Total Hip Arthroplasty Surgery Research Articles

Difficulty of diagnostic accuracy of periprosthetic joint infection: a retrospective analysis of revision surgery of total hip arthroplasty and total knee arthroplasty in a tertiary hospital

BackgroundDiagnostic accuracy of periprosthetic joint infection still remains controversial and an unsolved problem with respect to clinical signs and laboratory measures. Influencing factors of diagnosis like age, sex, abnormal physical findings and comorbidities are published with different results. The aim of our study was to find factors strengthening the diagnosis.MethodsWe therefore retrospectively investigated all revision surgeries of total knee arthroplasty and total hip arthroplasty in the years 2019 and 2020 in a tertiary hospital with special regard to diagnostic accuracy of periprosthetic joint infection and switch in diagnosis to aseptic mechanical loosening or vice versa. All patients were divided into 4 non-hierarchical groups: suspected and discharge diagnosis periprosthetic joint infection (P1), suspected and discharge diagnosis mechanical loosening (P2), suspected diagnosis mechanical loosening and discharge diagnosis periprosthetic joint infection (P3), suspected diagnosis PJI and discharge diagnosis mechanical loosening (P4).ResultsIn the years 2019–2020, 106 patients underwent revision surgery of total knee arthoplasty and total hip arthroplasty. 33 patients showed periprosthetic joint infection (31.1%) according to Infectious Diseases Society (IDSA) criteria, 73 patients showed mechanical loosening (68.9%). Of the periprosthetic joint infection -patients, 15 were men (46%) and 18 were women (54%). The patients with mechanical loosening were 27 men (37%) and 46 women (63%). In group P1 (25 patients), 22 could be classified according to the histopathological classification Krenn and Morawietz grade 2 and grade 3, 2 patients to grade 4 and one patient could not be classified. In group P3 (8 patients) all could be classified according to the classification Krenn and Morawietz grade 2 and 3. Groups P1 – P4 were correlated with categorial basic data: All Groups P1 – P4 showed a statistical correlation towards American Society of Anesthesiologists (ASA) categorization 3–4 versus ASA 2 (p = 0.01). In the pairwise comparison in the exact Fisher´s exact test P1 and P2 showed a statistical correlation towards ASA categorization 3–4 versus ASA 2 (p = 0.01). Charlson Comorbidity Index (CCI) categories 5–7 versus 0,1–2 and 3–4 showed a statistical correlation towards groups P1-P4 (p = 0.007) and in the pairwise comparison in the exact Fisher´s exact test a discrimination of P1 and P2 (p = 0.001) and P1 and P3 (p = 0.007). The preoperative corticoid therapy showed a statistical correlation to groups P1-P4 (p = 0.05) and in the pairwise comparison in the exact Fisher test a discrimination of P1 and P4 (p = 0.02).ConclusionWe therefore conclude that diagnosis of periprosthetic joint infection still remains difficult. Switches in diagnosis during hospital stay from periprosthetic joint infection to aseptic mechanical loosening and vice versa are not unusual and the role of different diagnostic tools needs further investigation. Patients categorized according to ASA and CCI as severely ill might be more likely to be diagnosed correctly with periprosthetic joint infection.

Predictive value of preoperative gluteus and iliacus muscle volumes for patient-reported outcomes following total hip replacement: a three-dimensional volumetric analysis.

This study aimed to investigate the relationship between hip muscle mass and patient-reported outcomes (PROs) after total hip arthroplasty (THA) surgery for hip disease using 3D volumetric measurements of the gluteus muscle group and iliac muscle. Between January 2020 and December 2021, 85 patients who had undergone unilateral THA for osteoarthritis or osteonecrosis of the femoral head were enrolled. Using a 3D modeler program, automatically generated 3D reconstructed images of the hip muscles were obtained, and volumetric measurements were performed. Both unadjusted and height (m2)-adjusted muscle volumes of the gluteus maximus (unadjusted volume: GmaxV; adjusted volume: GmaxI), gluteus medius (unadjusted volume: GmedV; adjusted volume: GmedI), gluteus minimus (unadjusted volume: GminV; adjusted volume: GminI), and iliacus (unadjusted volume: IliacV; adjusted volume: IliacI) muscles were measured on the affected side and both sides. Pearson correlation analysis between muscle volumes and postoperative 12-month PROs were performed. The preoperative Gmax volume on the affected side was significantly associated with post-operative PROs, especially mHHS (GmaxV: p = 0.026; GmaxI: p = 0.005) and UCLA scores (GmaxV: p = 0.006; GmaxI: p = 0.002). For measurements on both sides, Gmed volume was the sole index showing a significant correlation with postoperative UCLA scores (GmedV: p = 0.023; GmedI: p = 0.043). The current study suggests that preoperative gluteus muscle volume may have predictive value for postoperative PROs of hip disease patients who have undergone THA surgery.

Premature wear of the hip prosthesis as an early mechanical complication qualified for revision surgery – a rare case report and clinical implications

Background: Mechanical complications of total hip arthroplasty (THA) are potential issues that may arise following the primary THA. Improper placement of THA can lead to misalignment of the joint axis, resulting in instability, pain, and walking difficulties. Among the relatively rare postoperative mechanical complications, premature wear of prosthesis components is included. This wear can lead to catastrophic prosthesis dislocation, necessitating surgical revision of the THA. Aim of the study: The aim of this paper is to present an intriguing case description of a patient with premature THA wear classified as an early postoperative mechanical complication, warranting revision THA surgery. The likely cause of premature wear of the implanted acetabular cup was excessive prosthesis use associated with intense physical activity and a high level of patient fitness. Care report: The paper presents the medical history and treatment course of a 33-year-old active patient who underwent uncemented left hip THA surgery due to diagnosed coxarthrosis caused by congenital dysplasia. After 5 years, premature wear of the implanted acetabular cup occurred. The likely cause was excessive prosthesis exploitation related to intensive physical activity and a high level of patient fitness. A year after the first revision surgery, THA dislocation occurred, resulting in the necessity of a second revision with replacement of the acetabular cup, polyethylene inserts and femoral head of the endoprosthesis. Summary: Premature wear of THA poses a significant clinical challenge. Functional limitations, associated with the loss of hip joint stability, lead to difficulties in performing basic activities, further decreasing the patient's quality of life. It is also worth emphasizing that the treatment process for premature THA wear is associated with the possibility of surgical complications and a prolonged recovery period.

Can we trust the accuracy of the automatic calibration of the EOS system to measure lower limb length inequality after total hip arthroplasty? Comparison of EOS versus manual measurement on 110 calibrated radiographs

IntroductionTraditionally, to determine a length on a limb radiograph after total hip arthroplasty (THA), calibration is performed manually with the diameter of a ball or the femoral head. More recently, the development of EOS with automatic calibration has called into question the usefulness of manual calibration to highlight lower limb length inequality (LLLI). However, the validation of EOS with automatic calibration without landmarks to measure length inequalities on large images has not been verified against manual measurements on calibrated radiographs (conventional method), which motivated the present work. HypothesisEOS is more accurate and reproducible from one reader to another in highlighting LLLI after THA than the classic method. Patients and methodsOne hundred and ten patients included underwent primary THA surgery in 2 centers, with postoperative EOS performed. This EOS was extracted in 2 formats: a DICOM file with automatic calibration and an uncalibrated JPEG file (220 radiographic files in total).Two readers, without knowledge of the clinical data, each analyzed all of these images using 2 methods: by measuring the distance between the center of the femoral head and the center of the mortise on the operated side and the non-operated side on the DICOM file, therefore via the software integrated into the EOS image (method 1), or by measuring these same distances on the JPEG file by calibrating the measurement to the diameter of the prosthetic head (method 2). The reproducibility of the measurements from one reader to another (inter-observer reproducibility) and the agreement of the measurements between the 2 methods (inter-method agreement) were evaluated using the intraclass correlation coefficient (ICC) and the Bland- Altman graphic method. ResultsInter-method agreement was satisfactory regardless of the reader but with a significantly higher agreement for reader 1 (inter-method agreement for reader 1: CL1 = 0.95 and for reader 2: CL2 = 0.90 (p = 0.008)) and this result was also confirmed by the Bland-Altman plot with no bias tendency for each reader and less than 5% of measurements that were outside the agreement band. Inter-observer reproducibility for method 1 was better than that for method 2 to highlight an LLLI after THA according to the CCI. Inter-observer reproducibility for method 1 (RM1) was 0.96 and 0.92 for method 2 (RM2) (p = 0.009). This result was confirmed by the Bland-Altman plot with a mean difference of less than 1 mm for each of the methods (−0.2 (standard deviation = 2.23) and 0.81 (3.03) for method 1 and method 2 respectively). DiscussionOur hypothesis has therefore been partially verified. The use of the calibrated software integrated into the EOS system and manual calibration are two valid methods for searching for an LLLI. The measurements remain more reproducible from one reader to another with the calibrated software integrated into the EOS system. Level of evidenceIII; non-randomized prospective comparative study.

Femoral neck fractures: a cohort comparison of nonunion and complication rates after ballistic versus blunt mechanism fractures.

This study aims to review complications and union rates of ballistic femoral neck fractures when compared to their blunt counterparts. We hypothesize that gunshot injuries to the femoral neck may have higher rates of complications (nonunion, avascular necrosis [AVN], and implant failure) as a result of increasing comminution and disruption to the already tenuous blood supply through the femoral neck. Following the Institutional Review Board approval, a retrospective chart review was performed identifying femoral neck fractures at a single level 1 trauma center from 2018 to 2023. Inclusion criteria were age 16-45years old with intracapsular femoral neck fractures. Exclusion criteria were absence of radiographic and clinical follow-up beyond 6 weeks, prior femur fractures, pathologic fractures, or primary surgery of total hip arthroplasty. Garden classification and Pauwels angle were reported. Clinical union was defined as the absence of painwith ambulation in the absence of radiographic changes. Radiographic union was defined using the validated Radiographic Union Score for Hip (RUSH) scoring system. Complication rates (deep and superficial infection, failure of fixation, and AVN) and subsequent surgery were recorded. After exclusion, 12ballistic and 16 blunt femoral neck fractures met inclusion criteria and were reviewed. The ballistic cohort had significant more Garden I fractures than the blunt cohort (4 [33%] vs. 0 [0%]), and significantly fewer Garden IV fractures than the blunt cohort (2 [17%] vs. 9 [56%]). Despite different Garden classification types of fracture patterns, the Pauwels angle between the two cohorts was similar (51° ballistic vs. 60° blunt, p = 0.16). The overall nonunion rate was 24.1%. Nonunion rates were similar between the two cohorts (3, 25% ballistic vs. 4, 25% blunt, p = 0.99). The mean final RUSH score between the two cohorts was similar (20.1ballistic vs. 23.4 blunt [p = 0.05]). The total complication rate was 31% (9/28) consisting of 7 nonunions and 2 malunions across both cohorts. The current study found no difference in the union rates between blunt and ballistic femoral neck fractures. Although comparing these fractures using traditional classification systems (Garden and Pauwels) are difficult due to the inherent differences in mechanism and the applicability of these tools, both groups presented with high rates of nonunion and complications. We believe the similar RUSH scores and complication rates in both cohorts show these fractures fundamentally behave similarly and remain challenging injuries to manage with ORIF.

Delirium risk profiles in a population-based study of United States older adults undergoing common noncardiac surgeries.

Older adults often require surgical care and are at elevated risk of delirium. We explored delirium risk profiles across the population of U.S. older adults who underwent one of 10 common noncardiac surgeries. We analyzed Health and Retirement Study (HRS) participants linked with Medicare billing data who underwent the following 10 noncardiac surgeries from 2000 to 2018 at age 65 or more: total knee arthroplasty (TKA), total hip arthroplasty (THA), spine surgery, cholecystectomy, colorectal surgery, hernia repair (ventral, umbilical, or incisional), endarterectomy, prostatectomy, transurethral resection of the prostate (TURP), and hysterectomy. Demographic and health covariates were obtained from the HRS dataset. Latent cognitive ability was calculated from cognitive testing, proxy reports, and demographics at the preoperative HRS interview. We compared standardized differences for delirium risk factors across the 10 surgeries and qualitatively clustered them into phenotypical subgroups. We analyzed 7424 older adults (mean age 76 ± 6 years, 45% male). Endarterectomy patients presented with the highest burden of nearly all health and cognitive factors, implying higher delirium risk (e.g., stroke, 22%; depressive symptoms, 30%; high school or less education, 73%; frailty, 42%; lowest latent cognitive ability). A second "general surgery" phenotype, including cholecystectomy, colorectal, and hernia surgery patients, experienced more frailty (29%-32%) and depressive symptoms (24%-26%), with moderate comorbidity burden. A third "pain" phenotype, which included TKA, THA, and spine surgery patients, commonly reported moderate or severe pain (47%-53%) and impairment in activities of daily living (ADL, 23%-30%), but fewer comorbid medical conditions. The remaining surgery types (hysterectomy, prostatectomy, TURP) were not phenotypically grouped and generally had lower risk features for delirium. In an epidemiological cohort of US older adults, we identified clinically meaningful heterogeneity in delirium risk profiles across different surgical types, which may have implications for delirium risk stratification and delirium prevention or treatment.

Role of anxiolytic medications in maintaining perioperative blood pressure in total hip arthroplasty surgeries: case-control retrospective study

Background: Elevated blood pressure (BP) measurements seen in patients having total hip arthroplasty (THA), pose a significant issue for surgeons. The study objective was to investigate the effectiveness of preoperative anxiolytic medications in the maintenance of blood pressure and reduction of total blood loss in patients undergoing THA surgeries. Methods: A retrospective case-control cohort study in a tertiary care university hospital included patients who had THA and had either primary managed hypertension or were non-hypertensive. 190 patients who underwent primary THR; 103 controls and 87 treatment group (Oral 3 mg Bromazepam). Pearson’s chi-square, independent sample t-test, paired samples t-test, and a two- way repeated measures analysis of variance (ANOVA) was utilized in the analysis. Results: Bromazepam group had a significantly lowered ratio of systolic (SBP), diastolic (DBP), and mean arterial pressure (MAP) in the morning of the surgery (P<0.05). Bromazepam also reduced the ratio of SBP and MAP in theaters before anesthesia (P<0.05). A repeated measures ANOVA showed significant treatment effects for SBP and MAP but not DBP (P<0.001 for both). SBP, DBP, and MAP showed a significant time-treatment effect (P<0.001, 0.019, and<0.001, respectively). Conclusions: Oral bromazepam (anxiolytic) aids in the regulation of blood pressure in individuals with well-managed hypertension and in healthy patients having total hip arthroplasty without apparent adverse effects related to the medication. This could potentially reduce the number of uncontrolled hypertension-related surgery delays and patients on the surgical waiting list.

Association of Geographic Social Vulnerability with Race-Based Differences in the Utilization of Total Hip Arthroplasty Surgeries for Medicare Beneficiaries

BackgroundRacial disparities exist in the utilization of total hip arthroplasties (THAs). The social vulnerability index (SVI), which measures geographic-level disadvantage and includes themes such as socioeconomic status, minority status, and language, may partially explain disparities in THA use. Our objectives were to determine the association of the composite SVI with THA use for (i) White Medicare beneficiaries, (ii) Black Medicare beneficiaries, and (iii) the difference in THA use between White and Black beneficiaries. We also determined the association of SVI themes with these THA-use endpoints. MethodsWe used 2013 to 2019 Medicare data to calculate age- and sex-standardized THA use rates for 306 Hospital Referral Regions (HRRs). We estimated multivariable linear regression models to determine the association of the composite SVI and its four themes with THA utilization and with differences in use rates. ResultsLiving in HRRs with the highest SVI (most vulnerable, quartile 4) was associated with lower hip arthroplasty rates for both White and Black beneficiaries (e.g., quartile 4 for White beneficiaries: -0.9, 95% confidence interval [95% CI]: -1.2 to -0.7, P < 0.001; quartile 4 for Black beneficiaries: -0.9, 95% CI: -1.3 to -0.5, P < 0.001) compared to beneficiaries in the least vulnerable HRRs (quartile 1). Higher vulnerability in minority status and language (theme 3) was associated with lower THA utilization for Black beneficiaries only (e.g., quartile 4 for Black beneficiaries: -0.9, 95% CI: -1.2 to -0.5, P < 0.001) and was associated with widening of the White–Black difference in THA utilization (e.g., quartile 4: 0.7, 95% CI: 0.3 to 1.1, P < 0.001). ConclusionHigher composite SVI is associated with lower THA utilization for both White and Black beneficiaries. Higher vulnerability in minority status and language is associated with the widening of the disparity in THA rates. Our findings highlight important mechanisms that need to be addressed to ensure equity in THA access.

Menopause and Sexual Life Amongst Older Men: A Review Study

Objectives: To determine factors affecting the quality of men’s sexual life during menopause and identify the existing challenges. Design: A review study. Setting(s): Older people living in public institutions and living in their own homes. Participants: Older adults over 60 years of age. Outcome measures: All factors affecting the quality of sexual life of postmenopausal men in old age have been investigated in three physical, psycho-emotional, and social domains. Results: In the physical field, factors such as age, general health, disease, exercise, impotence, erectile dysfunction, genital warts, surgery of total hip arthroplasty, surgery of prostate, cancer radiotherapy, alopecia, and disorder in ejaculation, urinary disorders, and physical rehabilitation were known factors affecting the quality of men’s sexual life. The impacts of factors such as sleep problems, stressors, self-image, depression, alcohol addiction, premature ejaculation, emotional divorce, marital satisfaction, and fear of sexual activity were confirmed in the psycho-emotional field of studies. In the social field, factors such as education, duration of the marriage, marital status, income, life partners, number of sexual relations with spouse, the presence of multiple sexual partners, body mass of spouse (female), sex education and health literacy, sexual awareness, and quality of life related to health were recognized to be effective. Conclusions: Promoting sexual awareness through educational programs, providing opportunities for frequent sexual relationships, and addressing physical, psychological, emotional, cognitive, and social factors, and andropause could contribute to a more desirable sexual life quality in men during andropause.

Evolución del programa de recuperación rápida a cirugía ambulatoria en artroplastia total de cadera

IntroductionThe implementation of enhanced recovery programs has transformed total hip arthroplasty (THA) surgery. Outpatient prosthetic surgery is a safe and beneficial technique. Few centers in our country perform outpatient total hip arthroplasty (OTHA). We present the preliminary results of our experience. Material and methodThis is a prospective observational study conducted in 2023 with a sample of 30 patients proposed for THA following an outpatient surgery protocol by the orthopedic surgery and traumatology service. ResultsIn 2023, we performed 132 THAs in our center. Thirty patients, 27 men and 3 women with an average age of 55.7 years were included for an outpatient surgery circuit. Three patients did not meet the inclusion criteria identified by the Anesthesiology Department. Of the 27 patients included in the program, 25 were discharged on the same day. Two patients were admitted: one due to an intraoperative fracture and the other due to poor pain control and dizziness. No secondary complications related to the program were observed after discharge. All patients except one would recommend the outpatient protocol. ConclusionsOTHA programs should evolve from rapid recovery programs. Their implementation depends on an experienced multidisciplinary team. In this study, inclusion criteria were defined, achieving high satisfaction without increased complications. Outpatient surgery is a good option, and the implementation of this circuit is a safe, effective, and a satisfactory practice for selected patients.

When the Going Gets Tough: A Review of Total Hip Arthroplasty in Patients with Ipsilateral Above- and Below-Knee Amputation.

Life expectancy and overall function of amputated patients have improved significantly over the last few decades; for this reason, amputees are more exposed to primary or secondary degenerative disease of the hip, requiring total hip arthroplasty (THA) surgery. However, during training, not all the surgeons acquire adequate skills to manage these patients, and only a few studies and case reports describe technical pearls and outcomes of THA in patients with ipsilateral lower limb amputation, either above or below the knee. The objective of this narrative review is to present current evidence and surgical tips for performing THA in ipsilateral amputated patients, with a focus on the differences between patients with above- (AKA) and below-knee amputation (BKA). We reviewed manuscripts in major scientific databases, cross-referencing to retrieve adjunctive manuscripts, and summarized all relevant cases. We found 17 manuscripts, spanning 70 years of literature, collecting a total of 39 patients who underwent THA on an ipsilateral amputated limb: 13 AKA, 23 BKA, and 3 through-knee-amputation (TKA). The cohort primarily consists of patients with post-traumatic hip arthritis, often associated with sequelae such as fractures to other bones, soft tissue compromise and heterotopic calcifications. Managing with amputated patients requires careful planning, which includes the study of the residual bone, muscle anatomy, and the level of femoral amputation, as these factors present significant surgical challenges, especially in patients without a knee joint. In dealing with the post-traumatic and multi-comorbidity patients, rehabilitation goals should be considered prior to surgery and should drive the surgical strategy. We found that BKA patients typically have high functional demands, necessitating precise positioning of the components and an aggressive post-operative physiotherapy regimen to avoid unsatisfactory outcomes. AKA patients, on the other hand, often present with altered anatomy, and typically require more surgical instruments and expertise to achieve intraoperative dislocation of the hip joint.

A Registry Study on Acetabular Revisions Using Jumbo Cups: Do We Really Need a More Complex Revision Strategy?

BackgroundThe increasing global performance of total hip arthroplasty (THA) has led to a rise in revision surgeries, primarily due to cup failure, with aseptic loosening and periprosthetic infection being common causes. Various techniques and implants, including jumbo cups (JCs), manage residual bone loss post-cup removal, facilitating enhanced surface area for improved host bone contact, and osteointegration. The purpose of the study was to determine the outcomes of acetabular revision arthroplasty using JC implants over a 20-year follow-up period by reporting overall survivorships, complications leading to re-revision, and surgical strategies in re-revision. MethodsA cohort study based on a large regional registry was conducted, examining revision THA surgeries utilizing JCs between 2000 and 2020. The study included all the revision acetabular procedures performed with cementless JCs, identified with a diameter ≥ 62 millimeters (mm) in women or ≥ 66 mm in men. All iliac fixation cups were excluded. Data on demographics, revision surgery indications, components, fixation types, causes of failure, and reintervention strategies were collected and analyzed. A total of 541 JCs implanted from January 2000 to December 2020 were evaluated. The most common revision indications were “cup aseptic loosening” (54.5%) and “total aseptic loosening,” which included both the cup and stem (32%). ResultsThe JC survival rates were 92.5% at 5 years, 85.8% at 10 years, and 81.5% at 15 years. Among the 70 failures, the main causes were “cup aseptic loosening” (40%), “total aseptic loosening” (17.1%), and “septic loosening” (12.8%). Revisions primarily involved acetabular cup revision surgery (54 cases), component explantation (11 cases), or insert or head revision (five cases). ConclusionsThis registry-based study of JCs in revision THA demonstrates excellent 15-year survival rates and acceptable failure rates. It supports JCs as a viable option, offering relative surgical simplicity compared to alternatives like antiprotrusion cages, bone grafts, and augments.

Serum HMGB1 as a predictor for postoperative delirium in elderly patients undergoing total hip arthroplasty surgery.

Postoperative delirium (POD) is an acute mental disorder that occurs after surgery requiring general anesthesia. In animal studies, high-mobility group box 1 (HMGB1) plays a key role in mediating postoperative neuroinflammation and may have a direct impact on POD. The objective of this prospective observational study was to investigate the serum levels of HMGB1 in elderly POD patients undergoing total hip arthroplasty. This prospective observational study included 287 elderly patients who underwent total hip arthroplasty in our hospital from October 2019 to September 2022. Patients were assessed for the presence of POD using the Confusion Assessment Method (CAM) within 72 h of surgery. Serum HMGB1, interleukin (IL)-6, IL-1β, tumor necrosis factor alpha (TNF-α), and C-reactive protein (CRP) levels were measured using enzyme-linked immunosorbent assay (ELISA) before surgery, as well as at 24 h, 48 h and 72 h after surgery. Demographic and clinical data of all elderly patients were collected. The anesthesia time and surgical time in the POD group were significantly higher than those in the non-POD group. The serum levels of HMGB1, IL-6 and IL-1β in the POD group were significantly elevated compared to those in the non-POD group at all time points after surgery (p < 0.05). In addition, the serum levels of HMGB1 were positively correlated with TNF-α, IL-6 and IL-1β levels. HMGB1, IL-6 and IL-1β could be potential predictive biomarkers for the occurrence of POD in elderly patients undergoing total hip arthroplasty. Finally, we found that anesthesia time, surgical time, HMGB1, TNF-α, IL-6, and IL-1β were risk factors for POD in elderly patients undergoing total hip arthroplasty. Serum HMGB1 levels were markedly elevated in elderly POD patients undergoing total hip arthroplasty. In addition, HMGB1 could serve as a potential predictive biomarker for POD in elderly patients undergoing total hip arthroplasty.

Complications and Long-Term Outcome in 30 Canine Total Hip Arthroplasties Using a Second-Generation Selective Laser Melted Screw Cup.

The aim of this study was to report complications and outcomes of a cementless total hip arthroplasty (THA) system with a second-generation selective laser-melted screw cup (SCSL). All THA using the SCSL performed at a single institution between January 2017 and November 2022 were retrospectively evaluated. Patients with a minimum follow-up period of 12 months and complete medical records were included and analyzed for radiographic and clinical outcomes. Thirty THA with SCSL in 23 dogs were included in this study. Complications were observed in seven hips, comprising two minor and five major complications, with two hips experiencing two major complications. Among these seven major complications, six were associated with the femoral implant and one involved cup luxation. Of the 30 THA, 4 were explanted, while 26 remained in place for a median follow-up of 17.5 months (range, 12-38 months). No cases of late aseptic loosening were observed with SCSL. THA using SCSL helps reduce cup-associated complications and is appropriate for THA surgery, and the overall complication rate is comparable with that of other single-implant systems. Nevertheless, four hips were explanted.

Surgeons Who Perform Total Hip Arthroplasty Are at Risk for Noise-Induced Hearing Loss, Especially When Using Automated Broaching.

Noise-induced hearing loss (NIHL) is a serious concern for orthopedic surgeons. The National Institute for Occupational Safety and Health (NIOSH) sets the safe exposure limit at 85 dB for 8 hours, yet operating rooms often surpass this limit. This study investigated if using an automated broaching system exposes orthopedic surgeons to dangerous decibel (dB) levels. A prospective study analyzed 138 intraoperative sound recordings from 92 total hip arthroplasty (THA) surgeries and 46 baseline measurements at an academic-affiliated private practice, using the NIOSH Sound Level Meter (SLM) application and a microphone. The surgeries were categorized into manual and automated broaching. Key metrics measured included maximal dB level (MDL), peak sound pressure (LCpeak), average continuous sound (LAeq), and average weighted sound in an 8-hour period (TWA), along with dose representations, to identify hazardous noise levels. Of the 92 THA sound recordings, 50 used manual broaching and 42 employed automated broaching. Automated broaching exhibited higher noise levels, with an average MDL of 109.92 dBA, a LAeq of 86.09 dBA, a TWA of 76.48 dBA, and a projected noise dose of 137.74%. In contrast, manual broaching exhibited an average MDL of 105.87 dBA, a LAeq of 83.06 dBA, a TWA of 72.82 dBA, and a projected noise dose of 82.02%. This study highlights the auditory risks from automated broach and manual THA surgeries that orthopedic surgeons experience. Manufacturers should focus on reducing instrument noise when designing surgical tools and orthopedic surgeons and operating room staff should take measures to protect themselves from NIHL during surgery. [Orthopedics. 202x;4x(x):xx-xx.].

SHORT-TERM OUTCOME OF A MODERN MONOBLOCK TITANIUM FLUTED TAPERED REVISION STEM FOR COMPLEX PRIMARY AND REVISION TOTAL HIP ARTHROPLASTY

For over a decade, modular titanium fluted tapered (TFT) stems have demonstrated excellent clinical success for femoral revision total hip arthroplasty (THA) surgery. The aim of this study was to report the short-term outcomes of a novel modern monoblock TFT stem used for revision and complex primary THA with a minimum of 2 years follow-up.We identified 126 patients who received a single monoblock TFT stem - 26 patients for complex THA (failed fracture fixation) and 100 patients for revision THA. The reasons for revision THA included 40 for previous prosthetic joint infection (PJI), 42 for aseptic loosening, 9 for trunnionosis, 9 for periprosthetic fractures. The Paprosky grading for femoral bone loss at the time of surgery and the measured subsidence of femoral stems at 3 months follow-up were determined. We evaluated the number and indications for re-operations.The mean time from surgery was 3.9 years (range 2.0 to 6.9 years). A paired t-test analysis showed significant improvement from pre-operative versus post-operative clinical outcome scores (p&lt;0.001) for HHS (38.76 +/- 15.24vs. 83.42 +/- 15.38), WOMAC (45.6 ± 19.0 vs. 69.9 ± 21.3) and SF-12 Physical component (31.7 ± 8.1 vs. 37.8 ± 11.3) and SF-12 Mental component (48.2 ± 12.2 vs. 51.6 ± 12.5). The Paprosky grading for femoral bone loss was Grade 1 (3.9%), Grade 2 (35.7%), Grade 3A (47.6%), Grade 3B (11.1%) and Grade 4 (1.6%) cases. There were 18 re-operations (14.7%) with 13 for PJI (7 treated with implant retention, 6 treated with a two-staged revision), 4 for instability and one for acetabular aseptic loosening. There were no aseptic failures of the stem.This novel modern monoblock TFT stem provided reliable femoral fixation and has increasingly supplanted the use of modular TFT stems for complex primary and revision surgery in our institution.

Hip Arthroscopy After Total Hip Arthroplasty Is Rare (0.04%) and May be Contralateral

PurposeThe purpose of this study was to determine the patient demographics and incidence of hip arthroscopy after total hip arthroplasty using the PearlDiver database. MethodsThis is a retrospective study of patients undergoing total hip arthroplasty and arthroscopic hip surgery. The PearlDiver Claims Database was queried using CPT codes for records from 2010-2021. Inclusion criteria were presence of a hip arthroplasty CPT code, followed by a hip arthroscopy CPT code. Additional data collected included age, gender, and time between surgeries. A sub-analysis for ICD9/10 codes was completed to estimate association with iliopsoas tendinitis. ResultsQuery of the database showed that 314 patients had a hip arthroscopy code after a hip arthroplasty code. 0.04% of patientswho underwent arthroplasty subsequently underwent arthroscopy. 63.4% were female. Mean age was 58.2 ± 12.2 years at time of arthroscopy. 214 (72.3%) patients had a CPT code for synovectomy, 56 (18.9%) for loose body removal, and 44 (15.3%) for diagnostic arthroscopy. The mean time from arthroplasty code to arthroscopy code was 2.5 ± 2.0 years. 105 patients (33.4%) also had an ICD 10 diagnosis code for iliopsoas tendinitis and 116 (36.9.0%) had the ICD 9 code for enthesopathy of hip. ConclusionIn this limited study, we found that hip arthroscopy after hip arthroplasty is uncommon but occurs more frequently in female patients, is undertaken in a broad age range of patients, and is often associated with a diagnosis of iliopsoas or hip tendinitis. Level of Evidence: Level IV, Retrospective Case Series

Applications and accuracy of 3D-printed surgical guides in traumatology and orthopaedic surgery: A systematic review and meta-analysis.

Patient-Specific Surgical Guides (PSSGs) are advocated for reducing radiation exposure, operation timeand enhancing precision in surgery. However, existing accuracy assessments are limited to specific surgeries, leaving uncertainties about variations in accuracy across different anatomical sites, three-dimensional (3D) printing technologiesand manufacturers (traditional vs. printed at the point of care). This study aimed to evaluate PSSGs accuracy in traumatology and orthopaedic surgery, considering anatomical regions, printing methodsand manufacturers. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Studies were eligible if they (1) assessed the accuracy of PSSGs by comparing preoperative planning and postoperative results in at least two different planes (2) used either computer tomography or magnetic resonance imaging (3) covered the field of orthopaedic surgery or traumatologyand (4) were available in English or German language. The 'Quality Assessment Tool for Quantitative Studies' was used for methodological quality assessment. Descriptive statistics, including mean, standard deviation, and ranges, are presented. A random effectsmeta-analysis was performed to determine the pooled mean absolute deviation between preoperative plan and postoperative result for each anatomic region (shoulder, hip, spine, and knee). Of 4212 initially eligible studies, 33 were included in the final analysis (8 for shoulder, 5 for hip, 5 for spine, 14 for knee and 1 for trauma). Pooled mean deviation (95% confidence interval) for total knee arthroplasty (TKA), total shoulder arthroplasty (TSA), total hip arthroplasty (THA)and spine surgery (pedicle screw placement during spondylodesis) were 1.82° (1.48, 2.15), 2.52° (1.9, 3.13), 3.49° (3.04, 3.93)and 2.67° (1.64, 3.69), respectively. Accuracy varied between TKA and THA and between TKA and TSA. Accuracy of PSSGs depends on the type of surgery but averages around 2-3° deviation from the plan. The use of PSSGs might be considered for selected complex cases. Level 3 (meta-analysis including Level 3 studies).

Survivorship and Outcomes of 2-Stage Revision for Infected Total Hip Arthroplasty at a Mean of 7-Year Follow-Up

BackgroundPeriprosthetic joint infection (PJI) continues to be one of the leading causes of failure following total hip arthroplasty (THA). The objectives of the study were to (1) determine the minimum 2-year infection-free survivorship of 2-stage revision THA, (2) determine the causative organisms for repeat 2-stage revision THA, and (3) characterize the results of failed 2-stage revisions and evaluate patient-reported outcome measures (PROMs). MethodsA retrospective chart review was completed for patients who underwent 2-stage revision THA for PJI. Prospective data were collected on each patient, including demographics, causative organisms, complications, and type of reoperation. The PROMs, including Harris Hip Score, 12-item Short-Form Health Survey, and Western Ontario and McMaster Universities Osteoarthritis Index scores were obtained prior to 2-stage revision THA surgery and annually as part of standard clinical and radiographic follow-up. ResultsA total of 328 patients who underwent a 2-stage revision THA for a PJI were included in the study (mean age 67 years [range, 28 to 90], mean body mass index of 30.6 [range, 15 to 57]). The overall infection-free survivorship for 2-stage revision THA was 73.8% at a minimum of 2 years (range, 2 to 20). Overall, 194 (59.1%) patients who had successful infection eradication underwent a 2-revision THA only. The most common single organisms infected were Staphylococcus aureus (12.5%) and Staphylococcus epidermidis (11%). Higher reoperation rates were found in cases with methicillin-resistant Staphylococcus aureus and polymicrobial infections. All PROMs showed statistical improvement from preoperatively to the latest follow-up appointment. ConclusionsTwo-stage revision THA is associated with a good success rate in the treatment of PJIs at mid-term to long-term follow-up. Polymicrobial and methicillin-resistant Staphylococcus aureus infections are poor prognostic factors, making the eradication of infection more difficult. The management of PJIs continues to be one of the most important orthopaedic challenges to treat.

Evaluation of the Effectiveness of Canadian Cardiovascular Society Guidelines in Minimizing Cardiac Events After Total Hip Arthroplasty

BackgroundThe aim of the study was to analyze the Canadian Cardiovascular Society (CCS) guidelines for routine postoperative troponin testing after elective total hip arthroplasty (THA) to reduce the mortality rate resulting from myocardial injury. The purpose of this study was to assess the prognostic relevance of implementing these guidelines to minimize cardiac events in patients undergoing elective THA. MethodsPatients who underwent THA surgery in 2020 were included in the study. The inclusion criteria were elective THA patients aged ≥45 years, while emergency, revision, and simultaneous bilateral THA surgeries were excluded. The patients were categorized into 4 groups based on the CCS guidelines. ResultsThe study included 669 patients who had an average age of 67 years. There were 43 patients (6.4%), who experienced a rise in troponin levels ≥30 ng/L and developed myocardial injury after noncardiac surgery. Among these patients, 8 developed cardiac complications, and one experienced a serious cardiac event that resulted in death. Notably, there was a significant increase in the length of hospital stay for patients who received the postoperative screening protocol. ConclusionsThe implementation of the CCS guidelines for routine postoperative troponin testing in elective THA surgery did not significantly decrease the rate of cardiac events or mortality.