Initial Total Hip Research Articles

Changes in rotator movement during early gait acquisition in after total hip arthroplasty

BackgroundIn walking in healthy adults, rotation of the hip joint affects stride length and shifts the center of gravity, but these are not seen in hip osteoarthritis which affects gait. In gait of total hip arthroplasty, there are few reports on changes in the horizontal plane. This study clarified the preoperative and early postoperative gait characteristics of patients undergoing total hip arthroplasty. MethodsThe analysis included 12 females who underwent initial total hip arthroplasty using a posterolateral approach. Gait was measured pre and postoperatively using a three-dimensional motion analysis device. Statistics were compared pre and postoperative range of motion, muscle strength, walking speed, stride length, gravity movement distance, trunk angle, hip joint angle, and joint moment. FindingsThe maximum hip abduction moment and trunk flexion angle to the surgical side were lower than in healthy subjects. The angle of internal rotation during the stance phase was significantly higher in the postoperative period. The distance of the center of gravity shift in the left and right directions was significantly decreased postoperatively. InterpretationGait disturbance was seen preoperatively and remained after surgery. Walking after total hip arthroplasty provides the hip joint rotates inward which is closer to normal walking. However, no change was observed in the external rotation moment of the hip joint during walking. We suspect that the invasiveness of the posterolateral approach of total hip arthroplasty affects the muscles for external rotation of the hip joint. This can also cause in gait disturbances.

Anatomical changes in lumbosacral vertebrae and their correlation with facet joint-derived low back pain in patients with hip osteoarthritis after total hip arthroplasty: a cohort study.

BackgroundLittle is known about the anatomical changes in lumbosacral vertebrae and their correlation with facet joint-derived low back pain in patients with hip osteoarthritis (HOA) after total hip arthroplasty.MethodsSeventy-four HOA patients with low back pain who underwent initial total hip arthroplasty were included. Their Harris Hip Score (HHS), Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) and anatomical parameters were analyzed. Paired t-tests were used to compare the various index scores before and after surgery, and independent sample t-tests were used for the between-group comparisons.ResultsThe HHS and ODI significantly changed at 3 and 6 months postoperatively [HHS: preoperative (43.56±4.34) vs. 3 months (80.34±5.23) vs. 6 months (84.37±4.78); ODI: preoperative (36.26±5.34) vs. 3 months (26.44±3.23) vs. 6 months (19.34±3.27); P<0.001]. At the first 3 months after surgery, the VAS low back pain score decreased from 5.24±1.21 to 2.89±1.03 (P<0.001), and the VAS hip pain score decreased from 7.45±1.32 to 2.34±1.12 (P<0.001). There was also a statistically significant difference between the preoperative and 1-month postoperative anatomical indices: lumbar lordosis (LL) increased significantly after surgery [preoperative (43.46°±13.89°) vs. 1 month (48.27°±14.42°), P=0.001], while slip angle (SA) decreased significantly [preoperative (89.20°±5.03°) vs. 1 month (84.45°±4.89°), P=0.010]. Sacral slope (SS) and radial abduction angle (RAA) showed significant postoperative changes compared with preoperative assessments; after surgery, SS increased significantly [preoperative (31.33°±8.23°) vs. 1 month (37.65°±8.19°), P=0.006), while RAA decreased significantly [preoperative (42.32°±8.12°) vs. 1 month (35.45°±7.67°), P=0.021]. Moreover, the increase of LL was both significantly correlated with the decrease of the VAS low back pain (P=0.009) and the VAS hip pain score (P=0.038).ConclusionsTotal hip arthroplasty was associated with the anatomical changes in lumbosacral vertebrae.

Subsequent Total Joint Arthroplasty After Primary Total Knee or Hip Arthroplasty

Despite the large increase in total hip arthroplasties and total knee arthroplasties, the incidence and prevalence of additional contralateral or ipsilateral joint arthroplasty are poorly understood. The purpose of this study was to determine the rate of additional joint arthroplasty after a primary total hip arthroplasty or total knee arthroplasty. This historical cohort study identified population-based cohorts of patients who underwent primary total hip arthroplasty (n = 1,933) or total knee arthroplasty (n = 2,139) between 1969 and 2008. Patients underwent passive follow-up through their medical records beginning with the primary total hip arthroplasty or total knee arthroplasty. We assessed the likelihood of undergoing a subsequent total joint arthroplasty, including simultaneous and staged bilateral procedures. Age, sex, and calendar year were evaluated as potential predictors of subsequent arthroplasty. During a mean follow-up of 12 years after an initial total hip arthroplasty, we observed 422 contralateral total hip arthroplasties (29% at 20 years), 76 contralateral total knee arthroplasties (6% at 10 years), and 32 ipsilateral total knee arthroplasties (2% at 20 years). Younger age was a significant predictor of contralateral total hip arthroplasty (p < 0.0001), but not a predictor of the subsequent risk of total knee arthroplasty. During a mean follow-up of 11 years after an initial total knee arthroplasty, we observed 809 contralateral total knee arthroplasties (45% at 20 years), 31 contralateral total hip arthroplasties (3% at 20 years), and 29 ipsilateral total hip arthroplasties (2% at 20 years). Older age was a significant predictor of ipsilateral or contralateral total hip arthroplasty (p < 0.001). Patients undergoing total hip arthroplasty or total knee arthroplasty can be informed of a 30% to 45% chance of a surgical procedure in a contralateral cognate joint and about a 5% chance of a surgical procedure in noncognate joints within 20 years of initial arthroplasty. Increased risk of contralateral total knee arthroplasty following an initial total hip arthroplasty may be due to gait changes prior to and/or following total hip arthroplasty. The higher prevalence of bilateral total hip arthroplasty in younger patients may result from bilateral disease processes that selectively affect the young hip, such as osteonecrosis, or structural hip problems, such as acetabular dysplasia or femoroacetabular impingement. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

The Fate of the Remaining Knee(s) or Hip(s) in Osteoarthritic Patients Undergoing a Primary TKA or THA

The purpose of this study was to determine the fate of the remaining hip(s) and knee(s) following an initial total hip or knee arthroplasty in 5352 patients with idiopathic osteoarthritis who were followed for a minimum ten years (mean 17.8 ± 5.7 years). Following an initial primary TKA, 46.0% of patients had a contralateral TKA, 2.3% had an ipsilateral THA and 1.3% had a contralateral THA. Following an initial primary THA, 30.5% of patients had a contralateral THA, 6.8% had an ipsilateral TKA and 2.9% had a contralateral TKA. Cox regression analysis demonstrated that BMI was the sole risk factor for a second THA, but both age less than sixty years and a higher BMI were significant factors for patients requiring an additional primary TKA.

Multi-state models and arthroplasty histories after unilateral total hip arthroplasties

Background and purpose An increasing number of patients have several joint replacement procedures during their lifetime. We investigated the use and suitability of multi-state model techniques in providing a more comprehensive analysis and description of complex arthroplasty histories held in arthroplasty registries than are allowed for with traditional survival methods.Patients and methods We obtained data from the Australian Orthopaedic Association National Joint Replacement Registry on patients (n = 84,759) who had undergone a total hip arthroplasty for osteoarthritis in the period 2002–2008. We set up a multi-state model where patients were followed from their first recorded arthroplasty to several possible states: revision of first arthroplasty, either a hip or knee as second arthroplasty, revision of the second arthroplasty, and death. The Summary Notation for Arthroplasty Histories (SNAH) was developed in order to help to manage and analyze this type of data.Results At the end of the study period, 12% of the 84,759 patients had received a second hip, 3 times as many as had received a knee. The estimated probabilities of having received a second arthroplasty decreased with age. Males had a lower transition rate for receiving a second arthroplasty, but a higher mortality rate.Interpretation Multi-state models in combination with SNAH codes are well suited to the management and analysis of arthroplasty registry data on patients who experience multiple joint procedures over time. We found differences in the progression of joint replacement procedures after the initial total hip arthroplasty regarding type of joint, age, and sex.

Comparative Survival of Uncemented Acetabular Components Following Primary Total Hip Arthroplasty

Since their initial introduction in the early 1980s, uncemented acetabular components have become the preferred implant type for the majority of hip arthroplasties performed in the United States. The purpose of the present study was to compare differences in the survival of uncemented acetabular components following primary total hip arthroplasty. The study population included 7989 patients who had undergone 9584 primary total hip arthroplasties with twenty different types of uncemented acetabular components at the Mayo Clinic from January 1984 to December 2004. The overall rate of survival as well as the rate of survival free of revision for specific reasons (aseptic loosening, wear, osteolysis) were compared among the different components using age and sex-adjusted Cox proportional hazards regression models. The risk of acetabular cup revision was significantly higher for beaded and hydroxyapatite-coated designs as compared with titanium wire mesh designs. Cross-linked polyethylene performed better than conventional polyethylene, but this finding did not reach significance. Elevated liners were associated with a significantly higher risk of cup revision due to aseptic loosening. There are significant differences in the long-term survival of different types of uncemented acetabular components following total hip arthroplasty. The increased risk of revisions in the second decade after the initial total hip arthroplasty is a concern and is largely due to a steady increase in revisions because of polyethylene wear, osteolysis, and component loosening more than ten years after the time of the index arthroplasty.

Commentary on an article by Jeffrey N. Katz, MD, MSc, et al.: “Choice of Hospital for Revision Total Hip Replacement”

Katz et al., utilizing the Medicare data base, attempt to answer two questions: (1) On a numerical basis, does a revision of a primary total hip arthroplasty occur in the same hospital as the primary procedure, or in a different hospital? and (2) Do higher-volume hospitals perform a disproportionate number of revision arthroplasties (compared with the number of primary arthroplasties performed at the hospital and the expected number of revisions that would be generated)? The results have potentially important health policy implications. Previous studies involving the use of two large databases, the Medicare claims database and the Nationwide Inpatient Sample database, have given insight into the relationship between surgeon volume and the early outcomes of total hip arthroplasty, early complication rates after primary and revision total hip arthroplasty, and the types of revisions performed. In 2008, Manley et al. reported on the effect of surgical volume on early revision rates less than six months after the primary total hip arthroplasty and showed that patients who were managed by a surgeon who performed more than fifty total hip arthroplasties annually were less likely to have undergone a revision total hip arthroplasty than those who …

The fate of stable femoral components retained during isolated acetabular revision: a six-to-twelve-year follow-up study.

The decision as to whether to revise a well-fixed femoral component in hips requiring isolated acetabular revision is challenging. The purpose of the present study was to determine the long-term results of, and the complications associated with, retention of a stable and well-fixed femoral component during isolated acetabular revision. We retrospectively reviewed the clinical and radiographic results for thirty-one patients (thirty-two hips) who underwent isolated revision acetabuloplasty without removal of a well-fixed femoral component. The reason for acetabular revision was aseptic loosening in thirty-one hips and malposition in one hip. Of the thirty-two femoral components, twenty-one were cemented and eleven were cementless. The average duration of follow-up from the time of the index revision was 8.1 years (range, 6.4 to 12.5 years), and the average duration of total service of the femoral component was seventeen years (range, seven to twenty-five years) from time of the initial implantation. The average age of the patients at the time of the index revision was sixty-six years (range, twenty-nine to eighty-seven years). Thirty-one (97%) of the primary femoral components were judged to be stable and well fixed at the latest follow-up evaluation. One femoral component (3%) was revised because of aseptic loosening, eight years after the index acetabular revision and seventeen years after the initial total hip arthroplasty. Radiographic evaluation of the thirty-one femoral components that were not revised demonstrated no evidence of loosening or subsidence. There were no dislocations, nerve palsies, or intraoperative fractures associated with retention of the femoral component. Twenty-seven (84%) of the acetabular components were judged to be stable at the latest follow-up evaluation. In hips treated with isolated acetabular revision, a well-fixed femoral component can be retained successfully without adversely affecting the acetabular exposure; the placement, position, or stability of the acetabular component; or the ability to restore bone stock. The data from the present study support the decision to retain a well-fixed femoral component when the acetabular component needs to be revised.

Limited role of direct exchange arthroplasty in the treatment of infected total hip replacements.

A literature review was performed to determine when direct exchange was most likely to be successful. Twelve reports provided outcome data on infected hip replacements treated with direct exchange. The average duration of followup was 4.8 years, but the range was broad (0.1-17.1 years). Of the 1,299 infected hip replacements treated with direct exchange, 1,077 (83%) were thought to be free of infection at the last followup. Antibiotic-impregnated bone cement was used in 1,282 of the cases (99%). There was wide variability in the duration of parenteral antibiotic therapy, ranging from just 24 hours to as many as 8 weeks. In some cases, no oral antibiotics ever were given, whereas in others, oral antibiotics were given for as many as 8 months after parenteral therapy. Factors associated with a successful direct exchange included: (1) absence of wound complications after the initial total hip replacement; (2) good general health of the patient; (3) methicillin-sensitive Staphylococcus epidermidis, Staphylococcus aureus, and Streptococcus species; and (4) an organism that was sensitive to the antibiotic mixed into the bone cement. Factors associated with failure included: (1) polymicrobial infection; (2) gram-negative organisms, especially Pseudomonas species; and (3) certain gram-positive organisms such as methicillin-resistant Staphylococcus epidermidis and Group D Streptococcus. Methicillin-resistant organisms have become more common. Many current revision surgical techniques use cementless implants. Fixation without any cement (no depot antibiotics) may be a contraindication to direct exchange. Additionally, there essentially are no data on the use of bone graft in association with direct exchange. For these reasons, the indications for direct exchange are limited.

Evaluation of dislocation cases after initial total hip arthroplasties

Evaluation of dislocation cases after initial total hip arthroplasties

Revision of Aseptic Loosening of the Femora] Implant in a Dog Using Cable Cerclage

SummaryAseptic loosening of the femoral implant (ALFI) has been reported in 7.2% of total hip arthroplasty procedures in the dog. In this case report, ALFI was diagnosed in a nine year old male German Shepherd, seven years after the initial cemented total hip arthroplasty was performed. The revision of the ALFI was performed using a longitudinal osteotomy to extract the polymethylmethacrylate and the titanium femoral prosthesis was replaced with a cobalt chromium model. The osteotomy and an iatrogenic femoral fracture were repaired using four 1.3 mm cables. Postoperative radiographs revealed satisfactory alignment, reduction of the osteotomy and adequate positioning of the femoral prosthesis.Case report describing the revision of aseptic loosening of the femoral implant seven years after the initial total hip arthroplasty was performed. The revision utilized four 1.3 mm cable cerclage.

Charnley low-friction arthroplasty of the hip: Twenty-year results with cement

The first 333 Charnley (Thackray, United Kingdom) total hip arthroplasties performed at the Mayo Clinic between 1969 and 1970 have been followed since that time. One hundred twelve patients (112 hips) remain alive at 20 years. Clinical results remain excellent. The Mayo clinical and roentgenographic hip scoring system rates the results as good to excellent in 39 of 69 hips (with all necessary data to calculate the entire score), fair in 13 hips, and poor in 17 hips. The clinical score alone showed satisfactory results in 77 of 112 hips. Some clinical deterioration was attributed to the advancing age of the patients (mean age at final follow-up evaluation, 84 years). Probable roentgenographic loosening (component migration, complete bone-cement interface, radiolucent line greater than 1 mm, cement fracture) was noted in 12 of 69 acetabular components (17%) and 28 of 69 femoral components (36%). Two patients had required revision since the last report at 15 years for a total of 38 patients (32 revised, 4 Girdlestone arthroplasties, 2 stem fractures not yet revised). The probability of surviving 20 years without revision of the components was 84% (83% for men, 85% for women). The rates of loosening, revision, and failure (revision, Girdlestone, or symptomatic loosening) remain linear over 20 years of follow-up evaluation. If the probability of revision is based on patient age at the time of the initial total hip arthroplasty, there is a significantly increased probability of revision in those patients less than 59 years of age (27%) compared to those 59–65 years of age (13%), 65–70 years (7.5%), and over 70 years (12%).

Revision total hip arthroplasty.

Two hundred and ten hips in 206 patients who had an initial total hip arthroplasty performed at the Mayo Clinic between 1969 and 1978 required revision of the arthroplasty at the Mayo Clinic for reasons other than infection. One hundred and sixty-two of the patients (166 hips) were followed both clinically and roentgenographically for two years or more. One hundred and forty-five (90 per cent) reported that they had improvement after the surgical revision. Complications that occurred with revision included deep sepsis, superficial would infection, dislocation, intraoperative femoral fracture, and postoperative femoral fracture. Roentgenographic analysis showed probable loosening in thirty-three acetabular components (20.1 per cent) and seventy-two femoral components (44 per cent). Symptomatic loosening (moderate to severe pain and probable roentgenographic loosening) was seen in thirty-five patients. Eight patients required a second revision for this reason, and seven others required a second revision for other reasons. Modified Harris hip scores, calculated for 108 hips, showed a good or excellent result in sixty-seven hips (62 per cent), a fair result in twelve (11 per cent), and a poor result in twenty-nine (27 per cent). Using a new Mayo Clinic hip score that incorporates roentgenographic data (which will be described) in the evaluation of 165 revised hips, there was a good or excellent result in eighty-five (52 per cent), a fair result in thirty-two (19 per cent), and a poor result in forty-eight hips (29 per cent). Although 90 per cent of the patients thought that their condition had improved, the high incidence of roentgenographic signs of probable loosening of a component is of serious concern.