Unilateral Total Hip Arthroplasty Patients Research Articles

Image quality and metal artifact reduction in total hip arthroplasty CT: deep learning-based algorithm versus virtual monoenergetic imaging and orthopedic metal artifact reduction

BackgroundTo compare image quality, metal artifacts, and diagnostic confidence of conventional computed tomography (CT) images of unilateral total hip arthroplasty patients (THA) with deep learning-based metal artifact reduction (DL-MAR) to conventional CT and 130-keV monoenergetic images with and without orthopedic metal artifact reduction (O-MAR).MethodsConventional CT and 130-keV monoenergetic images with and without O-MAR and DL-MAR images of 28 unilateral THA patients were reconstructed. Image quality, metal artifacts, and diagnostic confidence in bone, pelvic organs, and soft tissue adjacent to the prosthesis were jointly scored by two experienced musculoskeletal radiologists. Contrast-to-noise ratios (CNR) between bladder and fat and muscle and fat were measured. Wilcoxon signed-rank tests with Holm-Bonferroni correction were used.ResultsSignificantly higher image quality, higher diagnostic confidence, and less severe metal artifacts were observed on DL-MAR and images with O-MAR compared to images without O-MAR (p < 0.001 for all comparisons). Higher image quality, higher diagnostic confidence for bone and soft tissue adjacent to the prosthesis, and less severe metal artifacts were observed on DL-MAR when compared to conventional images and 130-keV monoenergetic images with O-MAR (p ≤ 0.014). CNRs were higher for DL-MAR and images with O-MAR compared to images without O-MAR (p < 0.001). Higher CNRs were observed on DL-MAR images compared to conventional images and 130-keV monoenergetic images with O-MAR (p ≤ 0.010).ConclusionsDL-MAR showed higher image quality, diagnostic confidence, and superior metal artifact reduction compared to conventional CT images and 130-keV monoenergetic images with and without O-MAR in unilateral THA patients.Relevance statementDL-MAR resulted into improved image quality, stronger reduction of metal artifacts, and improved diagnostic confidence compared to conventional and virtual monoenergetic images with and without metal artifact reduction, bringing DL-based metal artifact reduction closer to clinical application.Key points• Metal artifacts introduced by total hip arthroplasty hamper radiologic assessment on CT.• A deep-learning algorithm (DL-MAR) was compared to dual-layer CT images with O-MAR.• DL-MAR showed best image quality and diagnostic confidence.• Highest contrast-to-noise ratios were observed on the DL-MAR images.Graphical

Predictive Factors of Pain and Functional Outcome 5 Years Following Total Hip Arthroplasty: A Prospective Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement Cohort Study

BackgroundPrevious reports have identified a number of potential predictors of pain and function after total hip arthroplasty (THA). However, the results of these studies were conflicting, and most had a short follow-up after THA. The purpose of this study was to identify factors predictive of pain and function 5 years after THA. MethodsA multicenter cohort of 7,934 primary unilateral THA patients was prospectively enrolled in the Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement consortium. Demographic data, comorbidities, and patient-reported outcome measures were collected preoperatively and postoperatively at 5 years, including the Hip Disability and OSteoarthritis Outcome Score (HOOS) pain and activities of daily living (ADL) scores. Multivariate logistic regression models with 95% confidence interval were used to identify independent predictors of pain and function at 5 years. ResultsThe patient dissatisfaction percentage was 8.2% at 5 years after THA. The multivariate regression identified the following predictive factors for the HOOS pain score at 5 years: age, educational level, insurance, smoking, race, Charlson Comorbidity Index, back pain severity, number of other lower extremity painful joints, the Knee Injury and Osteoarthritis Outcome Score pain severity of the ipsilateral knee, preoperative Short-Form Health Survey 36-item (SF-36) mental component summary score, and HOOS pain scores. The multivariate regression identified the following predictor factors for HOOS ADL score at 5 years: body mass index, insurance, smoking, race, back pain severity, number of other lower extremity painful joints, Knee Injury and Osteoarthritis Outcome Score pain severity of ipsilateral knee, preop HOOS ADL, and preoperative SF-36 mental component summary score and SF-36 physical component summary score. ConclusionsOverall, 8.2% of patients were dissatisfied 5 years after primary THA. We have identified a number of factors that predict less improvement in pain and function 5 years after THA. These potentially modifiable factors can be targeted with preoperative patient optimization programs to improve patient outcomes and satisfaction after primary THA. Knowledge of these factors that predict less improvement in pain and function can assist the surgeon and patient during shared decision-making, and in setting appropriate patient expectations preoperatively.

Increased Complication Risk Associated With Simultaneous Bilateral Total Hip Arthroplasty: A Contemporary, Matched Cohort Analysis

BackgroundSimultaneous bilateral total hip arthroplasty (sbTHA) continues to be performed in patients who have bilateral end-stage osteoarthritis. However, few studies have evaluated the risk associated with this practice compared to unilateral total hip arthroplasty (THA). MethodsUsing a large national database, primary, elective sbTHAs, and unilateral THAs were identified from January 1, 2015 to December 31, 2021. The sbTHAs were matched to unilateral THAs at a 1:5 ratio on age, sex, and pertinent comorbidities. Patient characteristics and comorbidities, and hospital factors were compared between both cohorts. Additionally, 90-day risk of postoperative complications, readmissions, and in-hospital deaths were assessed. After matching, 2,913 sbTHAs were compared to 14,565 unilateral THAs with an average age of 58.5 ± 10.0 years. ResultsCompared to unilateral patients, sbTHA patients demonstrated higher rates of pulmonary embolism (PE) (0.4 versus 0.2%, P = .002), acute renal failure (1.2 versus 0.7%, P = .007), acute blood loss anemia (30.4 versus 16.7%, P < .001), and need for transfusion (6.6 versus 1.8%, P < .001). After accounting for confounders, sbTHA patients demonstrated increased risk of PE (adjusted odds ratio [aOR]: 3.76, 95% CI: 1.84 to 7.70, P < .001), acute renal failure (aOR: 1.83, 95% CI: 1.23 to 2.72, P = .003), acute blood loss anemia (aOR: 2.3, 95% CI: 2.10 to 2.53, P < .001), and transfusion (aOR: 4.08, 95% CI: 3.35 to 4.98, P < .001) compared to unilateral THA patients. ConclusionThe practice of performing sbTHA was associated with an increased risk of PE, acute renal failure, and risk of transfusion. Careful evaluation of patient-specific risk factors is warranted when considering these bilateral procedures.

Reverse dynamics analysis of contact force and muscle activities during the golf swing after total hip arthroplasty

There are no reports on hip kinetics including contact forces and muscle activities during the golf swing after total hip arthroplasty (THA). The aim of this study was to identify the characteristics of three-dimensional dynamics during the golf swing. Ten unilateral primary THA patients participated in motion capture test of their driver golf swing. The driver swing produced approximately 20–30° of rotation in both lead and trail replaced hips. The mean hip contact forces (HCFs) of lead and trail replaced hips were 5.1 and 6.6 × body weight, respectively. Left and right THAs showed similar HCFs of lead and trail hips. More than 60% of the Percent maximum voluntary isometric contraction was found in bilateral iliopsoas muscles in all unilateral THA. Three factors [female sex, lower modified Harris Hip Score, and higher HCF of surgical side] were associated with the golf-related replacement hip pain. Golf is an admissible sport after THA because driver swings do not contribute excessive rotation or contact forces to hip prostheses. HCF could be reduced through swing adjustments, which may allow patients with golf-related replacement hip pain to develop a comfortable golf game free from pain.

Comparison of Intravenous Tranexamic Acid versus Combined Intravenous and Local Infiltration of Tranexamic Acid in Reducing Perioperative Blood Loss in Patients Undergoing Primary Unilateral Total Hip Arthroplasty: A Randomised Clinical Study

Introduction: The use of Tranexamic Acid (TXA) in primary unilateral Total Hip Arthroplasty (THA) is well documented. However, considering the potential side effects including deep vein thrombosis and pulmonary embolism, the ideal route of administration of TXA to patients undergoing THA is still not known. Aim: To compare the efficacy of single dose intravenous (i.v.) TXA administration versus combined intravenous and local infiltration of TXA in reducing the perioperative blood loss in primary unilateral THA patients. Materials and Methods: This prospective, randomised clinical study, was conducted in the Department of Anaesthesiology and Critical Care at Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India, between October 2020 to May 2021. 60 patients were randomly allocated into two groups: the combined group C (i.v. administration of 10 mg/kg of TXA combined with local infiltration of 600 mg TXA diluted to 60 mL with normal saline) and the single i.v. group S (i.v. administration of 10 mg/kg of TXA). The perioperative blood loss was calculated in terms of three variables- intraoperative blood loss, drainage blood loss and total blood loss. The number of postoperative blood transfusions noted. Student’s t-test and Fischer’s-exact tests were applied for statistical analysis. Results: A total of 60 patients scheduled to have primary unilateral THA. Both the groups were similar in demographic features, baseline biochemical values and procedural distribution. There was a statistically significant reduction in the (mean±SD) intraoperative blood loss (697.26±221.43 mL), drain blood volume (254.66±81.36 mL) and total blood loss (952.26±263.57 mL) in the combined group C when compared to the single group S. There was no statistically significant difference (p-value=0.671) in the postoperative blood transfusion rate between the two groups. Conclusion: Intravenous combined with local infiltration of TXA significantly reduced the perioperative blood loss in patients undergoing primary unilateral THA when compared to single dose intravenous administration of TXA.

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.

Anterolateral approach may be superior to posterolateral approach in controlling postoperative lower limb discrepancy in primary total hip arthroplasty: A single-center, retrospective cohort study.

This study aims to investigate the possible association and comparison between anterolateral approach (ALA) and posterolateral approach (PLA) and postoperative lower limb discrepancy (LLD) in selective total hip arthroplasty (THA). April 2021 and July 2021, a total of 266 consecutive patients (126 males, 140 females; mean age: 46.7±13.6 years; range, 22 to 60 years) who underwent unilateral primary THA via the ALA or the PLA were retrospectively analyzed. The operations were performed by a single surgical team. All patients were divided into two groups according to the approach: ALA group (n=66) and PLA group (n=200). Relevant data were recorded. Diagnosis including hip osteoarthritis, developmental dysplasia of the hip (DDH), aseptic avascular necrosis (AVN), and inflammatory arthritis were noted. Perioperative follow-up radiographs were evaluated and measured to compare the postoperative LLD and offset. The association between two approaches and postoperative LLD and offset was analyzed using the univariate and multivariate linear regression analysis. The mean follow-up was 20±3.7 (range, 16 to 25) months. Univariate analysis revealed that the postoperative LLD, the postoperative acetabular offset, and hospital costs were lower in the ALA group than the PLA group (p<0.01). However, the offset and length of stay were comparable between the two groups (p>0.05). Multivariate analysis revealed that the PLA (β=4.71; 95% confidence interval [CI]: 1.78 to 7.64), preoperative LLD (β=0.29; 95% CI: 0.21 to 0.37), DDH (β=5.01; 95% CI: 1.47 to 8.55), and AVN (β=3.81; 95% CI: 0.50 to 7.12) were the main contributors to the postoperative LLD. Our study results suggest that the ALA may be superior to the PLA in controlling the postoperative LLD among some of the selective unilateral primary THA patients. Both the ALA and the PLA were comparable in terms of the restoration of offset.

The Effect of Systemic Tranexamic Acid on Blood Loss and Blood Transfusion Requirement in Elective Total Hip Arthroplasty.

Although total hip arthroplasty (THA) is one of the most successful surgical procedures of the last century, high rates of bleeding and allogeneic blood transfusion may be required. Tranexamic acid (TXA) is an antifibrinolytic agent that has been increasingly used in THA in recent years to reduce blood loss and the need for transfusion. In this study, the effect of two doses of TXA, which was administered intravenously (iv) before and after surgery in unilateral THA patients, on total blood loss and blood transfusion need was compared retrospectively. A total of 327 patients who underwent elective THA at our department between January 2011 and January 2020 were identified. Demographic data, blood parameters before and after surgery and complications seen during a 90-day follow-up period were recorded from patient files. Total blood loss amounts were calculated according to Nadler&apos;s formula. The amount of transfused blood was recorded. 127 patients treated with IV TXA and 119 patients not given TXA were assigned to separate groups and compared. Total mean blood loss, decrease in hemoglobin levels and amount of blood transfusion were lower in the TXA group compared to the control group (p=0.001; p=0.001; p=0.001, respectively). The length of stay hospital was shorter in the TXA group than the control group (p=0.001). We think that it is an effective and reliable method in THA since giving IV TXA twice, as 15 mg / kg preoperatively and 10 mg / kg after the operation significantly reduces blood loss and the need for blood transfusion without causing an increase in thromboembolic complications.

Three-dimensional kinematics and kinetics of getting into and out of a car in patients after total hip arthroplasty

BackgroundIn modern society, car usage is one of the most important activities of daily living. However, the three-dimensional (3D) mechanics of getting into and out of a car in total hip arthroplasty (THA) patients have not been studied. Research questionThis study aimed to elucidate the hip kinematics and kinetics of unilateral THA patients while getting into and out of a car. Methods3D motion and ground reaction force data were collected for 40 unilateral primary THA and 30 control participants using motion capture of getting into and out of a car. Normalized joint power was used to determine the individual joint contribution and was calculated by dividing the power of each joint by the total lower-extremity power. These kinematic and kinetic data were compared between unilateral THA and control participants. ResultsWhen getting into the car using the surgical side as the pivot limb, the peak flexion, abduction angle, and normalized power of the pivot hip were significantly lower, and the normalized power of the contralateral ankle was significantly higher. The peak flexion and abduction angle of the pivot hip were significantly lower, and normalized contralateral hip power was significantly higher when getting out of the car. In getting into and out of the car using the contralateral side as the pivot limb, there was no significant difference in the range of motion (RoM) and normalized joint power. SignificanceThe restoration of RoM and muscle strength in the surgical hip joint and adopting the normal side as the pivot limb may allow for a more appropriate balance in motion of getting into and out of a car, which will lead to safe mobility, assist in social participation, and improved quality of life. Level of evidenceLevel III, therapeutic study.

Do Patient Outcomes Vary by Patient Age Following Primary Total Hip Arthroplasty?

Multiple authors have sought to determine what patient characteristics influence outcome after total hip arthroplasty (THA). Age has shown no effect on outcome in some evaluations, while others have reported higher functional improvement in younger patients. The aim of this study was to determine if outcome after THA varies based on patient age. A prospective, multicenter cohort of 7,934 unilateral primary THA patients from the FORCE-TJR comparative effectiveness consortium was evaluated. Demographic data, comorbid conditions, and Patient-Reported Outcome Measures, including (HOOS), HOOS-12, HOOS JR, and SF-36 (PCS) and (MCS), were collected preop and at 1-year postop. Descriptive statistics were generated, stratified by age (<55 years [younger adult], 55-64 years [older adult], 65-74 years [early elder], and ≥75 years [late elder]), and differences in pain, function, and quality of life among the 4 age groups were evaluated. A multivariate regression model with 95% confidence interval (CI) was used to assess the role of patient age as a predictive factor for HOOS pain and function scores reported 1 year after primary THA. Prior to surgery, younger patients (<55 years) reported worse pain, function, and quality of life than the other 3 patient groups. At 1 year after THA, younger patients (<55 years) reported slightly worse pain and quality of life but better function scores than the 3 older patients' groups. Younger patients (<55 years) achieved higher baseline to 1-year pain, and function score changes when compared to the older patients' groups. The quality of life score changes was not different among the 4 age groups. The differences in 1-year postop scores (ranging from 2.74 to 8.46) and the magnitude of score changes from baseline to 1 year (ranging from 1.9 to 5.85), although statistically significant (P < .001), did not reach the minimal clinically important difference (MCID). The multivariate regression analysis shows that age is a significant predictor for pain at 1 year but not for function. Although HOOS pain score is predicted to be higher by 4.38 points (less pain) 1 year after THA in older patients (≥75), when compared to younger patients (<55 years), again the difference is well below the MCID and is clinically insignificant. Although there are statistically significant differences in pain relief, functional improvement, and quality of life between younger and older patients among different patients' age groups, there is no clinically significant difference. THA provides an improvement in quality of life by decreasing pain and increasing function in all 4 age groups, with large improvements in Patient-Reported Outcome Measures scores (>2 standard deviations) without clinically significant age-related differences in THA outcome at 1 year.

The test-retest reliability, concurrent validity, and minimal detectable change of the L test in patients with total hip arthroplasty

BackgroundThe L test is a modified version of the timed up and go test (TUG) with an L-shaped walking path. The L test is more extensive than other performance tests, especially in turn direction and specific tasks. The study aimed to evaluate the test-retest reliability, concurrent validity, and minimal detectable change of the L test in patients with total hip arthroplasty (THA). A cross-sectional study was conducted with 33 unilateral and primary THA patients. The L test was performed twice with an interval of an hour on the same day for the test-retest reliability. Timed up and go test (TUG), five times sit to stand test (FTST), and Harris hip score (HHS) were carried out for the analysis of the concurrent validity of the L test.ResultsThe mean age of the participants was 74.6 ± 10.3 years. The ICC score of the L test was 0.992. Test-retest reliability was excellent. SEM95 and MDC95 values were 3.39 and 9.39, respectively. Both TUG and HHS were strongly correlated with the L test (r1 = 0.889, r2 = −0.568, p < 0.001). However, there was no significant correlation between FTST and L test (r = 0.024, p > 0.05).ConclusionsThe L test is valid and reliable performance measurement in patients with primary unilateral THA. MDC95 of the L test is an essential reference for clinicians in the rehabilitation follow-up process of THA patients.

Component placement accuracy of two digital intraoperative fluoroscopy supplementation systems in direct anterior total hip arthroplasty.

Intraoperative fluoroscopy (IF) may increase accuracy of component placement when performing direct anterior approach total hip arthroplasty (THA), however, unguided IF continues to produce inconsistent results. Supplementation of IF, with a digital grid (Grid) system or digital overlay (Overlay), may increase component placement accuracy. The purpose of this study was to compare component placement accuracy following THA when IF was supplemented with the Grid or Overlay technique. Acetabular abduction and anteversion, with leg length discrepancy (LLD) and global hip offset (GHO) were retrospectively evaluated for unilateral and bilateral THA patients from 6-week post-operative radiographs. Target component placement were GHO and LLD < 10mm, abduction 45° ± 10° and anteversion 15° ± 10° for Overlay and 17° ± 10° for Grid. Differences between the Overlay and Grid were determined by univariate analyses. The Overlay and Grid groups included 178 patients (217 hips) and 262 patients (317 hips), respectively. Target placement with the Overlay and Grid was achieved for GHO in 98.3% and 95.7% of cases (p = 0.108), LLD in 100% and 98.4% of cases (p = 0.121), cup abduction in 98.2% and 97.4% of cases (p = 0.384), and cup anteversion in 97.7% and 71.1% of cases (p < 0.001), respectively. Surgical time was significantly longer in Overlay compared to Grid (Unilateral 77.5 ± 14.1min and 68.8 ± 12.2; p < 0.001; Bilateral 184.6 ± 27.0min and 165.5 ± 23.1; p < 0.001, respectively). Although no difference was found between the Grid and the Overlay cohorts for LLD, GHO or abduction angle, the Overlay resulted in greater accuracy for acetabular component anteversion angle, with only a slight decrease in surgical efficiency.

Well-Placed Acetabular Component Oriented Outside the Safe Zone During Weight-Bearing Daily Activities.

Background: A comprehensive and thorough understanding of functional acetabular component orientation is essential for optimizing the clinical outcome after total hip arthroplasty (THA). This study aimed to quantify the functional acetabular anteversion and inclination of unilateral THA patients during walking and static standing and to determine whether the functional acetabular orientation falls within the Lewinnek safe zone.Methods: Seventeen patients with unilateral THA received a CT scan and dual fluoroscopic imaging during level walking and static standing to evaluate in vivo hip kinematics. The pelvic functional coordinate system of the 3D CT-based computer model was defined by the line of gravity and anterior pelvic plane (APP) to measure functional acetabular anteversion and inclination in different postures. The Lewinnek safe zone was used to determine the acetabular malposition during functional activities.Results: The THA side demonstrated an average of 10.1° (± 9.6°, range –7.5° to 29.9°) larger functional anteversion and 16.0° (± 9.2°, range –7.2° to 29.9°) smaller inclination than native hips during level walking. Functional acetabular anteversion in the THA side during level walking and static standing was significantly larger than anatomical measurements (p < 0.05). Acetabular orientation of most well-placed THA components anatomically in the Lewinnek safe zone fell outside the safe zone during more than half of the gait cycle and static standing.Conclusion: The current study revealed that an anatomically well-placed acetabular cup does not guarantee a well-functional orientation during daily activities. The in vivo mechanical performance and loading conditions of the THA component during other weight-bearing activities should be investigated in further studies.

Spinal Anesthesia Using Ropivacaine Leads to Earlier Ambulation After Total Hip Arthroplasty.

Spinal anesthesia has grown in popularity for total hip arthroplasty (THA) due to its documented low complications. However, the use of a local anesthetic agent dictates the recovery of neuraxial blockade. Bupivacaine has emerged as the most popular choice, but its relatively long-acting effect limits its use with rapid recovery. Although not well studied, ropivacaine may offer a viable alternative with shorter-acting properties. Primary unilateral THA patients who received either ropivacaine or bupivacaine spinal anesthesia were retrospectively reviewed. These groups were compared for common demographics, such as age, sex, and body mass index. The primary outcomes included postoperative ambulation time and distance, post-anesthesia care unit transition time, and selective complications. Five hundred three patients were included. Of these, 227 received ropivacaine and 276 received bupivacaine. The ropivacaine group showed superior ambulation time and distance, quicker post-anesthesia care unit transition, and equivalent complications compared with the bupivacaine group. Ropivacaine shows a clear advantage over bupivacaine for spinal anesthesia during THA when considering rapid recovery. Its use should be strongly considered, especially in the ambulatory setting. [Orthopedics. 2021;44(3):e343-e346.].

Sex-Specific Difference in Dynamic Balance Following Total Hip Replacement

Background and ObjectivesTotal hip arthroplasty (THA) is a common surgical procedure in older adults (65 years or older). THA has high patient satisfaction, but little is known about balance and mobility limitations after surgery and if outcomes are sex-specific. This study was aimed to evaluate post-THA asymmetry during unilateral standing and a dynamic balance and reach test and test the hypotheses that balance performance would be decreased on the surgical limb and that balance deficits would be greater in women than in men.Research Design and MethodsPrimary, unilateral THA (70 male, 57 female) patients completed a bilateral 10-s single-leg stance test. Sixty male but only 34 female participants could maintain unilateral balance for 10 s or greater. The cohort who successfully completed the 10-s single-limb stance test then completed a Lower Quarter Y-Balance Test in which the maximum anterior (ANT), posteromedial (PM), and posterolateral reach distances were obtained bilaterally and used to calculate the asymmetry score. All variables were compared using a mixed-model repeated-measures analysis of variance (sex by limb), while independent samples t tests were used to assess sex-specific asymmetry.ResultsWomen failed single-leg stance at a higher rate than men (85.7% vs 59.6%; p = .001). Reach distance was different between limbs for all reach directions (p < .004) with greater reach distance on the nonoperative limb for all patients. Men had a greater reach distance in the ANT (p = .004) and PM (p = .006) directions.Discussion and ImplicationsThese results indicate that post-THA, the operative limb and female patients have greater balance limitations. These results are novel and reveal sex-specific patterns that emphasize the need for sex-specific postoperative rehabilitation programs to improve long-term outcomes, especially in older adults with muscle weakness and balance deficits.

Optimizing the Femoral Offset for Restoring Physiological Hip Muscle Function in Patients With Total Hip Arthroplasty.

ObjectiveFemoral offset (FO) restoration is significantly correlated with functional recovery following total hip arthroplasty (THA). Accurately assessing the effects of FO changes on hip muscles following THA would help improve function and optimize functional outcomes. The present study aimed to (1) identify the impact of FO side difference on the hip muscle moment arms following unilateral THA during gait and (2) propose the optimal FO for a physiological hip muscle function.MethodsIn vivo hip kinematics from eighteen unilateral THA patients during gait were measured with a dual-fluoroscopic imaging system. The moment arms of thirteen hip muscles were calculated using CT-based 3D musculoskeletal models with the hip muscles’ lines of actions. The correlation coefficient (R) between FO and hip muscle moment arm changes compared with the non-implanted hip was calculated. We considered that the FO reconstruction was satisfactory when the abductor moment arms increased, while the extensor, adductor, and flexor moment arms decreased less than 5%.ResultsA decreased FO following THA was significantly correlated with a decrease of the abductor and external rotator moment arms during the whole gait (R > 0.5) and a decrease of extensor moment arms during the stance phase (R > 0.4). An increased FO following THA was significantly associated with shorter flexor moment arms throughout the gait (R < −0.5) and shorter adductor moment arms in the stance phase (R < −0.4). An increase in FO of 2.3–2.9 mm resulted in increased abductor moment arms while maintaining the maximum decrease of the hip muscles at less than 5.0%.ConclusionAn increase of 2–3 mm in FO could improve the abductor and external rotator function following a THA. Accurate surgical planning with optimal FO reconstruction is essential to restoring normal hip muscle function in THA patients.

The test-retest reliability and concurrent validity of the five times sit to stand test and step test in older adults with total hip arthroplasty.

The aim of the study was to determine the test-retest reliability and concurrent validity of the five times sit to stand test (FTST) and step test (ST) in older adults with total hip arthroplasty (THA). A cross-sectional and prospective study was carried out with 32 unilateral total hip arthroplasty patients. FTST, ST, and Timed Up & Go Test were evaluated at the first evaluation session. The test-retest reliability was evaluated by performing two repetitions of the FTST and ST. Besides, the functional status of the patients was evaluated with the Harris Hip Score (HHS). The test-retest reliability of the FTST and ST were assessed by the intraclass correlation coefficient (ICC). In the concurrent validity analysis, the Pearson correlation coefficient was analyzed. In addition, the standard error of measurement (SEM95) and minimal detectable change (MDC95) values of the FTST and ST were also calculated. The mean age of the participants was 75.4 ± 10.3 years. The ICC score of FTST, ST (right) and ST (left) were 0.987, 0.908 and 0.846, respectively. SEM95 and MDC95 values of the FTST were 1.05 and 2.91, respectively. FTST was correlated with both the HHS and TUG (r1 = -0.522, r2 = 0.730, p < 0.01). SEM95 and MDC95 values of the ST (right) were 0.37 and 1.02, respectively. SEM95 and MDC95 values of the ST (left) were 0.55 and 1.52, respectively. Also, ST (right) was only correlated with TUG (r = -0.654, p < 0.01). ST (right) were correlated with both the HHS and TUG (r1 = 0.503, r2 = -0.806, p < 0.01). The degree of correlations was strong. The FTST and ST are valid and reliable performance tests in older adults with primary unilateral THA.

Adverse effects of total hip arthroplasty on the hip abductor and adductor muscle lengths and moment arms during gait

BackgroundPrecise evaluation of the hip abductor and adductor muscles function in total hip arthroplasty (THA) patients during gait could help prevent postoperative complications and optimize the rehabilitation training program. The purpose of this study was to elucidate the effects of THA on the hip abductor and adductor muscle lengths and moment arms of in vivo patients during gait.MethodsTen unilateral THA patients received CT scans and dual fluoroscopic imaging for the hip kinematics during gait. The hip abductor and adductor muscle insertions were digitized on the 3D hip model for the determination of their dynamic lines of action and moment arms. Changes in the hip abductor and adductor muscle lengths and moment arms of THA patients between the implanted and non-implanted sides were quantified during gait.ResultsThe adductor longus, adductor brevis, and pectineus of the implanted hips had significantly (P < 0.05) less elongation than that of the non-implanted side during the stance phase. The gluteus medius, gluteus minimus, and piriformis moment arms of the implanted side were significantly shorter. The piriformis muscle moment arm was significantly larger. In the double support phase, the adductor magnus and adductor longus moment arms of the implanted sides were significantly decreased.ConclusionsResults suggested that the adverse effects of THA on hip stability. Development of a rehabilitation program considering the effects of THA is essential. Accurate surgical techniques may reduce the impact of THA on the peripheral muscles.

An ultrasound-guided fascia iliaca catheter technique does not impair ambulatory ability within a clinical pathway for total hip arthroplasty

BACKGROUND Both neuraxial and peripheral regional analgesic techniques offer postoperative analgesia for total hip arthroplasty (THA) patients. While no single technique is preferred, quadriceps muscle weakness from peripheral nerve blocks may impede rehabilitation. We designed this study to compare postoperative ambulation outcome in THA patients who were treated with a new ultrasound-guided fascia iliaca catheter (FIC) technique or intrathecal morphine (ITM). METHODS We reviewed the electronic health records of a sequential series of primary unilateral THA patients who were part of a standardized clinical pathway; apart from differences in regional analgesic technique, all other aspects of the pathway were the same. Our primary outcome was total ambulation distance (meters) combined for postoperative days 1 and 2. Secondary outcomes included daily opioid consumption (morphine milligram equivalents) and analgesic-related side effects. We examined the association between the primary outcome and analgesic technique by performing crude and adjusted ordinary least-squares linear regression. A P value < 0.05 was considered statistically-significant. RESULTS The study analyzed the records of 179 patients (fascia iliaca, n = 106; intrathecal, n = 73). The primary outcome (total ambulation distance) did not differ between the groups (P = 0.08). Body mass index (BMI) was the only factor (β = -1.7 [95% CI -0.5 to -2.9], P < 0.01) associated with ambulation distance. Opioid consumption did not differ, while increased pruritus was seen in the intrathecal group (P < 0.01). CONCLUSIONS BMI affects postoperative ambulation outcome after hip arthroplasty, whereas the type of regional analgesic technique used does not. An ultrasound-guided FIC technique offers similar analgesia with fewer side effects when compared with ITM.

One-stage bilateral total hip arthroplasty versus unilateral total hip arthroplasty: A retrospective case-matched study

BackgroundOne-stage bilateral hip replacement has the advantage of involving a single anesthesia, single hospital admission and single rehabilitation program. The theoretic drawback is increased surgical risk. Few French series have been reported, and none with comparison versus unilateral arthroplasty. We therefore conducted a comparative case-control study between 1-stage bilateral (1B-THA) and unilateral total hip arthroplasty (U-THA), assessing (1) morbidity/mortality, (2) survival, and (3) functional scores and forgotten hip rates. HypothesisIn a selected ASA 1 or 2 population, 1B-THA shows complications rates and implant survival comparable to U-THA. Material and methodBetween 2004 and 2018, 327 patients were included: 109 with 1B-THA, 218 with U-THA. One 1B-THA patient was matched to 2 U-THA patients on age, gender, diagnosis, ASA score 1 or 2, and anterior or posterior approach. Minimum follow-up was 12 months. Complications were collected for all patients in both groups. Early (≤90 days) or late (>90 days) morbidity/mortality and implant survival were recorded for both groups. Secondary endpoints concerned blood-sparing strategy and blood loss, functional scores, and patient satisfaction. ResultsMortality was zero in both groups. There was no significant difference in complications rates (1B-THA 38.5%, U-THA 40.8%) (p=0.69), whether early (8.3% [9/109] and 7.8% [17/218] respectively [p=0.89]) or late (30.3% [33/109] and 33.0% [72/218] respectively [p=0.61]). Limb-length discrepancy was significantly less frequent in 1B-THA (5.5% [6/109] versus 13.3% [29/218] [p=0.03]). Forgotten hip rate was significantly more frequent in 1B-THA (86% [94/109] versus 70% [152/218] [p=0.01]). Five-year Kaplan-Meier implant survival was 97.2% (95% CI [91.9–99.1]) in 1B-THA and 96.6% (95% CI [93.0–98.4]) in U-THA (p=0.08). DiscussionOne-stage bilateral total hip arthroplasty gave acceptable results in disabling bilateral osteoarthritis of the hip with low surgical risk in selected patients (ASA 1 or 2). Mortality, complications and implant survival were unaffected, but the 1-stage bilateral procedure allowed better control of limb-length and provided a higher rate of forgotten hip. Level of evidenceIII, matched case-control study.