Total Hip Replacement Patients Research Articles

Does Regional Anesthesia Reduce Complications Following Total Hip and Knee Replacement Compared With General Anesthesia? An Analysis From the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man

BackgroundRegional anesthesia is increasingly used in enhanced recovery programs following total hip replacement (THR) and total knee replacement (TKR). However, debate remains about its potential benefit over general anesthesia given that complications following surgery are rare. We assessed the risk of complications in THR and TKR patients receiving regional anesthesia compared with general anesthesia using the world’s largest joint replacement registry. MethodsWe studied the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man linked to English hospital inpatient episodes for 779,491 patients undergoing THR and TKR. Patients received either regional anesthesia (n = 544,620, 70%) or general anesthesia (n = 234,871, 30%). Outcomes assessed at 90 days included length of stay, readmissions, and complications. Regression models were adjusted for patient and surgical factors to determine the effect of anesthesia on outcomes. ResultsLength of stay was reduced with regional anesthesia compared with general anesthesia (THR = −0.49 days, 95% confidence interval [CI] = −0.51 to −0.47 days, P < .001; TKR = −0.47 days, CI = −0.49 to −0.45 days, P < .001). Regional anesthesia also had a reduced risk of readmission (THR odds ratio [OR] = 0.93, CI = 0.90-0.96; TKA OR = 0.91, CI = 0.89-0.93), any complication (THR OR = 0.88, CI = 0.85-0.91; TKA OR = 0.90, CI = 0.87-0.93), urinary tract infection (THR OR = 0.85, CI = 0.77-0.94; TKR OR = 0.87, CI = 0.79-0.96), and surgical site infection (THR OR = 0.87, CI = 0.80-0.95; TKR OR = 0.84, CI = 0.78-0.89). Anesthesia type did not affect the risk of revision surgery or mortality. ConclusionRegional anesthesia was associated with reduced length of stay, readmissions, and complications following THR and TKR when compared with general anesthesia. We recommend regional anesthesia should be considered the reference standard for patients undergoing THR and TKR.

Determining the risk of acute kidney injury in patients who underwent total joint replacement: A retrospective study

ObjectivesTotal joint replacement (TJR) is a commonly performed procedure worldwide, and postoperative acute kidney injury (AKI) is one of the complications that determine the overall prognosis in various surgical settings. We aimed to identify the risk of AKI after TJR (primary and revision) and determine the factors associated with postoperative AKI. MethodsWe performed a retrospective study of 1068 patients (>18 years) who underwent TJR between 2014 and 2019 at a tertiary medical center. Patients’ demographic, clinical, and laboratory data were reviewed. ResultsA total of 1068 patients were included in this study [mean age, 60.5 ± 13 years; 260 men (24.3%); 808 women (75.7%)]. A total of 962 patients (90.1%) underwent primary joint replacement (PJR) and 106 underwent joint revision (9.9%). Sixty-six patients (6.2%) had postoperative AKI. Primary total hip replacement patients had a lower risk of AKI than patients with other types of TJR (3.0%; p = 0.024). The factors associated with AKI (adjusting for known confounders) included male gender [adjusted odds ratio (AOR): 1.751; 95% confidence interval (CI): 1.01–3.03; p = 0.046], diabetes mellitus (DM) [AOR: 2.806; 95% CI: 1.687–5.023; p ≤ 0.001], hypertension (HTN) [AOR: 1.751; 95% CI: 1.159–3.442; p = 0.013], and the use of vancomycin as a prophylactic antibiotic [AOR: 1.691; 95% CI: 1.1–2.913; p = 0.050]. Chronic kidney disease (CKD) [AOR: 1.00; 95% CI: 0.432–2.27; p = 0.981] was not found to be a significant risk factor. ConclusionIn this study, the risk of preoperative AKI in patients who underwent TJR was 6.2%. Male gender, preoperative comorbidities such as DM and HTN, and preoperative use of vancomycin were associated with increased risk of postoperative AKI.

Clinical outcome before and after COVID-19 quarantine in patients affect of knee and hip osteoarthritis.

Background:The emergency caused by COVID-19 Pandemic resulted in a complete suspension and consequent delay of common planned surgery such as Total Hip replacement, Total Knee replacement and Partial Knee replacement. At the same time, the quarantine imposed changes to the normal lifestyle of these patients. The purpose of our study is to evaluate how the presence of these two factors affect the quality of live of patients living in the Italian red zone.Methods:From outpatient pre-operative assessment we collect data about: demographic data, WOMAC score, NRS (0-10), PCS SF12 and MCS SF12 score. Selected patients were therefore contacted by phone call and re-assess using the same score. In addition, patients were asked if they intended to undergo the planned surgery again despite the current emergencyResults:34 patient have been recruited for the study. Male/female ration was 16/18, mean age was 65 years. Pre operative outpatient assessment mean WOMAC score was 40.87 (SD ± 8.73), mean NRS was 8.29 (SD ± 1.03), PCS SF12 was 28.99 (SD ± 4.64) and MCS SF12 was 41.17 (SD ± 4.32). At re-evalutation the mean WOMAC score was 34.62 (SD ± 15.26), mean NRS was 5.32 (SD ± 2.85), PCS SF12 was 40.25 (SD ± 3.19) and MCS SF12 was 50.73 (SD ± 5.48).Conclusion:The never seen pandemic from Covid-19 has deeply changed our lifestyle, impacting normal daily activities but also on regular surgical activity in patients affected by osteoarthritis. Our study suggest the mandatory quarantine have a limited impact, or even beneficial effect, on clinical score of patient in list for joint replacement. (www.actabiomedica.it)

Non-invasive haemodynamic monitoring with Clearsight in patients undergoing spinal anaesthesia for total hip replacement. A prospective observational cohort study.

Background and aim of the work:Patients undergoing elective primary total hip replacement and spinal anesthesia may encounter significant hemodynamic instability.Objective:The study is aimed at observing the haemodynamic modifications after spinal anaesthesia during total hip replacement in patients managed to “preload independence” with goal directed fluid therapy (GDFT) and monitored non-invasively with Clearsight.Methods:Thirty patients, aged 50-80 years, with an American Society of Anaesthesiologists’ (ASA) score II-III, undergoing elective primary total hip replacement and spinal anaesthesia were enrolled. Patients were monitored with the EV1000 platform and the Clearsight finger-cuff and managed with a goal directed fluid therapy.Results:The 79% of the population showed preload independence at baseline. After spinal, the 93% did not show a significant mean arterial pressure reduction. In our population, 79% reported a decrease >10% of the stroke volume during surgery, while 66% in the Recovery Room. Patients showed an improvement in mean arterial pressure, systemic vascular resistances indexed (SVRI), stroke volume (SV) and stroke volume indexed (SVI) at spinal resolution compared to baseline.Conclusions:Our cohort population showed hemodynamic stability throughout the study period, with increased SV and decreased SVRI at spinal resolution compared to basal values. Further randomized prospective studies are advocated in the same setting. (www.actabiomedica.it)

Current Trends in Wound Closure and Postoperative Wound Management for Total Knee and Hip Replacement

The purpose of this study is to determine the current trends for wound closure and postoperative wound care for total knee and hip replacement patients. This study will compare common techniques for superficial would closure and discuss factors that influence wound healing. This study will also include the results of a physician assistant (PA) survey looking at what PAs are using for superficial skin closure techniques and postoperative wound care after total knee and hip replacement.

A prospective study to assess the efficacy of tranexamic acid in reducing blood loss during total hip arthroplasty

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Tranexamic acid has been reported to reduce bleeding, risk of thromboembolic events and the need for allogenic blood transfusion in total hip replacement patients. The present study was conducted to assess the efficacy of tranexamic acid in reducing blood loss during total hip replacement surgery.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Total hip arthroplasty patients (n=60) were divided into control and test groups with 30 patients each. Test group was administered with tranexamic acid (15 mg/kg) for 15 min before and after the surgery. Patients were administered cefuroxime (1.5 g), 30 min prior to the surgery and deep vein thrombosis prophylaxis; enoxaparin (40 mg), 48 hours after surgery. Demographic details along with levels of hemoglobin and blood loss before, during and after the surgery were recorded.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Tranexamic acid reduced the early post-surgical blood loss (292±132.38 vs. 155.8±86.56 ml; p&amp;lt;0.0001), total blood loss (989.6±340.98 vs. 580.4±131.88 ml; p&amp;lt;0.0001), and the blood loss during surgery (723.5±277.73 vs. 434.3±131.83 ml; p&amp;lt;0.05). Test group required fewer transfusions (6.7%) than control group (26%) and had no increased incidence of deep-vein thrombosis. Postsurgical hemoglobin in the control group had significantly reduced as compared to test group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Administration of intravenous tranexamic acid before and after the surgery was effective in reducing the blood loss and transfusion requirements and its related complications.&lt;/p&gt;

Cost-effectiveness of telerehabilitation versus traditional care after total hip replacement: A trial-based economic evaluation

Introduction: Physical rehabilitation for total hip replacement patients following hospital discharge is beneficial; however, accessing rehabilitation is often challenging. Telerehabilitation helps negate access issues and is efficacious in total knee and hip replacement patients. This study aims to compare the cost-effectiveness of a telerehabilitation programme delivered remotely into patients’ homes versus traditional care for total hip replacement patients following hospital discharge. Methods: A cost-effectiveness (cost-utility) analysis was conducted from the perspective of a health service alongside a two-arm randomised controlled trial comparing telerehabilitation (n=35) with in-person care (n=35) following hospital discharge after total hip replacement. The primary analysis used an Incremental Cost-Effectiveness Ratio to compare the cost per Quality Adjusted Life Year (QALY) accrued in the telerehabilitation group versus in-person control using costs and effects data from the randomised trial. A secondary analysis was conducted whereby the time accrued by patients attending rehabilitation sessions (including travel time) was considered the “cost” (i.e. a time burden), rather than cost from the health service perspective. Results: Estimated mean differences in healthcare costs and QALYs gained were detected but were not significant. The estimated mean (95%CI) difference in cost of telerehabilitation versus in-person was –$28.90 (–$96.37 to $40.45), favouring the telerehabilitation group. The estimated mean (95%CI) difference in QALYs gained from telerehabilitation versus in-person was –0.0025 (–0.0227 to 0.0217). The estimated mean (95%CI) difference in time burden favoured less time burden for the telerehabilitation group (–4.21 (–4.69 to –3.74) hours). Discussion: Telerehabilitation in the total hip replacement population incurred similar costs and yielded similar effects to traditional in-person care. Telerehabilitation significantly reduced the time burden for patients and carers. These findings are valuable for healthcare providers seeking to implement accessible patient-centred rehabilitation services.

Surgical Care Improvement Program and surgical site infections: initiatives to improve outcome in patients with joint replacements in a tertiary care center in Pakistan

Introduction: The Surgical Care Improvement Programme (SCIP) was initiated in 2002 with the vision of reducing the morbidity and mortality associated with postoperative surgical site infection by addresses to the antibiotics use and early discontinuation, catheter removal within 48 hours postoperatively, use of clipper for hair removal, controlled blood sugars on preop, first and second postop days and maintenance of normothermia. Objective: To assess the relationship between SCIP-infection prevention care measures and postoperative infection rates in patients undergoing total knee replacement (TKR) or total hip replacement (THR). Materials and Methods: A retrospective chart review was conducted including all patients who underwent primary total knee arthroplasty or total hip arthroplasty between January 2, 2013 and December 31, 2014 at our institute. Patients’ demographics and SCIP parameters were recorded in a preformed structured proforma. Outcome variable was recorded as presence of surgical site wound infection and compared. Results: A total of 307 patients (242 knee replacements and 65 hip replacements) were included in the study. Wound infection was observed in 2/242 patients (1%) in the TKR group while 3/65 (5%) showed infection in the THR group. Clipper was used after induction for operative site hair removal in 206 TKR patients and in 39 THR patients, none of them had wound infection which was significant (P=0.002 and 0.046). Conclusions: SCIP parameters ensure reduced surgical site infection rates, lesser duration of hospital stay, decreased incidence of deep venous thrombosis and reduced postop morbidity and mortality.

Total hip and knee replacement and return to work: clinicians’ perspectives

Purpose An ageing workforce means that our understanding of return to work following total hip and knee replacement is of increasing importance. The purpose of this qualitative study was to explore the views and experiences of clinicians in treating working patients undergoing total hip or knee replacement. Materials and methods We conducted semi-structured interviews in primary and secondary National Health Service care using framework methodology. A total of 40 interviews were conducted. Participants included 12 hospital-based Allied Health Professionals and nurses, 12 orthopedic surgeons, and 16 General Practitioners. Data were analyzed thematically. Results A key theme concerned participants' perceptions and experiences around the process and practice of listing working patients for total hip or knee replacement. Four sub-themes were identified; the perceived likelihood of listing employed patients for surgery, expectations and outcomes of surgery, the impact of work issues, and referral procedures and waiting lists. Conclusions Decisions around listing working patients for total hip and knee replacement are complex and difficult. Clinicians need to consistently consider patients’ work issues, and to be supported in this by appropriate commissioning and service delivery decisions. Further research is indicated to better understand the work-related expectations and anticipated outcomes of both patients and clinicians, and the optimum timing of surgery to maintain and improve patients’ work performance. Implications for rehabilitation Clinicians need to consistently consider patients’ work issues, and current evidence, in their consultations and decisions regarding total hip and knee replacement. Clinical practice should reflect the growing proportion of working patients undergoing total hip and knee replacement, and routinely measure work outcomes. Changes are required at commissioning and service levels to support clinicians in changing their practice with this patient population.

Cytokine Profile in Patients with Aseptic Loosening of Total Hip Replacements and Its Relation to Metal Release and Metal Allergy.

Metal release from total hip replacements (THRs) is associated with aseptic loosening (AL). It has been proposed that the underlying immunological response is caused by a delayed type IV hypersensitivity-like reaction to metals, i.e., metal allergy. The purpose of this study was to investigate the immunological response in patients with AL in relation to metal release and the prevalence of metal allergy. THR patients undergoing revision surgery due to AL or mechanical implant failures were included in the study along with a control group consisting of primary THR patients. Comprehensive cytokine analyses were performed on serum and periimplant tissue samples along with metal analysis using inductive coupled plasma mass spectrometry (ICP-MS). Patient patch testing was done with a series of metals related to orthopedic implant. A distinct cytokine profile was found in the periimplant tissue of patients with AL. Significantly increased levels of the proinflammatory cytokines IL-1β, IL-2, IL-8, IFN-γ and TNF-α, but also the anti-inflammatory IL-10 were detected. A general increase of metal concentrations in the periimplant tissue was observed in both revision groups, while Cr was significantly increased in patient serum with AL. No difference in the prevalence of metal sensitivity was established by patch testing. Increased levels of IL-1β, IL-8, and TNF-α point to an innate immune response. However, the presence of IL-2 and IFN-γ indicates additional involvement of T cell-mediated response in patients with AL, although this could not be detected by patch testing.

Telerehabilitation is non-inferior to usual care following total hip replacement — a randomized controlled non-inferiority trial

ObjectivesDetermine if outpatient physiotherapy care via telerehabilitation is as effective as in-person physiotherapy care after total hip replacement. DesignRandomised, single-blind, controlled, non-inferiority clinical trial. SettingQEII Jubilee Hospital, Brisbane, Australia. ParticipantsSeventy patients receiving a total hip replacement entered the study, sixty-nine completed the study. InterventionsThe control group (n=35; x¯ age 67; female 60%) received in-person outpatient physiotherapy and a paper-based home exercise programme. The intervention group (n=35; x¯ age 62; female 66%) received remotely delivered telerehabilitation directly into their homes and a technology-based home exercise program using an iPad application. Main outcome measuresThe primary outcome was the quality of life subscale of the Hip disability and Osteoarthritis Outcome Score measured at six weeks post-operatively. Secondary outcomes included objective strength and balance outcomes, self-reported function and satisfaction outcomes, and home exercise program compliance. ResultsNo between group difference was detected in the Hip disability and Osteoarthritis Outcome Score quality of life subscale at the primary end point of six weeks (P=0.970). Strength, balance and self-reported function showed no between group differences. Overall satisfaction was high across both groups, with the intervention group scoring higher for ease of attending appointments (intervention 95 (10), control 86 (18), mean difference 9 (95% CI 2 to 16), P=0.017. The intervention group were more compliant with their home exercise programme (intervention 86% (20%), control 74% (26%), mean difference 12% (95% CI 1% to 23%), P=0.048). ConclusionsTelerehabilitation programmes can be delivered to total hip replacement patients in their own homes, using readily available technology while maintaining high levels of satisfaction. More importantly, telerehabilitation patients appear to achieve non-inferior physical and functional outcomes as those receiving in-person rehabilitation programmes. Trial Registration: ACTRN12615000824561. (Australian New Zealand Clinical Trials Registry).

Decreasing the Incidence of Postoperative Urinary Retention and Incontinence With Total Joint Replacement Patients After Spinal Anesthesia in the Postanesthesia Care Unit: A Quality Improvement Project

Patients with postoperative urinary retention (POUR) can develop bladder atrophy, urinary incontinence, and hypertension. The purpose of this quality improvement project was to implement standardized guidelines for bladder scanning for patients who have total knee or hip replacement to decrease POUR and incontinent episodes. A retrospective descriptive study was implemented in a 425-bed Magnet community hospital. Patients were bladder scanned within the first hour of postanesthesia care unit admission. Straight catheterization was performed for those who had more than 400mL of retained urine. The protocol included both total knee and total hip replacement surgeries with spinal anesthesia. Compliance with scanning, percentages with POUR, and incontinent episodes were reviewed. POUR was detected in 46% of total knee replacement patients and 36% of total hip replacement patients. Incontinence rates for knee replacement patients decreased by 14% and by 2% for patients with total hip replacements. A bladder scanning protocol decreases postoperative incontinence. Bladder scanning also helps to decrease POUR by decreasing the potential risk of complications.

Fourier transform infrared spectroscopic imaging of wear and corrosion products within joint capsule tissue from total hip replacements patients.

Implant debris generated by wear and corrosion is a prominent cause of joint replacement failure. This study utilized Fourier transform infrared spectroscopic imaging (FTIR-I) to gain a better understanding of the chemical structure of implant debris and its impact on the surrounding biological environment. Therefore, retrieved joint capsule tissue from five total hip replacement patients was analyzed. All five cases presented different implant designs and histopathological patterns. All tissue samples were formalin-fixed and paraffin-embedded. Unstained, 5 μm thick sections were prepared. The unstained sections were placed on BaF2 windows and deparaffinized with xylene prior to analysis. FTIR-I data were collected at a spectral resolution of 4 cm-1 using an Agilent Cary 670 spectrometer coupled with Cary 620 FTIR microscope. The results of study demonstrated that FTIR-I is a powerful tool that can be used complimentary to the existing histopathological evaluation of tissue. FTIR-I was able to distinguish areas with different cell types (macrophages, lymphocytes). Small, but distinct differences could be detected depending on the state of cells (viable, necrotic) and depending on what type of debris was present (polyethylene [PE], suture material, and metal oxides). Although, metal oxides were mainly below the measurable range of FTIR-I, the infrared spectra of tissues exhibited noticeable difference in their presence. Tens of micrometer sized polyethylene particles could be easily imaged, but also accumulations of submicron particles could be detected within macrophages. FTIR-I was also able to distinguish between PE debris, and other birefringent materials such as suture. Chromium-phosphate particles originating from corrosion processes within modular taper junctions of hip implants could be identified and easily distinguished from other phosphorous materials such as bone. In conclusion, this study successfully demonstrated that FTIR-I is a useful tool that can image and determine the biochemical information of retrieved tissue samples over tens of square millimeters in a completely label free, nondestructive, and objective manner. The resulting chemical images provide a deeper understanding of the chemical nature of implant debris and their impact on chemical changes of the tissue within which they are embedded.

No difference in gait kinematics or kinetics between limbs in bilateral total hip replacement patients at long-term follow-up

BackgroundPrevious studies report that gait parameters of patients following total hip replacement improve from pre-operative levels, although in most cases do not reach those of normal subjects. However, studies are generally of unilateral total hip replacement patients at short-term follow-up. There have been no reports of 3D gait kinematics and kinetics in patients with bilateral total hip replacements at long-term follow-up. The aim of this study was to compare temporospatial parameters and 3D lower limb gait kinematics and kinetics at long-term follow-up between limbs and against controls for patients who have undergone staged bilateral total hip replacement. Methods3D gait analysis was performed on 13 patients who had undergone bilateral total hip replacement, at an average follow-up of 10.1 (first hip) and 9.3 years (second hip), and a normal elderly control group comprising 10 subjects. FindingsKnee flexion/extension range of motion was marginally greater in Hip 2 (p = 0.049) compared to Hip 1 by 3.2°. There were no other significant differences in temporospatial parameters or a range of lower limb kinematics or kinetics between the first and second operated hip. Multiple gait parameters were significantly worse for both hips compared to age-matched normal individuals. InterpretationAlthough symmetrical biomechanical recovery was achieved, significant gait deficiencies remain in both hips compared to normal controls. These deficits may provide targets for enhanced rehabilitation programs.

Readability of Information on Smartphone Apps for Total Hip Replacement and Total Knee Replacement Surgery Patients.

Background:Readability is a vital component of health information and providing this material at an appropriate literacy level may positively influence patient experience.Objective:To assess the readability of the information provided within total hip replacement and total knee replacement apps to understand more about the impact this could have on patients.Method:A systematic search was conducted across the 5 most popular smartphone app stores: iTunes, Google Play, Windows Mobile, Blackberry App World, and Nokia Ovi. Apps were identified for screening if they: targeted total hip replacement or total knee replacement patients; were free of charge; and were in English. App readability assessment was conducted independently by 3 reviewers using the Gunning Fog Index, the Flesch Reading Ease Score, and the Flesch-Kincaid Grade Level.Results:Fifteen apps met the inclusion criteria. Only one app was found “easy to read” (My THR).Conclusion:Findings suggest that the overall readability of information provided is written at a level which is difficult for patients to comprehend. App developers should engage patients in the design process of their apps, in order to enhance patient experience and for the potential impact of these innovative health technologies to be truly realized.

Step Length Asymmetry and Its Associations With Mechanical Energy Exchange, Function, and Fatigue After Total Hip Replacement.

Abnormalities in gait remain after total hip replacement (THR). The purpose of this study was to evaluate step length asymmetry and its links to other aspects of gait and physical function after THR and to investigate links with mechanical energy exchange. The rationale is that step length asymmetry may influence gait efficiency, which could adversely influence fatigue and physical function. We evaluated 18 participants (6 males and 12 females) 1-5 years post-THR. Step length symmetry and mechanical energy exchange were assessed by instrumented gait analysis. Fatigue was assessed using a PROMIS Fatigue Short Form. We assessed physical function using a 6-minute walk test (6MWT). We used a one sample T test to determine whether the symmetry index (SI) was significantly different from 0 and Pearson's correlations to explore associations among the variables. The step length SI was statistically significantly different from zero (p=0.01). A more symmetric step length was associated with better 6MWT (R=-0.57, p=0.03). Higher (better) mechanical energy exchange was associated with more fatigue (R=0.50, p=0.04). Mechanical energy exchange was not associated with step length SI or 6MWT. Better 6MWT was associated with less fatigue (R=-0.61, P=0.01). This suggests that the association between step length symmetry and function is not directly governed by its effect on the energy exchange. Additionally, after a relatively long period of postsurgery, participants may have adapted their gait by increasing mechanical energy exchange to minimize fatigue. Statement of Clinical Significance: A gait retraining intervention targeting step length symmetry could improve function without adversely affecting walking energetics in THR patients. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1563-1570, 2019.

Prior arthroscopic treatment for femoro-acetabular impingement does not compromise hip arthroplasty outcomes: a matched-controlled study with minimum two-year follow-up.

Femoro-acetabular impingement (FAI) is known as a predisposing factor in the development of osteoarthritis of the hip. In order to treat this condition, hip arthroscopy is considered as the gold standard in recent years. The number of performed hip arthroscopies has risen immensely. However, a number of patients with poor outcome after hip arthroscopy will require further surgical intervention, sometimes even conversion into THR (total hip replacement). The purpose of this study was to analyze whether outcomes of THR are affected by prior hip arthroscopy in these patients. Patients who underwent a THR following an ipsilateral hip arthroscopy were matched to a control group of THR patients with no history of prior ipsilateral hip surgery. Matching criteria were age, sex, body mass index, implants used, and surgical approach. Modified Harris Hip Score, surgical time, presence of heterotopic ossification, and post-operative complication were prospectively compared at a minimum twoyear follow-up. Thirty-three THR after hip arthroscopy patients were successfully matched to control patients. There was no significant difference in mHHS between both groups (FAI treatment group 92.8 vs. control group 93.8, p = 0.07). However, FAI treatment group showed a lower mHHS score pre-operatively (48 vs. 60, p = 0.002). There was no significant difference in surgical time and post-operative complication rate. No heterotopic ossification could be found. A prior hip arthroscopy has no affect to clinical outcomes of subsequent THR.

Differentiated approach to the choice of the acetabular component at total hip replacement in patients with dysplastic hip arthritis

Differentiated approach to the choice of the acetabular component at total hip replacement in patients with dysplastic hip arthritis

Association between patient survival following reoperation after total hip replacement and the reason for reoperation: an analysis of 9,926 patients in the Swedish Hip Arthroplasty Register

Background and purpose — The association between long-term patient survival and elective primary total hip replacement (THR) has been described extensively. The long-term survival following reoperation of THR is less well understood. We investigated the relative survival of patients undergoing reoperation following elective THR and explored an association between the indication for the reoperation and relative survival.Patients and methods — In this observational cohort study we selected the patients who received an elective primary THR and subsequent reoperations during 1999–2017 as recorded in the Swedish Hip Arthroplasty Register. The selected cohort was followed until the end of the study period, censoring or death. The indications for 1st- and eventual 2nd-time reoperations were analyzed and the relative survival ratio of the observed survival and the expected survival was determined.Results — There were 9,926 1st-time reoperations and of these 2,558 underwent further reoperations. At 5 years after the latest reoperation, relative survival following 1st-time reoperations was 0.94% (95% CI 0.93–0.96) and 0.90% (CI 0.87–0.92) following 2nd-time reoperations. At 5 years patients with a 1st-time reoperation for aseptic loosening had higher survival than expected; however, reoperations performed for periprosthetic fracture, dislocation, and infection had lower survival.Interpretation — The relative survival following 1st- and 2nd-time reoperations in elective THR patients differs by reason for reoperation. The impact of reoperation on life expectancy is more obvious for infection/dislocation and periprosthetic fracture.

Association of Traditional Chinese Medicine Therapy with Risk of Total Hip Replacement in Patients with Nontraumatic Osteonecrosis of the Femoral Head: A Population-Based Cohort Study.

Background Osteonecrosis of the femoral head (ONFH) contributes to 45% of total hip replacements (THRs) annually in Taiwan. Nontraumatic ONFH (NONFH) is multifactorial; no effective Western medicine is available to delay the disease process. This population-based cohort study investigated the association of traditional Chinese medicine (TCM) therapy with risk of THR in patients with NONFH. Methods This retrospective study was conducted using claims data from all insured residents covered by the National Health Insurance from 2000 to 2010. We enrolled 1,680 newly diagnosed ONFH patients who had not undergone THR, before or within 6 months after diagnosis of ONFH; these patients did not exhibit hip fracture or dislocation before the endpoint. In total, 595 propensity score-matched pairs were selected from among 1,028 TCM users and 652 non-TCM users. The association between TCM use and risk of THR was analyzed using a Cox proportional hazard model. Kaplan-Meier and log rank tests were performed to plot the cumulative incidence of THR. Results The mean follow-up periods were 5.00 years and 3.57 years for TCM and non-TCM cohorts, respectively. Compared to the non-TCM cohort, the TCM cohort had fewer patients undergoing THR surgery (25.4% vs. 18.2%, adjusted hazard ratio: 0.60, p<0.0001). The risk of reduction was noted in the group aged 30–59 years (adjusted hazard ratio: 0.56, p<0.0001), but there was no association with gender nor socioeconomic status. There was a significantly lower cumulative incidence of THR in TCM users (p<0.0001). Shu-Jing-Huo-Xue-Tang and Yan Hu Suo were the most frequently prescribed formula and single herb, respectively. Conclusions NONFH patients using TCM had a lower risk of THR; the risk of reduction was noted in the group aged 30–59 years but was not associated with gender nor socioeconomic status. TCM might be useful in conservative treatment for NONFH.