Number Of Total Hip Replacements Research Articles

The Effectiveness of 1 g Intravenous Tranexamic Acid in Reducing Blood Loss in Total Hip and Knee Replacement Surgeries: A Double-blind Controlled Study in a Regional Hospital

Abstract Background: Tranexamic acid (TXA) is one of the pharmacological drugs employed to reduce haemorrhage during total hip replacement (THR) and total knee replacement (TKR), but there is yet to be consensus on the doses and timing of administration during surgery. Aim: This is to assess the effectiveness of 1 g intravenous (IV) TXA compared to placebo for reducing blood loss in THR and TKR. Patients, Materials and Methods: This was a prospective randomised double-blind study conducted in our regional hospital between January 2016 and June 2017. THR and TKR patients were randomly allocated to placebo and TXA groups. Intraoperative blood loss (IBL), postoperative blood loss (PBL), total blood loss (TBL), haemoglobin (Hb) drop, duration of surgery, and transfusion rates were outcomes compared between the two groups. Results: The administration of 1000 mg (15 mg/kg) TXA significantly reduces IBL, PBL, and TBL by 30%, 31%, and 25.8%, respectively, when compared to placebo in patients who had THR. The mean IBL (187.7 ± 46.2 mL), PBL (334.4 ± 85.9 mL), and TBL (574.3 ± 102.1 mL) in the TXA group were significantly lower than those in the placebo group (344.3 ± 89.0 mL, 628.0 ± 197.4 mL, and 946.5 ± 152.3 mL) (P < 001), respectively, in TKR patients. There was a significant reduction in Hb drop in the TXA group when compared to the placebo group in both THR and TKR patients. The number of THR and TKR patients who received blood transfusions was significantly lower in the TXA group. Mean surgical time in the TXA group was reduced by 0.3 h during THR. However, there was no significant difference in the surgical time between TXA and placebo groups in TKR (P = 0.970). Conclusion: One gram of IV TXA is effective in reducing perioperative bleeding, Hb loss, and the need for blood transfusion requirements in THR and TKR.

Investigation of the Influence of Osteoporosis and Aging on Periprosthetic Femoral Fractures using Finite Element Analyses

With the increasing life expectancy and more active lifestyles of patients, the number of total hip replacements is constantly rising. Consequently, the incidence of periprosthetic femoral fractures (PFF) is also growing and facilitated by osteoporosis as well as advancing age of the patient. One way to prevent PFF is to optimize the treatment of individual patients, who are potentially at risk of osteoporotic fractures, by choosing the most suitable implant design for their subject specific circumstances. Thereby, revision surgeries due to PFF can be avoided. In this context appropriate models are necessary to predict fractures for aging and osteoporotic bone. On the basis of quantitative computed tomography (QCT) data subject specific finite element models with a heterogeneous material definition were created that can simulate PFF via element deletion. Statistical studies on the changes of bone quality with increasing patient age and developing osteoporosis were incorporated into the models. With statistical data, the bone mineral density (BMD) values measured in the QCT scans of the modelled femurs were varied, while the individual heterogeneous density distribution was preserved. The new density values were mapped onto the FE meshes of the femurs. This way, the femur was modelled to mirror the condition of the bone in different age groups and with different severity levels of osteoporosis in high age. The final models incorporate the subject specific geometry and density distribution of a patient's femur as well as the statistical density values resulting from aging and osteoporosis. The FE analyses revealed that a statistical change of bone density with aging leads to a relative small decrease in fracture load for periprosthetic fractures of a femur with a cementless endoprosthesis. However, for osteoporosis, the fracture load can differ by up to 56% with a cementless endoprosthesis, depending on the severity level of the disease.

An IMU-Based Real-Time Measuring System for Acetabular Prosthesis Implant Angles in THR Surgeries

With the aging of population, the number of total hip replacement (THR) surgeries increases year by year. To improve the success rate of THR operation, the measurement of acetabular prosthesis angles should be precise during the surgery. We design an inertial measurement unit based real-time measurement system, which measures the initial attitude of the pelvis coordinate, and traces the real-time attitude of the pelvis coordinate and prosthesis axis. By collecting real-time data of diff- erent pelvic and prosthesis attitudes in quaternion representation through accelerometers and gyroscopes, the relative position between pelvis and prosthesis is calculated in real time. An optimized algorithm is proposed to obtain prosthesis implant angles accurately from the data. The experimental results show that the measured implant angles agree with that calculated by radiographic value, the root mean square errors (RMSE) are less than 3.52 degrees, which is within the safe range of THR requirement. Furthermore, no matter how the implant angles change, the measured values agree with reference values, the RMSE is less than 3.27 degrees. The experimental results show that our system can trace the real-time dislocation of the prosthesis during the THR surgeries.

Claims in total hip arthroplasty: analysis of the instigating factors, costs and possible solution.

Over the years, the number of total hip replacements has been steadily increasing. Despite the improvement in surgical results, the number of claims for malpractice is higher. The primary endpoint of this work is to provide an analysis of litigation after hip replacement, to outline what are the instigating causes and costs. The secondary endpoint is to propose a possible preventive strategy for an improved care and a reduction in legal proceedings. The data of this study were collected from medical and legal files and from professional liability insurance of our institution from January 2005 to December 2016. Out of a total of 4770 THA, 40 claims were received. Peripheral nerve injuries represent the first cause of litigation (37%), followed by infectious complications, leg length discrepancy, metallosis, dislocations of the implant and a case of deep vein thrombosis. From the analysis of the past trial judgment, complications such as nerve lesions and infections are almost always recognized, as a medical error, with a high percentage of claims settled. This study shows the necessity of preventive strategies to reduce the higher number of claims for malpractice in total hip arthroplasty. Some complications such as nerve injuries and infection are frequently considered directly dependent on physician's errors. Litigations can be reduced providing evidence of a diligent execution of the surgical procedure and of a proper postoperative management: the correct compilation of a specific informed consent and adequate doctor-patient communication.

Measurement System for Attitude of Anterior Pelvic Plane and Implantation of Prothesis in THR Surgery

With the average age of population increasing in the world, the number of total hip replacement (THR) surgeries increases year by year. However, the failure rate of THR surgeries is up to 10% following primary surgery and 28% after revision arthroplasty, which has direct correlation to the implantation angles between prosthesis and pelvis. To improve the implanting accuracy of the prosthesis, we propose a measurement system and estimation algorithms. The system includes three parts: an initial attitude measurement instrument, which is used to determine the initial attitude of the anterior pelvic plane (APP), a real-time attitude measurement instrument, which aims to acquire the real-time attitude of the APP, and an acetabular cup angle measurement instrument, which obtains the relative angles between prosthesis and pelvis. Each of them is based on inertial measurement unit (IMU) and magnetometer. A quaternion-based extended Kalman filter is adopted to fuse the data from IMU and magnetometer to estimate the orientation, and the algorithm calculating the attitude of pelvis and relative angles between pelvis and prosthesis is designed in this paper. The reliability of this system, from the measurement point of view, has been verified by experiments. The experimental results show that the root-mean-square errors of APP attitude and acetabular cup implanting orientation are less than 1.6° and 3° with standard uncertainty of less than 0.22° and 0.17°, respectively. The accuracy of our system meets the requirement of the THR surgeries.

Risk of cancer after primary total hip replacement: The influence of bearings, cementation and the material of the stem

Background and purpose — Despite the increasing number of total hip replacements (THRs), their systemic influence is still not known. We have studied the influence of specific features of THRs—the bearing surface, the use of bone cement and the material of the stem—on the cancer incidence.Patients and methods — In a retrospective cohort study we identified 8,343 patients with THRs performed at Valdoltra Hospital from September 1, 1997 to December 31, 2009. Patient data were linked to national cancer and population registries. The standardized incidence ratios (SIR) and Poisson regression relative risks (RR) were calculated for all and specific cancers.Results — General cancer risk in our cohort was comparable to the population risk. Comparing with population, the risk of prostate cancer was statistically significantly higher in patients with metal-on-metal bearings (SIR =1.35); with metal-on-polyethylene bearings (SIR =1.30), with non-cemented THRs (SIR =1.40), and with titanium alloy THRs (SIR =1.41). In these last 3 groups there was a lower risk of hematopoietic tumors (SIR =0.69; 0.66 and 0.66 respectively). Risk of kidney cancer was significantly higher in the non-metal-on-metal, non-cemented, and titanium alloy groups (SIR =1.30; 1.46 and 1.41 respectively). Risk of colorectal and lung cancer was significantly lower in the investigated cohort (SIR =0.82 and 0.83, respectively). Risk for all cancers combined as well as for prostate and skin cancer, shown by Poisson analysis, was higher in the metal-on-metal group compared with non-metal-on-metal group (RR =1.56; 2.02 and 1.92, respectively).Interpretation — Some associations were found between the THRs’ features, especially a positive association between metal-on-metal bearings, and specific cancers.

Detection of joint capsule changes by differential scanning calorimetry (DSC) in different types of hip disorders to evaluate surgical techniques (a preliminary report)

With the growing number of total hip replacements (THR) in every year, new developments have recently been introduced in the operational technique. It is still debated whether the joint capsule during THR should be resected or preserved, based on the primary conditions. The differential scanning calorimetry (DSC) has recently been found useful in the evaluation of septic and non-septic arthritis. The purpose of this study was to evaluate whether there is a specific pattern in the thermal characteristics of joint capsule samples, collected from patients with arthritis, avascular femoral head necrosis (AVN) and femoral neck fractures. Materials and the capsule samples were harvested during THRs and considered to be a waste material. The thermal characteristics (maximal denaturation temperature, T m and calorimetric enthalpy change, ΔH cal) were monitored by SETARAM Micro DSC-II calorimeter between 37 and 90 °C with 0.3 K min−1 heating rate. The denaturation scans of different joint capsule samples have clearly demonstrated specific, representative changes in case of arthritis, AVN and femoral neck fractures. The marked differences in the thermal characteristics of arthritic and AVN samples compared to the acute fractures could be explained by the inflammatory or degenerative conditions, respectively. DSC could be a useful tool in the evaluation of the different conditions of human joint capsules, providing further help in the investigation of orthopaedic surgical methods.

The economic impact of surgically treated peri-prosthetic hip fractures on a university teaching hospital in Wales 7.5-year study

The number of total hip replacements taking place across the UK continues to grow. In an ageing population, with people placing greater demands on their prostheses, the number of peri-prosthetic fractures is increasing. We studied the economic impact this has on a large teaching hospital.All patients with peri-prosthetic femoral fracture in a 7.5year period were identified. Radiographic and case note analysis was performed. Costings from the finance departments were obtained.90 cases were identified, 58 female and 32 male, with a mean age of 76 (range: 38–91). 89 of the cases were managed surgically, 66% undergoing revision and 33% receiving open reduction and internal fixation. According to the Vancouver Classification, 3% were Type A, 79% Type B and 18% Type C. The mean length of stay was 43days. The mean cost of management was £31,370 (range: £6885–£112,327). Patients with type C fractures had the highest mean length of stay at 53 days and mean cost of £33,417.Including rehabilitation costs, our study illustrated a mean cost of £31,370, roughly four times the current basic NHS tariff of £8552. Although implant costs are greater, treatment with revision where appropriate allows earlier weight bearing, reduced length of stay and lower overall cost.

The impact of preoperative patient characteristics on the cost-effectiveness of total hip replacement: a cohort study.

BackgroundTo facilitate the discussion on the increasing number of total hip replacements (THR) and their effectiveness, we apply a joint evaluation of hospital case costs and health outcomes at the patient level to enable comparative effectiveness research (CER) based on the preoperative health state.MethodsIn 2012, 292 patients from a German orthopedic hospital participated in health state evaluation before and 6 months after THR, where health-related quality of life (HRQoL) and disease specific pain and dysfunction were analyzed using EQ-5D and WOMAC scores. Costs were measured with a patient-based DRG costing scheme in a prospective observation of a cohort. Costs per quality-adjusted life year (QALY) were calculated based on the preoperative WOMAC score, as preoperative health states were found to be the best predictors of QALY gains in multivariate linear regressions.ResultsMean inpatient costs of THR were 6,310 Euros for primary replacement and 7,730 Euros for inpatient lifetime costs including revisions. QALYs gained using the U.K. population preference-weighted index were 5.95. Lifetime costs per QALY were 1,300 Euros.ConclusionsThe WOMAC score and the EQ-5D score before operation were the most important predictors of QALY gains. The poorer the WOMAC score or the EQ-5D score before operation, the higher the patient benefit. Costs per QALY were far below common thresholds in all preoperative utility score groups and with all underlying calculation methodologies.

2011 nice guidelines and doubling the number of total hip replacements for a fractured neck of femur in high demand patients

2011 nice guidelines and doubling the number of total hip replacements for a fractured neck of femur in high demand patients

Trabecular metal acetabular revision system (cup-cage construct) to address the massive acetabular defects in revision arthroplasty

The increasing number of total hip replacements in the younger clique has added to the demand for revision procedures. Revision situations are often encountered with infection, loss of bone stock and bone defects. There are various methods of reconstruction of acetabular defects. The management options of type 3B Paprosky acetabular defects are limited with allograft and conventional cages. Trabecular metal technology has evolved to address these bone defects. Trabecular metal acetabular revision system (TMARS) cup-cage construct is a new technique to address massive acetabular defects. We describe a case of failed hip reconstruction done for a Giant cell tumour of proximal femur managed by a two stage procedure, initial debridement and second stage reconstruction of acetabulum with TMARS cup-cage construct and femur with allograft prosthesis composite.

Rehabilitation und Sport nach Hüfttotalendoprothese

The number of total hip replacement (THR) surgeries has increased significantly over the last few years and patients undergoing surgery are of decreasing age. In consequence the question of the influencing factors for the survival of artificial hip joints becomes more and more urgent. The expected survival time of an implant is nowadays 15-20 years and it seems that factors for a shorter lifetime are female gender, overweight, younger age and certain indications which led to surgery, such as rheumatoid arthritis or fractures. In the early phase of rehabilitation, measures against dislocation including training of the abductor muscles are most important. Starting rehabilitation programs early after surgery has positive effects on outcome, especially when strengthening programs are included. There are different opinions concerning the question how the lifetime of a THR is influenced by sports activities. However, it seems to have been demonstrated that suitable sports activities have a positive effect and do not necessarily correlate with higher loosening rates after THR. In general, high-impact sports should be avoided. Recommended activities are cycling, swimming, aquajogging, hiking, rowing and dancing.

A pragmatic randomized controlled study of the effectiveness and cost consequences of exercise therapy in hip osteoarthritis

Objective: To evaluate the short- and long-term effectiveness of exercise training in relation to pain, function and direct costs to health care systems attributable to hip osteoarthritis. Design: Prospective, two-year randomized controlled trial. Setting: An outpatient primary health care setting. Subjects: One hundred and twenty men and women aged from 55 to 80, with radiologically diagnosed hip osteoarthritis with associated clinical symptoms. Interventions: The combined exercise and general practitioner (GP) care group received 12 supervised (once per week) exercise sessions at the baseline and four additional booster sessions one year later. Both groups received standard GP care. Main measures: The WOMAC Osteoarthritis Index, physical functioning score of RAND-36 (SF-36), the use and health care system costs of doctor visits and physiotherapy associated with hip osteoarthritis, number of total hip replacements, the use of analgesic and non-steroidal anti-inflammatory drugs (NSAIDs), performance-based outcome scores and body mass index (BMI). Results: There were no differences between the groups with respect to WOMAC hip pain, physical functioning score of RAND-36, performance-based outcome scores or BMI. The effect of the exercise intervention on WOMAC function was statistically significant at 6 months (mean = −7.5; 95% confidence interval (CI) −13.9 to −1.0; P = 0.02) and 18 months (mean = −7.9; 95% CI −15.3 to −0.4; P = 0.04). There were no statistically significant differences in the total health care system costs between the groups. Conclusion: The mostly home-based exercise training programme provided in this study did not result in reduced hip pain over the two-year follow-up period.

Periprosthetic Femur Fractures: Current Concepts and Management

Periprosthetic femur fractures are complex problems. Its incidence is reported to be increasing with the increasing number of total hip replacements. Treatment recommendations are based upon the fracture location and implant fixation stability. Despite improvements in fixation and surgical techniques, clinical outcome remains suboptimal. This review focuses on the discussion of periprosthetic femur fractures around a total hip replacement.

Early discharge and home intervention reduces unit costs after total hip replacement: results of a cost analysis in a randomized study

Total hip replacement (THR) is a common and costly procedure. The number of THR is expected to increase over the coming years. Two pathways of postoperative treatment were compared in a randomized study. Fifty patients from two hospitals were randomized into a study group (SG) of 27 patients receiving preoperative and postoperative education programs, as well as home visits from an outpatient team. A control group (CG) of 23 patients received "conventional" rehabilitation augmented by a stay at a rehabilitation center if needed. All costs for the two groups both in hospitals and after discharge were collected and analyzed. On average total costs for the SG were $8,550 and $11,952 for the CG, a 28% cost reduction. Total inpatient costs were $5,225 for the SG and $6,515 for the CG. In a regression analysis the group difference is statistically significant. Adjusting for changes in the Oxford Hip Score gives effective costs (C/E). The ratio of the SGs C/E to the CGs is 0.60. That is a cost-effectiveness gain of 40%. A shorter hospital stay augmented with better preoperative education and home treatment appears to be more effective and costs less than the traditional in hospital pathway of treatment.

Principles of internal fixation and selection of implants for periprosthetic femoral fractures

Periprosthetic femoral fractures (PFF) are increasing as a result of changes in population demographics and the increase in the number of total hip replacements performed. The overall incidence has been reported to range from 0.1% to 6% of all total hip arthroplasties. Management of these fractures is often particularly demanding, complex and expensive. In many cases, the surgeon has to solve the simultaneous problems of implant loosening, bone loss and fracture. A thorough understanding of the unique characteristics of the different fracture types, the principles of PFF treatment and a familiarity with the various fixation devices, grafts and prosthetic implants are all of paramount importance. Internal fixation is used either alone or as an adjunct to stem revision. The stability of the original implant and the configuration of the fracture itself are the basic factors that influence the decision-making process. The current study reviews the existing literature on internal fixation of femoral periprosthetic fractures.

THE MANAGEMENT OF PERIPROSTHETIC FRACTURES AROUND THE FEMORAL STEM

©2004 British Editorial Society of Bone and Joint Surgery doi:10.1302/0301-620X.86B1.14864 $2.00 J Bone Joint Surg [Br] 2004;86-B:13-9. Total hip replacement is the second most common elective surgical procedure performed in the UK. It is estimated that by 2010 Europe will have more people over 60 years of age than under 20 years. The number of total hip replacements will therefore continue to rise in an ageing population, as will the frequency of occurrence of periprosthetic fractures. These injuries may occur during or after operation. The incidence of post-operative periprosthetic fractures has remained relatively constant, ranging from 0.6% after primary arthroplasty to 2.4% after revisions.1 This article deals only with post-operative fractures, and seeks to review the available surgical techniques and to develop a management algorithm.

The impact of medicare reimbursement policies on simultaneous bilateral total hip and knee arthroplasty

In October of 1992, Medicare reimbursement decreased by 50% for a second total hip or knee arthroplasty performed as part of a simultaneous bilateral procedure. The Medicare records of 67,726 patients who underwent total hip and knee arthroplasty were reviewed using data from the New York State Department of Health in the period from October 1, 1989, to September 30, 1996. Simultaneous bilateral total hip arthroplasties represented 1.8% of the total number of total hip replacements performed in fiscal year 1991 (60 of 3,418) compared with 1.7% (77 of 4,547) performed in fiscal year 1994 (P=.902). Similarly, the number of simultaneous bilateral total knee arthroplasties did not change significantly, with simultaneous bilateral procedures representing 5.9% of the total number of total knee replacements performed in fiscal year 1991 (214 of 3620) compared with 6.2% (369 of 5,931) performed in fiscal year 1994 (P=.568). Copyright 2003, Elsevier Science (USA). All rights reserved.

The epidemiology of total hip replacement in The Netherlands and Sweden: present status and future needs.

By combining data from the Discharge registers and the census bureaus in The Netherlands and Sweden, we calculated the age-specific incidences of primary total hip replacement (THR), studied the demographic profile of the population receiving THR and predicted demands. In the period 1986-1997, the number of THRs increased by 20% in Sweden to 10,000 operations (113/100,000 inhabitants) and by 68% to 17,400 operations (112/100,000 inhabitants) in The Netherlands. Of this increase 3% and 15% could be explained by changes in the age-profile and size of the population, respectively. Although the overall incidence of THR was similar in both countries in 1997, we found that, after correction for differences in population structure, the incidence of THR was 20% higher in The Netherlands. In Sweden, relatively more men were operated on than in The Netherlands. We also found that in Sweden, but not in the Netherlands, relatively more older people were operated on in 1997 than in 1987. Assuming no further change in the age- and sex-specific arthroplasty rates, the predicted annual number of total hip replacements by the year 2020 will increase by at least one fourth in Sweden and almost one half in The Netherlands.

One- or two-stage bilateral total hip replacement

It is not clear whether bilateral hip replacement should be done in 1 or 2 stages. The total number of total hip replacements (THRs) done in our center between 1989 and 1995 was approximately 4,000. The number of hips that were bilateral was 404, or 9% of the total number of THRs performed during this time period. Of these bilateral hip replacements, 190 (95 patients) were done as a 1-stage procedure, whereas 214 (107 patients) were done in 2 stages with 2 to 24 months in between the operations. In contrast to previous studies, there were no significant preoperative differences between the 2 groups of patients having 1-stage or 2-stage THRs, and, in particular, the comorbidity assessed by the American Society of Anesthiologists (ASA) grade was not significantly different. Our results demonstrate that, in our patient population, bilateral THR was equally safe whether performed as a 1-stage or 2-stage procedure. This was the case in the low-risk (ASA 1 and 2) and high-risk (ASA 3 and 4) patient subgroups. One-stage bilateral THR is cheaper and involves less time in the hospital.