Use Of Total Hip Arthroplasty Research Articles

FRICTION AND WEAR TEST OF POLISH COMPONENTSOF A HIP JOINT ENDOPROSTHESIS WITH CERAMICPOLYETHYLENEMATERIAL CONTACT USING HIP JOINTMOVEMENT SIMULATOR

The article presents the results of friction and wear tests of a total hip joint endoprosthesis. The researchmaterial consisted of three pairs of components of a hip joint endoprosthesis with a ceramic-polyethylenematerial contact for use in total hip arthroplasty. The rubbing pair was made of an acetabular cup made ofultra-high molecular weight polyethylene (UHMWPE) and a head made of ZTA oxide ceramic (Al2O3 +ZrO2) with a diameter of 28 mm. All the components of the endoprosthesis were made by the Polish company"Laser Polska" Marcin Garncarek.Friction and wear tests were carried out utilizing an SBT 01.2 simulator, designed and made in the ŁukasiewiczResearch Network – Poznań Institute of Technology. The simulator is designed to test the tribologicalproperties of hip joint endoprostheses in accordance with the ISO 14242-1 standard. An aqueous solution ofbovine serum, was used as the lubricant.For each rubbing pair, the set number of motion cycles was 5106. Based on the recorded values of frictiontorque and downforce, the coefficient of friction as a function of the number of cycles was determined. Theexact wear value of the acetabular cups was determined after the tests, in accordance with the ASTM F1714-96 standard.

Analysis of Biomechanical Gait Parameters in Patients after Total Hip Replacement in the Early Recovery Period

INTRODUCTION. The widespread use of total hip arthroplasty (THA) places high demands on the restoration of a normal gait pattern and is one of the key goals of rehabilitation. AIM. Determination of key parameters of walking in patients after THA to assess the effectiveness of restoration of the physiological gait pattern. MATERIALS AND METHODS. In a control prospective study, the main group consisted of 23 patients (11 men, 12 women, aged from 41 to 75 years, mean age 63.9 ± 9.4 years), who in the first 8 weeks after planned THA, moved with the help of assistive devices. supports (two crutches or walkers) who underwent stage II of medical rehabilitation; control group — 27 healthy people (12 men and 15 women, aged from 42 to 73 years, average age 60.9 ± 9.9 years). Spatiotemporal and kinematic gait parameters were recorded before and after the rehabilitation course using a gait simulator with biofeedback equipped with three sensors. For each leg, spatiotemporal and kinematic biomechanical parameters were separately recorded. RESULTS. All spatiotemporal gait parameters on both limbs and pelvic mobility in the sagittal plane in patients in the early recovery period after THA before the start of the rehabilitation course are significantly different from healthy people. After a course of rehabilitation, the studied gait parameters approach physiological values. The main asymmetry is observed in the single support phase from 16 % at the beginning of the course, to 10 % at the end; sagittal pelvic mobility are 2 times higher than the physiological normal meaning at the beginning of the course, without significant changes in dynamics. DISCUSSION. Disturbances in the gait pattern are observed in the majority of patients undergoing THA. Step symmetry is one of the significant parameters of walking, according to which the primary global assessment of its quality is carried out. Asymmetry of the single support phase of the limbs is a natural development of compensatory motor reactions after endoprosthetics. CONCLUSION. The gait parameters “step frequency” and “step cycle” quickly change after a course of rehabilitation and can be used to assess the locomotor activity of patients during short courses of medical rehabilitation in the early recovery period. Indicators of stance and swing phases, their symmetry changes much more slowly, can serve as criteria for assessing the effectiveness of measures taken at the stages of rehabilitation in the dynamics of gait restoration.

Increased Risk of 10-Year Revision Following Total Hip Arthroplasty for Femoral Neck Fracture

BackgroundAs the incidence of femoral neck fractures (FNFs) increases with the aging population, understanding its impact on surgical outcomes is important to improving implant survival and patient satisfaction. Despite increasing use of total hip arthroplasty (THA) as management for FNF, few studies have examined long-term implant survivability. Thus, this study sought to determine the 10-years cumulative incidence of revision and indications for revision in patients undergoing THA for FNF in comparison to osteoarthritis. MethodsPatients who underwent primary THA for FNF or osteoarthritis were identified using a national administrative claims database and propensity-score matched in a 1:2 ratio based on age, gender, the Charlson Comorbidity Index (CCI), smoking, obesity, and diabetes mellitus. Kaplan-Meier and Cox proportional hazards analyses were used to observe the cumulative incidence and risk of all-cause revision, periprosthetic joint infection (PJI), dislocation, mechanical loosening, and periprosthetic fracture (PPF) within 10 years of primary THA. In total, 19,735 patients who underwent THA for FNF and 39,383 patients who underwent THA for osteoarthritis were included. ResultsThe 10-years cumulative incidences of all-cause revision (7.1 versus 4.9%), PJI (5.0 versus 3.3%), dislocation (6.8 versus 3.8%), mechanical loosening (3.1 versus 1.9%), and PPF (7.8 versus 4.0%) were significantly higher for those who underwent THA for FNF versus osteoarthritis. Femoral neck fractures were associated with higher risks of revision (hazard ratio [HR]: 1.6), PJI (HR: 1.7), dislocation (HR: 2.0), mechanical loosening (HR: 1.6), and PPF (HR: 2.2) (P < 0.001 for all). ConclusionsDespite the advantages of THA, femoral neck fractures remain a major risk factor for long-term complications. Tailored preoperative planning, surgical techniques, and postoperative bone health optimization in these patients may help minimize poor outcomes.

ARE COGNITIVELY IMPAIRED PATIENTS SUITABLE CANDIDATES FOR HIP ARTHROPLASTY? A PROPENSITY SCORE-MATCHED COHORT STUDY

The growth of life expectancy during the last decades has led to an increment in age-related conditions such as hip arthritis and fractures. On the other hand, these elderly patients will present a higher incidence of mental diseases which, in some studies, have been associated with inferior results.This study aims to evaluate the differences in early complication rates between patients with cognitive impairment compared with those without this condition following total hip replacement for osteoarthritis or fracture in the context of contemporary perioperative care protocols.We conducted a retrospective cohort study where cognitively-impaired patients who required primary hip arthroplasty were compared to a propensity-score matched cohort of patients without cognitive alterations. Early major complications were measured and analyzed in order to determine significant differences.Screening and matching. 1196 patients were identified during the study period. After screening for inclusion and exclusion criteria and matching, two cohorts comprising 65 patients each were compared. After performing the propensity-score match, no significant differences were found in covariates between the two groups.Outcomes. The occurrence of delirium was more frequent in patients with cognitive deficit (27.5%) than in the control group (9%), p&lt;0.001. No significant differences were found among groups regarding myocardial infarction, venous thromboembolism, blood transfusion requirement, 30-day readmission, in-hospital death, 90-days death, dislocation or surgical site infection. The composite outcome of any adverse event did not exhibit a significant difference either.To our knowledge, this is the first study which demonstrates similar outcomes between patients with cognitive impairment and those without these alterations. Our results might indicate that contemporary protocols and implants are bridging the traditional gap between these two populations. These findings support the use of total hip arthroplasty in patients with mental alterations when indicated, especially in those institutions with strict perioperative protocols.

Periprosthetic Fractures: A Rising Tide of Hip Arthroplasty Failure Noted in the American Joint Replacement Registry and the Preventative Role of Cemented Stems

BackgroundThis investigation examined cemented femoral component use in total hip arthroplasty (THA) and its impact on the incidence of periprosthetic fractures (PPFx), a common failure mode in THA. The study leverages data from the American Joint Replacement Registry (AJRR) to assess trends in cemented femoral component usage over time, its association with PPFx rates, and compares the survivorship and 90-day complication rates between cemented and cementless femoral component THAs. MethodsPrimary THAs, captured in the AJRR, in patients aged 65 years and older from 2012 to 2021 were analyzed. Variables considered included age, sex, race, region, teaching status, year, Charlson comorbidity index, and institution bed size. Analysis compared fixation types for THA on all-cause linked revision and PPFx. Logistic regression models analyzed the odds ratios for all-cause linked revision and PPFx for any follow-up time as well as for 90-day revision. The models were adjusted for the listed variables. ResultsDuring the study period, the rate of cement utilization as a percentage of primary THAs performed and reported to the AJRR increased from 4.4 to 8.3%. The rate of THA failure from PPFx increased from 11.4 to 33.3%. When both fixation groups were compared in the univariate analysis, there was a statistically significant difference in all demographic variables (P < .001). To account for this, multivariable logistic regression models were applied. In our models, cemented stems showed a 54.4% (odds ratio: 0.456; 95% confidence interval: 0.347 to 0.599; P < .0001) and 65.8% (odds ratio: 0.342; 95% confidence interval: 0.237 to 0.493; P < .0001) lower risk of PPFx linked and PPFx early linked revision, respectively. ConclusionsPeriprosthetic fractures are becoming a leading failure mode for THAs in the AJRR. Given cemented fixation’s relative resistance to this failure mode compared to cementless fixation, we should consider increasing the utilization of this technique.

Development of a patient-centred tool for use in total hip arthroplasty.

The aim of this project was to develop a tool using the experience of previous patients to inform patient-centred clinical decision-making in the context of total hip arthroplasty (THA). We sought out the patients' views on what is important for them, leveraging registry data, and providing outcome information that is perceived as relevant, understandable, adapted to a specific patient's profile, and readily available. We created the information tool "Patients like me" in four steps. (1) The knowledge basis was the systematically collected detailed exposure and outcome information from the Geneva Arthroplasty Registry established 1996. (2) From the registry we randomly selected 275 patients about to undergo or having already undergone THA and asked them via interviews and a survey which benefits and harms associated with the operation and daily life with the prosthesis they perceived as most important. (3) The identified relevant data (39 predictor candidates, 15 outcomes) were evaluated using Conditional Inference Trees analysis to construct a classification algorithm for each of the 15 outcomes at three different time points/periods. Internal validity of the results was tested using bootstrapping. (4) The tool was designed by and pre-tested with patients over several iterations. Data from 6836 primary elective THAs operated between 1996 and 2019 were included. The trajectories for the 15 outcomes from the domains pain relief, activity improvement, complication (infection, dislocation, peri-prosthetic fracture) and what to expect in the future (revision surgery, need for contralateral hip replacement) over up to 20 years after surgery were presented for all patients and for specific patient profiles. The tool was adapted to various purposes including individual use, group sessions, patient-clinician interaction and surgeon information to complement the preoperative planning. The pre-test patients' feedback to the tool was unanimously positive. They considered it interesting, clear, complete, and complementary to other information received. The tool based on a survey of patients' perceived concerns and interests and the corresponding long-term data from a large institutional registry makes past patients' experience accessible, understandable, and visible for today's patients and their clinicians. It is a comprehensive illustration of trajectories of relevant outcomes from previous "Patients like me". This principle and methodology can be applied in other medical fields.

Registration in the supine position improve the accuracy of cup placement in total hip arthroplasty using a portable navigation system

Portable navigation systems have been developed for use in total hip arthroplasty (THA) in recent years. Although intraoperative registration in the lateral decubitus position or the supine position is need to create the three-dimensional coordinate system, it is not clear which position is appropriate. The purpose of this study was to assess the accuracy of cup placement in primary THA in the lateral decubitus position using an image-free handheld navigation device with registration in the lateral decubitus or the supine position, and clarify which position is appropriate. This retrospective study included 129 consecutive cementless THAs performed using an image-free handheld navigation device in the lateral decubitus position. Registration in the first 68 hips was performed in the lateral decubitus position and the last 61 hips was performed in the supine position. Postoperative cup radiographic inclination and radiographic anteversion were assessed, and the accuracy was compared between the two groups. The mean absolute errors of the postoperative measured inclination and anteversion from the target angles were 3.9° ± 2.2° and 4.8° ± 3.5° in the lateral group and 2.9° ± 2.7° and 3.2° ± 2.7° in the supine group (p < 0.05). The percentage of cups inside Lewinnek’s safe zone was 94% in the lateral group and 95% in the supine group (ns). The mean absolute values of navigation error in inclination and anteversion were 3.1° ± 2.1° and 4.2° ± 2.8° in the lateral group and 2.3° ± 2.0° and 3.1° ± 2.4° in the supine group (p < 0.05 and p < 0.05). Registration in the supine position improved the accuracy of cup insertion compared with the lateral decubitus position in THA using an image-free handheld navigation device in the lateral decubitus position.

Chronic obstructive pulmonary disease is an independent risk factor for increased opioid use in total hip arthroplasty: A retrospective PearlDiver study

BackgroundTotal hip arthroplasty (THA) has become an incredibly common procedure due to its’ predictability and high success rate. The success of surgery is related to strict indications and careful optimization of medical comorbidities to decrease risk and improve outcomes. Chronic obstructive pulmonary disease (COPD) has been associated with increased medical and surgical complications. A regulatory focus on opioid utilization does not usually consider COPD as a risk factor, but limited research exists on the impact of COPD on outcomes and risks after THA. MethodsRetrospective all-inclusive database analysis of Medicare patients who had undergone THA between 2007 and 2017 included in the PearlDiver Database were studied. Postoperative opioid usage was examined at 1-, 3-, 6-, and 12 months, along with surgical infection, implant complications, and revisions. Post-operative complications within 30 days, either medical or implant related, were identified. Controlling for comorbidities, age, and sex, odds ratios were calculated using multivariable logistic regression with a significant α value of 0.05. ResultsCOPD patients had significantly higher rates of opioid usage postoperatively. COPD patients also had an increased rate of readmissions, medical/implant complications, and revision surgeries. DiscussionThis is the only study raising concern regarding opioid use in COPD patients after total hip arthroplasty, which may be critical considering the associated respiratory depression further exacerbating the COPD. Considering the evidence of poor outcomes associated with COPD in arthroplasty, appropriately screening for COPD and counseling or planning for post-operative pain control and complications is paramount.

Contemporary posterior surgical approach with standard cemented total hip arthroplasty for femoral neck fracture in patients of age 60 years and older: Still a safe option?

PurposeThe ideal operative treatment of displaced intracapsular femoral neck fractures in the active elderly is contentious. Recent literature favours a better outcome with the use of total hip arthroplasty (THA). Dislocation remains a major concern with THA, especially when a posterior approach is used. More recently, the concept of dual mobility cups is being promoted to avoid dislocations. The aim of the present study was to look at the outcomes of cemented THA utilising the posterior approach for these patients using a 28 ​mm (mm) femoral head. MethodsThis study retrospectively analysed the outcome of 108 primary cemented THA, performed by specialist hip surgeons, using a posterior approach with robust soft tissue repair in patients of age 60 years and older presenting with displaced intra capsular femoral neck fractures using a 28 ​mm head. ResultAt mean follow-up of 5.2 years (2.0–10.5 years), there were 2 dislocations (1.9%). One underwent manipulation under anaesthesia and the other had application of a posterior lip augmentation device. No other revisions were performed during the follow up period. The 30 day mortality was nil and no post-operative deep infections. Hundred patients (93%) at 1 year follow-up were independently mobilising. ConclusionsWith optimal patient selection, an excellent outcome can be achieved for patients with displaced femoral neck fractures using the standard cemented THA via the posterior approach with 28 ​mm head. A robust soft tissue repair and a specialist hip surgeon is recommended for this cohort of patients.

Trends in the Use of Total Hip Arthroplasty in the Pediatric Population: A Review of the Literature.

Current literature shows that the utilization of total hip arthroplasty (THA) to address pediatric hip pathology has seen a significant rise worldwide in recent decades. However, performing THA in pediatric patients presents unique challenges due to their increased activity levels, varying skeletal maturity, and diverse medical conditions. These challenges have relegated THA to a secondary option for young patients. Nonetheless, despite these difficulties, recent studies have demonstrated a growing prevalence of THA in pediatrics. Consequently, there is an urgent need for a comprehensive review of the existing literature on this topic. In this study, we examined large database and single-institution studies involving pediatric patients aged 21 years and under who underwent THA. The primary indications for THA in this population were osteoarthritis, osteonecrosis, and inflammatory arthritis. To ensure informed decision-making for pediatric patients, it is crucial to gather consolidated information on trends and outcomes related to THA indications. This review aims to provide insights into these trends and facilitate better decision-making for the treatment of pediatric patients.

Otto Aufranc Award: Intraosseous Vancomycin in Total Hip Arthroplasty — Superior Tissue Concentrations and Improved Efficiency

BackgroundLiterature shows that intraosseous (IO) infusions are capable of providing increased local concentrations compared to those administered via intravenous (IV) access. Successes while using the technique for antibiotic prophylaxis administration in total knee arthroplasty (TKA) prompted consideration for use in total hip arthroplasty (THA) however; no study exists for the use of IO vancomycin in THA. MethodsThis single-blinded randomized control trial was performed from December 2020 to May 2022. Twenty patients were randomized into 1 of 2 groups: IV vancomycin (15 mg/kg) given routinely, or IO vancomycin (500 mg/100cc of NS) injected into the greater trochanter during incision. Serum vancomycin levels were collected at incision and closure. Soft tissue vancomycin levels were taken from the gluteus maximus (at start and end of case), and acetabular pulvinar tissue. Bone vancomycin levels were taken from the femoral head, acetabular reamings, and intramedullary bone. Adverse local/systemic reactions, 30-day complications, and 90-day complications were also tracked. ResultsA statistically significant reduction in serum vancomycin levels was seen when comparing IO to IV vancomycin at both the start and at the end of the procedure. All local tissue samples had higher concentrations of vancomycin in the IO group. Statistically significant increases were present within the acetabular bone reamings, and approached significance in intramedullary femoral bone. ConclusionThis study demonstrates the utility of IO vancomycin in primary THA with increased local tissue and decreased systemic concentrations. With positive findings in an area without tourniquet use, IO may be considered for antibiotic delivery for alternative procedures.

Total hip arthroplasty versus hemiarthroplasty for treatment of femoral neck fractures : a population-based analysis of practice variation in Ontario, Canada.

This study aimed to describe practice variation in the use of total hip arthroplasty (THA) for older patients with femoral neck fracture and to determine the association between patient, surgeon, and institution factors and treatment with THA. We performed a cross-sectional analysis of 49,597 patients aged 60 years and older from Ontario, Canada, who underwent hemiarthroplasty or THA for femoral neck fracture between 2002 and 2017. This population-based study used routinely collected healthcare databases linked through ICES (formerly known as the Institute for Clinical Evaluative Sciences). Multilevel logistic regression modelling was used to quantify the association between patient, surgeon, and institution-level variables and whether patients were treated with THA. Variance partition coefficient and median odds ratios were used to estimate the variation attributable to higher-level variables and the magnitude of effect of higher-level variables, respectively. Over the study period, 9.4% of patients (n = 4,638) were treated with THA. Patient factors associated with higher likelihood of treatment by THA included: younger age, male sex, and diagnosis with rheumatoid arthritis. Long-term care residence, use of home care services prior to hip fracture, diagnosis of dementia, higher comorbidity burden, and the most marginalized group were negatively associated with treatment by THA. Treating surgeon and institution accounted for 54.2% and 17.8% of the total variation in treatment with THA, respectively. Surgeon volume of THA procedures in the 365 days prior to surgery was the strongest higher-level predictor of treatment with THA. Specific treating surgeons and institutions still accounted for significant proportions of the variability in treatment with THA (40.3% and 19.5% of total observed variation, respectively) after controlling for available patient, surgeon, and institution-level variables. The strongest predictors for treatment of patients with femoral neck fracture with THA were patient age, treating surgeon, and treating institution. This practice variation highlights differential access to care for patients.Cite this article: Bone Joint J2023;105-B(2):180-189.

Comparing Outcomes of Total Hip Arthroplasty for Displaced Neck of Femur Fractures in Elderly Patients Utilizing Dual Mobility Cups and Conventional Implants: A Single Center Retrospective Study of 129 Patients.

Studies comparing the use of total hip arthroplasty (THA) with conventional implants and hemiarthroplasty for displaced femoral neck fractures (DFNF) have reported better patient satisfaction scores and outcomes in the former, but also significant dislocation rates (6.9-13%).The total hip arthroplasty with dual mobility cup (THA-DMC) design is mechanically proven to increase the hip range of motion and jump distance to dislocation relative to conventional implants. Despite its potential benefit, clinical studies analyzing the use of THA-DMC in the treatment of DFNF in comparison to conventional THA within the Asian population are still limited. Our study aims to compare the rate of complications and functional outcomes between the 2 implants in the treatment of DFNF. This was a retrospective cohort study conducted in a single tertiary care institution. From January 2015 to May 2020, data from 129 consecutive patients who satisfied the inclusion criteria and underwent either a THA or THA-DMC for DFNF were collected and divided into 2 groups. All patients received a standardized post-operative treatment and follow-up regime. Both groups of patients were assessed for post-operative complications such as dislocation, peri-prosthetic fractures, surgical site infections, medical complications. Their functional outcomes as well as patient-reported outcome scores were also assessed via the SF-36 score and Oxford hip score questionnaires at 6months and 1year. A total of 42 patients with dual mobility implants and 87 patients with conventional implants were recruited. There was no dislocation in the THA-DMC group while there were 4 cases (4/87, 4.6%) of dislocation in the THA group. Regarding post-operative function, both groups had comparable functional outcomes. There were no statistically significant differences between the patient-reported outcome scores (Oxford hip score and SF-36) at 6months and 1year. We report promising short-term outcomes utilizing dual mobility implants in total hip arthroplasty for the treatment of DFNFs.

Effect of Tranexamic Acid and Cell Salvage System Use in Total Hip Arthroplasty on Allogeneic Blood Transfusion and Hospital Costs in Geriatric Patients: A Retrospective Cohort Study

Effect of Tranexamic Acid and Cell Salvage System Use in Total Hip Arthroplasty on Allogeneic Blood Transfusion and Hospital Costs in Geriatric Patients: A Retrospective Cohort Study

Tantalum Versus Titanium Acetabular Cups in Primary Total Hip Arthroplasty: Current Concept and a Review of the Current Literature.

Primary total hip arthroplasty (THA) is becoming an increasingly popular and efficacious medical procedure. There have been a number of studies evaluating tantalum acetabular cups compared with the conventional titanium acetabular cups for use in total hip arthroplasties. We conducted a systematic review and summarize clinical studies comparing tantalum acetabular cups with the conventional titanium acetabular cups for use in primary total hip arthroplasties. A literature search was performed to find all relevant clinical studies until March 2020, which then underwent a further selection criteria. The inclusion criteria was set as follows: Reporting on human patients undergoing primary total hip arthroplasty; Direct comparison between tantalum acetabular cups with conventional titanium acetabular cups for use in primary total hip arthroplasty; Radiological evaluation (cup migration, osteointegration); Clinical (functional scores, need for subsequent revision, patient-reported outcomes; Post-operative complications; Reporting findings in the English Language. After a thorough search a total of six studies were included in the review. The primary outcome measures were clinical outcomes, implant migration, change in bone mineral density and rate of revision and infection. Tantalum is superior to titanium with regards to fewer radiolucencies, 100% survivorship at 12 years post-operatively, improved long-term implant osteointegration and survivorship as well as decreasing osteolysis and mechanical loosening. There has been no significant difference in radioisometric analysis, bone mineral density or Harris Hip Score. Revision and infection rates were found to be significantly lower in tantalum group at 10 years from pooled data of national joint registry (England and Wales), while it was found to be higher in the same at 9 years from pooled data of Swedish and Australian registry although this is not statistically significant. The use of tantalum should be reserved for cases of high risk of failure or mechanical loosening, where failure of a contralateral joint occurred. The use of Tantalum carries lower risk of failure and infection. Further studies with longer follow-up would be useful in drawing further conclusions.

Comparison between Outcomes of Small Head and Large Head Prosthesis Use in Total Hip Arthroplasty

Introduction: Total hip replacement (THR) currently uses a various size of head and bearing. These days the most common head diameter used in the THR is 32 mm. The purpose of our study is to compare the functional and radiographic evaluation of outcomes of two groups of patients undergoing the THR, received either small diameter (≤28 mm) or large diameter (≥32 mm) femoral head prosthesis. Materials and Methods: This was an interventional prospective study done between September 2018 and August 2020. The diameter of femoral head sizes 32 mm and 28 mm was used in this study. At definite intervals, patients were regularly followed and specifically assessed for functional and radiographic evaluation. Results: During follow-up of patients with 32-mm femoral head diameter excellent functional results were achieved as graded by Harris hip score (P &lt; 0.0001). No patients showed any complications in the large diameter femoral head group. Conclusions: Large femoral head diameter prosthesis may lead to more stability, range of motion, wear rate, and reducing the complications of revision surgery, but with small diameter femoral head, there is an increased chance of dislocation, impingement, and more complications.

Use of Total Hip Arthroplasty in Patients Under 21 Years Old: A US Population Analysis.

The purpose of this study is to evaluate trends in the use of total hip arthroplasty (THA) in the United States in patients under 21 years of age. Specifically, we examined the frequency of THA in this patient population over the past 2 decades, the epidemiologic characteristics of patients under 21 who underwent THA, and the characteristics of the hospitals where these procedures were performed. We retrospectively reviewed the Kids' Inpatient Database, an inpatient US national weighted sample of hospital admissions in patients under 21 from approximately 4200 hospitals in 46 states. We queried the database using Current Procedural Terminology codes for elective and non-elective primary THA for the years 2000-2016. We utilized the International Classification of Diseases, Ninth Revision and International Classification of Diseases, Tenth Revision codes to determine primary diagnoses. The weighted total number of THAs performed in patients under 21 in the Kids' Inpatient Database increased from 347 in 2000 to 551 in 2016. The most common diagnoses were osteonecrosis, osteoarthritis, and inflammatory arthritis. The frequency of THA for osteonecrosis increased from 24% in 2000 to 38% in 2016, while the frequency of THA for inflammatory arthritis decreased from 27% in 2000 to 4% in2016. The number of THAs in patients under 21 in the United States has increased over the past 2 decades and these procedures are increasingly performed in urban teaching hospitals. The decrease in THA for inflammatory arthritis in this population likely reflects improvements in medical management during the study period.

Surgical management of avascular necrosis of femoral head in young adults treated with uncemented total hip replacement

&lt;p class="abstract"&gt;&lt;strong&gt;Background: &lt;/strong&gt;Normal hip joint is subjected to many stresses during daily activities performed by an individual. Since it is one of the major weight bearing joints of the body, its normal function is necessary for daily activities. Avascular necrosis (AVN) of the femoral head is one of the common causes of painful hip in a young adult. Core decompression, fibular sturt graft can be considered in early stages, total hip arthroplasty in later stages of AVN of femoral head.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a retrospective study of 30 patients following uncemented total hip replacement, who were operated between August 2017 and March 2020 at MNR medical college and hospital, Sangareddy. They were followed up for a minimum period of 1 year and evaluated using Harris hip scoring system. Harris hip score is designed specifically for measuring functional outcomes in hip arthroplasty.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results: &lt;/strong&gt;There was a significant improvement in function as measured with the Harris hip score. The overall preoperative Harris hip score was 43, which remarkably improved to 89 postoperatively. The results observed, showed that all patients had good to excellent results, (Harris hip score ≥0) thus showing a good degree of pain relief, improvement in function and range of motion.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Although the use of total hip arthroplasty in young patients will more likely necessitate future revision surgery, the consistent relief of pain and good functional results have made this procedure an attractive treatment choice for the debilitating arthritis resulting from osteonecrosis of the femoral head. &lt;/p&gt;

Fixation and Implant Retention of Extracapsular Femoral Neck Periprosthetic Fractures Around Hip Resurfacing Arthroplasty - A Case Series.

Background:Extracapsular femoral neck fractures in the presence of a resurfacing hip arthroplasty (RHA) appear to be independent of suboptimal technique during the initial implantation of the RHA and present with a similar etiology as native hip fractures – that is, a fragility fracture related to pathological or age-related osteoporosis, as a consequence of trauma. In the presence of a well-fixed and previously well-functioning RHA, the options for management include revision arthroplasty or open reduction and internal fixation (ORIF). In the absence of loosening through mechanisms of wear, infection, metallosis, or suboptimal prosthesis positioning, many authors have advocated ORIF with implant retention. However, there is often debate regarding the use of total hip arthroplasty in these casesCase Series:The authors conducted a thorough assessment of the literature followed by a retrospective review of outcomes for three patients treated by ORIF with implant retention for extracapsular femoral neck fractures around a RHA, using a standardized technique. All patients were independently mobile and active with well-fixed and well-functioning RHAs before the date of injury. All patients suffered low-energy trauma resulting in the fracture. There were no intraoperative or perioperative complications. All patients achieved full weight-bearing status and independent mobility. Two patients achieved radiographic union and returned to full range of movement and independent mobilization comparable to their preoperative state. One patient was lost to follow-up.Conclusion:The authors believe that fixation of extracapsular proximal femoral fractures distal to a well-fixed, well-functioning RHA is a good management option in an independent and active patient. A higher level of evidence is needed to investigate the surgical management options of these injuries comparing osteosynthesis with revision arthroplasty.

High Satisfaction and Activity Levels After Total Hip Arthroplasty in Patients Under Age 21

BackgroundWith improved materials and bearing surfaces, the use of total hip arthroplasty (THA) in young patients is increasing. Functional outcomes and activity level are particularly relevant in this higher-demand patient population. There is a paucity of data on patient-reported outcomes and activity levels after THA in extremely young (<21 years old) patients. MethodsWe identified 196 patients (222 hips) who underwent THA at age <21 years at our institution from 1982 to 2018. After applying exclusion criteria, 113 of 160 (70.6%) patients (129 hips) were available for follow-up. Patient activity levels and functional outcomes were evaluated using the UCLA activity score, Forgotten Joint Score (FJS), Hip Disability and Osteoarthritis Outcome Score for Joint Replacement, and a validated 5-question satisfaction survey. Survivorship and reasons for revision were recorded. ResultsThe mean age at surgery was 17.0 ± 2.8 years, and the mean follow-up was 13.2 years (range 2-38 years). The most common indications for THA were osteonecrosis (34%) and juvenile idiopathic arthritis (30%). The mean UCLA activity score was 5.9 ± 2.0, and 64% of patients reported a score ≥6. The mean FJS was 57.9 ± 31.0. The mean Hip Disability and Osteoarthritis Outcome Score for Joint Replacement score was 84.6 ± 16.6. Ninety percent of patients reported that they were very or somewhat satisfied with their surgery. At final follow-up, 27 of 129 (20.9%) hips had undergone revision surgery. ConclusionTHA performed in patients under 21 years of age with end-stage hip disease allows for high levels of activity and satisfaction postoperatively, with most patients being able to participate in moderate recreational activities. These data may be useful for surgeons in planning for and counseling extremely young patients indicated for THA.