Total Hip Arthroplasty Cohort Research Articles

LONG-TERM RESULTS OF THE BIRMINGHAM HIP RESURFACING IMPLANT IN THE UNITED STATES: AN UPDATED ANALYSIS OF A SINGLE INSTITUTION'S EXPERIENCE

We previously reported the five to ten-year results of the Birmingham Hip Resurfacing (BHR) implant. The purpose of this study was to evaluate the survivorship, radiographic results, and clinical outcomes of the BHR at long-term follow-up.We retrospectively reviewed 250 patients from the original cohort of 324 BHRs performed from 2006 to 2013 who met contemporary BHR indications. Of these, 4 patients died and 4 withdrew. From the 242 patients, 224 patients (93%) were available for analysis. Modified Harris hip score (mHHS) and University of California, Los Angeles (UCLA) scores were collected and compared to a matched total hip arthroplasty (THA) cohort. Mean follow-up was 14 years.Survivorship free of aseptic revision was 97.4% and survivorship free of any revision was 96.0% at 15 years. Revisions included 3 periprosthetic joint infections, 2 for elevated metal ions and symptomatic pseudotumor, 2 for aseptic femoral loosening, and 1 for unexplained pain. The mean mHHS was 93 in BHR patients at final follow-up, similar to the THA cohort (p=0.44). The UCLA score was significantly higher for BHR patients (p=0.02), however there were equal proportions of patients who remained highly active (UCLA 9 or 10) in both groups, 60.5% and 52.2% (p=0.45) for BHR and THA respectively. Metal ion levels at long term follow-up were low (mean serum cobalt 1.8±1.5 ppb and mean serum chromium 2.2±2.0 ppb).BHR demonstrated excellent survivorship in males less than 60 years of age at time of surgery. Clinical outcomes and activity levels were similar to THA patients. Failures related to the metal-on-metal bearing were rare and metal levels were low at long-term follow-up.Level of evidence: IIIKeywords: survivorship; hip arthroplasty; activity; metal-on-metalSurface Replacement Arthroplasty demonstrates low revision rates and similar activity level compared to total hip arthroplasty at long-term follow-up.

Impact of diabetic kidney disease on post-operative complications after primary elective total hip arthroplasty: a nationwide database analysis

BackgroundThe high prevalence of diabetic kidney disease (DKD) in the United States necessitates further investigation into its impact on complications associated with total hip arthroplasty (THA). This study utilizes a large nationwide database to explore risk factors in DKD cases undergoing THA.MethodsThis research utilized a case–control design, leveraging data from the national inpatient sample for the years 2016 to 2019. Employing propensity score matching (PSM), patients diagnosed with DKD were paired on a 1:1 basis with individuals free of DKD, ensuring equivalent age, sex, race, Elixhauser Comorbidity Index (ECI), and insurance coverage. Subsequently, comparisons were drawn between these PSM-matched cohorts, examining their characteristics and the incidence of post-THA complications. Multivariate logistic regression analysis was then employed to evaluate the risk of early complications after surgery.ResultsDKD's prevalence in the THA cohort was 2.38%. A 7-year age gap separated DKD and non-DKD patients (74 vs. 67 years, P < 0.0001). Additionally, individuals aged above 75 exhibited a substantial 22.58% increase in DKD risk (49.16% vs. 26.58%, P < 0.0001). Notably, linear regression analysis yielded a significant association between DKD and postoperative acute kidney injury (AKI), with DKD patients demonstrating 2.274-fold greater odds of AKI in contrast with non-DKD individuals (95% CI: 2.091–2.473).ConclusionsThis study demonstrates that DKD is a significant risk factor for AKI in patients undergoing total hip arthroplasty. Optimizing preoperative kidney function through appropriate interventions might decrease the risk of poor prognosis in this population. More prospective research is warranted to investigate the potential of targeted kidney function improvement strategies in reducing AKI rates after THA. The findings of this study hold promise for enhancing preoperative counseling by surgeons, enabling them to provide DKD patients undergoing THA with more precise information regarding the risks associated with their condition.

Revision Surgery Risk After Open Reduction and Internal Fixation Versus Acute Total Hip Arthroplasty in Geriatric Acetabular Fractures: A Nationwide Study.

The aging population has contributed to a rising incidence of acetabular fractures in older patients, yet current evidence guiding surgical treatment is limited by small sample sizes. This study used a nationwide database to investigate outcomes in older patients undergoing open reduction and internal fixation (ORIF) versus acute total hip arthroplasty (THA). The PearlDiver database was queried for patients aged 60 years and older with an acute acetabular fracture who underwent ORIF or acute THA (2010 to 2021). ORIF patients were matched 1:1 to THA patients based on age, sex, US region, insurance plan, and Charlson Comorbidity Index score. Patients with less than 2 years of follow-up were excluded. The primary outcome was revision surgery. Of 120,032 patients with an acetabular fracture, 3,768 (3.1%) underwent surgical treatment: 1,482 (39.3%) THA and 2,286 (60.7%) ORIF. Mean age was 71.0 ± 6.51 years. Mean follow-up duration was 5.2 ± 2.1 years. THA patients were slightly older (72.4 versus 70.2 years), had higher Charlson Comorbidity Index scores (3.3 versus 2.7), and had a higher percentage of female patients (62.5% versus 32.2%). After matching, 962 ORIF and 962 THA patients were included. ORIF patients had longer LOS (10.7 versus 8.1 days). ORIF patients were less likely to experience joint infections and periprosthetic fractures, but more likely to experience transfusions. The overall revision surgery rate within 10 years was 14.8% in the ORIF cohort and 6.2% in the THA cohort. In the ORIF cohort, 13.5% of patients had a delayed conversion to THA. In this large national database, acute with or without internal fixation for geriatric acetabular fractures was associated with lower rates of revision surgery within 10 years when compared with a matched cohort undergoing ORIF. ORIF was associated with increased LOS, increased transfusion risk, and lower risk of joint infection and periprosthetic fracture. III.

Comparison of iliopsoas tendonitis after hip resurfacing arthroplasty and total hip arthroplasty: A case-controlled investigation using a validated simulation.

Iliopsoas tendonitis, typically caused by impingement with the acetabular cup, occurs in up to 18% of patients after total hip arthroplasty (THA) and up to 30% of patients after hip resurfacing arthroplasty (HRA). We have developed a simulation for detecting iliopsoas impingement and validated it in a previous study of THA patients. However, due to the difference in incidence between HRA and THA, this study had two aims. First, to validate the simulation in a cohort of HRA patients and, second, to comparethe results of the HRA and THA patients to understand any differences in their etiology. We conducted a retrospective search in an experienced surgeon's database for HRA patients with iliopsoas tendonitisand control patients without iliopsoas tendonitis, resulting in two cohorts of 12 patients. Using CT scans, 3D models of the each patient's prosthetic and bony anatomy were generated, landmarked, and simulated. Regarding validation of the simulation for HRA patients, impingement significantly predicted the probability of iliopsoas tendonitis in logistic regression models and the simulation had a sensitivity of 83%, specificity of 100%, and an AUC ROC curve of 0.95. Unexpectedly, the HRA cohort exhibited less impingement than the THA cohort. Our novel simulation has now been demonstrated to detect iliopsoas impingement and differentiate between the symptomatic and asymptomatic cohorts in investigations of THA and HRA patients. This tool has the potential to be used preoperatively, to guide decisions about optimal cup placement, and postoperatively, to assist in the diagnosis of iliopsoas tendonitis.

The Relationship of Cup Inclination and Anteversion in the Coronal Plane with Ante-Inclination in the Sagittal Plane: Exposing the Fallacy of Cup Safe Zones.

This study aimed to establish an equation for calculating cup ante-inclination (AI) from radiographic cup inclination and anteversion, to validate this equation in a total hip arthroplasty (THA) cohort, and to test whether achieving previously described radiographic cup inclination and anteversion targets would also satisfy sagittal cup AI targets. A mathematical equation linking cup AI, radiographic inclination (RI), and anteversion (RA) was determined: tan(AI) = tan(RA)/cos(RI). Supine and standing anteroposterior and lateral radiographs of 440 consecutive THAs were assessed to measure cup RI and RA and spinopelvic parameters, including cup AI, using a validated software tool. Whether orientation within previously defined RI and RA targets was associated with achieving the AI target and satisfying the sagittal component orientation (combined sagittal index, 205° to 245°) was tested. The cups in the THA cohort had a measured mean inclination (and standard deviation) of 43° ± 7°, anteversion of 26° ± 9°, and AI of 34° ± 10°. The calculated cup AI was 34° ± 12°. A strong correlation existed between measured and calculated AI (r = 0.75; p < 0.001), with a mean error of 0° ± 8°. The inclination and anteversion targets were both satisfied in 194 (44.1%) to 330 (75.0%) of the cases, depending on the safe zone targets that were used, and 311 cases (70.7%) satisfied the AI target. Only 125 (28.4%) to 233 (53.0%) of the cases satisfied the AI target as well as the inclination and anteversion targets. Satisfying inclination and anteversion targets was not associated with increased chances of satisfying the AI target. Achieving optimal cup inclination and anteversion does not ensure optimal orientation in the sagittal plane. The equation and nomograms provided can be used to determine and visualize how the 2 planes used for evaluating the cup orientation and the pertinent angles relate, potentially aiding in preoperative planning.

Total hip and knee arthroplasty in HIV- and HCV-positive hemophilia patients: short term follow-up of 14 patients

BackgroundHaemophilic arthropathy (HA) is a common comorbidity of haemophilia. Some people with haemophilia (PWH) were human immunodeficiency virus (HIV)-positive. Arthroplasty is an effective treatment for end-stage HA. This study was carried out to report the effectiveness and satisfaction following total hip arthroplasty (THA) or total knee arthroplasty (TKA) in PWH with HIV.Patients and methodsAll patients with haemophilia and HIV undergoing THA or TKA in our centre from January 2015 to June 2020 were reviewed. All patients were followed for at least twenty-four months. The improvements in postoperative indicators were evaluated at the latest follow-up, including the Visual Analogue Scale (VAS) score, range of motion (ROM), and validated joint scores such as Knee Society Score (KSS; clinical and functional) and Harris Hip Score (HHS). The complications and satisfaction were analysed likewise. Those were utilized to weigh the risks and benefits of the procedure in the population.ResultsFourteen patients (7 hips and 14 knees) were included in the study. The follow-up of the THA cohort was 53.3 months (range, 27–82) and the TKA cohort was 50.1 months (range, 25–85), respectively. The average VAS score was ameliorated from 7.3 to 3.0 and 6.6 to 2.8 in the two groups (P < .001, respectively). Similarly, two cohorts (THA and TKA) showed statistically significant changes in the extension and flexion ROM between the preoperative and the latest follow-up (P < .05, P < .001, respectively). Besides, statistically significant differences between the preoperative and final follow-up values of HHS (from 41.6 to 82.3), clinical KSS (from 34.8 to 72.8), and functional KSS (from 42.9 to 73.2) were observed (P < .001, respectively). Notably, there were 4 complications noted among 21 arthroplasties performed, giving a 19.0% complication rate. Based on the satisfaction score, the majority of patients were optimistic about the arthroplasty.ConclusionGiven these findings, THA or TKA of the PWH with HIV is a worthwhile procedure and can be performed by an experienced and collaborative multidisciplinary team in a tertiary centre with a good haemophilia care system.

Readmission rate and healthcare utilization outcomes of computer-assisted fluoroscopy-based hip navigation versus manual total hip arthroplasty

ABSTRACT Introduction The study evaluates the technology of fluoroscopy-based hip navigation that has shown to improve implant positioning in total hip arthroplasty (THA). Methods Premier Healthcare data for patients undergoing manual THA or fluoroscopy-based hip navigation THA between 1 January 2016-30 September 2021, were analyzed 90- and 365-day post-THA. The primary outcome was inpatient readmission. Secondary outcomes were operating room (OR) time, length of stay, discharge status, and hospital costs. Baseline covariate differences were balanced using fine stratification and analyzed using generalized linear models. Results Among 4,080 fluoroscopy-based hip navigation THA and 429,533 manual THA balanced patients, hip-related readmission rates were statistically significantly lower for the fluoroscopy-based hip navigation THA cohort vs. manual THA for both 90-day (odd ratio [95% CI]: 0.69 [0.52 to 0.91] and 365-day (0.63 [0.49 to 0.81] follow-up. OR time was higher with fluoroscopy-based hip navigation THA vs. manual THA (134.65 vs. 132.04 minutes); however, fluoroscopy-based hip navigation THA patients were more likely to be discharged to home (93.73% vs. 90.11%) vs. manual THA. Hospital costs were not different between cohorts at 90- and 365-day post-operative. Conclusions Fluoroscopy-based hip navigation THA resulted in fewer readmissions, greater discharge to home, and similar hospital costs compared to manual THA.

Poster 363: Post-Operative Protein Supplementation following Orthopaedic Surgery: A Systematic Review

Objectives: Decreased mechanical loading after orthopaedic surgery predisposes patients to develop muscle atrophy. The purpose of the study was to assess whether oral protein supplementation can help decrease postoperative muscle atrophy and/or improve patient outcomes following orthopaedic surgery. Methods: A systematic review of the literature was performed following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The review was registered with the Prospective Register of Systematic Reviews (PROSPERO). A search of the PROSPERO registration did not identify similar prior systematic reviews or meta-analyses. Databases were searched during April 2021 and included: MEDLINE (Pubmed), Embase, Scopus, and Web of Science. Each search contained a combination of the following terms: “orthopaedic procedures” AND “protein” OR “amino acid” AND “dietary supplements” OR “supplementation” OR “supplement.” Orthopaedic procedures were listed individually using the PubMed index of orthopaedic procedures, as well as using the mesh function to extract articles with orthopaedic procedures listed as keywords. Eligibility Criteria The principal inclusion criteria consisted of randomized controlled trials evaluating protein or amino acid regimens as a measure to counteract muscle atrophy following orthopaedic surgery. Articles that evaluated other forms of dietary supplementation or non-orthopaedic procedures were excluded. Control groups included either placebo or a natural history control (i.e. routine post-operative protocol). The scope of surgery was intentionally left broad, to allow for a comparison of protein supplementation effectiveness across different surgical interventions. Each study’s reference list was manually reviewed for additional articles to prevent unintentional exclusion of studies. Two reviewers independently assessed all articles identified by the search strategy and applied the eligibility criteria. Data Extraction The content extracted from each article included: (1) demographic data, (2) protein supplement regimen used, (3) outcomes, (4) complications, and (5) length of follow up. Primary outcomes included functional or physiologic measures of muscle atrophy or strength. Secondary outcomes included patient satisfaction and time to return to sport or work. Data Analysis Quality assessment of studies was performed using Modified Coleman Methodology Scoring (MCMS). Heterogeneity of study design was noted including differences in protocols, measurement techniques, and outcomes measured, which prevented an adequate statistical comparison for meta-analysis. Results: Fourteen studies including 611 patients (224 male, 387 female) were analyzed (Figure 1). Four surgical cohorts were identified: Anterior cruciate ligament reconstruction (ACLR), total hip arthroplasty (THA), hip fractures (THA, revision THA, hip resurfacing), and total knee arthroplasty (TKA). The ACLR, THA, and hip fracture cohorts were each composed of 3 studies, while there were 5 studies in the TKA cohort. Average length of follow-up was 9 weeks for ACLR, 7 weeks for THA, 10 weeks for hip fracture, and 7 weeks for TKA. Protein supplementation included various combinations of essential amino acids in tablet form or whey protein powder. Placebo supplements were most commonly an isocaloric carbohydrate tablet or powder. Protein supplementation was reported to have beneficial effects across all types of identified surgeries. The primary benefit was decreased muscle atrophy measured by muscle cross sectional area. The most significant difference in muscle atrophy was observed in the final week of follow-up for the majority of studies (average follow up was 8 weeks). Multiple studies also demonstrated improved functional measures, including increased muscle function measured by isokinetic muscle strength. Of note, most participants were involved in some form of formal physical therapy for varying durations after surgery, but this was not standardized across all studies. There were no significant increases in side effects reported comparing protein supplementation cohorts to controls. Of the included investigations, only 2 studies (both for hip fracture) had participants follow a standardized diet. Average MCMS scores for each surgical cohort were as follows: ACLR 55 (fair), TKA 55 (fair), THA 46 (poor), hip fracture 44 (poor). Conclusions: In conclusion, protein supplementation appears to have beneficial effects on mitigating muscle atrophy in the postoperative period following ACLR, THA, TKA, and surgical treatment of hip fracture. This response often correlates with improved functional measures and quicker achievement of rehabilitation benchmarks. Further research is needed to establish standardized supplementation regimens and guidelines for improving clinical outcomes in the postoperative period.

Intersurgeon Variability of Minimal Clinically Important Difference for Worsening Achievement Rates After Total Joint Arthroplasty

BackgroundUsing the Patient-Reported Outcome Measurement Information System, we sought to evaluate surgeon performance variability via minimal clinically important difference for worsening (MCID-W) achievement rates in primary and revision total knee and hip arthroplasty. MethodsThis retrospective study analyzed 3,496 primary total hip arthroplasty (THA), 4,622 primary total knee arthroplasty (TKA), 592 revision THA, and 569 revision TKA patients. Patient factors collected included demographics, comorbidities, and Patient-Reported Outcome Measurement Information System physical function short form 10a scores. Surgeon factors collected included caseload, years of experience, and fellowship training. The MCID-W rate was calculated as the percent of patients in each surgeon’s cohort who achieved MCID-W. Distribution was presented via a histogram with associated average, standard deviation, range, and interquartile range (IQR). Linear regressions were performed to evaluate the potential correlation between surgeon- and patient-level factors with MCID-W rate. ResultsThe average MCID-W rates of the surgeons represented in the primary THA and TKA cohorts were 12.7 ± 9.2% (range, 0 to 35.3%; IQR, 6.7 to 15.5%) and 18.0 ± 8.2% (range, 0 to 36%; IQR, 14.3 to 22.0%). The average MCID-W rates among the revision THA and TKA surgeons were 36.0 ± 22.2% (range, 9.1 to 90%; IQR, 25.0 to 41.4%) and 21.2 ± 7.7% (range, 8.1 to 37.0%; IQR, 16.6 to 25.4%). Strong correlations were not found between patient- or surgeon-level factors and MCID-W rate of the surgeon. ConclusionWe demonstrated variance in MCID-W achievement rates across surgeons in both primary and revision joint arthroplasty, independent of patient- or surgeon-level factors.

Hip Resurfacing is Associated with Significantly Shorter Length of Stay and Increased Postoperative Mobilization than Total Hip Arthroplasty

AbstractMetal-on-metal hip resurfacing (HRA) is performed as an alternative for total hip arthroplasty (THA) for symptomatic hip osteoarthritis in young, active male patients. This article seeks to determine if there is a difference in postoperative pain, mobilization, and opioid consumption between HRA and THA. A single-institution total joint arthroplasty database was utilized to identify adult patients who underwent elective HRA or THA between 2016 and 2019. Baseline demographic data along with operative time and Charlson Comorbidity Index (CCI) were collected. Patients were matched by age, sex, race, smoking status, body mass index (BMI), and CCI. Morphine milligram equivalents (MME) and visual analog scale scores were collected. Activity Measure for Post-Acute Care (AM-PAC) was used to determine physical therapy progress. A total of 7,387 cases were identified: 96.59% THA (7,135) and 3.41% HRA (252). HRA patients were significantly younger (52.52 vs. 64.04 years; p &lt; 0.001), had higher BMI (30.03 vs. 29.40; p = 0.029), and were almost exclusively male as compared with the THA cohort (98.8% vs. 42.2%; p &lt; 0.001). HRA patients had lower CCI scores (0.36 vs. 1.14; p &lt; 0.001). Surgical time was greater for HRA (124.81 vs. 103.82 minutes; p &lt; 0.001). HRA patients had significantly shorter length of stay (LOS) than THA patients (1.17 vs. 1.48 days; p &lt; 0.001) and had significantly better AM-PAC scores (21.52 vs. 20.65; p = 0.032). HRA patients exhibited a trend toward home discharge (0.4% vs. 2.4%; p = 0.057). Aggregate opioid consumption (23.63 vs. 27.89 MME; p = 0.321) and pain scores (3.47 vs. 3.28; p = 0.438) were not different between matched cohorts. HRA patients are younger, almost exclusively male, and have lower CCI scores at time of surgery. HRA is associated with significantly shorter LOS and greater mobilization measures. They tended to have a higher rate of home discharge. Both groups had similar pain scores and opioid consumption. Level III Retrospective Cohort Study.

Preoperative Patient Optimization: Outcomes from Elective Total Joint Arthroplasty in a Large US Healthcare System.

Patient factors are known to affect outcomes in arthroplasty surgery. A preoperative program to address modifiable factors may aid in more appropriate patient selection. We sought to assess patient selection and 90-day postoperative outcomes for total joint arthroplasty (TJA) candidates before and after implementation of a preoperative optimization protocol. A retrospective time-trend study using data from an integrated healthcare system's total joint replacement registry was done. The study sample consisted of patients aged 18 years or older who underwent primary elective total hip arthroplasty (THA) and total knee arthroplasty (TKA) for osteoarthritis between 2009 and 2019. Patients were divided into two cohorts: procedures performed from 2009 to 2013 ("preoptimization protocol") and those from 2015 to 2019 ("postoptimization protocol"); 2014 was excluded because an evidence-based preoperative patient optimization protocol was progressively implemented throughout the year. Patient characteristics, optimization factors, and 90-day outcomes (including emergency department [ED] visits, readmission, all-cause revision, deep infection, venous thromboembolism, and mortality) were compared between the two cohorts using the Pearson chi-square test or Wilcoxon test. The study sample included 25,925 THA and 60,484 TKA. In the THA cohort, 10,364 (40.0%) and 15,561 (60.0%) were from the preoptimization and postoptimization cohorts, respectively. The postoptimization THA cohort saw lower rates of ED visits (12.1% vs. 9.4%, P < 0.001) and readmissions (5.6% vs. 3.8%, P < 0.001). In the TKA cohort, 24,054 (39.8%) and 36,430 (60.2%) were from the preoptimization and postoptimization cohorts, respectively. The postoptimization TKA cohort saw lower rates of ED visits (13.1% vs. 11.9%, P < 0.001), readmissions (5.6% vs. 3.0%, P < 0.001), all-cause revisions (0.5% vs. 0.3%, P = 0.003), venous thromboembolism (1.3% vs. 0.9%, P < 0.001), and mortality (0.3% vs. 0.2%, P = 0.011). An evidence-based protocol to improve patient selection based on modifiable patient factors was adopted by orthopaedic surgeons in the system and utilization of the protocol before TJA was associated with fewer postoperative complications over time. Level IV.

Cutibacterium positive cultures in total joint arthroplasty: a comparison of the hip, knee, and shoulder.

Cutibacterium spp. (formerly Propionibacterium) is a slow growing, Gram-positive, anaerobic bacteria and is an emerging clinical entity in prosthetic joint infection (PJI). This study compares the presentation, surgical management, and post-operative antibiotic therapy of patients with positive intraoperative cultures during revision total joint arthroplasty (TJA) of the hip, knee, and shoulder. This was a retrospective cohort study of patients from 2014 to 2020 of 57 revision TJAs (27 total hip arthroplasty (THA), 17 total shoulder arthroplasty (TSA), and 13 total knee arthroplasty (TKA)) with intraoperative cultures positive for Cutibacterium at a tertiary academic centre. Patient demographics, pre-operative labs, radiographs, and aspirate results were collected. Intraoperative data was reviewed. Post-operative antibiotic therapy and repeat infections were recorded. Data was compared with univariate analyses. There was no significant difference in pre-operative lab values between the cohorts. All cohorts had >58% radiographic lucency. Revision TSA patients had significantly fewer pre-operative aspirates. Six patients undergoing revision THA, three TKA and one TSA had a repeat infection requiring further surgery. Four in the THA cohort and one in the TKA cohort with repeat infections did not receive prolonged antibiotic therapy. Cutibacterium is an infectious agent that can present in an indolent fashion after TJA. It commonly causes progressive radiographic lucency. The workup and post-operative management differs in the hip, knee, and shoulder, which is likely due to existing literature guiding physician practice. In all joints, Cutibacterium is a virulent pathogen that can cause repeat infections requiring surgical treatment.

The AAHKS Best Podium Presentation Research Award: A Second Dose of Dexamethasone Reduces Postoperative Opioid Consumption and Pain in Total Joint Arthroplasty

BackgroundThe optimal administration of dexamethasone for postoperative pain management and recovery following primary elective total joint arthroplasty (TJA) remains unclear. This study aimed to evaluate the effect of a second intravenous (IV) dose of dexamethasone on postoperative pain scores, inpatient opioid consumption, and functional recovery after total hip arthroplasty (THA) and total knee arthroplasty (TKA). MethodsA retrospective review was conducted of 2,256 primary elective THAs and 1,951 primary elective TKAs between May 2020 and April 2021. Patients who received 2 perioperative doses (2D) of dexamethasone 10 mg IV were propensity-matched 1:1 to a control group who received 1 perioperative dose (1D). Primary outcomes were opiate consumption as morphine milligram equivalences (MMEs), postoperative pain as Verbal Rating Scale (VRS) pain scores, and functional status assessed by the Activity Measure for Post-Acute Care (AM-PAC) scores. ResultsThe 2D THA and 2D TKA cohorts consumed significantly less opiates at the 24 to 48-hour and 48 to 72-hour intervals. The 2D TKA cohort had significantly lower total opiate consumption compared to the 1D TKA cohort. Compared to the 1D cohorts, the 2D THA cohort and 2D TKA cohorts had significantly lower pain scores at the 48 to 60-hour interval; additionally, the 2D TKA cohort had significantly lower pain scores in the 36 to 48-hour interval. AM-PAC scores did not differ between cohorts for both TKA and THA at any interval. ConclusionThe administration of a second perioperative dexamethasone dose significantly decreased opioid consumption in the immediate postoperative period. Inpatient opioid administration can be significantly reduced while maintaining comparable functional recovery and superior pain control. Level III EvidenceRetrospective Cohort Study.

Contralateral Total Hip Arthroplasty Staged Within Six Weeks Increases the Risk of Adverse Events Compared to Unilateral Surgery

BackgroundThe ideal timing for bilateral total hip arthroplasty (THA) remains controversial. This study compared 90-day outcomes after simultaneous bilateral THA and contralateral surgery in staged bilateral THA to a matched cohort of unilateral procedures. MethodsPatients undergoing primary, elective THA during 2015 to 2020 were reviewed in a national database. Of the 273,281 patients identified, 39,905 (14.6%) were bilateral. Patients were divided into cohorts of unilateral THA, simultaneous bilateral THA, and staged bilateral THA at 1 to 14 days, 15 to 42 days, 43 to 90 days, and 91 to 365 days. Bilateral THA cohorts were matched with unilateral THA patients based on demographics and comorbidities. Ninety-day outcomes after the second THA were compared between matched groups. ResultsSimultaneous bilateral THA resulted in higher rates of transfusion (odds ratio [OR] 4.43, 95% confidence interval 2.31-2.63, P < .001), readmission (OR 2.60, 2.01-3.39, P < .001), and any complication (OR 1.86, 1.55-2.24, P < .001) compared to unilateral THA. Contralateral THA staged at 1 to 14 days increased the risk of readmission (OR 1.83, 1.49-2.24, P < .001) and any complication (OR 1.45, 1.26-1.66, P < .001) relative to unilateral THA. Contralateral THA staged at 15 to 42 days increased the risk of periprosthetic joint infection (OR 3.15, 1.98-5.19, P < .001), readmission (OR 1.92, 1.55-2.39, P < .001), and any complication (OR 1.70, 1.46-1.97, P < .001). Contralateral THA staged beyond 42 days resulted in similar or decreased rates of adverse events relative to unilateral THA. ConclusionsBilateral THA should be staged a minimum of 6 weeks apart in appropriately selected patients to avoid an increased risk of adverse events after the second THA compared to unilateral THA.

Hip Arthroscopy Results in Similar Short-Term Function Compared to Total Hip Arthroplasty in Patients of Similar Demographic Profiles

PurposeTo review short-term functional outcomes in patients who underwent hip arthroscopy and to compare their outcomes to those of a demographically similar cohort who underwent total hip arthroplasty (THA).MethodsData were prospectively collected and retrospectively reviewed for patients undergoing hip arthroscopy (SCOPE) between April 2008 and October 2015. SCOPE patients were included if they were ≥35 years, had preoperative and postoperative 2-year follow-up, and had no prior hip condition or ipsilateral hip surgery. SCOPE patients were matched 1:1 to a demographically similar cohort of patients who underwent THA at our institution. Matching criteria included similar age (within 5 years), gender, and body mass index (within 5). SCOPE patients were assessed with modified Harris Hip Score (mHHS), non-arthritic hip score, and visual analogue scale (VAS). THA patients were assessed with mHHS, forgotten joint score, and VAS.ResultsSixty-seven patients were included in each cohort. Patients who underwent hip arthroscopy for management of labral tears achieved nearly equivalent mHHS, Health Survey Short Form (SF-12) Mental, SF-12 Physical, Veterans RAND 12 Item Health Survey (VR-12) Mental, VR-12 Physical scores at latest follow-up compared to demographically similar patients who underwent THA. There was no significant difference in mHHS scores (SCOPE = 82.9 ± 16.4 vs THA = 87.3 ± 15, P = .095) between the 2 group groups. In addition, average patient satisfaction on a 10-point scale was 8.1 for the SCOPE cohort and 8.8 for the THA cohort (P = .052).ConclusionsOur results show that hip arthroscopy, when performed in patients with the appropriate indications, can lead to comparably excellent outcomes as total hip arthroplasty with significant pain relief at short term follow-up.Level of EvidenceLevel III, retrospective cohort study.

Comparison of modern periacetabular osteotomy for hip dysplasia with total hip arthroplasty for hip osteoarthritis-10-year outcomes are comparable in young adult patients.

ABSTRACTYoung adult patients with symptomatic acetabular dysplasia and marginal secondary osteoarthritis can be faced with the decision to either undergo periacetabular osteotomy (PAO) to relieve symptoms and slow osteoarthritis progression or wait until progression to more advanced disease and undergo total hip arthroplasty (THA). The decision can be difficult, and contemporary literature to guide these decisions is sparse. Therefore, we retrospectively assessed complication rate, survivorship and patient-reported clinical outcomes [modified Harris Hip score (mHHS), UCLA Activity score] in two, consecutive cohorts of patients aged 18–40 years that underwent either PAO for symptomatic acetabular dysplasia (mean age 28.9 years) or THA for advanced secondary osteoarthritis (32.5 years). PAO patients were followed for a mean of 10.5 years (8–19) and THA patients for 11.9 (8–17) years. Between PAO and THA groups, there were no differences in overall complication rate (4.7% versus 4.7%), non-revision reoperation rate (5.9% versus 2.3%, P = 0.37) or end-revision rate [7 (8.2%) PAOs converted to THA at mean 10.8 years versus 3 (7.0%) THAs revised at 6.2 years, P = 0.80]. Latest scores remained significantly improved from baseline in both the PAO (mHHS 86.1 versus 63.3, P < 0.001; UCLA 7.5 versus 6.9, P < 0.05) and THA (mHHS 82.6 versus 48.4, P < 0.001; UCLA 7.2 versus 4.6, P < 0.001) cohorts. Final scores were similar between groups (mHHS 86.1 versus 82.6, P = 0.46; UCLA 7.5 versus 7.2, P = 0.37). Clinical success [mHHS minimal clinically important difference (8) OR PASS (>70) at latest follow-up without end-revision] was achieved in 81.2% of PAO hips and 83.7% of THA hips (P = 0.72).

Primary Sjögren's syndrome is not associated with poor outcomes after total hip arthroplasty: a retrospective case-control study with a matched cohort of osteoarthritis patients.

IntroductionThe number of patients with primary Sjögren’s syndrome (PSS) requiring total hip arthroplasty (THA) is expected to increase, but few studies have detailed their outcomes. The purpose of this study was to evaluate a THA cohort of patients with avascular necrosis of the femoral head (ANFH) who had PSS and to compare their outcomes with those of matched patients with osteoarthritis.MethodA case–control study using data from a single-institution arthroplasty registry was performed. Forty-two THAs in 32 patients undergoing THA with a diagnosis of PSS were identified and were matched with 84 THAs in 64 patients with osteoarthritis (1:2 ratio). Functional and health-related quality of life (QoL) evaluations were performed, and complications were recorded at the last follow-up. Logistic regression was used to determine factors associated with reaching the transfusion trigger of hemoglobin < 8 g/dL (TT8) in PSS patients.ResultsAfter a mean 5-year follow-up, both cohorts had similar hip function and health-related QoL outcomes. The incision complications and reaching TT8 were greater in the PSS group. No differences were observed in the rate of 90-day readmission, reoperation, or overall revision. By multivariate analysis, the influencing factors for reaching TT8 in PSS patients were lower preoperative hemoglobin (OR = 0.842, 95% CI [0.741–0.958], P < 0.05).ConclusionOur study demonstrated PSS patients who received THA due to ANFH could achieve clinical outcomes similar to those of non-PSS patients. Improving preoperative Hb level can reduce the risk of transfusion.Key Points• THA significantly improved hip function and health-related quality of life in PSS patients with osteonecrosis of the femoral head.• Patients with PSS were more likely to reach the transfusion trigger and higher rates of incision complications after THA.• Improving preoperative Hb level can reduce the risk of transfusion for PSS patients who underwent THA.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10067-022-06256-2.

Indication for Proximal Femoral Replacement Is Associated With Risk of Failure.

Proximal femoral replacement (PFR) is reserved as a salvage procedure after failed total hip arthroplasty (THA) or after wide margin resection of tumors involving the proximal femur. Although failure of the PFR construct remains a significant problem, indication has not previously been investigated as a risk factor for failure. This study retrospectively evaluated patients who underwent PFR over a consecutive 15-year period for primary sarcoma or metastatic disease of the proximal femur, compared with conversion to PFR after failed THA. PFR failure was defined as recurrent prosthetic dislocations, periprosthetic fracture, aseptic loosening, or infection that ultimately resulted in revision surgery. Overall, 99 patients were evaluated, including 58 in the neoplasm and 41 in the failed THA cohorts. Failed THA patients were older (P < .001), with a greater proportion having comorbid hypertension (P= .008), cardiac disease (P= .014), and history of prior ipsilateral and intracapsular surgeries (P< .001). The failure rate was significantly higher in failed THA patients (39.0% vs 10.3%; P < .001) with significantly shorter implant survivorship on Kaplan-Meier analysis (P= .003). A multivariate Cox proportional hazards model showed that THA failure was the only independent predictor for PFR failure (hazard ratio: 4.26, 95% confidence interval: 1.66-10.94; P= .003). This study revealed significantly worse PFR implant survivorship in patients undergoing PFR for the indication of failed THA compared with neoplasm. Although the underlying etiology of this relationship remains to be explicitly outlined, poor bone quality and soft tissue integrity, multiple prior surgeries, and comorbid conditions are likely contributing factors.

Short-Stay Arthroplasty is Not Associated With Increased Risk of 90-Day Hospital Returns

BackgroundWith the removal of total hip arthroplasty (THA) and total knee arthroplasty (TKA) from the inpatient-only list, medical centers are faced with challenging transitions to outpatient surgery. We investigated if short-stay arthroplasty, defined as length of stay (LOS) <24 hours, would influence 90-day readmissions and emergency department (ED) visits at a tertiary referral center. MethodsThe institutional database was retrospectively queried for primary TKAs and THAs from July 2015 to January 2018, resulting in 2,217 patients (1,361 TKA and 856 THA). Patient demographics, including age, gender, body mass index, and American Society of Anesthesiologists score were collected. LOS, disposition, cost of care, 90-day ED visits, and readmissions were identified through the institutional database using electronic medical record data. Univariable and multivariable models were used to evaluate rates of 90-day readmissions and ED visits based on LOS <24 hours vs ≥24 hours. ResultsLOS <24 h was associated with significant decreases in 90-day ED visits (P = .003) and readmissions (P = .002). After controlling for potential confounding variables with a multivariable model, a significant decrease in ED visits (P = .034) remained in the THA cohort alone. Within TKA and THA cohorts, LOS <24 h was associated with lower costs (P < .001). Eighteen percent of patients with ≥24 h LOS were discharged to skilled nursing or rehabilitation facilities. ConclusionIn this cohort, LOS <24 hours was associated with decreased 90-day readmissions, ED visits, and costs. With the goal of minimizing costs and maintaining patient safety while efficiently using resources, outpatient and short-stay arthroplasty are valuable, feasible options in tertiary academic centers.

Cohort analysis of two thousand nine hundred forty-three Link Lubinus SP II cemented total hip arthroplasties from a single hospital with surgeon stratification and twenty six thousand, nine hundred and eighty one component-years of follow-up.

Cemented total hip endoprosthesis Link Lubinus SP II has been used for decades with very good results in arthroplasty registries, but surgeon-stratified reports of endoprosthetic survival are very rare. The aim of the presented single hospital cohort analysis of this implant was to determine Link Lubinus SP II survival rates 10/15/20/25/30years after the primary implantation and to find out whether endoprosthesis survival depended on patients' age, gender, operated side, implanted femoral head diameter, and the operating surgeon. The study included 2943 consecutive primary Link Lubinus SP II hip endoprostheses implanted at the University Medical Centre Ljubljana, Department of Orthopaedic Surgery (Ljubljana, Slovenia) between January 1, 1985, and December 31, 2018. Kaplan-Meier analysis and Cox regression were performed after minimum two and maximum 30years of follow-up. At 10/15/20/25/30years after implantation, the estimated cumulative proportion of revision-free surviving Link Lubinus SP II total hip endoprostheses was 94/90/88/87/87% and the cumulative proportion with unremoved endoprosthetic components was 96/93/90/89/89%, respectively. Higher patient's age at operation was associated with lower risk of subsequent implant removal (hazard ratio 0.97 for each additional year of age; 95% confidence interval 0.95-0.99; p = 0.00), while the patient's gender, the implanted femoral head diameter, and the operating surgeon had no significant impact on implant survival. The study presents the largest published Link Lubinus SP II total hip arthroplasty cohort from a single non-developmental hospital with 26,981 component-years of observation. The findings highlight excellent outcomes of this implant in the elderly population, regardless of performance variability between surgeons.