Risk Of Revision Arthroplasty Research Articles

Early- to mid-term outcome of a short, cementless, titanium, flat, tapered stem for primary total hip arthroplasty: an independent series.

This study aims to: (1) describe perioperative complications amongst patients who underwent primary total hip arthroplasty (THA) using a short cementless, titanium, flat, tapered stem; (2) estimate this stem's early- to mid-term survival; (3) identify factors associated with revision arthroplasty; and (4) describe femoral remodelling at minimum 6 years postoperatively. A retrospective review of consecutive patients who underwent THA using a Taperloc Microplasty stem (Zimmer-Biomet, Warsaw, Indiana, USA) with minimum 2-year follow-up was performed. Surgeries were performed by 1 of 6, non-designer, arthroplasty surgeons between 2014 and 2018. Outcomes included perioperative complications including revision arthroplasty, and survival. Cox analysis was used to analyse the effect of different factors on risk of revision arthroplasty. Radiographs with 6-year follow-up served to describe femoral remodelling. In 1205 patients, followed for 5.1 ± 1.4 years, the incidence of perioperative complication was 5.2% for which 29 patients (2.4%) required revision arthroplasty. The 5- and 7-year survival rates were 97.8% (95% CI, 96.9-98.5) and 97.0% (95% CI, 95.6-98.0), respectively. The only factor associated with revision arthroplasty was proximal femur morphology, as per Dorr classification (HR 1.24 [95%CI, 1.09-1.41]; p = 0.005). During radiographic assessment, 12% of patients showed ⩾25% of relative change in cortical thickness in Gruen zones 3 or 5. We observed calcar remodelling in 50% of radiographs while 10% showed presence of a pedestal sign. The 7-year survivorship of the Taperloc Microplasty stem is within National Institute for Health and Care Excellence (NICE) guidelines. Patients ⩽65 years with osteoarthritis and Dorr A/B femoral morphology may be ideal candidates for THA with this stem. Femoral remodelling is common and not associated with adverse outcome.

Statins, bone biology and revision arthroplasty: review of clinical and experimental evidence.

Osteoarthritis is a painful, disabling condition which is increasing in prevalence as a result of an ageing population. With no recognized disease-limiting therapeutics, arthroplasty of the hip and knee is the most common and effective treatment for lower limb osteoarthritis, however lower limb arthroplasty has a finite life-span and a proportion of patients will require revision arthroplasty. With increasing life expectancy and an increasing proportion of younger (<65 years) patients undergoing arthroplasty, the demand for revision arthroplasty after implant failure is also set to increase.Statins are cholesterol-modulating drugs widely used for cardiovascular risk reduction which have been noted to have pleiotropic effects including potentially influencing arthroplasty survival. In vitro studies have demonstrated pleiotropic effects in human bone cells, including enhancement of osteoblastogenesis following simvastatin exposure, and in vivo studies have demonstrated that intraperitoneal simvastatin can increase peri-implant bone growth in rats following titanium tibial implant insertion. There is evidence that statins may also influence osseointegration, enhancing bone growth at the bone–implant interface, subsequently improving the functional survival of implants. Data from the Danish Hip Arthroplasty Registry and the Clinical Practice Research Datalink in the UK suggest a reduction in the risk of lower limb revision arthroplasty in statin ever-users versus never-users, and a time-dependent effect of statins in reducing the risk of revision. In this article we review the clinical and experimental evidence linking statins and risk of revision arthroplasty.

Association between household income and the outcome of arthroplasty: a register-based study of total hip and knee replacements.

Previous research findings regarding the association between the outcomes of total hip and knee arthroplasty and patients' socioeconomic status have been contradictory. Consequently, we wanted to analyse whether individual-level household income was associated with the risk of revision arthroplasty and whether the time span in days from the primary arthroplasty to the revision operation varied according to income quintile. All first total hip and knee arthroplasties performed due to primary osteoarthritis in Finland from 1998 to 2007 were included in the study. Cox proportional hazard regression modelling was applied in the analysis regarding the risk of revision after the primary operation, while Poisson regression modelling was applied in the analysis regarding differences in the time from the primary to the revision operation between income quintiles. The relationship between household income and the risk of revision arthroplasty was not statistically significant. The relationship remained insignificant, even when age, sex, and other confounding factors were adjusted for or analyses concerned revision in short or long term. In both the total hip arthroplasty and knee arthroplasty populations, patients in the lowest income quintiles underwent revision surgery earlier than patients in the highest income groups, but this difference was not statistically significant. The quality of arthroplasty as measured by the risk of revision does not seem to depend on patients' income quintile.

Single Mini-Incision Total Hip Replacement for the Management of Arthritic Disease of the Hip

Mini-incision total hip replacement continues the current trend in orthopaedics and other specialties toward smaller-incision surgery. The purpose of this systematic review was to assess the effectiveness and safety of single mini-incision compared with standard-incision total hip replacement for treatment of arthritis of the hip. We conducted an electronic literature search for relevant studies published in any language up to March 2010. Key conference proceedings and national orthopaedic registries were searched, professional organizations and implant manufacturers were approached, and reference lists from included studies were screened. We included randomized and quasi-randomized controlled trials assessing single mini-incision surgery, defined as an incision of ≤ 10 cm, compared with standard primary total hip replacement. Two reviewers independently assessed studies for inclusion and extracted data. Fifteen randomized and five quasi-randomized controlled trials, involving 1857 participants, were eligible. Included trials were of mixed methodological quality, with the sample size ranging from twenty to 219. Mean follow-up periods were short, ranging from six weeks to three years. Compared with standard total hip replacement, mini-incision procedures may have small perioperative advantages in terms of less blood loss, shorter operative time, and shorter inpatient stay, but the differences were not clinically important. Few complications were reported, and the complication rate did not differ significantly between groups. There was insufficient evidence to suggest any major difference in the short-term revision rate, and confidence intervals for surrogate measures for long-term outcome were broad enough to include clinically important differences in favor of either approach. Although there were marginal short-term advantages and disadvantages for each of the surgical techniques, there was no strong evidence either for or against mini-incision compared with standard-incision total hip replacement. Importantly, evidence on longer-term performance, especially the risk of revision arthroplasty, for mini-incision hip arthroplasty is very limited.

The Relationship of Sporting Activity and Implant Survivorship After Hip Resurfacing

The effect of sports on the durability of the prosthesis after hip resurfacing has not been studied, to our knowledge. The purpose of this study was to correlate sporting activity levels calculated as Impact and Cycle Scores with the survivorship of the hip resurfacing implants. Four hundred and forty-five patients were surveyed from one to five years after surgery. The mean age of the patients was 48.7 years, and 74% were men. The Impact and Cycle Score included two scores: an Impact Score and a Hip Cycle Score. All patients were also evaluated with the University of California at Los Angeles activity score. Twenty-three patients (twenty-seven hips) underwent revision surgery after they had completed the survey. The mean duration of follow-up at the time of survey data collection was 1.9 years (range, 1.0 to 4.9 years), and the mean follow-up period was 10.2 years (range, 6.1 to 13.7 years). The mean Impact Score was 28.1 (range, 0 to 128), and the mean Hip Cycle Score was 33 (range, 0 to 144). Positive correlations were found between the University of California Los Angeles activity score and the Impact Score (r = 0.535) or Hip Cycle Score (r = 0.497). After adjustment for femoral component size, body mass index, and femoral defect size, a 10-point increment in Impact Score corresponded to a 37% increase (hazard ratio, 1.37; 95% confidence interval, 1.18 to 1.59) in the risk of revision arthroplasty, while a 10-point increment in the Hip Cycle Score increased the risk of revision by 22% (hazard ratio, 1.22; 95% confidence interval, 1.06 to 1.41).Patients with an Impact Score of < 50 had a risk of revision 3.8 times lower (hazard ratio, 3.8; 95% confidence interval, 1.6 to 8.9) than that of the patients with an Impact Score of ≥ 50, with a survivorship rate at eight years of 96.4% (95% confidence interval, 93.6% to 98.0%) compared with 88.8% (95% confidence interval, 74.7% to 95.3%). We found no association between the University of California at Los Angeles activity score and the survivorship of the implants. High levels of sporting activities can be detrimental to the long-term success of hip resurfacing devices, independently from other risk factors. Patients seeking hip resurfacing are usually young and should limit their involvement in sports to levels that the implant construct will be able to tolerate.