Results Of Total Hip Arthroplasty Research Articles

Association of osteotomy, age, and component fixation with the outcomes of total hip arthroplasty in patients with hip dysplasia: a Dutch population-based registry study.

Hip dysplasia can present challenges for total hip arthroplasty (THA) due to anatomic abnormalities. We aimed to assess the association of age, sex, osteotomies prior to THA, and fixation method on 5- and 10-year revision-free implant survival and patient-reported outcome measures (PROMs) of THAs in patients with hip dysplasia. Using Dutch Arthroplasty Register data, we studied hip dysplasia patients receiving primary THAs in 2007-2021 (n = 7,465). THAs were categorized by age, pelvic osteotomy prior to THA (yes/no), and fixation (cemented, uncemented, hybrid, reverse hybrid). Kaplan-Meier and multivariable Cox models were used to determine 5- and 10-year revision-free implant survival and adjusted hazard ratios including 95% confidence intervals (CIs). Reasons for revision and PROMs were compared within the categories. We found a 10-year revision-free implant survival of 94.9% (CI 94.3-95.5). Patients younger than 50 years had a 10-year implant survival of 93.3% (CI 91.9-94.7), Patients with prior pelvic osteotomy had a 10-year implant survival of 92.0% (CI 89.8-94.2). Fixation method and sex were not associated with implant survival. Patients with a prior pelvic osteotomy had more revisions due to cup loosening and reported lower PROM scores than patients without earlier osteotomy. 5- and 10-year revision-free implant survival rates of THA for hip dysplasia are 96.4% and 94.9%. Age and prior osteotomies were associated with decreased implant survival rates in patients with hip dysplasia, while fixation method was not. Prior osteotomies were also associated with reduced PROM scores.

Risk factors for deep vein thrombosis of the lower extremity after total hip arthroplasty

ObjectiveTo investigate the risk factors for deep vein thrombosis (DVT) following total hip arthroplasty (THA).MethodsPatients who underwent THA in the Department of Joint Surgery at the Sixth Affiliated Hospital of Xinjiang Medical University from September 2020 to December 2022 were retrospectively selected based on inclusion criteria. They were divided into the DVT group (n = 65) and the non-DVT group (n = 397) according to the occurrence of postoperative DVT. The following variables were reviewed for both groups: age, sex, Body Mass Index (BMI), affected limb, previous history (smoking and drinking), diabetes, hypertension, operation time, total cholesterol, triglycerides, fibrinogen, hemoglobin, albumin, platelets, D-dimer, International Normalized Ratio (INR), and fibrin degradation products. Univariate analysis was conducted on these factors, and those with statistical significance were further analyzed using a binary logistic regression model to assess their correlation with DVT after THA.ResultsA total of 462 patients were included in the study, with the DVT group representing approximately 14% and the non-DVT group approximately 86%. The DVT group had an average age of 67.27 ± 4.10 years, while the non-DVT group had an average age of 66.72 ± 8.69 years. Univariate analysis revealed significant differences in diabetes mellitus, preoperative fibrinogen, preoperative D-dimer, preoperative INR, and preoperative and postoperative fibrin degradation products between the DVT and non-DVT groups. Binary logistic regression analysis identified diabetes mellitus, elevated preoperative fibrinogen, preoperative D-dimer, and preoperative INR (p < 0.05) as risk factors for DVT after THA.ConclusionThis study found that diabetes mellitus, elevated preoperative fibrinogen, preoperative D-dimer, and preoperative INR are independent risk factors for DVT following THA. Surgeons should thoroughly assess these risk factors, implement timely and effective interventions, and guide patients to engage in functional exercises as early as possible to reduce the incidence of DVT, thereby improving the outcomes of THA and improving patient quality of life.

Perioperative Outcomes of Total Hip Arthroplasty in Trisomy 21 Patients in Comparison With a Control Population: Analysis From a Large National Sample of 367,894 Patients

Perioperative Outcomes of Total Hip Arthroplasty in Trisomy 21 Patients in Comparison With a Control Population: Analysis From a Large National Sample of 367,894 Patients

Short-term primary and revision modular dual-mobility cup total hip arthroplasty outcomes in high-risk dislocation patients: a retrospective study.

Modular dual-mobility cups (MDMCs) have a lower risk for dislocation after total hip arthroplasty (THA). The primary aims of our study were to analyze implant survivorship and to determine complications, especially dislocation, and revision rates of primary THAs used for hip fracture patients and for revision THAs. Secondary aims were to evaluate mortality after MDMC surgery and to find out if introduction of MDMC at our institution (Kuopio University Hospital, Finland) have decreased dislocation rate. This retrospective cohort study consisted of 101 MDMC patients who were consecutively operated at our institution between April 1, 2018 and June 30, 2020. The implant survival rate, complications and mortality were evaluated with minimum of 2-year follow-up. Finnish Hospital Discharge Register was used to find out yearly dislocation rates following THA at our institution. The cumulative estimate implant survival after MDMC in the primary THA group was 97% at 2 years, and in the revision THA group, it was 90% at 2 years. Dislocation was a rare complication in the primary THA group (1.4%), while it was common in revision THA group (12.9%). The cumulative estimate for mortality after MDMC in the primary THA group was 13% at 2 years, and in the revision group, it was also 13% at 2 years. The yearly number of patients who had re-hospitalization period due to THA dislocation decreased 46% after implementation of MDMC. Short-term survival and complication rates after MDMC were excellent after primary THA and moderate after revision THA. Implementation of MDMC THA for hip fracture patients seems to have effectively decrease dislocation rate during a short follow-up.

Change of Sacral Slope according to the Surgical Position in Total Hip Arthroplasty.

Pelvis tilting in sagittal plane influences the acetabular cup position. Majority of total hip arthroplasty (THA) are performed in lateral decubitus surgical position. This study is to assess whether there is any difference in sacral slope between standing and lateral decubitus position and influence of this variation in planning acetabular cup anteversion. This is a prospective study including 50 patients operated between January 2020 to March 2022. Preoperative radiograph included lumbosacral spine lateral X-ray in standing, supine and lateral decubitus positions to calculate the sacral slope for assessment of anterior or posterior pelvic tilting. In our study, we determined the position of the acetabular cup based on changes in sacral slope between standing and lateral decubitus postures. For patients whose sacral slope increased from lateral decubitus to standing, we implanted the acetabular component with a higher degree of anteversion. Conversely, for patients with reverse phenomenon, the cup was inserted at lower anteversion. Twenty-four patients (48.0%) had increase in sacral slope from lateral decubitus to standing whereas 26 patients (52.0%) had decrease in sacral slope. There was linear correlation between difference in preoperative sacral slope and postoperative cross table lateral cup anteversion. Harris hip scores improved from 40.78 to 85.43. There was no subluxation or dislocation in any patient at minimum 2-year follow-up. Individualized acetabular cup placement is important for better functional outcome in THA. Evaluation of pelvic tilting in lateral decubitus position is necessary for better positioning of acetabular cup and avoid postoperative complications.

Why Are Contemporary Primary Ceramic-on-Highly Crosslinked Polyethylene Total Hip Arthroplasties Failing? An Analysis of Over 5,500 Cases

Ceramic-on-highly crosslinked polyethylene (HXLPE) has become the most common bearing surface utilized in primary total hip arthroplasty (THA). The purpose of this study was to determine the implant survivorship and clinical outcomes of THAs with ceramic-on-HXLPE in a large, single institutional, series. We identified 5,536 primary THAs performed from 2007 to 2017 using a ceramic-on-HXLPE bearing through our total joint registry. The mean age was 60 years, 51% were women, and the mean body mass index (BMI) was 30. A cementless femoral component was used in 98% of cases, and a head size of ≥ 36 was used in 75%. Kaplan-Meier survivorship analyses were completed to assess survivorship free of any revision or reoperation. Clinical outcomes were assessed via Harris Hip Scores (HHS). The mean follow-up was 4 years. The 5-year survivorship free of any revision was 97%. The most common indications for revision were dislocation (41 hips), periprosthetic joint infection (PJI) (39 hips), and periprosthetic femur fracture (18 hips). The 5-year survivorship free of any reoperation was 96%. There were an additional 70 reoperations, with the most common indications being wound dehiscence (32 hips), iliopsoas impingement (11 hips), and periprosthetic femur fracture (11 hips). There were only two bearing surface failures: one HXLPE liner fractured and one dissociated. There were no ceramic head fractures or failures. The mean HHS increased from 57 to 92 (P < 0.0001). In over 5,500 THAs completed with modern ceramic-on-HXLPE bearings, failures of the bearing surface were nearly eliminated at midterm follow-up, and overall 5-year survivorship free of revision was excellent. Dislocation, PJI, and periprosthetic femur fracture were the most common causes of failure. As bearing surfaces have evolved, traditional failure mechanisms such as polyethylene wear, corrosion and metal reactions, and ceramic fractures have become nearly extinct.

Midterm Results of Severe Hip Dysplasia after Using a Cementless Acetabular Component with Bulk Bone Graft in Total Hip Arthroplasty: A Minimum Five-Year Follow-Up Study.

In patients with severe hip dysplasia, total hip arthroplasty (THA) using bulk bone graft (BBG) enhances anatomic cup positioning and provides early structural support. This study assesses the mid-term outcomes of THA with BBG in patients with over 50% graft bone coverage. Among 1951 patients who underwent THA between 2003 and 2007, 183 had BBG. After excluding early dropouts and infections, 151 patients remained. They were classified into uncovered (<50% coverage, 79 patients) and covered (>50% coverage, 72 patients) groups. The efficacy of cup fixation was compared between these groups. After ten years, the survival rate for not needing THA revision was 98% in the uncovered group and 100% in the covered group, while the rate for radiographic stability was 93% versus 99%, respectively. Although the cutoff value for the uncovered portion could not be clarified in this study, the mid-term results for 50% to approximately 70% uncovered were comparable to those for 50% or lesser, which have previously been expected to perform well. Recently, biomechanically advantageous bone grafting techniques have been identified, and based on the results of this study, it may be possible to expand the indications for THA with bone grafting for developmental dysplasia of the hip.

Cemented Calcar-Guided Short-Stem Prostheses in Geriatric Patients: Short-Term Results from a Prospective Observational Study.

Both cementless and cemented stems have exhibited favorable long-term outcomes in total hip arthroplasty. Nonetheless, in elderly patients, cemented hips offer an advantage due to their reduced risk of periprosthetic fractures. This study aimed to assess the initial outcomes of 28 patients who underwent unilateral cemented total hip arthroplasty utilizing a calcar-guided A2 stem (ARTIQO GmbH, Lüdinghausen, Germany). Various types of antibiotic-loaded bone cement were employed. During follow-up, we recorded demographic data and comorbidities and employed standardized clinical assessment tools, including the Harris Hip Score. Radiographic assessments included preoperative, postoperative, and follow-up imaging to evaluate subsidence, osteolysis, and bone resorption. The results indicated that among the 28 patients, 5 withdrew consent and 2 patients passed away from unrelated causes. Additionally, one prosthesis was explanted due to the undersizing of the cement stopper, which resulted in an inadequate cement mantle. As a result, 20 patients underwent a 1-year follow-up, revealing noteworthy enhancements in clinical scores, with no instances of radiolucent lines or osteolysis. No infections were detected. In summary, our short-term experience with this particular cemented short-stem design yielded promising results, exhibiting excellent functional outcomes, no aseptic loosening attributable to the stem, and no infections. Further clinical studies and registry data are essential to corroborate these findings.

Mid-term outcomes of total hip arthroplasty in patients younger than 30 years.

Total hip arthroplasty (THA) has predominantly been utilized to treat older patients with primary osteoarthritis. However, recent improvements in surgical technique and implant materials have increased implant longevity, making THA a viable option for younger patients (< 30years old). While trend analyses indicate an expanding utilization of THA in younger patients with non-OA diagnoses, current data on mid- and long-term THA outcomes in this population are limited. This study aims to describe the demographics, perioperative data, and implant survivorship of patients younger than 30years undergoing THA. A retrospective study across two large urban academic medical institutions identified 135 patients aged < 30years who underwent 155 primary THAs between 2012 and 2017, with up to 10-year clinical follow-up. Baseline demographics, surgical indications, intraoperative details, and postoperative outcomes were analyzed. The mean age at surgery was 24.9 years (range 18-29). Osteonecrosis of the femoral head (55.5%), developmental hip dysplasia (28.3%), and arthritis (15.5%) were the primary indications. Most surgeries utilized the posterior approach (64.5%), manual technique (65.8%), and Ceramic-on-Polyethylene articulation (71.6%). Seven patients (4.5%) were readmitted within 90-days of surgery, including three non-orthopedic-related readmissions (1.9%) and four orthopedic-related readmissions (2.6%). Dislocations were reported in two patients (1.3%). There were six all-cause revisions (3.9%), four aseptic (2.6%) and two septic (1.3%). Kaplan-Meier analysis showed 10-year survival from implant retaining reoperation was 98.7%, 10-year survival from all-cause revision was 96.1%, and 10-year survival from aseptic revision was 97.4%. With a 10-year aseptic implant survivorship rate of 97.4%, THA is a reliable surgical intervention for patients younger than 30 years of age who have severe hip pathology. Further studies are warranted for a more comprehensive understanding of mid- and long-term survivorship risk factors in this demanding population, facilitating improved risk assessment and informed surgical decisions.

Total Hip Arthroplasty Outcomes in Patients with Gout: A Retrospective Analysis of Matched Large Cohorts.

Gout is the most prevalent form of inflammatory arthritis in the world. Total hip arthroplasty (THA) has emerged as a widely sought-after and highly effective surgical procedure for advanced hip diseases. However, there is a lack of research on the impact of gout on primary THA outcomes in large cohorts. This study aimed to address this gap by primarily investigating complications following THA in patients with or without gout. Patients with records of gout in the 2 years leading up to their primary THA and who also have at least 2 years of follow-up were identified using a national insurance database and compared to a 5:1 matched control. A total of 32,466 patients with gout and 161,514 patients without gout undergoing THA were identified. Multivariable logistic regression analyses were done for medical complications up to 90 days and surgical complications up to 2 years. In addition, 90-day emergency department (ED) visits and inpatient readmission were also documented. Patients with gout demonstrated higher rates of medical complications including deep vein thrombosis, transfusion, acute kidney injury, and urinary tract infection than non-gout patients (p < 0.001). Gout patients also showed higher rates of pulmonary embolism (p = 0.017). Increased incidences of surgical complications were identified in gout patients, specifically wound complications and periprosthetic joint infection (p < 0.001). There was an increased risk of revision for gout patients up to 90 days (p = 0.003), 1 year (p = 0.027), and 2 years (p = 0.039). There was also an increased risk of dislocation for gout patients up to 90 days (p = 0.022) and 1 year (p = 0.047), but not at 2 years. No significant difference was observed in aseptic loosening or periprosthetic fracture. Additionally, gout patients also demonstrated a higher likelihood of 90-day ED visits and readmission (p < 0.001). Primary THA in gout patients is associated with increased risks of multiple medical and surgical complications. Our findings provide insights into the planning and expectation of THA for patients with gout. These insights have the potential to benefit the decision-making process for gout patients considering THA.

Advancements in ceramic-on-ceramic bearing materials for total hip arthroplasty: Properties, challenges, and future directions

Total hip arthroplasty (THA) is a vital procedure for addressing hip injuries and end-stage arthritis, offering relief to millions annually. However, long-term issues like femoral headwear and osteolysis persist, with 25-year survival rates of around 77.6%. Material selection significantly influences THA outcomes. This article investigated five typical ceramic-on-ceramic (CoC) bearing materials, including alumina, zirconia, zirconia-toughened alumina (ZTA), delta ceramic, and sapphire. Alumina, known for hardness and wear resistance, improved with lower fracture rates, and some squeaking and zirconia ceramics addressed fractures but require impurity reduction. ZTA combines alumina and zirconia, excelling in mechanical properties but also exhibiting squeaking. Optimized with nanostructures, delta ceramic shows fracture resistance despite occasional squeaking. Sapphire offers excellent biocompatibility but requires complex manufacturing and more clinical trials. The quest for optimal THA-bearing surfaces is ongoing, demanding rigorous research and collaboration.

Association between cup fixation screw and iliopsoas impingement after total hip arthroplasty

BackgroundIliopsoas impingement after total hip arthroplasty can result not only from acetabular cup but also from cup fixation screw. However, research addressing this screw impingement is scarce, leaving the details undetermined. This study aimed to elucidate the incidence and threshold of symptomatic iliopsoas impingement attributable to protrusion of the cup fixation screw into the iliopsoas muscle and to evaluate its impact on postoperative radiographic imaging findings and patient-reported outcome measures. MethodsA total of 152 hips were included in this study. The symptomatic threshold of screw protrusion was determined using a receiver operating characteristic curve, and patients were divided into low-protrusion and high-protrusion groups using this threshold. The area and Hounsfield Unit values of the iliopsoas muscle on CT and the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire postoperatively were investigated. Findings10 hips (6.5%) were exhibited symptoms of IPI in this series. The threshold for screw protrusion length was identified as 6.4 mm. Patients in the high protrusion group exhibited significantly larger area and lower Hounsfield Unit values of the iliopsoas muscle. In addition, the high protrusion group revealed significantly lower scores (total, pain, movement, mental). Furthermore, subscales scores (pain, movement) in the high protrusion group didn't improve from 3 months to 12 months postoperatively with significance. InterpretationThis study underscores the imperative for surgeons to consider the length of the cup fixation screw. This careful consideration is crucial for mitigating the incidence of postoperative iliopsoas impingement and enhancing total hip arthroplasty outcomes.

Learning curve and initial outcomes of a novel percutaneously endoscopic-assisted total hip arthroplasty through mini bikini direct anterior approach: an observational cohort study

ObjectiveAlthough the direct anterior approach can reduce muscle damage and ensure accurate prosthesis placement, the steep learning curve and increased risk of complications associated with DAA necessitate careful consideration. Therefore, we describe a technique for a novel percutaneously endoscopic-assisted total hip arthroplasty through mini bikini direct anterior approach (mDAA) and report the learning curve and initial outcomes.MethodsThe first 125 THA performed by a single surgeon between September 2020 and February 2022 using the anterior approach were included, comprising the initial 41 cases of bikini DAA (bDAA) and the subsequent 84 cases of mDAA. Outcome measures included perioperative outcomes and postoperative complications. The cumulative sum analysis (CUSUM) was used to determine the learning curve of anterior approach THA for each patient’s ORT. Multivariable analysis was performed to determine risk correlation.ResultsA total of 125 anterior approach THA completed between 2020 and 2022 were identified. Among these, 41 were performed via bDAA and 84 via mDAA. No statistically significant differences were observed between the groups in terms of age, gender distribution, BMI or follow-up time. A significant reduction in ORT was noted, from 140 min for bDAA to 130 min for mDAA. Furthermore, there was a consistent decrease in LOI, LOS, and wound-healing problems. There was no statistically significant difference between groups with respect to Harris Hip Scores and other postoperative complications. The curve inflection points of the learning curve for the bDAA and mDAA group were located in the 22nd and 68th cases, respectively. The reduction of hemoglobin indicated a predicted increase in ORT.ConclusionsIn this study, ORT, LOI, LOS, and wound-healing problems decreased overall in mDAA group. After mastering the bDAA technique, approximately 27 mDAA cases are needed to acquire proficiency in this technique. Hence, mDAA is a valuable alternative for those seeking smaller incisions, resolving wound healing problems, and aiming for enhanced recovery after surgery.

Outcomes of Total Hip Arthroplasty in Patients Who Have Ehlers-Danlos Syndrome: A Matched Cohort Study

BackgroundTotal hip arthroplasty (THA) is an effective surgical treatment for severe osteoarthritis of the hip. While THA is considered a reliable and safe procedure, outcome data on patients who have Ehlers-Danlos syndrome (EDS) is limited. The purpose of this study was to compare rates of postoperative complications after primary THA in patients who have EDS against matched controls. MethodsA large national database was searched to identify patients who underwent THA between 2009 and 2020. Patients younger than 18 years, those who have a history of prior THA, and those undergoing THA for a hip fracture were excluded from analysis. Propensity score matching was utilized to match patients who had EDS with patients who did not have EDS at a 1:4 ratio. Rates of medical and surgical complications at 90 days and 2 years were queried and compared between the cohorts using multivariable logistic regression. We identified 118 patients who had EDS and underwent primary THA, who were then matched with 418 controls. ResultsAt 90 days, the EDS cohort had greater rates of dislocation (8.5 versus 3.8%, P = 0.038). At 2 years, the EDS cohort had greater odds of dislocation (OR [odds ratio] 2.47, P = 0.018), aseptic loosening (OR 6.91, P = 0.002), and aseptic revision (OR 2.66, P = 0.02). ConclusionsPatients who have EDS possess significantly higher odds of complications after THA compared to matched controls, including dislocation, aseptic loosening, and aseptic revision. Careful surgical planning in these patients should be made to prevent dislocation and potentially minimize the risk of other prosthesis-related complications leading to revision.

Clinical outcomes of total hip arthroplasty after femoral neck fractures vs. osteoarthritis at one year follow up—A comparative, retrospective study

PurposeThe objective of the study is to determine if there was a difference in medical complications and in-hospital mortality among the patients who underwent THA for femoral neck fracture relative to same procedure for elective patients with coxarthrosis.MethodsWe compared characteristics and short-term outcomes during the rehabilitative postsurgical period. We included all patients older than 45 years who underwent THA for primary/secondary hip arthritis and displaced femoral neck fractures type Garden III and IV. Clinical examination, functional outcome and radiographic evaluation were performed during follow-up. Patients were evaluated at the following time points: preoperatively, postoperatively at three days, six weeks, 12 weeks and one year and we registered Visual Analogue Scale (VAS) pain score, Harris Hip Score (HHS), the Western Ontario McMaster Osteoarthritis Index (WOMAC), internal and external rotation of the hip and operated limb length compared with the opposite.ResultsThere is no significant statistically differences between the two groups regarding the preoperative comorbidities. The frequencies of patients experiencing in-hospital and 30-day postoperative complications were generally low and same in groups we studied. The mean quantity of surgical blood loos during the operation was significantly higher in the hip fracture group compared with elective patient group with OA (340.09 ± 86.03 vs 309.43 ± 102.52). With respect to postoperative recovery the patients with THA after FNF were mobilized by active walking a little bit faster as the patient with OA (2.77 ± 1.18 days vs 3.1 ± 1.14 days). The average inpatient hospital length of stay after THA for OA was 11.07 days compared to 13.41 days following a THA for FNF.ConclusionOur study showed that THA for treatment of an acute fracture of the femoral neck in an elderly patient can provide results comparable to those of patients who received THA for OA and we found that the results are similar.

Variation in Demographics, Hospital, and Patient-Reported Outcomes Following Total Hip Arthroplasty According to Biological Sex

BackgroundThe effect of biological sex on the outcomes of total hip arthroplasty (THA) remains unclear. Accounting for biological sex in research is crucial for reproducibility and accuracy. Average combined data may mask sex-related variation and obscure clinically relevant differences in outcomes. The aim of this study is to investigate hospital and patient-reported outcome measures (PROMs) after THA by biological sex to elucidate differences and ultimately provide more equitable care. MethodsWe performed a retrospective review of patients undergoing primary THA at a single large academic center between January 2013 and August 2020. Demographics, operative variables, hospital outcomes, and PROMs were compared between men and women patients. The PROMs included preoperative, 6-weeks, 6-months, and 1-year Single Assessment Numeric Evaluation, Visual Analog Scale, Hip Disability and Osteoarthritis Outcome Score Joint Replacement, University of California, Los Angeles, and Patient-Reported Outcomes Measurement Information System mental and physical scores, as well as satisfaction scores. ResultsA total of 6,418 patients were included (55% women). Women were older (P < .001), had a lower body mass index (P < .001), and were more likely to have public insurance (P < .001). Fewer women were discharged to home or self-care (P < .001). Women had higher rates of cementation (P < .001) and fracture within 90 days (P < .001), and these associations remained significant with adjusted multivariable analyses. Women had significantly higher pain and lower functional scores preoperatively; postoperatively, most PROMs were equivalent. ConclusionsImportant differences were observed in several areas. Demographic parameters differed, and a variable effect of biological sex was observed on surgical and hospital outcomes. Women had an increased incidence of cemented femoral components (indicated for osteoporotic bone) and postoperative fractures. Women’s PROMs demonstrated globally lower functional scores and higher pain preoperatively. Differences attributed to sex should continue to be investigated and accounted for in risk-stratification models. Future studies are needed to elucidate the underlying causes of observed biological sex differences and are essential for equitable arthroplasty care.

The role of subcutaneous fat and BMI in predicting surgical outcomes and patient reported outcomes in robotic-assisted total hip arthroplasty

BackgroundThe purpose of this study was to assess if subcutaneous fat (SCF) or BMI is a predictor of surgical complications and patient reported outcomes in patients undergoing robotic-assisted total hip arthroplasty (THA). MethodsPatients who underwent robotic-assisted primary THAs at one institution between 2018 and 2020 were included in this retrospective cohort study. Prior to surgery, computed tomography (CT) was used to measure SCF in the posterolateral quadrant of the hip. SCF was measured 3 centimeters (cm) proximal to the greater trochanter (PGT) and 3 cm inferior to the distal tip of the greater trochanter (DGT).Measurements were normalized to the size of the patient's bony anatomy by dividing the subcutaneous fat area measurement by the transverse diameter of the femur 10 cm inferior to the tip of the greater trochanter. Patients were divided into quintiles determined by SCF distribution around the mean (groups 1-5) and BMI (BMI<25, BMI 25-29.9, BMI 30-34.9, BMI 35-39.9, and >40). Ninety day outcomes and PROMIS (Patient Reported Outcome Measures Information System) scores were acquired from the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) database preoperatively, at 14-112 days post-operative and at the latest follow up. ResultsThere were 175 patients identified with a mean age of 63.83 years (range 27-89) and a mean BMI of 30.73kg/m2 (range 18.2-48.4). Interclass correlation coefficient was greater than 0.9 in all PGT, DGT, and GT measurements. Analysis of Variance (ANOVA) found there was a significantly shorter time from incision to closure in quintiles 1 and 3 when compared to the SCF quintile 5 (p<0.05) and that there was a significantly shorter time from incision to closure in BMI categories 1, 2, and 3 when compared to BMI category 5 (BMI > 40). There were no differences between SCF and BMI as predictive of length of stay, transfusion status, infection, or PROMIS scores. ConclusionIt can be concluded that hip SCF on axial CT images can reliably measure SCF and is predictive of time from incision to closure, but it does not show a significant difference in predicting the length of stay, infection, or PROMIS scores when compared to BMI.

Primary Total Hip Arthroplasty Outcomes for Labral Tears are Comparable to Advanced Osteoarthritis

BackgroundThere is a paucity of evidence on outcomes following total hip arthroplasty (THA) in patients who have symptomatic degenerative labral tears and mild to moderate osteoarthritis. The purpose of this study was to determine if outcomes of primary THA in the setting of painful, symptomatic labral tear, and mild to moderate arthritic changes (MMOA) were comparable to outcomes of primary THA performed for severe arthritic changes (AOA). Primary outcomes were patient-reported outcomes (PRO) scores. Secondary outcomes included length of stay (LOS) and perioperative complications. MethodsThis was a retrospective investigation of all THAs between January 2018 and July 2022. There were 111 patients who had THA due to failure of non-operative treatment of a degenerative labral tear without advanced arthritic changes (MMOA cohort, Kellgren-Lawrence (KL) Grades 1 to 3). These patients were matched to 111 patients who underwent THA for advanced OA (AOA cohort, KL Grade 4). Patient-reported outcomes (PROs) included the Western Ontario McMaster Universities Arthritis Index (WOMAC). The average age for the labral tear cohort was 59 years, with 50.6% women, compared to 70 years (P < 0.001), and 49.4% women (P = 0.93) in the advanced OA cohort. ResultsThere were no differences in preoperative PROs, complications, or length of stay (LOS) between groups. When looking at postoperative PROs between cohorts, the labral tear cohort had less improvement in WOMAC-S (24.3 versus 34.0, P = 0.005) and WOMAC-F (26.3 versus 36.0, P = 0.005) at 12 months and greater improvement in WOMAC-P at 12 months (38.3 versus 34.7, P = 0.04). The SF12-P scores were significantly higher among the labral tear cohort compared to the AOA cohort at 12 months (48.5 versus 47.8, P < 0.001). The SF12-M scores were significantly higher in the AOA cohort compared to the labral tear cohort at 3 months (47.1 versus 47.4, P = 0.02) and 12 months (46.7 versus 47.6, P < 0.001). In the multivariate analysis, the change in WOMAC-P at 12 months was significantly better for labral tear patients (OR [odds ratio] 7.5 versus, P = 0.008, CI (confidence interval) [6.85 to 8.14]). ConclusionOur study showed that patients who have symptomatic degenerative labral tears with mild to moderate arthritic changes have comparable outcomes to patients who have advanced OA following primary THA. Given suboptimal outcomes with hip arthroscopy for labral tear in the setting of early arthritis, primary THA can be a reasonable treatment modality for patients failing non-operative treatments.

Does total hip arthroplasty in elderly patients with femoral neck fractures reduce complications? A Japanese DPC study

BackgroundThe global increase in femoral neck fractures due to aging and osteoporosis is a major clinical challenge. The debate on the optimal surgical intervention for femoral neck fractures remains unresolved. This large-scale study explores femoral neck fractures among the elderly, focusing on the comparative outcomes of Total Hip Arthroplasty (THA) versus Bipolar Hemiarthroplasty (BHA) in Japanese patients. MethodsUsing the Japanese National Administrative Diagnosis Procedure Combination (DPC) database, we studied cases of femoral neck fracture from April 2016 to March 2023, and after propensity score matching by age, sex, and comorbidities, we examined the association between THA, complications, and clinical outcomes, and the usefulness of THA for elderly patients with femoral neck fracture. ResultsOne-to-one propensity score matching identified 7741 pairs of THA and BHA cases. There was no difference in length of stay between the THA and BHA groups. Significantly more blood transfusions were required in the THA group. There was no significant difference in mortality between the THA and BHA groups, but there was a reduced risk of pneumonia in the THA group, with a ratio of 0.547 (95% CI: 0.418–0.715). On the other hand, the THA group had a higher risk of pulmonary embolism, with a ratio of 1.607 (95% CI: 1.379–1.874). The THA group shows improved discharge rates directly home from the facility where the operation was performed, with a ratio of 1.798 (95% CI: 1.675–1.929). ConclusionThe findings of this research indicate that THA is more effective than BHA in enabling elderly Japanese patients with femoral neck fractures to be discharged directly home and in preventing pneumonia, despite concerns about pulmonary embolism. These findings suggest that THA may improve functional prognosis in elderly patients with femoral neck fractures, although there is a trade-off with an increased risk of pulmonary embolism.

Association between diabetes mellitus and total hip arthroplasty outcomes: an observational study using the US National Inpatient Sample

ObjectivesTo investigate the association of diabetes with postoperative outcomes in patients undergoing primary total hip arthroplasty (THA).DesignRetrospective cohort study using data from the US National Inpatient Sample (NIS).SettingStudy cohort was...