCLA Activity Scale, Lower Extremity Activity Scale) used to assess joint replacement outcomes, providing a resource for data harmonization and pooled analysis. Crosswalks were developed using regression methods (9 studies), equipercentile equating methods (5 studies), a combination of equipercentile equating and item response theory methods (2 studies), and a combination of regression and equipercentile equating methods (1 study). A range of crosswalk validation approaches were adopted, including the use of external datasets, separate samples or subsets, follow-up data from additional time points, or bootstrapped samples. Efforts are needed to standardize crosswalk methodology and achieve consistent reporting.