Primary Uncemented Total Hip Replacement Research Articles

Defining the Most Effective Patient Blood Management Combined with Tranexamic Acid Regime in Primary Uncemented Total Hip Replacement Surgery.

The application of patient blood management (PBM) combined with tranexamic acid administration (TXA) results in decreased total blood loss volume (TVB) and transfusions in total hip replacements (THRs). Dosages, timing, and routes of administration of TXA are still under debate as all these aspects, as well as interpatient variations, may affect the efficacy of the protocol. This study aims to examine the effectiveness of timing and route of administration of TXA in combination with PBM by reducing the TBV following THR surgery. Consecutive primary uncemented THRs operated by a single surgical and anaesthetic team had the data prospectively collected and then retrospectively studied. Five treatment groups were formed, reflecting the progressive evolution of our protocol. Group 1 included patients managed with PBM alone (preoperative erythrocyte mass optimisation to at least 14 g/dL haemoglobin (Hb), hypotensive spinal anaesthesia and restrictive red blood cell transfusion criteria). Group 2 included patients with PBM and topical 3 g TXA diluted in normal saline to a total volume of 50 mL. Group 3 were patients with PBM and an IV dose of 20 mg/kg TXA at induction, followed by 20 mg/kg TXA as a continuous infusion for the duration of the operation. Group 4 consisted of patients managed as per Group 3 plus another 20 mg/kg TXA at three-hour post-procedure. Group 5 (combined): PBM and IV TXA as per Group 4 and topical TXA as per Group 2. A generalised linear model with the treatment group as an independent variable was modelled, using TBV as the dependent variable. The transfusion rate for all groups was 0%. TBV at 24 h, oscillated from 613.5 ± 337.63 mL in Group 1 to 376.29 ± 135.0 mL in Group 5. TBV at 48 h oscillated from 738.3 ± 367.3 mL (PBM group) to 434 ± 155.2 mL (PBM + combined group). The multivariate regression model confirmed a significant decrease of TBV in all groups with TXA compared with the PBM-only group. Overweight and preoperative Hb were confirmed to significantly influence TBV. The optimal regime to achieve the least TBV and a transfusion rate of 0% requires PBM and one loading 20 mg/kg dose of TXA, followed by continuous infusion of 20 mg/kg for the duration of the operation in uncemented THRs. Additional doses of TXA did not add a clear benefit.

Secondary osteoarthritis hip in young individuals managed with primary uncemented total hip replacement using ha-coated conventional stem and acetabular component

Background: The management of young individuals seeking medical attention due to progressive hip pain as a result of secondary osteoarthritis and who want active and pain-free hip was challenging in past. The actual incidenece of secondary osteoarthritis is difficult to ascertain. Young individuals with secondary osteoarthritis hip due to developmental dysplasia of hip, coxa plana (Legg-Calvé-Perthes disease), post-traumatic, slipped capital femoral epiphysis, Paget disease, Haemophilia, Avascular necrosis of femoral head, and so on can be effectively managed with primary uncemented total hip replacement (THR) with good functional outcome in short-term follow-up. This will increase the revision THR rate later. Long-term follow-up is required to watch for prosthesis-related complications Materials and Methods: Material includes 64 patients who attended our OPD from Oct 2013 to Dec2017 and all of them were diagnosed to have secondary osteoarthritis hip with poor hip function as assessed by Harris hip score. All of them underwent uncemented total hip replacement (THR) through posterior/anterolateral approach to hip. Conventional HA-coated stem and acetabular components were used. They were post-operatively assessed at regular intervals with Harris hip score and were found to have excellent functional outcome with high level of patient satisfaction. Result: All patients have excellent Harris hip scorepost-operatively. Patients became independent and were able to carry out day-to-day activities with ease. No complications were noticed. The dramatic change in their hip function was appreciable even on the day of surgery itself. Conclusion: We conclude that uncemented THR using conventional HA-coated components is an excellent surgical modality for the management of secondary osteoarthritis in young individuals with poor hip function. The functional outcome is promising and makes patient independent and pain free. The said procedure is cost-effective and reliable based on excellent hip function achieved in immediate post-operation. Long-term follow-up is recommended.

Combined Intracapsular And Extracapsular Neck Of Femur Fractures Case Series, Literature Review And Management Recommendations

Concomitant ipsilateral intracapsular and extracapsular fractures of the femoral neck are rare injuries with only 14 cases described in the literature as single case reports. We present three cases that were successfully and uniquely treated by uncemented hip arthroplasties. Two patients underwent complex primary uncemented total hip replacements, and one patient underwent an uncemented bipolar fluted stem hemiarthroplasty. The level of bearing constraint varied between implants. After describing our cases we review the literature and make recommendations on the management of these injuries. We believe that these are significant injuries and best functional results can be achieved with an early diagnosis and patient-specific approach that can include a total hip replacement in appropriate cases.

Traumatic Posterior Hip Dislocation with an Ipsilateral Comminuted Femoral Intertrochanteric Fracture: A Case Report

Traumatic Posterior Hip Dislocation with an Ipsilateral Comminuted Femoral Intertrochanteric Fracture: A Case Report

Decreasing the Blood Transfusion Rate in Elective Hip Replacement Surgery Using an Autologous Drainage System

This is a prospective study looking at the effectiveness of autologous postoperative drains in primary uncemented total hip replacement (THR) surgery. A total of 86 patients were studied, with 43 using standard suction drains (normal drain group) and 43 using autologous drains (autologous drain group). Thirty-seven units of homologous blood were transfused in the normal drain group and 5 units in the autologous drain group. The mean number of units of homologous blood transfused per patient was reduced from 0.86 to 0.12 (P < 0.01) with the use of autologous drains and the transfusion rate was reduced from 23% to 6% (P < 0.02). The mean length of hospital stay was also reduced by two nights (P < 0.05). There were no adverse effects from using the autologous system and it does reduce the need for a homologous blood transfusion. The system is simple and easy to use and we have also found it to be cost effective. Previously, it has not been reported as being effective in hip arthroplasty surgery, unlike knee arthroplasty surgery. We would recommend using autologous postoperative drains in primary THR surgery.

Anterior thigh pain after cementless total hip arthroplasty.

We compared the incidence of anterior thigh pain retrospectively following primary uncemented total hip replacement in 70 patients (78 hips) with osteoarthritis. In one group (38 hips), an Endoplus porous-coated, canal-filling prosthesis was inserted through an anterolateral approach. In the other group (40 hips), a Furlong hydroxyapatite-coated prosthesis was inserted through a posterior approach. The latter prosthesis has a relatively longer femoral stem and does not achieve diaphyseal press-fit contact. Three patients in the Furlong group had anterior thigh pain, which eventually resolved in two patients. In the Endoplus group, two patients developed anterior thigh pain; in both cases, there was an underlying cause, which had to be treated. Idiopathic anterior thigh pain is more common in non-canal-filling prostheses. When anterior thigh pain is noticed in canal-filling prosthesis, a search for and treatment of the cause will cure the pain. The hydroxyapatite coating did not prevent thigh pain in the Furlong group.

Mid-term results with primary uncemented total hip replacement: a 7- to 11-year follow-up

We reviewed 102 uncemented total hip replacements (THRs) in 90 patients with a mean age of 66 years (range, 33–87 years) and with an average postoperative follow-up period of 8.5 years (range, 7–11 years). The patients were prospectively observed clinically using the Harris hip score (HHS). The excellent and good results totaled over 90%. We had two serious complications treated by revisions, one for an “alarming” stem migration and a second one for an improper stem neck height. We had one late infection, and one early postoperative death. We had no mechanical loosenings or osteolysis. We found a common, up to 2 mm, slow migration of the cup and stem during the first 2 postoperative years. This was symptomless and was considered to be adaptive. Early, rapid, painful, severd, progressive, multidirectional migration is of concern. We used this uncemented prosthesis for patients of all ages. The rate of radiolucent, non-sclerotic demarcation was minimal (2%), limited, less than 2 mm wide and resolving. The occurrence of thigh pain was minimal (2%) and resolved. We believe that our results reflect the properties of this prosthesis and our surgical technique.

Proliferative cell response to loosening of total hip replacements: a cytofluorographic cell cycle analysis

Monocyte/macrophages and fibroblasts are the major reactive cells in the periprosthetic connective tissue in a loose totally replaced hip. Monocyte/macrophages are bone-marrow-derived, hematogenous cells, whereas mesenchymal fibroblasts replenish by local proliferation. The cell-cycle-phase frequency distribution therefore reflects the local mitotic fibroblast response to the loose total hip replacement (THR) implant. In 13 patients who underwent revision of a loose THR implant, most of the local cells were in the resting G0/G1 phase (88.1 +/- 6.3%, mean +/- SD), whereas 8.6 +/- 3.7% were in the S phase of the cycle, and 3.4 +/- 2.9% had already reached the G2/M phase. The highest DNA values were recorded in an osteoarthritic patient undergoing revision 4 years after the primary uncemented THR, while the lowest values were observed in a rheumatoid arthritis patient with a loose cemented prosthesis 15 years after the primary operation. The results suggest that the local proliferative fibroblast response in general is uniform and does not seem to depend on the type of prosthesis or the use of cement. The responses in aggressive granulomatous-type loosening and the common type of loosening were similar.

Incidence of heterotopic ossification after total hip replacement

The incidence and severity of heterotopic ossification after sixty-five consecutive primary uncemented total hip replacements were compared with those after seventy consecutive primary hybrid total hip replacements (consisting of an uncemented acetabular component and a cemented femoral component). All patients had had the arthroplasty because of osteoarthrosis. The sex distribution, prevalence of bilateral disease of the hip, and frequency of previous operations were similar in both groups. All of the operations were performed by one surgeon who used the same operative approach. Preoperative, immediate postoperative, and six-month follow-up radiographs were reviewed for all patients. For 90 per cent of the hips, radiographs that were made after a minimum follow-up of one year were also reviewed. In the group of patients who had an uncemented femoral component, there was a statistically significant increase in the frequency of heterotopic bone and in its severity. Either none or only class-I ectopic bone developed in 74 per cent of the hips in the hybrid group, compared with 40 per cent of the hips in the uncemented group (p less than 0.005). In contrast, class-III or IV heterotopic ossification was evident in 13 per cent of the hips in the uncemented group (p less than 0.005). None of the patients in the hybrid group needed reoperation for excision of ectopic bone, but four (6 per cent) of the patients in the uncemented group needed such a reoperation because of severe limitation of motion.(ABSTRACT TRUNCATED AT 250 WORDS)