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BACKGROUND: Hemiarthroplasty (HA) for hip fractures can be performed with a unipolar or bipolar head. We describe the use of unipolar and bipolar HA after a hip fracture in the Netherlands and determined revision rates and risk factors. METHODS: All HAs for an acute hip fracture registered in the Dutch Arthroplasty Register (LROI) during 2007 to 2021 were included; 44,127(88%) unipolar and 6,013(12%) bipolar HAs. Competing risk survival analyses were performed with revision for any reason as the endpoint. Multivariable Cox regression analyses were performed adjusting for patient and surgery-related factors. RESULTS: The 1-year, 5-year, and 10-year revision rates were comparable for unipolar and bipolar HA. Cox regression analysis showed a hazard ratio of 1.2 (95% confidence interval (CI) 1.0 to 1.4)) after adjustment for confounders for bipolar heads. In cases of a cemented stem, the 1-year cumulative incidence of revision was lower (1.5% (CI 1.4 to 1.7%) compared to uncemented stems (2.4% (CI 2.1 to 2.7%); uncemented stems showed higher risks for revision after adjustment compared to cemented stems (hazard ratio 1.4 (CI 1.2 to 1.5)). The anterior, antero-lateral, and straight-lateral approach showed lower risk for revision compared to the postero-lateral approach. CONCLUSION: The revision rate for bipolar HA and unipolar HA was comparable. However, after adjustment for potential confounders the risk for revision showed an estimated 20% increased revision risk for bipolar heads, although not statistically significant. For both head types, the risk for revision was significantly higher when an uncemented stem was chosen or the postero-lateral approach was used.
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Artroplastia de Reemplazo de Cadera , Hemiartroplastia , Fracturas de Cadera , Prótesis de Cadera , Humanos , Artroplastia de Reemplazo de Cadera/efectos adversos , Prótesis de Cadera/efectos adversos , Hemiartroplastia/efectos adversos , Reoperación , Sistema de Registros , Fracturas de Cadera/etiología , Factores de Riesgo , Falla de PrótesisRESUMEN
BACKGROUND: Femoral head size and surgical approach might affect the revision rate for dislocation and for any other reason after total hip arthroplasty (THA). We penetrated this question based on registry data with up to 9-year follow-up. METHODS: 269,280 primary THAs documented in the Dutch Arthroplasty Registry (LROI) between 2007 and 2019 were included. Revision rates were calculated by competing risk analyses. Multivariable Cox proportional hazard regression ratios (HR) were used for comparison. RESULTS: Revisions for dislocation were rare. They were more frequent after posterolateral (1.4% [95% CI, 1.3-1.5]), compared to straight lateral (0.6% [95% CI, 0.5-0.7]), anterolateral (0.6% [95% CI, 0.5-0.7]) and anterior (0.4% [95% CI, 0.3-0.5]) approach. Larger femoral head size decreased the dislocation revision risk: 1.4% [95% CI, 1.3-1.5) for 22-28-mm heads; 0.9% (95% CI, 0.8-1.0) for 32-mm heads; 0.6% (95% CI, 0.6-0.7) for 36-mm heads. For the anterior approach, the HR for both revision for dislocation (0.3, 95% CI, 0.3-0.4) and any other reason (0.8, 95% CI, 0.8-0.9) were lowest compared to other approaches including posterolateral (HR 1). Revision risk for any other reason was highest with anterolateral (HR 1.3 (95% CI, 1.2-1.4)) and straight lateral approach (1.1 [95% CI, 1.0-1.2]). CONCLUSIONS: The anterior approach might reduce revision rates for both dislocation and all cause revision. Posterolateral approach is associated with a higher risk of dislocation revision but has a lower risk of any other revision. Increasing femoral head size up to 36 mm reduces revision for dislocation and improves overall revision rates for all approaches.
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Artroplastia de Reemplazo de Cadera , Luxación de la Cadera , Prótesis de Cadera , Luxaciones Articulares , Humanos , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/métodos , Cabeza Femoral/cirugía , Estudios de Seguimiento , Reoperación/efectos adversos , Falla de Prótesis , Luxaciones Articulares/cirugía , Luxación de la Cadera/epidemiología , Luxación de la Cadera/cirugía , Luxación de la Cadera/complicaciones , Sistema de Registros , Prótesis de Cadera/efectos adversos , Factores de Riesgo , Diseño de PrótesisRESUMEN
AIMS: This study aimed to investigate the estimated change in primary and revision arthroplasty rate in the Netherlands and Denmark for hips, knees, and shoulders during the COVID-19 pandemic in 2020 (COVID-period). Additional points of focus included the comparison of patient characteristics and hospital type (2019 vs COVID-period), and the estimated loss of quality-adjusted life years (QALYs) and impact on waiting lists. METHODS: All hip, knee, and shoulder arthroplasties (2014 to 2020) from the Dutch Arthroplasty Register, and hip and knee arthroplasties from the Danish Hip and Knee Arthroplasty Registries, were included. The expected number of arthroplasties per month in 2020 was estimated using Poisson regression, taking into account changes in age and sex distribution of the general Dutch/Danish population over time, calculating observed/expected (O/E) ratios. Country-specific proportions of patient characteristics and hospital type were calculated per indication category (osteoarthritis/other elective/acute). Waiting list outcomes including QALYs were estimated by modelling virtual waiting lists including 0%, 5% and 10% extra capacity. RESULTS: During COVID-period, fewer arthroplasties were performed than expected (Netherlands: 20%; Denmark: 5%), with the lowest O/E in April. In the Netherlands, more acute indications were prioritized, resulting in more American Society of Anesthesiologists grade III to IV patients receiving surgery. In both countries, no other patient prioritization was present. Relatively more arthroplasties were performed in private hospitals. There were no clinically relevant differences in revision arthroplasties between pre-COVID and COVID-period. Estimated total health loss depending on extra capacity ranged from: 19,800 to 29,400 QALYs (Netherlands): 1,700 to 2,400 QALYs (Denmark). With no extra capacity it will take > 30 years to deplete the waiting lists. CONCLUSION: The COVID-19 pandemic had an enormous negative effect on arthroplasty rates, but more in the Netherlands than Denmark. In the Netherlands, hip and shoulder patients with acute indications were prioritized. Private hospitals filled in part of the capacity gap. QALY loss due to postponed arthroplasty surgeries is considerable.Cite this article: Bone Jt Open 2022;3(12):977-990.
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BACKGROUND: Clinical observations revealed higher rates of aseptic loosening for hybrid fixated rotating hinge knee implants compared to fully cemented ones. We hypothesize that the use of a fully cemented fixation technique had a higher survival rate for aseptic loosening compared to a hybrid fixation technique in a rotating hinge knee implant. METHODS: All procedures of patients who were treated with the RT-PLUS rotating hinge knee implant (Smith & Nephew, Memphis, TN) between 2010 and 2018 were included. Primary outcome was revision for aseptic loosening. Kaplan-Meier survivorship and Cox proportional hazard regression analysis were performed to calculate survival rates and hazard ratios. RESULTS: A total of 275 hinge knee implants were placed in 269 patients (60 primary procedures, 215 revisions). Median follow-up was 7.3 ± 3.9 years. In total, 24 components (16 hybrid femur, 2 fully cemented femur, 6 hybrid tibia; all revision procedures) in 19 patients were revised for aseptic loosening. Kaplan-Meier survivorship analysis showed superior survival rates of fully cemented components (femur 97.1%; tibia 100%) compared to hybrid fixated components (femur 89.5%; tibia 95.9%) at the 10-year follow-up. Multivariate Cox hazard analysis showed a significantly higher risk of aseptic loosening for hybrid fixated components, a prior stemmed component and the femoral component. CONCLUSION: Fully cemented fixation showed superior survival rates for aseptic loosening compared to hybrid fixation in a single design rotating hinge knee implant. A prior stemmed component appears to be a risk factor for aseptic loosening and the femoral component seems to be more prone to loosening.
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Artroplastia de Reemplazo de Rodilla , Prótesis de la Rodilla , Artroplastia de Reemplazo de Rodilla/efectos adversos , Fémur/cirugía , Humanos , Prótesis de la Rodilla/efectos adversos , Diseño de Prótesis , Falla de Prótesis , Reoperación , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Background and purpose - From previous studies, we know that clinical outcomes of revision total knee arthroplasty (rTKA) differ among reasons for revision. Whether the prevalence of repeat rTKAs is different depending on the reason for index rTKA is unclear. Therefore, we (1) compared the repeat revision rates between the different reasons for index rTKA, and (2) evaluated whether the reason for repeat rTKA was the same as the reason for the index revision.Patients and methods - Patients (n = 8,978) who underwent an index rTKA between 2010 and 2018 as registered in the Dutch Arthroplasty Register were included. Reasons for revision, as reported by the surgeon, were categorized as: infection, loosening, malposition, instability, stiffness, patellar problems, and other. Competing risk analyses were performed to determine the cumulative repeat revision rates after an index rTKA for each reason for revision.Results - Overall, the cumulative repeat revision rate was 19% within 8 years after index rTKA. Patients revised for infection had the highest cumulative repeat revision rate (28%, 95% CI 25-32) within 8 years after index rTKA. The recurrence of the reason was more common than other reasons after index rTKA for infection (18%), instability (8%), stiffness (7%), and loosening (5%).Interpretation - Poorest outcomes were found for rTKA for infection: over 1 out of 4 infection rTKAs required another surgical intervention, mostly due to infection. Recurrence of other reasons for revision (instability, stiffness, and loosening) was also considerable. Our findings also emphasize the importance of a clear diagnosis before doing rTKA to avert second revision surgeries.
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Artroplastia de Reemplazo de Rodilla , Prótesis de la Rodilla , Complicaciones Posoperatorias/cirugía , Reoperación/estadística & datos numéricos , Anciano , Dinamarca , Femenino , Humanos , Masculino , Persona de Mediana Edad , Falla de PrótesisRESUMEN
Background and purpose - Collaborations between arthroplasty registries are important in order to create the possibility of detecting inferior implants early and improve our understanding of differences between nations in terms of indications and outcomes. In this registry study we compared patient and procedure characteristics, and revision rates in the Nordic Arthroplasty Register Association (NARA) database and the Dutch Arthroplasty Register (LROI).Patients and methods - All total hip arthroplasties (THAs) performed in 2010-2016 were included from the LROI (n = 184,862) and the NARA database (n = 290,823), which contains data from Denmark, Norway, Sweden, and Finland. Descriptive statistics and Kaplan-Meier survival analyses based on all reasons for revision and stratified by fixation were performed and compared between countries.Results - In the Netherlands, the proportion of patients aged < 55 years (9%) and male patients (34%) was lower than in Nordic countries (< 55 years 11-13%; males 35-43%); the proportion of osteoarthritis (OA) (87%) was higher compared with Sweden (81%), Norway (77%), and Denmark (81%) but comparable to Finland (86%). Uncemented fixation was used in 62% of patients in the Netherlands, in 70% of patients in Denmark and Finland, and in 28% and 19% in Norway and Sweden, respectively. The 5-year revision rate for THAs for OA was lower in Sweden (2.3%, 95% CI 2.1-2.5) than in the Netherlands (3.0%, CI 2.9-3.1), Norway (3.8%, CI 3.6-4.0), Denmark (4.6%, CI 4.4-4.8), and Finland (4.4%, CI 4.3-4.5). Revision rates in Denmark, Norway, and Finland were higher for all fixation groups.Interpretation - Patient and THA procedure characteristics as well as revision rates evinced some differences between the Netherlands and the Nordic countries. The Netherlands compared best with Denmark in terms of patient and procedure characteristics, but resembled Sweden more in terms of short-term revision risk. Combining data from registries like LROI and the NARA collaboration is feasible and might possibly enable tracking of potential outlier implants.
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Artroplastia de Reemplazo de Cadera/estadística & datos numéricos , Prótesis de Cadera/estadística & datos numéricos , Reoperación/estadística & datos numéricos , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pautas de la Práctica en Medicina , Países Escandinavos y NórdicosRESUMEN
In the Dutch Arthroplasty Register (LROI), the product and batch number of prosthetic components and cement are registered for traceability. Registration of the product number provides opportunities to extend the information about a specific prosthesis. All product numbers used from the beginning of the registration in 2007 were characterized to develop and maintain an implant library.The Scientific Advisory Board developed a core-set that contains the most important characteristics needed to form an implant library. The final core-set contains the brand name, type, coating and material of the prosthesis. In total, 35 676 product numbers were classified, resulting in a complete implant library of all product numbers used in the LROI.To improve quality of the data and increase convenience of registration, the LROI implemented barcode scanning for data entry into the database. In 2017, 82% of prosthetic components and cement stickers had a GS1 barcode. The remaining product stickers used HIBCC barcodes and custom-made barcodes.With this implant library, implants can be grouped for analyses at group level, e.g. evaluation of the effect of a material of a prosthesis on survival of the implant. Apart from that, the implant library can be used for data quality control within the LROI database.The implant library reduces the registration burden and increases accuracy of the database. Such a system will facilitate new designs (learning from the past) and thus improve implant quality and ultimately patient safety. Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180063.
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BACKGROUND: Total hip arthroplasty (THA) is one of the most successful interventions in medical care. Because of shifting trends in THA and failure rates being higher in younger patients, we aimed to assess trends in implant fixation, bearing type, head diameter, and surgical approach in patients younger than 55 years in the Netherlands using data from the Dutch Arthroplasty Register. METHODS: Trends in the method of implant fixation, bearing type, head diameter, and surgical approach were analyzed over year of surgery (2007-2016) and over age groups (<25, 25-29, 30-34, 35-39, 40-44, 45-49, and 50-54 years). RESULTS: Between 2007 and 2016, a total of 19,915 primary THAs were performed in patients <55 years. Osteoarthritis was the most prevalent diagnosis (66.1%). Uncemented fixation was used in 79.5% of all performed THAs. The use of 32-mm head diameters increased (from 32.6% in 2007 to 50.1% in 2016), where an increasing trend toward the use of ceramic-on-polyethylene as most frequently used bearing type was present (from 37.5% in 2007 to 53.8% in 2016). The posterolateral surgical approach was the most frequently used approach; however, the anterior approach is used increasingly (0.1% in 2007 to 21.1% in 2016). Ceramic-on-polyethylene bearing surfaces, 32-mm head diameters, and the anterior approach were most commonly used in patients between 50 and 54 years. CONCLUSION: There was a clear preference for uncemented fixation in young patients. In head diameter, bearing type, and surgical approach, clear trends were visible. Characteristics of THA in young patients were subject to changing perspectives.
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Artroplastia de Reemplazo de Cadera/estadística & datos numéricos , Artroplastia de Reemplazo de Cadera/tendencias , Sistema de Registros , Adulto , Artroplastia de Reemplazo de Cadera/instrumentación , Artroplastia de Reemplazo de Cadera/métodos , Cerámica , Femenino , Prótesis de Cadera/tendencias , Humanos , Masculino , Persona de Mediana Edad , Países Bajos , Osteoartritis , Osteoartritis de la Cadera/cirugía , Polietileno , Diseño de Prótesis , Falla de Prótesis , Resultado del Tratamiento , Adulto JovenRESUMEN
Background and purpose - Impaction bone grafting (IBG) is an established method in hip revision surgery to reconstruct loss of bone stock. There is limited knowledge concerning the actual bone remodelling process within the allograft. We investigated with repeated bone mineral density (BMD) measurements the biological process of bone remodelling in the allograft in vivo. We hypothesized that an initial decrease in BMD would be followed by an increase towards baseline values. Patients and methods - Dual-energy X-ray absorptiometry (DXA) was used to measure BMD values in 3 regions of interest (ROI) in 20 patients (average age at surgery 70 years, 11 males) after an acetabular reconstruction with IBG and a cemented cup. A postoperative DXA was used as baseline and DXA was repeated at 3 and 6 months and at 1 and 2 years. The Oxford Hip Score (OHS), the 12-Item Short Form Health Survey (SF12), and a 0 to 100 mm visual analogue scale (VAS) for pain and satisfaction were obtained simultaneously. Results - The overall mean BMD in the IBG regions increased significantly by 9% (95% CI 2-15) at 2 years' follow-up. In the cranial ROI BMD increased 14% (CI 6-22), whereas the BMD in the medial and caudal ROI showed an increase of 10% (CI 1-18) and 4% (CI -6-16), respectively. The OHS, SF12-mental, and VAS for pain all improved statistically significantly 2 years after surgery, with a mean VAS for satisfaction of 77 (CI 63-90) out of 100 points. The SF12-physical showed non-significant improvement. Interpretation - The BMD in the allograft gradually increased after IBG for acetabular reconstruction arthroplasties, particularly in the cranial ROI. An initial decrease in the BMD was not encountered. These BMD changes, as proxy measurements for bone remodeling, may indicate progressive apposition of vital new host bone in the grafted area.
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Acetábulo/cirugía , Artroplastia de Reemplazo de Cadera , Densidad Ósea , Trasplante Óseo , Fémur/trasplante , Artropatías/cirugía , Absorciometría de Fotón , Anciano , Remodelación Ósea , Femenino , Humanos , Artropatías/etiología , Artropatías/patología , Masculino , Satisfacción del Paciente , Estudios Prospectivos , Resultado del TratamientoRESUMEN
INTRODUCTION: Total hip arthroplasties (THAs) in younger patients are becoming increasingly popular. However, the outcome of subsequent revisions in younger patients is not well known and, therefore, their success (subsequent revision prosthesis survival) might be overestimated. We investigated available data on the outcome of primary- and subsequent revision THAs performed in the same cohort of patients who underwent primary THA under the age of 50. METHODS: Medline, Embase and the Cochrane Library (CENTRAL) were searched up until April 13, 2016 for studies that reported both the survival of primary and subsequent revisions THA of single cohorts of patients younger than 50. Eligible articles had to include Kaplan Meier analysis or competing risk analysis for survival of the primary THA at a mean follow-up of 10 years, as well as for the subsequent revision THA within the same cohort. RESULTS: We found 4,799 unique records; 43 of which were potentially eligible. Only 1 paper met our inclusion criteria. It reported on the survival of 69 primary prostheses at a mean of more than 10 years follow-up and 13 subsequent revisions. CONCLUSIONS: There is a clear lack of evidence about the outcomes of the revision arthroplasty in younger patients. Only 1 study reported the survival-rate of subsequent revision arthroplasty with the minimum 10-year survival rate of the original THA cohort. In the future, this serious lack of knowledge could result in a large number of patients with no further reconstructive options after failed THA, and a large medical burden for society.
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Artroplastia de Reemplazo de Cadera/métodos , Prótesis de Cadera , Humanos , Diseño de Prótesis , Reoperación , Factores de Riesgo , Factores de TiempoRESUMEN
BACKGROUND: Staphylococcal species account for more than 50% of periprosthetic joint infections (PJI) and antimicrobial therapy with rifampin-based combination regimens has been shown effective. The present study evaluates the safety and efficacy of clindamycin in combination with rifampin for the management of staphylococcal PJI. METHODS: In this retrospective cohort study, patients were included who received clindamycin-rifampin combination therapy to treat a periprosthetic hip or knee infection by Staphylococcus aureus or coagulase-negative staphylococci. Patients were treated according to a standardized treatment algorithm and followed for a median of 54 months. Of the 36 patients with periprosthetic staphylococcal infections, 31 had an infection of the hip, and five had an infection of the knee. Eighteen patients underwent debridement and retention of the implant (DAIR) for an early infection, the other 18 patients underwent revision of loose components in presumed aseptic loosening with unexpected positive cultures. RESULTS: In this study, we report a success rate of 86%, with five recurrent/persistent PJI in 36 treated patients. Cure rate was 78% (14/18) in the DAIR patients and 94% (17/18) in the revision group. Five patients (14%) discontinued clindamycin-rifampin due to side effects. Of the 31 patients completing the clindamycin-rifampin regimen 29 patients (94%) were cured. CONCLUSION: Combined therapy with clindamycin and rifampin is a safe, well tolerated and effective regimen for the treatment of staphylococcal periprosthetic infection.
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Antibacterianos/uso terapéutico , Clindamicina/uso terapéutico , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Rifampin/uso terapéutico , Infecciones Estafilocócicas/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/efectos adversos , Terapia Combinada , Desbridamiento , Quimioterapia Combinada , Femenino , Prótesis de Cadera , Humanos , Prótesis de la Rodilla , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Staphylococcus/patogenicidad , Staphylococcus aureus/patogenicidad , Resultado del TratamientoRESUMEN
After the low friction arthroplasty by John Charnley was no longer confined to specialized hospitals but commonplace in the general orthopedic practice, the issue remained how to most optimally reach the hip. The names of the authors of these approaches remain in a lot of cases connected to the approach. By evaluating the original articles in which the approaches are described we ascertain the original description and technique. By various sources we obtained the (short) biography of the people whose name is connected to the approach. Our research covers the biographies of colleagues Smith-Petersen, Watson-Jones, Hardinge, Charnley, Moore and Ludloff. The eponymous approaches are shown and described after the short biography on each individual. This study shows that without the work of our colleagues we cannot proceed in our profession. An understanding and knowledge of the people who dedicated themselves to developing the orthopedic surgery to the high standard it has today is the least honour we should give them.
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Artroplastia de Reemplazo de Cadera/historia , Articulación de la Cadera/cirugía , Procedimientos Ortopédicos/historia , Artroplastia de Reemplazo de Cadera/métodos , Epónimos , Historia del Siglo XIX , Historia del Siglo XX , Humanos , Masculino , OrtopediaRESUMEN
PURPOSE: Acetabular deficiencies in young patients can be restored in several ways during total hip arthroplasty. Currently, cementless cups are most frequently used. Impaction bone grafting of acetabular defects is a more biological approach, but is it cost-effective in young patients on the long term? METHODS: We designed a decision model for a cost-utility analysis of a cemented cup with acetabular impaction bone grafting versus an uncemented cup, in terms of cost per quality-adjusted life year (QALY) for the young adult with acetabular bone deficiency, in need for a primary total hip arthroplasty. Outcome probabilities and effectiveness were derived from the Radboud University Nijmegen Medical Centre and the Norwegian Hip Register. Multiple sensitivity analyses were used to assess the contribution of the included variables in the model's outcome. RESULTS: Cemented cups with impaction bone grafting were more cost-effective compared to the uncemented option in terms of costs per QALY. A scenario suggesting equal primary survival rates of both cemented and uncemented cups still showed an effect gain of the cemented cup with impaction bone grafting, but at higher costs. CONCLUSIONS: Based on this model, the first choice of treatment of the acetabular bone deficient osteoarthritic hip in a young patient is reconstruction with impaction bone grafting and a cemented cup.
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Artroplastia de Reemplazo de Cadera/economía , Artroplastia de Reemplazo de Cadera/métodos , Trasplante Óseo/economía , Prótesis de Cadera/economía , Osteoartritis de la Cadera/cirugía , Acetábulo/patología , Acetábulo/cirugía , Adulto , Factores de Edad , Anciano , Artroplastia de Reemplazo de Cadera/instrumentación , Cementación , Análisis Costo-Beneficio , Técnicas de Apoyo para la Decisión , Humanos , Persona de Mediana Edad , Osteoartritis de la Cadera/economía , Osteoartritis de la Cadera/patología , Falla de Prótesis , Años de Vida Ajustados por Calidad de Vida , Adulto JovenRESUMEN
INTRODUCTION: This retrospective analysis evaluates 10 patients with a late infection of a cemented total hip arthroplasty (THA) treated with two-stage revision with retention of the original well-fixed femoral cement mantle. METHODS: Clinical, laboratory, and radiological outcomes were evaluated. The average age at the first-stage revision procedure was 61.5 years (range 38-80 y). The mean follow-up period was 26 months (range 5-54 m). RESULTS: Successful eradication of the primary microorganism was achieved in 2 patients. These patients had negative cultures at second stage and did not show any signs of infection during follow-up.The other 8 patients were considered as failures. In 3 patients, the femoral cement mantle was removed after the first stage due to recurrent infection in Girdlestone situation. In 2 patients, cultures showed the same micro-organism at first and second stage, treated with 3 months of antibiotics after second stage. 2 patients showed negative cultures at second stage but still had recurrent infection afterwards. These where treated with debridement and implant retention (DAIR) and 3 months of antibiotics. 1 patient was treated with suppressive antibiotics for persistent prosthetic joint infection after second stage, despite DAIR and therapeutic antibiotic treatment. CONCLUSIONS: Based on this study, results of two-stage revision with retention of femoral cement mantle are disappointing in treatment of infected THA. Therefore, more research is required to determine which patients are appropriate for cement-within-cement revision.
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Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/instrumentación , Cementación/efectos adversos , Osteoartritis de la Cadera/cirugía , Infecciones Relacionadas con Prótesis/cirugía , Reoperación/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Falla de Prótesis/efectos adversos , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Impaction bone grafts (IBG) in two-stage revision for prosthetic hip infection (PHI) might be more susceptible for infection, therefore antibiotic mixing through these grafts has been suggested. However, outcomes have not been compared with IBG without antibiotics and no long-term results are available. Therefore, we evaluated long-term infection-free outcome after the use of IBG without antibiotic supplement in two-stage revision for PHI. Patients were divided into positive (group 1, n = 8) and negative (group 2, n = 28) cultures at re-implantation and followed up to 18 years after re-implantation. Five of 36 patients died from non-orthopaedic causes (median 37, range 24-149 months). Five patients had a re-operation not related to infection (median 39, range 7-140 months). These were censored in the Kaplan-Meier estimator at the last outpatient evaluation. We found an overall re-infection rate of 2.8% within two years, which matches comparative studies in which antibiotic impregnated bone grafts had been used. In group 1, there was one re-infection after 44 months. In group 2, all three infections occurred within 56 months with an estimated infection-free percentage at 10 years of 87% (95% CI 66-96). Follow-up should be extended beyond two years and randomised clinical trials are needed for further comparison with IBG impregnated with antibiotics.
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Antibacterianos/administración & dosificación , Artroplastia de Reemplazo de Cadera/métodos , Infecciones Bacterianas/prevención & control , Trasplante Óseo/métodos , Prótesis de Cadera , Falla de Prótesis/etiología , Infecciones Relacionadas con Prótesis/prevención & control , Adulto , Anciano , Anciano de 80 o más Años , Cementos para Huesos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Reoperación/métodos , Factores de TiempoAsunto(s)
Artroplastia de Reemplazo de Cadera/efectos adversos , Inhibidores de la Ciclooxigenasa 2/uso terapéutico , Osificación Heterotópica/etiología , Osificación Heterotópica/prevención & control , Osteoartritis de la Cadera/cirugía , Piridinas/uso terapéutico , Sulfonas/uso terapéutico , Femenino , Humanos , MasculinoRESUMEN
PURPOSE: Heterotopic ossification is a common complication after total hip arthroplasty. Non-steroidal anti-inflammatory drugs (NSAIDs) are known to prevent heterotopic ossifications effectively, however gastrointestinal complaints are reported frequently. In this study, we investigated whether etoricoxib, a selective cyclo-oxygenase-2 (COX-2) inhibitor that produces fewer gastrointestinal side effects, is an effective alternative for the prevention of heterotopic ossification. METHODS: We investigated the effectiveness of oral etoricoxib 90 mg for seven days in a prospective two-stage study design for phase-2 clinical trials in a small sample of patients (n = 42). A cemented primary total hip arthroplasty was implanted for osteoarthritis. Six months after surgery, heterotopic ossification was determined on anteroposterior pelvic radiographs using the Brooker classification. RESULTS: No heterotopic ossification was found in 62 % of the patients that took etoricoxib; 31 % of the patients had Brooker grade 1 and 7 % Brooker grade 2 ossification. CONCLUSIONS: Etoricoxib seems effective in preventing heterotopic ossification after total hip arthroplasty. This finding further supports the use of COX-2 inhibitors for the prevention of heterotopic ossification following total hip arthroplasty.
Asunto(s)
Artroplastia de Reemplazo de Cadera/efectos adversos , Inhibidores de la Ciclooxigenasa 2/uso terapéutico , Osificación Heterotópica/etiología , Osificación Heterotópica/prevención & control , Osteoartritis de la Cadera/cirugía , Piridinas/uso terapéutico , Sulfonas/uso terapéutico , Administración Oral , Adulto , Anciano , Anciano de 80 o más Años , Inhibidores de la Ciclooxigenasa 2/administración & dosificación , Inhibidores de la Ciclooxigenasa 2/efectos adversos , Relación Dosis-Respuesta a Droga , Etoricoxib , Femenino , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/cirugía , Prótesis de Cadera , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Piridinas/administración & dosificación , Piridinas/efectos adversos , Radiografía , Índice de Severidad de la Enfermedad , Sulfonas/administración & dosificación , Sulfonas/efectos adversos , Resultado del TratamientoRESUMEN
BACKGROUND: Gentamicin-polymethylmethacrylate (PMMA) beads release gentamicin gradually, and high concentrations develop only locally. It is unclear how frequent and in which patients gentamicin serum concentrations are measurable and possibly lead to toxicity. The aim of this study was to investigate the measurability of gentamicin serum concentrations after the implantation of gentamicin-PMMA beads and to assess the nephrotoxicity of these beads. METHODS: In this observational cohort study, gentamicin and creatinine concentrations were measured in 34 serum samples of 23 patients with implanted gentamicin-PMMA beads for infected hip joints with our regular immunoassay (lower limit of quantitation 0.4 mg/L). Samples were also analyzed with an adjusted immunoassay with a lower limit of quantitation of 0.05 mg/L. RESULTS: Gentamicin serum concentrations were >0.4 mg/L in 9 of 34 (26%) of all the samples measured (both after the first implantation and change of beads) and in 5 of 23 patients (22%) after the first implantation of gentamicin-PMMA beads. Gentamicin serum concentrations were >0.05 mg/L in 31 samples (91%). Nephrotoxicity (defined as increase in serum creatinine >44 µmole/L and/or a relative increase >25%) occurred more frequently in patients with measurable gentamicin serum concentrations than in those without measurable gentamicin serum levels (57% versus 43%, P = 0.02). Both nephrotoxicity and gentamicin serum concentration could not be associated with the number of implanted gentamicin-PMMA beads. CONCLUSIONS: Gentamicin serum concentrations >0.4 mg/L can be measured after the implantation of gentamicin-PMMA beads in certain patients with infected hip joints. Furthermore, elevated (>0.4 mg/L) gentamicin serum concentrations are associated with nephrotoxicity in patients with gentamicin-PMMA beads for infected hip joints.
Asunto(s)
Infecciones Bacterianas/tratamiento farmacológico , Gentamicinas/administración & dosificación , Gentamicinas/uso terapéutico , Articulación de la Cadera/patología , Artropatías/tratamiento farmacológico , Metilmetacrilatos/administración & dosificación , Metilmetacrilatos/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/administración & dosificación , Antibacterianos/sangre , Antibacterianos/uso terapéutico , Estudios de Cohortes , Implantes de Medicamentos , Gentamicinas/sangre , Humanos , Persona de Mediana EdadRESUMEN
BACKGROUND: Physicians face a new challenge; the self-educated patient. The internet is an important source that patients use to become self-educated. However, the individual choice for best treatment is difficult. The aim of this study was to investigate what kind of information is offered to total hip arthroplasty patients by internet and what information is appreciated by them. METHODS: Websites of orthopedic departments of all hospitals in the Netherlands were evaluated. In addition, a cohort of 102 patients, diagnosed with arthritic joint disorders, filled in an online survey and gave their opinion concerning the importance of this information. RESULTS: Eighty different orthopedic websites of hospitals were identified. Websites presented information regarding the orthopedic staff surgeon (76%) and the postoperative rehabilitation process (66%). They also offered referral to other orthopedic websites (61%), the opportunity to make an outpatient appointment (21%), and the opportunity to submit an online question (15%). Patients rated the presence of information regarding prosthesis survival as very important (>70%). However, the information on the type of prosthesis used by the hospital, and survival data of the prosthesis, were only present in ~9% and 5% respectively, of the websites. CONCLUSIONS: The content of health information on websites of hospitals is highly variable for total hip arthroplasty. Information regarding the hip implant and prosthesis survival is highly appreciated by patients, however, mostly absent on orthopedic websites in the Netherlands. The internet provides an enormous potential for orthopedic surgeons to inform the self-educated patient.