Long-Term Outcomes of a Titanium-Encased Ceramic Liner Total Hip Arthroplasty (15 to 21Year Results).

BACKGROUND: Historically, aseptic loosening and osteolysis were responsible for most of the revisions among young and more active patients. Ceramic-on-ceramic bearings reduced wear but presented mechanical issues such ceramic fracture or liner chipping during insertion. To prevent this from happening a titanium-encased alumina liner was developed. The aim of this study is to address long-term results of this specific ceramic design. METHODS: All patients received an uncemented acetabular component with ceramic-on-ceramic bearing (94 hips in 77 patients). Patients were prospectively followed over 15 years. Clinical evaluation included the Harris Hip Score and Visual Analog Scale pain scale. Radiographic analysis included integration, osteolysis, and ceramic-related mechanical issues, such as malseating of the insert. RESULTS: The studied acetabular design survivorship was 98.9% at a mean follow-up of 17.2 years. One arthroplasty was revised secondary to infection but no cup had loosened or migrated during the study. Only 1 cup showed complete radiolucent lines. There was no fracture of any ceramic component in the study group. Malseating was present in 12 acetabular components (12.8%). No osteolysis was observed with over 15 years of follow-up. CONCLUSION: In conclusion, this acetabular component demonstrates a favorable clinical and radiological outcome with over 15 years of follow-up. Osteolysis was not observed and incomplete seating of the titanium-sleeved ceramic liner did not lead to mechanical problems.

Predictive model for a second hip fracture occurrence using natural language processing and machine learning on electronic health records.

Hip fractures (HFx) are associated with a higher morbidity and mortality rates, leading to a significant reduction in life quality and in limitation of patient´s mobility. The present study aimed to obtain real-world evidence on the clinical characteristics of patients with an initial and a second hip fracture (HFx) and develop a predictive model for second HFx using artificial intelligence. Electronic health records from one hospital centre in Spain from January 2011 to December 2019 were analysed using EHRead® technology, based on natural language processing and machine learning. A total of 1,960 patients with HFx were finally included during the study period after meeting all inclusion and exclusion criteria. From this total, 1835 (93.6%) patients were included in the HFx subgroup, while 124 (6.4%) were admitted to the second HFx (2HFx) subgroup. The mean age of the participants was 84 years and 75.5% were female. Most of comorbidities were more frequently identified in the HFx group, including hypertension (72.0% vs. 67.2%), cognitive impairment (33.0% vs. 31.2%), diabetes mellitus (28.7% vs. 24.8%), heart failure (27.6% vs. 22.4%) and chronic kidney disease (26.9% vs. 16.0%). Based on clinical criteria, 26 features were selected as potential prediction factors. From there, 16 demographics and clinical characteristics such as comorbidities, medications, measures of disabilities for ambulation and type of refracture were selected for development of a competitive risk model. Specifically, those predictors with different associated risk ratios, sorted from higher to lower risk relevance were visual deficit, malnutrition, walking assistance, hypothyroidism, female sex, osteoporosis treatment, pertrochanteric fracture, dementia, age at index, osteoporosis, renal failure, stroke, COPD, heart disease, anaemia, and asthma. This model showed good performance (dependent AUC: 0.69; apparent performance: 0.75) and could help the identification of patients with higher risk of developing a second HFx, allowing preventive measures. This study expands the current available information of HFx patients in Spain and identifies factors that exhibit potential in predicting a second HFx among older patients.