Treatment Of Hip Osteoarthritis Research Articles

Annual epidemiological and health insurance disease burden of hip osteoarthritis in Hungary based on nationwide data

BackgroundHealth services utilization related to hip osteoarthritis imposes a significant burden on society and health care systems. Our aim was to analyse the epidemiological and health insurance disease burden of hip osteoarthritis in Hungary based on nationwide data.MethodsData were extracted from the nationwide financial database of the National Health Insurance Fund Administration (NHIFA) of Hungary for the year 2018. The analysed data included annual patient numbers, prevalence, and age-standardized prevalence per 100,000 population in outpatient care, health insurance costs calculated for age groups and sexes for all types of care. Patients with hip osteoarthritis were identified using code M16 of the International Classification of Diseases (ICD), 10th revision. Age-standardised prevalence rates were calculated using the European Standard Population 2013 (ESP2013).ResultsBased on patient numbers of outpatient care, the prevalence per 100,000 among males was 1,483.7 patients (1.5%), among females 2,905.5 (2.9%), in total 2,226.2 patients (2.2%). The age-standardised prevalence was 1,734.8 (1.7%) for males and 2,594.8 (2.6%) for females per 100,000 population, for a total of 2,237.6 (2.2%). The prevalence per 100,000 population was higher for women in all age groups. In age group 30–39, 40–49, 50–59, 60–69 and 70 + the overall prevalence was 0.2%, 0.8%, 2.7%, 5.0% and 7.7%, respectively, describing a continuously increasing trend. In 2018, the NHIFA spent 42.31 million EUR on the treatment of hip osteoarthritis. Hip osteoarthritis accounts for 1% of total nationwide health insurance expenditures. 36.8% of costs were attributed to the treatment of male patients, and 63.2% to female patients. Acute inpatient care, outpatient care and chronic and rehabilitation inpatient care were the main cost drivers, accounting for 62.7%, 14.6% and 8.2% of the total health care expenditure for men, and 51.0%, 20.0% and 11.2% for women, respectively. The average annual treatment cost per patient was 3,627 EUR for men and 4,194 EUR for women.ConclusionsThe prevalence of hip osteoarthritis was 1.96 times higher (the age-standardised prevalence was 1.5 times higher) in women compared to men. Acute inpatient care was the major cost driver in the treatment of hip osteoarthritis. The average annual treatment cost per patient was 15.6% higher for women compared to men.

Association between abductor tears and hip pathology: A nationwide large cohort study

IntroductionAlthough gluteal tears have been observed in a substantial percentage of total hip arthroplasty (THA) patients and hip osteoarthritis (OA) has been shown to alter the function of the gluteal muscles, the association between gluteal tears and hip OA has not been characterized. Therefore, we evaluated (1) the overlap between hip OA and gluteal tears, (2) the relative risks of gluteal tears in patients who have hip OA, and (3) gluteal tear-free survival after diagnosis or treatment for hip osteoarthritis. MethodsThis retrospective study sourced data from TriNetX, a research network that aggregates data from over 92 million patients. Relative risks for gluteal tears were calculated for known risk factors for gluteal tears, age ≥45 years, female sex, and obesity, as well as for hip OA, hip injections, and THA. A subgroup analysis was performed utilizing a Cox proportional hazard model for patients who were diagnosed with hip OA, received a hip injection, or underwent THA in 2015 to assess gluteal tear-free survival over a 9-year timeframe. ResultsThere was a large degree of overlap between patients with hip OA and gluteal tears, as 17.9% of patients with hip OA and 27.5% of patients with a gluteal tear also had the other pathology. Hip OA was associated with a markedly increased risk of a gluteal tear compared to healthy controls (Relative risk: 26.75, 95% CI: 26.64–26.86). Upon controlling for the established risk factors of gluteal tears, patients with hip OA had a markedly more likely to subsequently be diagnosed with an abductor tear (Hazard ratio: 12.46, 95% CI: 11.75–13.22). ConclusionOverall, these findings suggest a strong association between hip OA and the development of gluteal tears, in which further investigation is merited to determine the biomechanical pathophysiology underlying this potential relationship to inform prevention and treatment strategies.

Ultrasound guided injection with Collagen-based Medical Device: real-life evaluation of efficacy and safety in hip osteoarthritis.

Data regarding the treatment of hip osteoarthritis (OA) with collagen-based extracellular bio-scaffolds are lacking. We evaluated the treatment of hip OA with ultrasound guided intraarticular injections of Collagen-based Medical Device(CMD). Forty-four patients with Kellgren-Lawrence grade (KLG) I or II were selected, and 20/44randomly selected patients (CMD group), were treated with 2 weekly consecutive ultrasound guided intraarticular injections ofCMD (MD-HIP, Guna S.p.a. Milan, Italy). An additional 24/44 patients were treated with oral non-steroidal anti-inflammatorydrugs (NSAIDs) daily (NSAIDs group). Clinical assessment, X-rays and ultrasound evaluation were performed at baseline,and after 1 month in both groups, and after 3 months in the CMD group. Outcome measures were general pain VAS (0-10), thewhole WOMAC score, and the WOMAC specific subscores. CMD and NSAIDs group were homogenous for age,gender, VAS pain and WOMAC scores. The CMD group had significant improvement of the VAS pain (p<0.0001), globalWOMAC score (p<0.0001) and WOMAC function (p<0.0001) from baseline to the 1st month, with further improvementfrom the 1st to the 3rd month (p<0,001; p<0.01; p<0.03, respectively). Significant improvement in WOMAC pain (p<0.0001)and WOMAC stiffness (p<0.0001) was detected at 1st month, with no significant change at 3rd month. In the NSAIDs groupsignificant improvement in WOMAC function was detected after 1 month (p=0.021) only. No adverse events were recorded inthe CMD and NSAIDs group. The ultrasound guided intraarticular hip injections of CMD resulted in significantimprovement in VAS pain and WOMAC scores compared to treatment with oral NSAIDs.

Men and women undergoing total hip arthroplasty have different clinical presentations before surgery and different outcomes at 1-year follow-up.

The purpose of this study was to investigate the influence of sex on patients undergoing total hip arthroplasty (THA) for hip osteoarthritis (HOA), aiming to assess the clinical and functional outcomes using patient-reported outcome measures (PROMs). A retrospective analysis of patients undergoing THA at Ospedale Galeazzi-Sant'Ambrogio between 2016 and 2022 was conducted. Inclusion criteria encompassed Kellgren-Lawrence grade III or IV HOA, with preoperative and 12-month postoperative PROMs. Enroled patients have been selected from a larger cohort without matching design for confounders. The analyses were performed using R software v4.0.3 (R Core Team) and data distributions were assessed using the Shapiro-Wilk normality test. One hundred ninety patients (72 male and 118 female) who had both preoperative and postoperative PROMs have been analysed from our institutional prosthesis registry (Datareg). Baseline and 12-month post-THA PROMs showed significant improvements overall. VAS score dropped notably from baseline to 3 months postsurgery (7.1 ± 2.1 vs. 0.9 ± 1.7). Functional and mental PROMs, including Harris Hip Score-functional (HHS-F), Harris Hip Score-total (HHS-t), SF-12PSand SF-12MS, exhibited substantial improvements post-THA. Stratifying by sex, males had lower baseline VAS, higher HHS-F, SF-12MSand hip disability and osteoarthritis outcome score-physical function short form (HOOS-PS). At 12 months, males displayed significantly better VAS, HHS-F, SF-12PSand HOOS-PS scores. Complication rates were minimal (1.5%), with stable rates across genders, mostly involving dislocation and periprosthetic fractures. Implant survival at 12 months reached an impressive 99%. THA remains an effective treatment for severe HOA. However, females presented with worse baseline conditions and showed relatively less improvement at 1-year postsurgery compared to males. This difference could be attributed to physiological and psychosocial factors associated with sex, including hormonal changes, muscle mass declineand perception of pain. Longer follow-ups and prospective studies are necessary to validate these findings and facilitate personalised approaches in HOA treatment, emphasising the need for careful consideration of sex-related variables in clinical decision-making for THA patients. Level III.

Viscosupplementation with High Molecular Weight Hyaluronic Acid for Hip Osteoarthritis: a Systematic Review and Meta-Analysis of Randomised Control Trials of the Efficacy on Pain, Functional Disability, and the Occurrence of Adverse Events.

Hip osteoarthritis (OA) has a prevalence of around 6.4% and is the second most commonly affected joint. This review aims to assess the clinical outcomes of intra-articular high molecular weight hyaluronic acid (HMWHA) in the management of hip osteoarthritis. We conducted a comprehensive search across PubMed, Google Scholar, and the Cochrane Library for randomised trials investigating the effectiveness of high molecular weight hyaluronic acid (HMWHA) in the treatment of hip osteoarthritis. Quality and risk of bias assessments were performed using the Cochrane RoB2 tool. To synthesise the data, we utilised the Standardised Mean Difference (SMD) for assessing pain relief through the Visual Analogue Scale (VAS) and the Lequesne index (LI) for evaluating functional outcomes. Risk Ratio (RR) was calculated to assess the occurrence of complications. A total of four studies involving HMWHA and control groups were included. The standardised mean difference (SMD) for the Visual Analogue Scale (VAS) (SMD -0.056; 95% CI; -0.351, 0.239; p = 0.709) and the Lequesne index (SMD -0.114; 95% CI; -0.524, 0.296; p = 0.585) were not statistically significant. Analysis for complications demonstrated an overall relative risk ratio (RR) of 0.879 (95% CI; 0.527, 1.466; p = 0.622), and was not statistically significant. Intra-articular HMWHA in hip OA can significantly reduce pain and improve functional recovery when compared with the condition before treatment. However, there is no significant difference between HMWHA, or saline, or other therapeutic treatments. Currently, available evidence indicates that intra-articular HMWHA in hip OA would not increase the risk of adverse events. hip osteoarthritis, hyaluronic acid, intra-articular, molecular weight, viscosupplementation.

Platelet-rich plasma injections for hip osteoarthritis : a systematic review

Osteoarthritis (OA) is the most prevalent type of joint disorder. Symptomatic hip OA was observed in 9.2% of adults aged 45 and above, with 27% displaying radiographic evidence of the condition. While there is no definitive cure for OA, numerous research studies have explored the application of PRP (Platelet-Rich Plasma) for addressing knee OA, there is a relatively limited number of investigations dedicated to hip OA. It is important to note that the hip joint possesses distinct characteristics compared to the other three joints. Therefore, in this systematic review, we wanted to focus on hip osteoarthritis and gave a brief update from the previous studies. This systematic review was conducted in accordance with the Preferred Reporting Items of Systematic Reviews (PRISMA) guidelines. All randomized control trials that compared injection of Platelet-Rich Plasma and Hyaluronic Acid in hip osteoarthritis patients using English language from 2018 until 2023 will be included. Six studies involved in this study with total samples of 237 in PRP group and 220 in HA group. The injection site, injection volume, number of injections, interval, and follow up were varied between these studies. All of the patients are undergoing treatment with ultrasound-guided intraarticular injections of PRP. The outcomes tabulated were Visual Analog Scale (VAS), Harris Hip Score (HHS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score which showed improvements from the baseline. All of the studies showed improvement of the score from the baseline. Although, there were improvements, it can be concluded that there was not enough evidence to promote the utilization of intra-articular PRP injections as a treatment for hip osteoarthritis. Since international guidelines only recommend intra-articular steroid injections for managing hip OA, it would be advantageous to conduct additional studies comparing PRP to steroids to assess the effectiveness of PRP injections in treating hip OA.

Causal relationships between CD25 on immune cells and hip osteoarthritis.

Previous research has indicated a potential association between immune factors and osteoarthritis (OA), but the causal relationship between CD25 expression on immune cells and hip OA remains enigmatic. To shed light on this relationship, this study utilized the two-sample Mendelian Randomization (MR) method. Leveraging genome-wide association studies (GWAS) data from the UK Biobank and arcOGEN, the investigation encompasses a substantial European cohort comprising 15,704 hip OA cases and 378,169 controls. Genetic insights into CD25 stem from a subgroup of 3,757 individuals with European ancestry, encompassing 77 CD25-related traits. Several MR methods were applied, and robustness was assessed through heterogeneity and sensitivity analysis. Among the 77 traits examined, 66 shared the same single nucleotide polymorphisms (SNPs) with hip OA. Of these, 7 CD25-related traits were found to be causally associated with hip OA (adjusted P><0.05), with F-statistics ranging from 33 to 122. These traits are specifically related to CD4+CD25+ T cells, exhibiting odds ratios (OR) and 95% confidence intervals (CI) less than 1. Notably, no causal link was discerned with the CD8+CD25+ T cell subset. Within absolute count (AC) and relative count (RC) trait types, a significant causal relationship was observed solely between CD4+CD25+ T cells and hip OA, without subtype localization. A more intricate examination of CD25 expression levels within the CD4+CD25+ T cell subset revealed a correlation with the CD39+ regulatory T (Treg) subset and hip OA, particularly within the CD39+ activated Treg subset. Furthermore, a notable causal relationship emerged between CD25 expression levels in the CD45RA- not Treg subset and hip OA. However, no significant causal link was established with any subsets of B cells. The genetic prediction suggests that CD25, particularly within the realm of CD4+CD25+ T cells, may exert a protective influence against the development of hip OA. These findings provide a novel therapeutic approach for the prevention and treatment of hip OA.

The surgical destabilization ofthe abductor muscle leads to development ofinstability-associated hip osteoarthritis inmice.

Osteoarthritis (OA) of the hip is a common and debilitating painful joint disease. However, there is paucity of surgically induced hip OA models in small animals that allow scientists to study the onset and progression of the disease. A growing body of evidence indicates a positive association between periarticular myotendinous pathology and the development of hip OA. Thus, in the current study, we aimed to establish a novel mouse instability-associated hip OA model via selective injury of the abductor complex around the hip joint. C57BL6/J mice were randomized to sham surgery or abductor injury, in which the myotendinous insertion at the third trochanter and greater trochanter were surgically detached. Mice were allowed free active movement until they were sacrificed at either 3 weeks or 20 weeks post-injury. Histologic analyses and immunohistochemical staining of the femoral head articular cartilage were performed, along with microCT (µCT) analysis to assess subchondral bone remodeling. We observed that mice receiving abductor injury exhibited significantly increased instability-associated OA severity with loss of proteoglycan and type II collagen staining compared to sham control mice at 20 weeks post-surgery, while comparable matrix metalloproteinase 13 expression was observed between injury and sham groups. No significant differences in subchondral bone remodeling were found after 3 or 20 weeks following injury. Our study further supports the link between abductor dysfunction and the development of instability-associated hip OA. Importantly, this novel surgically induced hip OA mouse model may provide a valuable tool for future investigations into the pathogenesis and treatment of hip OA.

Ultrasound-guided PENG block versus intraarticular corticosteroid injection in hip osteoarthritis: a randomised controlled study.

This study aimed to compare the effectiveness of the pericapsular nerve group (PENG) block and intra-articular injection (IAI) of steroid-bupivacaine in the treatment of hip osteoarthritis (OA). After randomization, patients received either a PENG block or IAI under ultrasound-guidance. Clinical evaluations were recorded at baseline, day 1, and weeks 1, 4, and 8 post-intervention. The numerical rating scale (NRS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), Harris Hip Scale (HHS) scores, pain medication use determined by a quantitative analgesic questionnaire, and patient satisfaction were evaluated. Sixty patients were included in this study. NRS scores improved significantly for both groups during the follow-up compared to pretreatment (P < 0.001), with better pain scores for the PENG group (P < 0.001) at day 1 with larger effect size (Cohen's d = 4.62), and IAI group at 4 (Cohen's d = 5.15) and 8 (Cohen's d = 4.33) weeks (P < 0.001). There was no significant difference in pain medication consumption (P = 0.499) and patient satisfaction (P = 0.138) between groups. Patients in the IAI group experienced significant improvement in HHS (Cohen's d = 2.16, P = 0.007) and WOMAC (Cohen's d = 1.02, P = 0.036) scores at 8 weeks compared to the PENG group. The ultrasound-guided PENG block provides effective pain relief which improves functionality and quality of life in hip OA patients up to 2 months. The PENG block can be considered an easy, safe, and useful alternative treatment modality for hip OA.

The Short-Term Efficacy of Large-Focused and Controlled-Unfocused (Radial) Extracorporeal Shock Wave Therapies in the Treatment of Hip Osteoarthritis.

Although the classical treatments listed in the guidelines for osteoarthritis are widely used, the majority of patients do not fully recover from their pain. It is a fact that new treatment methods are needed both to relieve pain and restore deteriorated joint function. No study has been found to date that evaluated the efficacy of ESWT in hip OA. This pilot trial is the first in the literature to investigate the comparative effects of the two ESWT types (f-ESWT and r-ESWT) in the treatment of hip OA. Briefly, 148 patients were randomly distributed into the three ESWT groups: focused (f-ESWT), radial (r-ESWT), and sham (s-ESWT). Patients were assessed with the Visual Analog Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores just before the treatment (0 week), just after the treatment (4th week), and 1 month after completion of the treatment (8th week). VAS and all WOMAC scores were significantly reduced at follow-up points (4th and 8th weeks) in both the f-ESWT and r-ESWT groups compared with baseline (0 week) (for all, p &lt; 0.001). Statistical comparisons between the f-ESWT and r-ESWT groups showed that f-ESWT was superior to r-ESWT for the decrease in VAS and WOMAC scores from baseline to the 4th and 8th weeks (p &lt; 0.001 or p &lt; 0.002). Both r-ESWT and f-ESWT were found to have significant treatment efficacy compared with s-ESWT. However, f-ESWT produced a superior improvement in follow-up parameters compared to r-ESWT.

Aspirin and the Hip: Back to the Future? A 70-Year History: Commentary on an article by Leanne Ludwick, BS, et al.: "Aspirin May Be a Suitable Prophylaxis for Patients with a History of Venous Thromboembolism Undergoing Total Joint Arthroplasty".

Commentary In their article, Ludwick et al. provide data regarding the suitability of aspirin as prophylaxis against venous thromboembolism (VTE) in selected patients with a history of VTE undergoing total joint arthroplasty. Although observational, non-prospective, and nonrandomized, this study raises many questions about the practice of anticoagulation after arthroplasty during the last 50 years in orthopaedic surgery. In 1951, when Harold Ellis sat for the Fellowship examination of the Royal Colleges of Surgeons1, he was advised that, if questioned by an examiner, “What is the best treatment for osteoarthritis of the hip?” he should reply, “Provide the patient with a walking stick and prescribe aspirin.” In that time period, aspirin was given for pain. Later, when arthroplasty became the treatment for hip osteoarthritis, Charnley (cited by Salzman) and Harris2,3, as early as 1971, began to use aspirin to prevent fatal pulmonary embolism. Between 1970 and 2020, arthroplasties were performed with increasing frequency, and the risk of VTE in total hip arthroplasty (THA) was evaluated to be among the highest among procedures in all surgical specialties. Many drugs were tested and approved by regulatory agencies for the prevention of VTE. Yet, despite the millions of dollars spent on pharmaceutical research to develop new anticoagulants, we cannot answer4 this simple question: Which is the best one? Ludwick et al. confirm that aspirin, a drug known for 4,000 years, is still an actual pharmacologic approach for VTE prevention. Around 4,000 years ago5, herbal medicine used salicylic acid (the natural substance) from willow, myrtle, and meadow sweet. In the Assyrian and Sumerian periods, clay tablets recommended willow leaves for rheumatic disease. The aspirin that we know arrived in 1897 when a stabler form, acetylsalicylic acid, was synthesized by the chemist Felix Hoffmann (at Bayer in Germany), and in 1971 it was proposed to prevent VTE2. Why, for 50 years, have the pharmaceutical industry and orthopaedic surgeons spent so much money (compared with the cost of aspirin) without demonstrating the superiority of new anticoagulants? Nowadays, large-scale data, such as administrative governmental and clinical registries, are a powerful tool to answer questions, but only if there are answers to the questions. There is a difference between a scientific demonstration of effectiveness in the reduction of thrombophlebitis and pulmonary embolism and the scientific evaluation of effectiveness in the prevention of death by fatal pulmonary embolism. For the orthopaedic surgeon, the question remains simple: is it possible to predict and prevent a pulmonary embolism, particularly a fatal one? The prevalence of a fatal pulmonary embolism after hip arthroplasty is around 1.8% without prophylaxis and around 0.1% with any method of prevention4. Surgeons must remember that predicting the future remains difficult (even impossible). It is probably impossible to make a comparative scientific evaluation of the effectiveness of the prevention by 2 different treatments when the phenomenon is prevented. Clinicians use mortality statistics from the natural history of fatal pulmonary embolism and well-designed multicenter prospective studies of prevention using aspirin, anticoagulants, physical methods, or other drugs to change the natural history without increasing hematoma. A fair proportion of patients undergoing primary or revision arthroplasty are older than average. Underlying diseases and medications may contribute to the morbidity and mortality associated with the operation and pulmonary embolism. So, this prevention remains empirically a choice based on 2 assumptions: to use new methods to avoid death is to do good, and to use old methods suggests negligence. For many years, doing good appeared to be giving a new anticoagulation agent, which was more expensive, probably in the same way that doing good had been thought to be performing arthroplasty on young patients after that procedure became available. We know that the results of such thinking can sometimes be paradoxical. In an era of targeted therapy that is increasing health-care costs, aspirin is an old, inexpensive, and well-tolerated drug with a relatively low risk of excessive bleeding that, as proposed by Ludwick et al., may prove to be an effective agent to prevent venous thrombosis.

Intra-articular injection of monoiodoacetate induces diverse hip osteoarthritis in rats, depending on its dose

BackgroundMonoiodoacetate (MIA)-induced arthritis models are used widely in osteoarthritis (OA) research to develop effective conservative treatments for hip OA, as an alternative to joint replacement surgery. In joint OA models, such as the MIA-induced knee OA model, various doses of MIA are utilized, depending on the purpose of the research. So far, only 2 mg of MIA has been used for MIA-induced hip OA research. We hypothesized that the amount of MIA should be adjusted according to the osteoarthritis model under investigation. We performed radiographic and histological evaluations in rats for hip OA models induced by different doses of MIA.MethodsOne hundred and eighty right hips of six-week-old, male Sprague–Dawley rats (n = 30 rats per group) were treated with either a single intra-articular injection of various doses of MIA (0.25, 0.5, 1.0, 2.0, and 4.0 mg) dissolved in 25 μl of sterile saline (MIA group), or with 25 μl of sterile saline alone (Sham group). Radiographic and histological evaluations of the hip joint were performed at one, two, four, eight, and 12 weeks after administration (n = 6 rats per group per time point).ResultsOA changes progressed from 1 week after administration in the 1.0-mg, 2.0-mg, and 4.0-mg MIA groups. The degree of OA changes increased as the dose of MIA increased. The 0.25-mg and 0.5-mg MIA groups presented fewer OA changes than the 2.0-mg and 4.0-mg MIA groups during the entire study period (up to 12 weeks). The administration of 0.25 mg and 0.5 mg of MIA-induced both radiographic and histological OA changes in a time-dependent manner, whereas more than 2 mg of MIA provoked end-stage OA at 8 weeks after injection. Absolute, dose-dependent histopathological OA changes were observed 4 weeks after MIA administration.ConclusionsIntra-articular MIA injection to the hip joints of rats induced diverse OA changes dose-dependently. Research for developing novel conservative treatments for hip OA and intractable pain should consider the pathological condition when determining the dose of MIA to be employed.

Comparison of the Effect of MFAT and MFAT + PRP on Treatment of Hip Osteoarthritis: An Observational, Intention-to-Treat Study at One Year.

Hip osteoarthritis (OA) is a major contributor to reduced quality of life and concomitant disability associated with lost working life months. Intra-articular injection of various biological materials has shown promise in alleviating symptoms and potentially slowing down the degenerative process. Here, we compared the effects of treatment of a cohort of 147 patients suffering from grade 1–4 hip OA; with either micro-fragmented adipose tissue (MFAT), or a combination of MFAT with platelet-rich plasma (PRP). We found significant improvements in both the visual analogue score for pain (VAS) and Oxford hip score (OHS) that were similar for both treatments with over 60% having an improvement in the VAS score of 20 points or more. These results suggest a positive role for intra-articular injection of MFAT + PRP as a treatment for hip osteoarthritis which may be important particularly in low body mass index (BMI) patients where the difficulty in obtaining sufficient MFAT for treatment could be offset by using this combination of biologicals.

Platelet-rich Plasma and Its Application in Clinical Trial

Platelet-rich Plasma and Its Application in Clinical Trial

Is dislocation following total hip arthroplasty caused while suffering from delirium?

ABSTRACTThe mechanisms and pathologies of dislocation following total hip arthroplasty (THA) in patients with postoperative delirium remain unclear. Therefore, we conducted a retrospective study of 738 patients (738 hips) who underwent unilateral THA for the treatment of hip osteoarthritis. The patients were divided into two groups; with (n = 8) and without postoperative delirium (n = 730). Patients with postoperative delirium had a higher rate of dislocation following THA due to falling from a standing position on hospitalization than those without postoperative delirium (1/8 [12.5%] patients vs. 0/730 [0%] patients, p = 0.011). A power of 80.2% was provided for the rate of dislocation following THA due to falling from a standing position on hospitalization. Postoperative delirium after THA could be a cause of falling from standing position, leading to dislocation following THA during hospitalization. Therefore, postoperative delirium and its associated falls and injuries during hospitalization should be avoided by the elimination of patient’s preventable conditions and adjustment of the hospital environments, particularly in patients with the risk factors for postoperative delirium (eg, older age, general anesthesia, medications given [intraoperative opioids and ketamine and postoperative ketamine and benzodiazepines], higher comorbidity burden [diabetes mellitus, renal diseases, depression, anxiety, and psychoses], and blood transfusions). Further investigations with a larger cohort are needed to clarify this issue.

Postoperative Comprehensive Nursing Experience of Total Hip Arthroplasty in the Treatment of Hip Osteoarthritis

Postoperative Comprehensive Nursing Experience of Total Hip Arthroplasty in the Treatment of Hip Osteoarthritis

Cell technologies in the treatment of hip osteoarthritis

SummaryThe article is dedicated to the current state and prospects of cell technologies in the treatment of hip osteoarthritis. The material is based on the analysis of clinical trials on this topic submitted to international registry СlinicalTrials.gov. It has been founded 5 clinical trials relevant to the theme. Only one of these trials was completed with the results pub-lished. It has been stated that the use of cell technologies for the treatment of hip osteoarthritis is still in the stage of a pilot clinical experiment. Thus, it can not yet be the subject of any translation into common clinical practice. At the same time, there is a reason to expect in the upcoming years a serious progress in this direction. This is indicated by the fact that, as of March 1, 2020, the СlinicalTrials.govregistry lists 4 active clinical trials in which the usage of cell technologies in the treatment of hip osteoarthritis is tested. Some of these trials have been already recruiting patients or are ready to begin the recruitment.

Cost minimization of artificial hip bone implantation surgery by adopting additive manufacturing technique and its feasibility assessment

Osteoarthritis (OA) of the hip is the most common joint disease in elderly people and associated with significant physical disability. Pain relief is a primary treatment of hip OA. When the patient with hip OA has failed medical treatment modalities and remains in pain, the patient should be referred for hip replacement surgery in which the damaged surfaces of the joint is removed and replaced with a set of artificial ball-and-socket implants. In this research, a proposition for Additive Manufacturing (AM) is advocated to produce the bone implant to enhance the customer satisfaction along with minimization of costs. AM primarily differs from traditional material removal process because it creates product by successive deposits of material layer by layer. Because of this difference, the cost and operational methodologies are distinct from traditional manufacturing. For this reason, additive manufacturing is adopted for this artificial bone manufacturing and a stochastic optimization model is proposed to help a manufacturer decide when AM is best for them.

Conservative treatment of hip osteoarthritis; comparison between three medium/high molecular weight hyaluronic acid injections and two injections of HYADD®4: a randomized controlled double-blind study.

Conservative treatment of hip osteoarthritis; comparison between three medium/high molecular weight hyaluronic acid injections and two injections of HYADD®4: a randomized controlled double-blind study.

Platelet-rich plasma injections for hip osteoarthritis: a review of the evidence.

Osteoarthritis is a significant cause of chronic pain in the elderly population with hip osteoarthritis as one of the main causes of functional disability and joint pain in adults older than 55 years. Recently, platelet rich plasma (PRP) injections have been introduced for treatment of osteoarthritis. The aim of this systematic review is to assess its effectiveness in the management of hip osteoarthritis. We performed a search of the literature for published prospective studies that assessed the effectiveness of PRP injections in the treatment of hip osteoarthritis, with a minimum follow-up of 3 months. Primary outcome measures were WOMAC and VAS scores. Five trials were identified with 185 patients undergoing treatment with ultrasound-guided intra-articular injections of PRP, compared with patients treated with hyaluronic acid alone (n = 148) or hyaluronic acid combined with PRP (n = 31) in one study. PRP was shown to improve patient outcome scores at follow-up at 6 and 12 months; however, there was no significant difference seen between patients treated with PRP or hyaluronic acid alone. Following this systematic review, we cannot currently recommend the use of intra-articular injections of PRP for the treatment of hip OA. Given that intra-articular steroid injections are the only such injection recommended by international guidelines for the treatment of hip OA, further studies comparing PRP to steroid would be of benefit to determine the value of PRP injections in hip OA.