Total Hip Arthroplasty Research Articles

Perceived Risk of Elective Total Hip Arthroplasty: A Brazilian Hip Society Survey.

As total hip arthroplasty (THA) has become more common and widely available, candidates now often present with multiple risk factors that increase the risk of complications, directly impacting the cost of surgery and provider compensation. The present study was designed to better understand the impact of these factors and the perceptions of hip surgeons in Brazil. All 880 full members of the Brazilian Hip Society (SBQ) were invited to complete an online questionnaire on preoperative risk factors, adapted from the previous American Association of Hip and Knee Surgeons (AAHKS) survey. Statistical analyses of survey response data were performed. A total of 398 responses were received (45.2% of SBQ members). Most (81.7%) work in high-complexity hospitals; 46% have more than 15 years of experience in THA; and 30.2% perform more than 100 THAs/year (47% perform 40 to 100/year). Overall, 56.5% restrict THA eligibility based on modifiable risk factors: 76.6% view malnutrition and 65.8% view poorly controlled diabetes as factors precluding THA; most (89.2%) recommend waiting 6 to 24 months after bariatric surgery. Although 59.5% of respondents turn down candidates who abuse alcohol, 80.9% are willing to operate on smokers and 75.6%, on opioid users. Advanced age was not a relevant factor for 87.2, and 71.1% perceive risk as equal in men and women. Among respondents who restrict THA eligibility, 78% do so based on personal experience or literature, while 32.6% follow the opinion of the patient's primary clinician. 90.4% believe risk-based compensation would expand access to THA. Compared to their peers in Latin America, Asia, Europe, and the United States, SBQ members have a largely similar perception of restrictions to performing THA, but are more willing to operate on smokers and more likely to defer THA in post-bariatric patients. Nearly all favor adjusting surgeon compensation to take patient risk factors into account.

Low-Volume Surgeons Operating at High-Volume Hospitals Have Low Rates of Periprosthetic Joint Infection after Hip and Knee Arthroplasty

IntroductionThe relationship between surgeon and hospital case volumes and postoperative risk following total hip and total knee arthroplasty (THA and TKA) has been described independently. This study aimed to assess the risk of periprosthetic joint infection (PJI) following primary TKA and THA to determine if lower volume surgeons operating at higher volume centers would have lower rates of complications compared to lower volume surgeons operating at lower volume hospitals. MethodsA healthcare database was used to retrospectively identify all primary, and elective total joint arthroplasties (TJAs) from October 2015 to December 2021. Using restricted cubic splines, high-volume hospitals were defined using Markov chain Monte Carlo simulation, which identified a volume beyond which PJI rates no longer decreased significantly with increasing hospital volume. A similar methodology was used to identify low-volume surgeons operating in high- and low-volume hospitals. There were 605,254 patients who underwent TJA (total hip arthroplasty [THA]: 37.71%; total knee arthroplasty [TKA]: 62.29%) by low-volume surgeons (< 57 THAs and < 68 TKAs) identified and divided into high-volume and low-volume hospital cohorts. High-volume hospitals were defined as > 508 THA and > 812 TKAs per year, and low-volume hospitals were defined as < 145 THAs and < 243 TKAs per year. Multivariable models accounting for potential confounding covariates were created to determine the odds of PJI between cohorts. ResultsAfter taking confounding variables into account, low-volume surgeons at high-volume hospitals had lower rates of PJI relative to their counterparts at low-volume hospitals (THA 0.67 versus 0.80%, aOR [adjusted odds ratio] = 0.69 [95% confidence interval (CI) = 0.54 to 0.88], P = 0.002; TKA 0.51 versus 0.69%, aOR = 0.73, [95%-CI = 0.61 to 0.87], P = 0.007). ConclusionIncreasing institutional case volume may mitigate the increased risk of PJI associated with low annual surgeon case volume.

The effect of sacral erector spinae plane block on the quality of recovery after total hip arthroplasty: a prospective, randomized, controlled, multicenter study.

Total hip arthroplasty, commonly performed to alleviate hip pain and enhance functionality in elderly patients, requires effective postoperative pain management to reduce opioid consumption and its associated side effects. A novel regional anaesthesia technique, the sacral erector spinae plane block, has the potential to enhance the quality of postoperative recovery significantly. This prospective, randomized, controlled multicenter study investigated the effects of the sacral erector spinae plane block on recovery quality in patients undergoing total hip arthroplasty. The study comprised 50 patients, divided into Group S (patients receiving patients receiving sacral erector spinae plane block [S-ESPB]) and Group C (patients getting just multimodal analgesia). The primary outcome measured was the Quality of Recovery-15 score 24 hours post-surgery. Secondary outcomes included postoperative numerical rating scale scores (A score of 0 indicates no pain, while 10 indicates the most severe pain), total consumption of rescue analgesics, time to first rescue analgesic administration, patient satisfaction, time to first ambulation, the occurrence of complications, and the need for antiemetics. Group S had markedly higher quality of recovery-15 scores compared to Group C (Group S: median 117 percentiles [97-121]; Group C: median 89 percentiles [75-96]; P<0.001). Group S scored higher in postoperative pain, physical comfort, support, emotional state, and general quality of recovery-15 (P<0.001). Nevertheless, the physical independence category ratings were comparable across both groups (P=0.286). Sacral erector spinae plane block is a promising analgesic technique that enhances postoperative recovery and patient comfort in total hip arthroplasty.

Assessing pain management in total joint arthroplasty using the Detroit interventional pain assessment scale—A prospective cohort study

BackgroundTotal joint arthroplasty (TJA) is an effective treatment for end-stage osteoarthritis, but postoperative pain has been poorly managed. The purpose of this study was to (1) assess how much narcotic medication was prescribed after TJA; (2) assess if patients were satisfied with their pain management; (3) compare these same data between total hip arthroplasty (THA)/total knee arthroplasty (TKA); (4) compare these same data between preoperative opioid users/opioid-naïve patients.MethodsAn IRB-approved prospective study was conducted at a US academic joint replacement practice. Patients were evaluated by an independent observer at three weeks, three months, and six months postoperatively using the Detroit Interventional Pain Assessment (DIPA) scale. Patients verbally rated their pain with their current medication regimen as 0 (no pain), 1 (tolerable pain), or 2 (intolerable pain) on the DIPA scale. Narcotic usage was verified by the Michigan Automated Prescription System (MAPS). Patients were divided into THA, TKA, previously on opioids, and opioid-naïve groups. Provider efficiency scores reflected pain management satisfaction and were calculated as the percentage of patients reporting no pain or tolerable pain.ResultsOut of 200 patients, the percentage of patients using narcotics and their daily usage (MMEs) significantly decreased from 75.5% (27.5 MMEs) at three weeks to 42.9% (5.3 MMEs) at six months (P < 0.001). In 80% of patients, narcotics taken at six months were prescribed by outside providers. Significantly fewer patients used narcotics at six months for THA (15.4%) compared to TKA (52.7%) (P < 0.021). There was a significant difference in daily narcotic usage between patients who took narcotics preoperatively (22.9 MMEs) and opioid-naïve ones (13.4 MMEs) (P < 0.001). Provider efficiency scores were best at three weeks (76.6%) and three months (70%) but declined at six months (57.2%).ConclusionsNarcotic tapering practices were observed as postoperative daily narcotic intake decreased across six months. However, outside providers prescribed 80% of narcotics at six months, necessitating a better-coordinated practice with surgeons. Patients taking preoperative narcotics experienced higher daily MME requirements than their opioid-naïve counterparts. In terms of the percentage of patients on narcotics, THA is a better procedure for tapering patients off narcotics by six months.

Wound complication rates after anterior total hip arthroplasty: A case series comparison of interrupted vs. continuous sutures for skin closure

BackgroundThe anterior approach for total hip arthroplasty (THA) carries a higher risk of wound complications, which can significantly affect patient outcomes and increase healthcare costs. There is limited research comparing infection rates based on closure techniques in patients who undergo THA. Therefore, this study aims to compare wound complications based on interrupted or continuous sutures for skin closure after anterior approach THA. MethodsThis single-surgeon retrospective study extracted data from 388 patients who had undergone a primary THA using the anterior approach. Patient demographics, comorbidities, perioperative factors, and infection-related complications were recorded. All variables associated with a given infection complication were controlled for in a binary logistic regression model. ResultsAfter controlling for confounding variables, wound closure type was not associated with any infectious complications. BMI was a strongly associated factor in PJI (p = 0.028; 95 % CI = 1.02–1.34), prolonged drainage (p < 0.001; 95 % CI = 1.08–1.28), readmission (p = 0.023; 95 % CI = 1.01–1.20), and I&D and revision surgery (p = 0.021; 95 % CI = 1.02–1.31). ConclusionBody mass index was the sole factor associated with a higher risk of wound complications postoperatively. These findings suggest a non-inferiority between continuous and interrupted suture closure techniques regarding wound-related infectious complications in anterior total hip arthroplasty.

Ulcerative Colitis Patients are at Increased Risk for Adverse Events Following Total Hip Arthroplasty

BackgroundPatients who have the autoinflammatory bowel disease ulcerative colitis (UC) may become candidates for total hip arthroplasty (THA). Having UC may predispose patients to postoperative adverse events, but it remains unclear if these events are related more to the disease process itself or perhaps related to the medications used to treat the condition. MethodsPatients undergoing THA were identified from a large administrative dataset. Those who did not have and those who had UC were matched 4:1 based on patient age, sex, and the Elixhauser Comorbidity Index (ECI). Matched THA patients who did not have UC (n = 19,482) and those who had UC (n = 4,874) were identified. The matched groups were compared regarding 90-day adverse and five-year survival. Further analyses were performed based on classes of medications. ResultsControlling for patient age, sex, and ECI, UC patients were at significantly higher odds of 90-day adverse events: any (odds ratio [OR] 1.59), severe (OR 1.72), and minor (OR 1.63) (all P < 0.001). Despite this, no differences in 5-year survival were identified. Relative to those who did not have UC, there were increasing odds of any adverse event based on the potency of related medications: no corticosteroids /immunomodulators/5-aminosalicylic acid (5-ASA) (OR 1.42), corticosteroids only (OR 1.58), 5-ASA ± corticosteroids OR (1.72), and immunomodulators ± corticosteroids (OR 1.74, all P < 0.001). ConclusionsTotal hip arthroplasty patients who have UC were at higher odds for 90-day postoperative adverse events relative to those who did not have UC, and this risk was even greater for those on defined classes of medications. Total hip arthroplasty patients who have UC bear specific considerations, and surgeons must carefully consider and manage the patient’s medication regimen in the perioperative period of the THA.

A Proposed Patient Selection Algorithm for Total Joint Arthroplasty Same-Day Discharge from an Ambulatory Surgery Center

IntroductionIdentifying appropriate patients for same-day discharge total joint arthroplasty (TJA) is critical for maintaining optimal patient safety and outcomes. This study investigated patient outcomes after same-day discharge TJA at a single ambulatory surgery center (ASC) and proposes a TJA patient-selection algorithm based on findings and existing literature. MethodsA retrospective chart review of 660 patients was performed between July 2019 and October 2021 for all patients who underwent primary TJA in a single ASC. Successful same-day discharge (SDD), length of surgery (LOS), estimated blood loss (EBL), complications, and readmission events were recorded for each patient. There were 20 total complications in 331 primary total knee arthroplasties (TKAs) (6.0%) and 15 total complications in 329 primary total hip arthroplasties (THAs) (4.6%). ResultsThere was one direct admission to the hospital in TKA patients and four direct admissions in THA patients, making the successful SDD rate 99.7% in TKAs, 98.8% in THAs, and 99.2% overall. In the TKA cohort, body mass index (BMI) was associated with total complications (r = -0.15, P = 0.006), comorbidities with wound complications (P = 0.006), and EBL was with readmissions (r = 0.30, P < 0.001), revision surgery (r = 0.12, P = 0.04), and total complications (r = 0.16, P = 0.03). In the THA cohort, BMI was weakly associated with wound complications (r = -0.12, P = 0.02), EBL was with emergency department visits (r = 0.18, P = 0.002) and total complications (r = 0.14, P = 0.01). However, there was no direct association between any of the analyzed characteristics and direct admission. ConclusionIn our ASC cohort, patients had low rates of perioperative complications and hospital admissions, supporting the safety of same-day discharge TJA using our proposed evidence-based algorithm to guide patient selection for same-day discharge.

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&lt;0.05). Bromazepam also reduced the ratio of SBP and MAP in theaters before anesthesia (P&lt;0.05). A repeated measures ANOVA showed significant treatment effects for SBP and MAP but not DBP (P&lt;0.001 for both). SBP, DBP, and MAP showed a significant time-treatment effect (P&lt;0.001, 0.019, and&lt;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.

Early adverse outcomes remain challenging to prevent in morbidly obese patients undergoing total hip arthroplasty.

The prevalence of obesity is increasing substantially around the world. Elevated BMI increases the risk of complications following total hip arthroplasty (THA). We sought to evaluate trends in BMI and complication rates of obese patients undergoing primary THA over the last 30 years. Through our institutional total joint registry, we identified 15,455 primary THAs performed for osteoarthritis from 1990 to 2019. Patients were categorized according to the World Health Organization (WHO) obesity classification and groups were trended over time. Cox proportional hazards regression analysis controlling for confounders was used to investigate the association between year of surgery and two-year risk of any reoperation, any revision, dislocation, periprosthetic joint infection (PJI), venous thromboembolism (VTE), and periprosthetic fracture. Regression was stratified by three separate groups: non-obese; WHO Class I and Class II (BMI 30 to 39 kg/m2); and WHO Class III patients (BMI ≥ 40 kg/m2). There was a significant increase in the proportion of all obesity classes from 1990 to 2019, and the BMI values within each WHO class significantly increased over time. Risk of any reoperation did not change over time among non-obese or WHO Class I/II patients, but increased for WHO Class III patients (hazard ratio (HR) 1.04; p = 0.044). Risk of dislocation decreased over time for non-obese (HR 0.96; p < 0.001) and WHO Class I/II (HR 0.96; p = 0.002) patients, but did not change over time for WHO Class III (HR 0.94; p = 0.073) patients. Risks of any revision and PJI did not change over time for any group. The proportion of patients undergoing THA who are obese has increased dramatically at our institution between 1990 and 2019. Despite BMI values increasing within all WHO classes over time, two-year complication risks have remained stable or decreased in WHO Class I/II patients. However, continued efforts will be required to mitigate risks in the heaviest WHO Class III patients.

Dual Mobility Articulations in Primary Total Hip Arthroplasty: Midterm Outcomes from the American Joint Replacement Registry

In recent years, there has been an increased utilization of dual mobility (DM) implants in primary total hip arthroplasty (THA) to mitigate the risk of postoperative hip instability. This study aimed to present midterm outcomes of DM bearings in primary THA using data from the American Joint Replacement Registry (AJRR). Screening was conducted on patients aged ≥ 65 years who underwent primary THA between 2012 and 2018. Patients were categorized into three groups: (1) DM articulation, (2) ≤ 32 mm femoral head, and (3) ≥ 36 mm femoral head. Multivariable statistical modeling was employed to analyze patient and hospital characteristics, minimizing potential confounding variables and identifying independent associations with revision. Cox proportional hazards regression analyses were used to assess all-cause revision and revision specifically for instability. A total of 207,526 primary total hip arthroplasties (THAs) were identified. Among them, 13,896 (6.7%) utilized dual mobility (DM) articulation, 60,358 (29.1%) had a femoral head size of ≤ 32 mm and 133,272 (64.2%) had a femoral head size of ≥ 36 mm. At the eight-year follow-up, the all-cause revision rate was higher in the DM group (3.5%, 95% confidence interval [CI] 3.1 to 4.1) compared to the ≤ 32 mm (2.6%, 95% CI 2.5 to 2.8) and ≥ 36 mm (2.7%, 95% CI 2.5 to 2.9) groups. However, the revision rate for instability was comparable among the DM (0.4%, 95% CI 0.2 to 0.5), ≤ 32 mm (0.5%, 95% CI 0.4 to 0.5), and ≥ 36 mm (0.3%, 95% CI 0.3 to 0.4) groups at eight-year follow-up. The utilization of DM was associated with higher overall revision rates. However, no significant differences in rates of revision for instability were observed among any of the bearing surface groups. These findings may be attributed to surgeons selectively utilizing DM articulations in higher-risk patients.

Medical Malpractice Litigation Following Revision Total Hip and Knee Joint Arthroplasty: A Review of Reported Legal Claims in the U.S. in the Past 20 Years

IntroductionThe increasing incidence of primary total hip (THA) and knee (TKA) arthroplasty has been accompanied by a subsequent rise in revision surgeries. Revision total joint arthroplasty (TJA) is associated with major litigation risk, primarily due to procedural and post-surgical errors. However, the understanding of the causes and outcomes of revision TJA malpractice cases remains unstudied. This study aimed to analyze litigated malpractice claims against orthopaedic surgeons performing revision TJA using a national legal database. MethodsA database was queried for a nationwide analysis of medical malpractice litigation in revision TJA from 2000 to 2023. Data on the time, duration, and locations of the litigations, allegations of surgical negligence, the damages cited, the outcomes of the trials, and indemnities were collected. ResultsOf 110 TJA malpractice cases identified over two decades, 32 cases involving revision THA and TKA surgeries were included in the final analysis. The cases were equally divided between THA and TKA, spanning 16 states, with the highest proportions in New York, Connecticut, and Louisiana. “Procedural error” (28%; n = 9) was the most frequently cited negligence, followed by “post-surgical error” (25%; n = 8) and “failure to treat” (19%; n = 6). The most common damages were “continued pain/mobility limitations” (28%; n = 9) and “infections” (19%; n = 6). Most cases resulted in a verdict for the defense (63%; n = 20). The average indemnity was $5,713,635, with considerable variability. ConclusionThis study presents the leading causes of litigated malpractice claims over the past two decades in the United States in revision TJA as perceived procedural and post-surgical errors, with the most common damages reported being “persistent pain/mobility limitations” and “infections.” Given the rising incidence of revision TJA, orthopaedic surgeons may utilize these trends to better inform patients about the potential risks and outcomes of surgery and mitigate litigation risks.

Is aspirin an effective prophylaxis against VTE in patients undergoing routine total knee or total hip arthroplasty?

Is aspirin an effective prophylaxis against VTE in patients undergoing routine total knee or total hip arthroplasty?

Comparison of Implant Placement Accuracy Between Manual, Robot-Assisted, Computer-Navigated, Augmented Reality Navigated, Patient-Specific Instrumentation, and Accelerometer Navigated Total Hip Arthroplasty: A Systematic Review and Network Meta-Analysis.

Malpositioning of the acetabular cup during total hip arthroplasty (THA) can lead to complications. Robotic surgery and navigation techniques aim to address this issue, but there is limited evidence regarding which method can achieve better clinical outcomes. Therefore, this network meta-analysis (NMA) aimed to compare the efficacy of various navigation methods. This NMA of prospective randomized controlled trials compared robot-assisted systems (RAS), computer-assisted navigation systems (CAS), augmented reality-based portable navigation (AR), patient-specific instrumentation (PSI), portable accelerometer-based navigation (PN), and conventional methods (C) for THA procedures. We searched MEDLINE, EMBASE, Cochrane, Central Register of Controlled Trials, International Clinical Trials Platform Search Portal, and ClinicalTrials.gov. databases. The primary outcomes included revision surgery and postoperative clinical scores, and the secondary outcomes encompassed cup placement accuracy, acetabular cup placement outliers from the Lewinnek safe zone, surgical time, and complications. We used a Bayesian random-effects NMA, and confidence of evidence was assessed using confidence in NMA. We identified 45 studies including 2,122 patients. We did not find large differences in revision surgery, clinical outcome scores, cup inclination, or anteversion angle accuracy among the modalities. AR, CAS, and PSI exhibited a lower risk of outliers from safe zones than C. In addition, RAS and CAS had a longer surgical time than C. Robotic and navigation tools did not reduce the revision risk or enhance clinical outcomes. AR, CAS, PSI, and PN may decrease the risk of cup placement outliers in safe zones. However, the cup placement accuracy was equivalent, and the surgical time may be longer in RAS and CAS than in C. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Enhanced recovery after surgery for hip and knee arthroplasty: A systematic review and meta-analysis on randomized control trials

ObjectivesThis review aimed to compare the efficacy and safety of enhanced recovery after surgery (ERAS) versus traditional care in patients who underwent total hip arthroplasty (THA) and total knee arthroplasty (TKA). MethodsAll randomized controlled trials (RCTs) were acquired via a comprehensive search of multiple databases. A meta-analysis was performed using Cochrane Collaboration's RevMan 5.4 software to calculate effect sizes. ResultsThis meta-analysis included 850 patients in the ERAS group and 845 patients in the control group (patients who received traditional care). The outcomes suggested no significant difference in operative time, intraoperative blood loss, visual analogue scale, 30-day readmission rate, and mortality rate between the two groups. However, the ERAS group was associated with a significant decrease in transfusion rate, hospital length of stay, and postoperative complications. Moreover, the ERAS group had higher Hospital for Special Surgery scores and satisfaction rates. ConclusionsPatients who underwent THA and TKA would benefit more from ERAS than traditional care.

Contemporary insights into spinopelvic mechanics.

Understanding spinopelvic mechanics is important for the success of total hip arthroplasty (THA). Despite significant advancements in appreciating spinopelvic balance, numerous challenges remain. It is crucial to recognize the individual variability and postoperative changes in spinopelvic parameters and their consequential impact on prosthetic component positioning to mitigate the risk of dislocation and enhance postoperative outcomes. This review describes the integration of advanced diagnostic approaches, enhanced technology, implant considerations, and surgical planning, all tailored to the unique anatomy and biomechanics of each patient. It underscores the importance of accurately predicting postoperative spinopelvic mechanics, selecting suitable imaging techniques, establishing a consistent nomenclature for spinopelvic stiffness, and considering implant-specific strategies. Furthermore, it highlights the potential of artificial intelligence to personalize care.

Patient and Surgical Factors Associated with Long-term Mortality Outcomes up to Fifteen Years after Total Hip and Knee Arthroplasty: An Australian Orthopaedic Association National Joint Replacement Registry Study

Patient and Surgical Factors Associated with Long-term Mortality Outcomes up to Fifteen Years after Total Hip and Knee Arthroplasty: An Australian Orthopaedic Association National Joint Replacement Registry Study

Indications and Outcomes of Conversion Total Hip Arthroplasty via the Anterior and Posterior Approaches

Indications and Outcomes of Conversion Total Hip Arthroplasty via the Anterior and Posterior Approaches

Is there a difference between modular versus monoblock femoral stem used during revision total hip arthroplasty?

Response/Recommendation The literature delineates distinct differences between modular and monoblock femoral stems in revision total hip arthroplasty (rTHA), each presenting unique advantages and limitations. Modular stems offer intraoperative flexibility, enabling precise restoration of leg length and offset. However, they are associated with complications such as junctional fatigue, corrosion, and implant breakage, and they incur much higher costs compared to monoblock stems. In contrast, monoblock stems provide enhanced mechanical stability and no risk of modular junction complications, though their implantation is technically more challenging. Both modular and monoblock femoral stem designs perform well in revision THA, exhibiting no significant differences in long-term (3-5 years) clinical outcomes or subsidence rates. The choice between modular and monoblock stems should be tailored to individual patient needs and specific clinical scenarios. LEVEL OF EVIDENCE: Moderate. DELEGATES VOTE: 92.7% Agree, 5.7% Disagree, 1.7% Abstain.

Clinical and Radiographic Outcomes of a Long Cementless Monobloc Stem for Revision Total Hip Arthroplasty Due to Chronic Periprosthetic Infection

BackgroundA long cementless monobloc stem is widely used for aseptic loosening, with satisfactory five-to-ten-year outcomes reported. Nonetheless, related studies on chronic periprosthetic joint infection (PJI) are scant. This study evaluated the clinical and radiographic outcomes of the stem in two-stage revisions due to PJI. MethodsThis prospective multicenter cohort study consisted of patients from three medical centers who were enrolled in a single arm from January 2017 to May 2022. All patients were diagnosed with chronic PJI based on International Consensus Meeting (ICM) criteria and underwent two-stage revisions using a long monobloc cementless revision stem. Among 44 patients, 37 (12 women and 25 men) completed an average follow-up of 35.6 months (range, 14 to 75). The primary outcome was the stability of the stem; secondary outcomes included infection eradication, Harris hip score, leg length discrepancy, major complications, and isolated pathogens at intraoperative cultures. ResultsAt one year after revision, the infection-free prosthesis survival rate was 97.3% (95% CI [confidence interval]: 96.4 to 98.2%). At the last follow-up, the mean subsidence was 2.9 ± 2.1 mm (range, 0.8 to 4.8). Postoperative leg length discrepancy averaged −4.6 ± 4.9 mm (range, −16 to 0). The Engh score averaged 14.1 ± 6.9 (range, 0 to 22). The Harris hip score improved from a preoperative average of 35.7 ± 8.5 (range, 12 to 50) to 80.4 ± 9.3 (range, 58 to 92) at the 1-year postoperative follow-up (P < 0.01). ConclusionThe long cementless monobloc stem used in the current study presents a feasible option for two-stage revision in cases of chronic PJI. The bone ingrowth and stability could be observed within the short follow-up time.

Planning Accuracy and Stem Offset Assessment in Digital Two-Dimensional Versus Three-Dimensional Planning in Cementless Hip Arthroplasty: A Systematic Review and Meta-Analysis.

Background/Objectives: Total hip arthroplasty (THA) planning is crucial for restoring hip function and minimizing complications. The present systematic review and meta-analysis aimed to assess and compare the accuracy of 2D versus 3D preoperative planning in THA. Methods: The inclusion criteria were randomized controlled trials (RCTs) and observational studies (ROSs) published in English comparing the accuracy of 2D and 3D preoperative planning for total hip arthroplasty. We excluded review articles, registers, studies not written in English, studies that did not report the cup sizing accuracy or stem sizing accuracy or give a description of the preoperative planning method used, and non-comparative studies. In June 2024, following the PRISMA 2020 statement, a systematic review and a meta-analysis of the literature were conducted in PubMed, Scopus, and the Cochrane Library. The statistical analysis software Review Manager (RevMan) version 5.4 was used to perform the meta-analysis to compare the accuracy of 2D and 3D planning, and to assess the risk of bias, the ROBINS-I tool was used. Results: The analysis included 777 patients from six studies. The analysis showed that 3D planning offers superior precision compared to 2D planning, both for the cup (96.92% vs. 87.14%) and the stem (94.72% vs. 86.28%). The forest plots assessed a better trend for 3D planning in terms of exact size prediction and accuracy within ±1 size. Conclusions: The three-dimensional method was more precise and accurate than two-dimensional planning, both for the stem and the cup. It offered a detailed three-dimensional view of the patient's anatomy. The main limitation was the challenge in finding homogeneous data regarding biomechanical parameters, surgical approaches, and different planning systems for both three-dimensional and two-dimensional methods.