RESUMO
BACKGROUND AND PURPOSE: Periprosthetic femoral fracture (PFF) is a significant complication of total hip arthroplasty (THA). Although biomechanical studies have indicated that the technique by which the femoral canal is prepared plays a role, few clinical studies have reported on how this might affect the fracture risk. This study compares the fracture risk between compaction and broaching with toothed instruments in cementless THA. METHODS: Prospectively collected data from the quality register of a high-volume hospital was used. All primary arthroplasties using the Corail stem (DePuy Synthes) were included. All femoral fractures occurring within the first 90 days after the operation were included in the analysis. We determined the relative risk of sustaining PFF with compaction compared with broaching and adjusted for confounders (sex, age group, BMI, and use of a collared stem) using multivariable Poisson regression. RESULTS: 6,788 primary THAs performed between November 2009 and May 2023 were available for analysis. 66% were women and the mean age was 65.0 years. 129 (1.9%) fractures occurred during the first 90 days after the operation, 92 (2.3%) in the compaction group and 37 (1.3%) in the broaching group. The unadjusted relative risk of fracture in the compaction group compared with the broaching group was 1.82 (95% confidence interval [CI] 1.25-2.66), whereas the adjusted relative risk was 1.70 (CI 1.10-2.70). CONCLUSION: Compaction was associated with more periprosthetic fractures than broaching (2.3% versus 1.3%) within 90 days after surgery.
Assuntos
Artroplastia de Quadril , Fraturas do Fêmur , Fraturas Periprotéticas , Complicações Pós-Operatórias , Humanos , Feminino , Fraturas Periprotéticas/etiologia , Fraturas Periprotéticas/cirurgia , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Masculino , Idoso , Fraturas do Fêmur/cirurgia , Fraturas do Fêmur/etiologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Prótese de Quadril/efeitos adversos , Fatores de Risco , Estudos Prospectivos , Complicações Intraoperatórias/etiologiaRESUMO
BACKGROUND AND PURPOSE: The low-dose EOS Imaging System is an emerging tool for 3-dimensional measurements in orthopedics. The clinical feasibility for measuring total hip arthroplasty (THA) liner wear has not yet been investigated. We aimed to evaluate the feasibility of using EOS to measure THA liner wear by examining the experimental accuracy using a THA phantom and clinical precision of patients with THA, considering a clinically relevant precision at the 95% repeatability limit to be 0.2 mm. METHODS: An experimental THA phantom with movable stem and a fixed cup with a plastic liner was constructed to simulate progressive 3D liner wear. Series of 11 pairs of radiographs with 50 µm femoral movement in between were obtained for each 3D axis in EOS. 30 patients with a THA were scanned twice using EOS to assess precision. Model-based radiostereometric analysis (RSA) was used for wear measurement. RESULTS: The mean difference (true minus simulated wear) with standard deviation (SD) and 95% limits of agreement for experimental THA wear were 0.005 (0.037) and [-0.069 to 0.079] mm for the vertical (y) axis. The mean (SD) and 95% repeatability limit for precision for clinical measurement were -0.029 (0.105) and 0.218 mm. CONCLUSION: Experimental THA liner wear using EOS was within clinically relevant tolerances and without bias. The clinical precision was just outside our defined clinically relevant precision. Compared with conventional RSA, EOS is less accurate and precise but may still be of value for certain clinical applications, provided larger sample size or longer follow-up are available.
Assuntos
Artroplastia de Quadril , Prótese de Quadril , Imagens de Fantasmas , Humanos , Artroplastia de Quadril/instrumentação , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Falha de Prótese , Imageamento Tridimensional , Análise Radioestereométrica , Reprodutibilidade dos Testes , Estudos de ViabilidadeRESUMO
BACKGROUND AND PURPOSE: Hip dysplasia can present challenges for total hip arthroplasty (THA) due to anatomic abnormalities. We aimed to assess the association of age, sex, osteotomies prior to THA, and fixation method on 5- and 10-year revision-free implant survival and patient-reported outcome measures (PROMs) of THAs in patients with hip dysplasia. METHODS: Using Dutch Arthroplasty Register data, we studied hip dysplasia patients receiving primary THAs in 2007-2021 (n = 7,465). THAs were categorized by age, pelvic osteotomy prior to THA (yes/no), and fixation (cemented, uncemented, hybrid, reverse hybrid). Kaplan-Meier and multivariable Cox models were used to determine 5- and 10-year revision-free implant survival and adjusted hazard ratios including 95% confidence intervals (CIs). Reasons for revision and PROMs were compared within the categories. RESULTS: We found a 10-year revision-free implant survival of 94.9% (CI 94.3-95.5). Patients younger than 50 years had a 10-year implant survival of 93.3% (CI 91.9-94.7), Patients with prior pelvic osteotomy had a 10-year implant survival of 92.0% (CI 89.8-94.2). Fixation method and sex were not associated with implant survival. Patients with a prior pelvic osteotomy had more revisions due to cup loosening and reported lower PROM scores than patients without earlier osteotomy. CONCLUSION: 5- and 10-year revision-free implant survival rates of THA for hip dysplasia are 96.4% and 94.9%. Age and prior osteotomies were associated with decreased implant survival rates in patients with hip dysplasia, while fixation method was not. Prior osteotomies were also associated with reduced PROM scores.
Assuntos
Artroplastia de Quadril , Osteotomia , Sistema de Registros , Reoperação , Humanos , Masculino , Feminino , Osteotomia/métodos , Artroplastia de Quadril/métodos , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Reoperação/estatística & dados numéricos , Fatores Etários , Idoso , Adulto , Falha de Prótese , Luxação do Quadril/cirurgia , Luxação do Quadril/etiologia , Medidas de Resultados Relatados pelo Paciente , Prótese de Quadril , Resultado do TratamentoRESUMO
The present Bayesian network meta-analysis compared different types of polyethylene liners in total hip arthroplasty (THA) in terms of wear penetration (mm/year) and rate of revision. The type of liners compared were the crosslinked ultra-high molecular weight polyethylene (CPE/UHMWPE), Vitamin E infused highly cross-linked polyethylene (HXLPE-VEPE), modified cross-linked polyethylene (MXLPE), highly cross-linked polyethylene (HXLPE), Cross-linked polyethylene (XLPE). This study was conducted according to the PRISMA extension statement for reporting systematic reviews incorporating network meta-analyses of healthcare interventions. In June 2024, PubMed, Scopus, Embase, Google Scholar, and Cochrane databases were accessed. A time constraint was set from January 2000. All investigations which compared two or more types of polyethylene liners for THA were accessed. Only studies that clearly stated the nature of the liner were included. Data from 60 studies (37,352 THAs) were collected. 56% of patients were women. The mean age of patients was 60.0 ± 6.6 years, the mean BMI was 27.5 ± 2.0 kg/m2. The mean length of follow-up was 81.6 ± 44.4 months. Comparability was found at baseline between groups. XLPE and HXLPE liners in THA are associated with the lowest wear penetration (mm/year) and the lowest revision rate at approximately 7 years of follow-up.
Assuntos
Artroplastia de Quadril , Prótese de Quadril , Polietileno , Falha de Prótese , Reoperação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/instrumentação , Teorema de Bayes , Prótese de Quadril/efeitos adversos , Metanálise em Rede , Polietileno/química , Polietilenos/química , Desenho de Prótese , Reoperação/estatística & dados numéricos , IdosoRESUMO
BACKGROUND AND PURPOSE: We aimed to evaluate polyethylene (PE) wear, cup migration, and clinical outcome over 10 years in total hip arthroplasties (THA) using different articulations. METHODS: This is a secondary analysis of 150 patients randomized into 5 groups, using different articulations: Charnley/Charnley Ogee for steel and conventional polyethylene (CPE), or Spectron EF/Reflection with either CPE or highly cross linked polyethylene (XLPE) cups, paired with heads made of either cobalt-chromium (CoCr) or oxidized zirconium (OxZr). All cups were cemented. Patients underwent repeated radiostereometric analysis (RSA) measurements for up to 10 years to assess wear and migration. Clinical outcome was assessed using Harris Hip Score (HHS). RESULTS: After 10 years, the XLPE cups demonstrated low wear rates: 0.08 mm (95% confidence interval [CI] -0.11 to 0.26 mm) with CoCr heads and 0.06 mm (CI -0.14 to 0.26 mm) with OxZr heads, with a mean difference of 0.01 mm (CI -0.26 to 0.29 mm). In contrast, CPE cups exhibited significantly more wear: 1.35 mm (CI 1.16 to 1.55 mm) with CoCr heads and 1.68 mm (CI 1.44 to 1.92 mm) with OxZr heads, with a mean difference of 0.33 mm (CI 0.02 to 0.64 mm). The Charnley/Ogee group (CPE) showed PE wear of 0.34 mm (CI 0.12 to 0.56 mm). The CPE groups with OxZr and CoCr heads had 0.67 mm (CI 0.38 to 0.96 mm) and 0.35 mm (CI 0.09 to 0.61 mm) greater proximal migration respectively than the corresponding XLPE groups. HHS was similar across all groups. CONCLUSION: We found no significant advantage of OxZr over CoCr heads in reducing wear or migration. XLPE demonstrated a major reduction in wear as well as a reduction in cup migration compared with CPE. Charnley performed better than the other CPE cups in terms of PE wear and cup migration. No differences in clinical outcome were found.
Assuntos
Artroplastia de Quadril , Prótese de Quadril , Polietileno , Desenho de Prótese , Falha de Prótese , Análise Radioestereométrica , Zircônio , Humanos , Artroplastia de Quadril/métodos , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Ligas de Cromo , Aço , Seguimentos , Cobalto , CromoRESUMO
BACKGROUND: In total hip arthroplasty (THA), the positioning of components holds critical importance for factors such as joint stability, polyethylene liner wear, and range of motion. This meta-analysis aimed to compare the effects of intraoperative fluoroscopy (IF) versus no use of IF on component positioning and the restoration of patient anatomy during THA. METHODS: We conducted our systematic review following the recommendations outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The literature search was performed from the inception of medical databases up to August 2023. PubMed, Embase, Web of Science, Cochrane Controlled Trials Register, Cochrane Library, Highwire, Wanfang, China National Knowledge Infrastructure (CNKI), China Biology Medicine Disc (CBM), and China Science and Technology Journal (CSTD) databases were systematically searched to identify relevant studies comparing IF versus no IF during primary THA. RESULTS: Thirteen studies involving 2195 patients (2207 hips) were incorporated in the Analysis. No statistically significant differences were observed between the groups in terms of acetabular cup inclination angle (ACIA, Pâ =â .9), ACIA within the safe zone rate (Pâ =â .87), acetabular cup anteversion angle (ACAA, Pâ =â .42), ACAA within the safe zone rate (Pâ =â .35), combined safe zone rate (Pâ =â .30), limb length difference (LLD, Pâ =â .13), dislocation rate (Pâ =â .76), and infection rate (Pâ =â .97). In comparison to the no fluoroscopy group, the IF group exhibited prolonged operation time (Pâ <â .00001) and reduced femoral component offset difference (FCOD, Pâ =â .03). CONCLUSION: IF did not demonstrate improvements in acetabular cup placement, limb length difference, or dislocation occurrence. Nonetheless, IF showed a significant enhancement in restoring femoral offset. It is noteworthy that surgeons operating in facilities with lower patient volumes may observe more pronounced benefits from IF.
Assuntos
Acetábulo , Artroplastia de Quadril , Humanos , Artroplastia de Quadril/métodos , Fluoroscopia/métodos , Acetábulo/cirurgia , Acetábulo/diagnóstico por imagem , Prótese de QuadrilRESUMO
Objective: To compare the clinical outcomes between ceramic-on-ceramic (CoC) and ceramic-on-polyethylene (CoP) bearing surfaces in patients undergoing total hip arthroplasty (THA) through a pooled analysis and evidence update. Methods: We performed a systematic literature search using PubMed, Embase, Cochrane Library and Web of Science up to March 2023 for studies that compared the bearing surfaces of CoC and CoP in patients undergoing THA. The primary outcomes were the incidence of common postoperative complications and the rate of postoperative revision. The secondary outcome was the Harris Hip Score. Results: A total of 10 eligible studies involving 1,946 patients (1.192 CoC-THA versus 906 CoP-THA) were included in the evidence synthesis. Pooled analysis showed no significant difference in the rates of common postoperative complications (dislocation, deep vein thrombosis, infection, wear debris or osteolysis) and of revision. After eliminating heterogeneity, the postoperative Harris Hip Score was higher in the CoC group than in the CoP group. However, the strength of evidence was moderate for the Harris Hip Score. Conclusion: CoC articulations are more commonly used in younger, healthier, and more active patients. While the performance of conventional polyethylene is indeed inferior to highly cross-linked polyethylene, there is currently a lack of sufficient research comparing the outcomes between highly cross-linked polyethylene and CoC bearing surfaces. This area should be a focal point for future research, and it is hoped that more relevant articles will emerge. Given the limited number of studies included, the heterogeneity and potential bias of those included in the analysis, orthopaedic surgeons should select a THA material based on their experience and patient-specific factors, and large multicentre clinical trials with >15 years of follow-up are needed to provide more evidence on the optimal bearing surface for initial THA.
Assuntos
Artroplastia de Quadril , Cerâmica , Prótese de Quadril , Polietileno , Complicações Pós-Operatórias , Desenho de Prótese , Humanos , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/instrumentação , Artroplastia de Quadril/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Prótese de Quadril/efeitos adversos , Prognóstico , ReoperaçãoRESUMO
Objective: To analyze the occurrence of osteolysis in total hip arthroplasty (THA) with highly cross-linked polyethylene prosthesis during a follow-up of more than 15 years. Methods: The clinical data of 84 patients (105 hips) treated with THA in the Affiliated Hospital of Kanazawa Medical University in Japan between June 2000 and April 2004 and met the selection criteria was retrospectively analyzed. There were 7 males and 77 females, aged from 41 to 75 years, with an average of 56.4 years. There were 94 hips with secondary hip osteoarthritis, 4 hips after pelvic osteotomy, 2 hips with primary hip osteoarthritis, 2 hips with traumatic hip osteoarthritis, 2 hips with osteonecrosis of the femoral head, and 1 hip with rheumatoid arthritis. According to Crowe classification, there were 79 hips of type â , 19 hips of type â ¡, 6 hips of type â ¢, and 1 hip of type â £. The highly cross-linked polyethylene acetabular liner combined with a 26 mm zirconia femoral head were used in all patients. X-ray films were taken after operation to analyze the radiation transmission and osteolysis around the acetabular prosthesis. The vertical distance (the distance between the teardrop line at the lower edge of the pelvis and the perpendicular line of the hip rotation center), the horizontal distance (the horizontal distance between the hip rotation center and the interteardrop line and the vertical line at the lower edge of the teardrop), and the acetabular cup anteversion angle were measured at last follow-up. The acetabular and femoral osteolysis was analyzed by CT scan and three-dimensional multiplanar reconstruction (3D-MPR). Combined with X-ray film and CT results, osteolysis was evaluated according to the Narkbunnam score. Results: Deep vein thrombosis of lower limbs occurred in 2 cases. All patients were followed up 15-18 years, with an average of 15.9 years. One hip dislocation and 1 periprosthetic fracture occurred postoperatively, and no acetabular loosening or prosthetic lining ruptures occurred. Except for 1 patient who had a radiolucent line in the acetabulum after operation, the other 83 patients did not show any radiolucent line in the acetabulum or the femur. None of the patients underwent hip revision. X-ray films at last follow-up showed an acetabular cup anteversion angle of -10°-39°, with an average of 22°; a vertical distance of 3.5-47.1 mm, with an average of 24.6 mm; and a horizontal distance of 22.6-48.1 mm, with an average of 31.7 mm. There was no acetabular or femoral osteolysis in all patients on X-ray films and CT 3D-MPR images at last follow-up, and the Narkbunnam score was 0 in any region. Conclusion: Highly cross-linked polyethylene prosthesis does not increase the risk of long-term complications such as osteolysis after THA.
Assuntos
Artroplastia de Quadril , Prótese de Quadril , Osteólise , Polietileno , Tomografia Computadorizada por Raios X , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Idoso , Prótese de Quadril/efeitos adversos , Osteólise/etiologia , Osteólise/diagnóstico por imagem , Adulto , Tomografia Computadorizada por Raios X/métodos , Seguimentos , Complicações Pós-Operatórias/etiologia , Desenho de Prótese , Falha de PróteseRESUMO
Objective: To summarize the latest research progress of bone cement type femoral head replacement in the treatment of unstable intertrochanteric fractures in elderly patients. Methods: The literature on the application of bone cement type femoral head replacement for unstable intertrochanteric fractures in elderly patients both domestically and internationally was reviewed, and the findings in aspects of selection of prosthesis types, proximal femoral reconstruction methods, postoperative complications, and rehabilitation were summarized and analyzed. Results: The bone cement type femoral head replacement has shown significant effectiveness in the treatment of unstable intertrochanteric fractures in elderly patients. The surgery provides immediate stability, allowing patients to quickly bear weight and regain walking function, thereby reducing the incidences of postoperative complications and mortality. However, due to the generally poor physical condition and low surgical tolerance of elderly patients, the risk of postoperative complications significantly increases, which has a significant impact on patients' postoperative recovery. Common complications include deep vein thrombosis, bone cement implantation syndrome, joint dislocation, prosthesis loosening, and periprosthetic fractures. Therefore, despite the apparent short-term effectiveness of the surgery, it is crucial to emphasize the prevention and management of postoperative complications to improve the long-term prognosis of elderly patients. Conclusion: For unstable intertrochanteric fractures in elderly patients, when choosing bone cement type femoral head replacement, it is necessary to strictly adhere to surgical indications, reduce the occurrence of complications, and improve the patients' quality of life through refined preoperative evaluation, intraoperative operation, and effective postoperative management.
Assuntos
Artroplastia de Quadril , Cimentos Ósseos , Fraturas do Quadril , Complicações Pós-Operatórias , Humanos , Fraturas do Quadril/cirurgia , Idoso , Artroplastia de Quadril/métodos , Artroplastia de Quadril/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Resultado do Tratamento , Prótese de Quadril , Cabeça do Fêmur/cirurgia , Idoso de 80 Anos ou maisRESUMO
OBJECTIVE: To explore planning effect of AI-HIP assisted surgical planning system in primary unilateral total hip arthroplasty (THA) and its influence on clinical outcomes. METHODS: A retrospective analysis was conducted on clinical data of 36 patients who underwent their first unilateral THA from March 2022 to November 2022 and continuously used AI-HIP system (AI-HIP group), including 16 males and 20 females, aged from 43 to 81 years old with an average of (62.2±10.9) years old. According to the matching principle, 36 patients who were planned by the traditional template method at the same period were selected as the control group, including 16 males and 20 females, aged from 40 to 80 years old with an average of (60.9±12.1) years old. The accuracy between two groups of prostheses were compared, as well as the combined eccentricity difference between preoperative planning and postoperative practice, lower limb length difference, osteotomy height from the upper edge of the lesser trochanter and top shoulder distance to evaluate planning effect. Harris score and visual analogue scale (VAS) were used to evaluate clinical efficacy. RESULTS: Both groups were followed up for 12 to 18 months with an average of (14.5±2.1) months. The complete accuracy and approximate accuracy of acetabular cup and femoral stalk prosthesis in AI-HIP group were 72.2%, 100%, 58.3%, 88.9%, respectively, which were better than 44.4%, 83.3%, 33.3%, 66.7% in control group (P<0.05). There was no statistical significance in planning of femoral head prosthesis size (P>0.05). The actual combined eccentricity difference and combined eccentricity difference (practical-planning) in AI-HIP group were 1.0(0.2, 2.4) mm and 1.1(-2.1, 3.2) mm, respectively;which were better than 3.0 (1.4, 4.9) mm and 3.5 (-1.6, 6.5) mm in control group (P<0.05). There was no significant difference between two groups in actual osteotomy height of the upper margin of the lesser trochanter (P>0.05). In AI-HIP group, the actual difference of lower extremity length after surgery, the difference of lower extremity length (practical-planning), osteotomy height from the upper margin of lesser trochanter (practical-planning), actual topshoulder distance after surgery, and topshoulder distance (practical-planning) were 1.5 (0.2, 2.8), 1.1 (-0.3, 2.2), 2.1(-2.3, 4.1), (15.3±4.1), 2.2(-4.8, 0.3) mm, respectively;which were better than control group of 2.6(1.3, 4.1), 2.5 (0.3, 3.8), 5.8(-2.4, 7.7), (13.0±4.3), -5.7(-9.4, -2.2) mm(P<0.05). At final follow-up, there were no significant differences in Harris scores of pain, function, deformity, total scores and VAS between two groups (P>0.05). The range of motion score was 4.8±0.6 in AI-HIP group, which was higher than that in control group (4.4±0.8)(P<0.05). CONCLUSION: Compared with traditional template planning, AI-HIP assisted surgical planning system has good accuracy in predicting the prosthetic size of the acetabular cup and femoral stalk, restoring joint eccentricity, planning lower limb length, osteotomy height and top shoulder distance on the first unilateral THA, and the clinical follow-up effect is satisfactory.
Assuntos
Artroplastia de Quadril , Fêmur , Osteotomia , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Artroplastia de Quadril/métodos , Idoso , Osteotomia/métodos , Estudos Retrospectivos , Adulto , Fêmur/cirurgia , Idoso de 80 Anos ou mais , Prótese de QuadrilRESUMO
This study aimed to investigate the long-term serum metal ion levels of patients who received metal-on-metal hip resurfacing arthroplasty (MoM HRA). We conducted a retrospective study of 99 patients (110 hips) from March 2006 to May 2017 who underwent MoM HRA. The Harris Hip Score (HHS) and the University of California at Los Angeles (UCLA) activity score were measured, and the patients underwent clinical and radiological management. Serum levels of cobalt (Co), chromium (Cr), and molybdenum (Mo) were measured using inductively coupled plasma mass spectrometry (ICPMS) at 1, 6, and 12 months, and each year follow-up after prosthesis implantation. Patients were followed up from 1 to 156 months, with a mean of 98 months. No complications occurred. Metal ion analysis revealed significantly elevated levels compared to preoperative levels. The metal ions levels increased and reached a peak after surgery, and then the levels began to decline gradually. Approximately 84-108 months after surgery, the metal ion levels increased again to approximately peak levels. Then, up to 156 months after surgery, the metal ions levels will drop approximately to preoperative levels. The serum levels of Cr in women were higher than those in men, with the difference being statistically significant. Patients with a body mass index (BMI) of ≥24.9 kg/m2 Co levels were significantly higher than those of normal-weight patients. The serum levels of metal ions showed no significant differences between the prostheses. The use of the MoM HRA was clinically effective, and the Co, Cr, and Mo levels increased significantly after HRA; however, upon long-term follow-up, serum metal ion levels tended to decrease to preoperative levels. Longer follow-up periods and larger study samples are needed to establish the long-term outcome of patients undergoing HRA with MoM bearings. Level IV, Therapeutic Study.
Assuntos
Artroplastia de Quadril , Cromo , Cobalto , Prótese de Quadril , Próteses Articulares Metal-Metal , Molibdênio , Humanos , Feminino , Masculino , Artroplastia de Quadril/métodos , Artroplastia de Quadril/efeitos adversos , Cobalto/sangue , Cromo/sangue , Estudos Retrospectivos , Pessoa de Meia-Idade , Adulto , Próteses Articulares Metal-Metal/efeitos adversos , Molibdênio/sangue , Prótese de Quadril/efeitos adversos , Estudos Longitudinais , China , Desenho de Prótese , Osteoartrite do Quadril/cirurgia , Osteoartrite do Quadril/sangue , Íons/sangue , População do Leste AsiáticoRESUMO
BACKGROUND AND PURPOSE: Prosthetic joint infection (PJI) following total hip arthroplasty (THA) has a severe impact on patients. We investigated the risk of second revision and mortality following first-time revision due to PJI. METHODS: We identified 1,669 first-time revisions including 416 treated with debridement, antibiotics, and implant retention (DAIR) from the Danish Hip Arthroplasty Register (DHR). First-time revision due to PJI was defined as a revision with ≥ 2 culture-positive biopsies for the same bacteria or re-ported as PJI to the DHR within 1 year after primary THA with non-PJI revisions as controls. We retrieved information on Charlson Comorbidity Index (CCI), death, cohabitation status, and cultures from intraoperative biopsies. The adjusted relative risk (RR) with 95% confidence interval (CI) was calculated by first-time revision (PJI or non-PJI). Patients were followed from first-time revision until end of study. RESULTS: PJI was found in 140 of 280 patients having a second revision following any first-time revision. Of these 280 patients, 200 were treated with DAIR as second revision. Patients with first-time revision due to PJI had an increased risk of second revision compared with first-time revision for non-PJI with an adjusted RR for second revision due to any cause of 2.7 (CI 1.9-3.8) and second revision due to PJI of 6.3 (CI 4.0-10). The 10-year adjusted RR for mortality for patients with first-time revision due to PJI compared with non-PJI was 1.8 (CI 0.7-4.5). CONCLUSION: The risk of second revision was increased both for second revision due to any reason and due to PJI following first-time revision due to PJI. Mortality risk following first-time revision due to PJI was increased, but not statistically significant.
Assuntos
Artroplastia de Quadril , Prótese de Quadril , Infecções Relacionadas à Prótese , Sistema de Registros , Reoperação , Humanos , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/mortalidade , Reoperação/estatística & dados numéricos , Infecções Relacionadas à Prótese/mortalidade , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/cirurgia , Masculino , Feminino , Dinamarca/epidemiologia , Idoso , Pessoa de Meia-Idade , Prótese de Quadril/efeitos adversos , Fatores de Risco , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Desbridamento , AdultoRESUMO
BACKGROUND: The trabeculae-oriented pattern (TOP®) cup was designed to minimize acetabular periprosthetic bone loss. In our previous prospective study comprising 30 patients with a two-year follow-up we found a substantial decrease in periprosthetic bone mineral density (pBMD) in the proximal and medial regions of the TOP cup. The present study aims to investigate pBMD changes in the mid-term and how this affects implant survival. METHODS: We followed the previous cohort and estimated implant survival by Kaplan-Meier analysis, evaluated pBMD with dual-energy X-ray absorptiometry (DXA) and clinical outcome using the Harris Hip Score (HHS). RESULTS: Mean follow-up was 8.6 (range 7.8-9.1) years. The eight-year implant survival rate for cup revision for all reasons was 83% (95% confidence interval {CI}: 70-97) and 86% (CI: 74-99) when cup revision due to aseptic loosening was the endpoint. Mean HHS at eight years was 95 (range 77-100). A further 12% (CI: 5-17) loss in pBMD was detected in the proximal Digas zone 1 and 12% (CI: 7-17) loss in Digas zone 2 also between two and eight years after surgery. pBMD continued to decrease up to 30% (CI: 24-36) in Digas zones 1, 2 and 3 compared to pBMD immediately postoperatively. CONCLUSIONS: The TOP cup shows inferior mid-term survival rates compared to other uncemented cups, as well as a continuous decrease in pBMD. Periprosthetic bone loss cannot be prevented by this uncemented cup. CLINICAL TRIAL NUMBER: Not applicable.
Assuntos
Artroplastia de Quadril , Densidade Óssea , Prótese de Quadril , Falha de Prótese , Humanos , Estudos Prospectivos , Feminino , Masculino , Seguimentos , Idoso , Pessoa de Meia-Idade , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/instrumentação , Prótese de Quadril/efeitos adversos , Absorciometria de Fóton , Desenho de Prótese , Reabsorção Óssea/diagnóstico por imagem , Reabsorção Óssea/etiologia , Reoperação/estatística & dados numéricos , Acetábulo/cirurgia , Acetábulo/diagnóstico por imagem , Estudos de Coortes , Idoso de 80 Anos ou mais , Fatores de TempoRESUMO
INTRODUCTION: For patients unsuitable for prosthesis reimplantation or temporary spacer placement, Girdlestone resection arthroplasty (GRA) is a suitable option to eliminate infection. Using a large-scale database, this study aims to determine factors associated with reimplantation. METHODS: This study included patients who underwent GRA and subsequent total hip arthroplasty (2012 to 2015 Medicare Limited Data Set with ≥5-year follow-up). A mixed-effects model measured associations between patient characteristics and reimplantation. Odds ratios (OR) with 95% confidence intervals (CI) were reported. RESULTS: Among 2,772 GRA cases, 2,025 (73.1%) were reimplanted (median time to reimplantation 3.0 months). In multivariable analysis, patient factors associated with reduced odds of reimplantation were increased age (OR 0.96; CI, 0.94 to 0.97; P < 0.0001), Black race (OR, 0.58; CI, 0.37 to 0.90; P = 0.0149), obesity (OR, 0.74; CI, 0.58 to 0.94; P = 0.0150), and increased Deyo-Charlson comorbidities (1 comorbidity: OR, 0.78; CI, 0.61 to 0.99; P = 0.0453; two comorbidities: OR, 0.53; CI, 0.39 to 0.71; P < 0.0001; ≥3 comorbidities: OR, 0.69; CI, 0.49 to 0.95; P = 0.0244). Male (versus female) patients, however, had increased odds of reimplantation (OR, 1.64; CI, 1.32 to 2.02; P < 0.0001). DISCUSSION: Age, race, and comorbidities influence the likelihood of reimplantation after GRA. Owing to variability in patients who undergo additional surgery, additional studies should be conducted to determine the rationale of patient selection.
Assuntos
Artroplastia de Quadril , Infecções Relacionadas à Prótese , Reoperação , Humanos , Masculino , Feminino , Infecções Relacionadas à Prótese/cirurgia , Idoso , Idoso de 80 Anos ou mais , Prótese de Quadril , Fatores Etários , Estudos Retrospectivos , Fatores de Risco , Pessoa de Meia-Idade , Estados Unidos , ReimplanteRESUMO
INTRODUCTION: total hip arthroplasty (THA) is one of the most performed surgeries worldwide, with high satisfaction rates. The orientation of the acetabular component has a direct impact on the risk of dislocation, recently with the support of robotic surgery the margin of error in implant placement has decreased; however, the conventional technique even without fluoroscopic support continues to have satisfactory results within the safety zone. MATERIAL AND METHODS: retrospective, cross-sectional, descriptive case series of patients treated with THA at Hospital General Xoco between 2022 and 2024. Degrees of anteversion and inclination were measured with Widmer's method on postoperative radiographs. RESULTS: the radiographs of 113 patients were studied, 80 female and 33 male, with a mean age of 63.2 ± 13.01 years (95% CI: 60.6-65.4), a mean inclination of 42.2° ± 8.1° (95% CI: 40.7-43.2) and anteversion of 14.3° ± 8.5° (95% CI: 12.5-15.4); 76% of the population was within Lewinnek safe zone; by etiology: osteoarthrosis 74%, sequelae of dysplasia 68% and intracapsular fracture 82%; difference between the values of the affected side: left 65%, right 83%, of 3.9° and 4.7°/6.4o and 9° in relation to the overall values of the population. CONCLUSION: in our population undergoing THA, without the use of robotic technique or support of imaging studies, anteversion and inclination figures were recorded within the Lewinnek safety parameters with a conventional method.
INTRODUCCIÓN: la artroplastía total de cadera (ATC) es una de las cirugías más realizadas a nivel mundial, con altos porcentajes de satisfacción. La orientación del componente acetabular tiene impacto directo en el riesgo de luxación; recientemente, con el apoyo de la cirugía robótica, el margen de error en la colocación de los implantes ha disminuido; sin embargo, la técnica convencional, incluso sin apoyo fluoroscópico, continúa teniendo resultados satisfactorios dentro de la zona de seguridad. MATERIAL Y MÉTODOS: serie de casos retrospectiva, transversal y descriptiva, de pacientes tratados con ATC en Hospital General Xoco entre 2022 y 2024. Se midieron los grados de anteversión e inclinación con el método de Widmer en las radiografías postoperatorias. RESULTADOS: se estudiaron las radiografías de 113 pacientes, 80 mujeres y 33 hombres, con edad media de 63.2 ± 13.01 años (IC95%: 60.6-65.4), se obtuvo una inclinación media de 42.2° ± 8.1° (IC95%: 40.7-43.2) y anteversión de 14.3° ± 8.5° (IC95% 12.5-15.4); 76% de la población se encontraba dentro de la zona segura de Lewinnek; por etiología: osteoartrosis 74%, secuelas de displasia 68% y fractura intracapsular 82%; diferencia entre los valores del lado afectado: izquierdo 65%, derecho 83%, de 3.9° y 4.7°/6.4° y 9° en relación con los valores globales de la población. CONCLUSIÓN: en nuestra población sometida a ATC, sin uso de técnica robótica o apoyo de estudios de imagen, se registraron cifras de anteversión e inclinación dentro de los parámetros de seguridad de Lewinnek con un método convencional.
Assuntos
Acetábulo , Artroplastia de Quadril , Humanos , Artroplastia de Quadril/métodos , Feminino , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acetábulo/cirurgia , Acetábulo/diagnóstico por imagem , Estudos Transversais , Idoso , Radiografia/métodos , Prótese de Quadril , Procedimentos Cirúrgicos Robóticos/métodosRESUMO
BACKGROUND: Prosthetic joint infections (PJI) are recalcitrant, hard-to-treat infections and severe complications of joint arthroplasty. Therefore, there is a need to develop new effective treatment strategies, and animal models of high clinical relevance are needed. This study aimed to develop a detailed surgical protocol for hip hemiarthroplasty in Göttingen minipigs and a thorough post-mortem sampling protocol to pave the way for creating a minipig PJI model. METHODS: Three adult female Göttingen minipigs underwent surgery with insertion of a hip hemiarthroplasty, using the anterior approach to the hip joint. After surgery the minipigs were followed closely with daily clinical evaluation and gait scoring. Comprehensive post-mortem analyses were performed with evaluation of macroscopic lesions, microbiology, synovial fluid analysis and histology. RESULTS: The study resulted in the first Göttingen minipig with hip hemiarthroplasty and identified several points of awareness when inserting a hip prosthesis in minipigs, especially the high risk of joint dislocation. A spontaneous PJI occurred in one of the minipigs, revealing an impaired ability of the immune cells to reach the bacteria at the bone-prosthesis interface. CONCLUSION: The present study provides a detailed description of surgical technique and post-mortem sampling and validates the suitability of the hip hemiarthroplasty minipig model for future experimental modeling of PJI.
Assuntos
Artroplastia de Quadril , Hemiartroplastia , Infecções Relacionadas à Prótese , Porco Miniatura , Animais , Suínos , Hemiartroplastia/métodos , Hemiartroplastia/efeitos adversos , Feminino , Artroplastia de Quadril/métodos , Artroplastia de Quadril/efeitos adversos , Infecções Relacionadas à Prótese/etiologia , Modelos Animais de Doenças , Prótese de Quadril/efeitos adversosRESUMO
BACKGROUND: Reinfection rates after two-stage revision (TSR) for prosthetic joint infection (PJI) range from 7.9 to 14%. Many factors, including sinus tracts, are associated with reinfection after this procedure. This study aimed to delineate whether the presence of sinus tract could increase reinfection rate after TSR and to investigate other potential risk factors for reinfection after TSR. METHODS: We conducted a case-control study by retrospectively reviewing patients who underwent TSR for prosthetic hip joint infection from 2002 to 2022. The case group included patients who developed reinfection after TSR, while the control group consisted of patients who did not experience reinfection. PJI and reinfection after TSR were defined based on Delphi-based international consensus criteria. Patient demographics, past medical history, clinical manifestations, laboratory results, interval between stages, microbiological culture results were collected. Univariate analyses were utilized to assess the effect of sinus tract on reinfection and to identify other risk factors for reinfection after TSR. RESULTS: Six patients with reinfection after TSR were included as the case group and 32 patients without reinfection were in the control group. Significant difference was observed in percentage of patients with sinus tracts between the two groups (67% in the case group versus 19% in the control group, p = 0.031, OR = 8.7). Significant difference was also found in percentage of patients with positive cultures of synovial fluid and synovium harvested during the first-stage revision between the two groups (100% in the case group versus 50% in the control group, p = 0.030). Additionally, patients in the case group had a significantly higher C-reactive protein (CRP) level prior to the second stage revision than that of patients in the control group (8.80 mg/L versus 2.36 mg/L, p = 0.005), despite normal CRP levels in all patients. CONCLUSIONS: Our study revealed that the presence of sinus tracts could significantly increase risk of postoperative reinfection after TSR. Positive cultures during the first stage revision and elevated CRP level prior to the second stage revision could also increase the risk of reinfection after TSR. Further studies with a larger sample size are required. TRIAL REGISTRATION: Retrospectively registered.
Assuntos
Artroplastia de Quadril , Prótese de Quadril , Infecções Relacionadas à Prótese , Reinfecção , Reoperação , Humanos , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/cirurgia , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/microbiologia , Feminino , Masculino , Idoso , Estudos de Casos e Controles , Estudos Retrospectivos , Pessoa de Meia-Idade , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/instrumentação , Fatores de Risco , Prótese de Quadril/efeitos adversos , Idoso de 80 Anos ou maisRESUMO
The most frequent indication for total hip arthroplasty (THA) is hip osteoarthritis. THA is inserted to improve function, reduce pain, and improve quality of life. Results are generally good, and 90-95% of the patients are satisfied. However, there are risks associated with THA, and patients must be well informed. Before THA is considered, non-surgical treatment must be completed, as the need for surgery often is postponed. Patients can expect rapid mobilisation and a return to a near-habitual level of physical activity within a year. In Denmark, 95% have their THA after five years and 76% after 25 years.
Assuntos
Artroplastia de Quadril , Osteoartrite do Quadril , Artroplastia de Quadril/efeitos adversos , Humanos , Osteoartrite do Quadril/cirurgia , Prótese de Quadril/efeitos adversos , Falha de Prótese , DinamarcaRESUMO
Aims: Our aim was to estimate the total costs of all hospitalizations for treating periprosthetic joint infection (PJI) by main management strategy within 24 months post-diagnosis using activity-based costing. Additionally, we investigated the influence of individual PJI treatment pathways on hospital costs within the first 24 months. Methods: Using admission and procedure data from a prospective observational cohort in Australia and New Zealand, Australian Refined Diagnosis Related Groups were assigned to each admitted patient episode of care for activity-based costing estimates of 273 hip PJI patients and 377 knee PJI patients. Costs were aggregated at 24 months post-diagnosis, and are presented in Australian dollars. Results: The mean cost per hip and knee PJI patient was $64,585 (SD $53,550). Single-stage revision mean costs were $67,029 (SD $47,116) and $80,063 (SD $42,438) for hip and knee, respectively. Two-stage revision costs were $113,226 (SD $66,724) and $122,425 (SD $60,874) for hip and knee, respectively. Debridement, antibiotics, and implant retention in hips and knees mean costs were $53,537 (SD$ 39,342) and $48,463 (SD $33,179), respectively. Suppressive antibiotic therapy without surgical management mean costs were $20,296 (SD $8,875) for hip patients and $16,481 (SD $6,712) for knee patients. Hip patients had 16 different treatment pathways and knee patients had 18 treatment pathways. Additional treatment, episodes of care, and length of stay contributed to substantially increased costs up to a maximum of $369,948. Conclusion: Treating PJI incurs a substantial cost burden, which is substantially influenced by management strategy. With an annual PJI incidence of 3,900, the cost burden would be in excess of $250 million to the Australian healthcare system. Treatment pathways with additional surgery, more episodes of care, and a longer length of stay substantially increase the associated hospital costs. Prospectively monitoring individual patient treatment pathways beyond initial management is important when quantifying PJI treatment cost. Our study highlights the importance of optimizing initial surgical treatment, and informs treating hospitals of the resources required to provide care for PJI patients.