Patient-Reported Outcomes and Perioperative Complications of Total Hip Arthroplasty Following Joint Preservation Surgery for Hip Dysplasia.

BACKGROUND: There is growing recognition of the importance of patient-reported outcome measures and assessment of patient satisfaction in the evaluation of outcomes following surgical interventions. This study aimed to evaluate patient-reported outcomes and complication rates after total hip arthroplasty following joint preservation surgery for hip dysplasia. METHODS: Patient-reported outcomes and complication rates of 85 hips with previous joint preservation surgery (salvage group) were compared with those of 1279 hips without joint preservation surgery (primary arthroplasty group). As a patient-reported outcome measure, the Japanese Orthopedic Association Hip Disease Evaluation Questionnaire was used to evaluate the hip condition both preoperatively and 12 months postoperatively. Operative data and postoperative (within 12 months) complications were investigated. RESULTS: The salvage group had a longer operative time (56.8 vs 44.9 minutes, P < .001) and a higher total complication rate (5.9% vs 1.1%, P < .001). Additionally, the salvage group exhibited a lower degree of improvement in the visual analog scale value for satisfaction (75.1 vs 83.1 mm, P = .011), the pain and movement category scores, and the total score of the Japanese Orthopedic Association Hip Disease Evaluation Questionnaire (14.2 vs 16.2, P = .031; 13.7 vs 16.0, P = .005; and 42.3 vs 47.9, P = .007, respectively) compared with the primary arthroplasty group. CONCLUSION: This study demonstrated a lower rate of improvement in patient satisfaction and worse self-reported outcomes in the salvage group. Furthermore, these patients had a longer operative time and a higher risk of operative complications.

Epidemiology of Dislocation Following Direct Anterior Total Hip Arthroplasty: A Minimum 5-Year Follow-Up Study.

BACKGROUND: The cumulative mid- to long-term risk of dislocation following total hip arthroplasty is considerably greater than has been reported in short-term studies. We retrospectively investigated the epidemiology of first-time dislocation following total hip arthroplasty using 28-mm heads through the direct anterior approach in patients with hip dysplasia who were followed up for more than 5 years. METHODS: The operative records of 871 hips in 790 consecutive patients were reviewed to determine the incidence of postoperative first-time dislocation. RESULTS: The mean follow-up duration was 7.8 (range, 5.6-11.7) years. The direct anterior approach was used for all hips. Postoperative dislocation was observed in 8 hips (0.92%) in 8 patients. First-time dislocation occurred during the first 3 weeks in 6 hips (75%). The cumulative risk of postoperative dislocation was 0.69% at 1 month, 0.80% at 1 year, and 0.93% at 5 years. One patient underwent revision surgery for recurrent dislocation within the first month due to malalignment of the cup. CONCLUSION: Our findings demonstrated that the direct anterior approach limits the time of dislocation to the very early postoperative period; that is, the risk of a first-time dislocation after the first month is considerably low. Preserving muscular structures may contribute to continuous dynamic stability of the hip, which could explain the slight increase in the cumulative risk of first-time dislocation.

Perioperative complication rate of one-stage bilateral total hip arthroplasty using the direct anterior approach.

BACKGROUND: To date, details of the surgical and clinical outcomes of one-stage bilateral total hip arthroplasty using the direct anterior approach have not been widely available. The purpose of this study was to report the perioperative blood management and investigate the perioperative complication rate of one-stage bilateral total hip arthroplasty using the direct anterior approach. METHODS: We retrospectively assessed 325 consecutive patients (650 hips) who underwent one-stage bilateral total hip arthroplasty through the direct anterior approach. RESULTS: The mean intraoperative blood loss and operating time were 412 g and 87.2 min, respectively. One patient (0.3%) required postoperative transfusions of allogeneic blood. Post-operative local major complications occurred in 6 hips (0.9%) in 6 patients, including 2 (0.3%) dislocations, 2 (0.3%) early cup migrations, and 2 (0.3%) peri-prosthetic femoral fractures. No systemic major complication was detected. CONCLUSION: We conclude that the low rate of systemic complications in this study was due to supine positioning and the minimally invasive aspect of the direct anterior approach, and that the approach is therefore a reasonable choice for one-stage bilateral THA.

Radiographic factors to predict operation time of direct anterior total hip arthroplasty for dysplastic hips.

BACKGROUND: This study aimed to identify radiographic factors that could predict surgical difficulty in direct anterior total hip arthroplasty (THA) for dysplastic hips. PATIENTS AND METHODS: The clinical records of 160 patients (204 hips) who underwent primary THA for the treatment of developmental dysplasia of the hip were retrospectively investigated. All THAs were performed through a direct anterior approach by a single surgeon. A multiple regression analysis was developed to identify the independent predictor of operation time, including variables such as age, sex, height, body mass index (BMI), the use of bone cement, previous hip surgery, and radiographic references, including the pelvic horizontal to vertical ratio, the extent of proximal and horizontal migration of the femoral head, flatness of the femoral head, and the vertical distance between the tips of the greater trochanter and the femoral head. RESULTS: A multiple regression analysis revealed that as radiographic factors, proximal migration of the femoral head, and lower position of the femoral head related to the greater trochanter were significantly associated with longer operation time. In addition, our results revealed that younger age, male sex, height, high BMI, cement use, and previous hip surgery were also significantly associated with longer operation time. CONCLUSIONS: Our findings indicate that proximal migration of the femoral head and high-riding greater trochanter are isolated radiographic predictors of the longer operation time of direct anterior THA for dysplastic hips.

Improvement of the Gap Adjustment in Total Knee Arthroplasty Using the Posterior Condylar Pre-cut Technique.

To provide adequate gaps for knee extension and flexion during total knee arthroplasty, a femoral component placement decreases the extension gap because the posterior capsule tension increases against the protrusion of the posterior part of the femoral component. We thought that the influence of this component on the extension gap depends on the amount of posterior femoral bone resection and the thickness of the posterior femoral components. We hypothesized that less bone resection and a thinner posterior part of the femoral component might avoid these problems. To verify our hypothesis, a 4-mm posterior condylar pre-cut technique and temporary femoral components that were 8 and 4 mm thick in the distal and posterior parts, respectively, were made using the FINE Total Knee System (Teijin-Nakashima Medical Co., Okayama, Japan). After bone resection, the pre-cut trial component was set to the femur, and the bone and component setting gaps were estimated. Seventy-one patients (98 knees) were investigated. The average bone gaps were 17.2/15.0 mm (extension/flexion, after pre-cut), 18.3/16.3 mm (after soft tissue release), and 8.7/12.2 mm (after pre-cut trial setting). After pre-cut trial setting, the extension gap decreased significantly; the amount was 1.6 mm (0-4 mm) on average (p < 0.0001), whereas a change of 3 mm or more occurred in 15 knees (15.3%), which could be problematic. The degree of these changes after component setting could be reduced by using the posterior femoral condylar pre-cut technique. However, the problem of component setting on the extension gap was not completely resolved. To precisely project the intraoperative gap to the ultimate postoperative gap, a posterior small protrusion device such as a pre-cut trial with the pre-cut technique would be necessary.

Pseudotumor Caused by Titanium Particles From a Total Hip Prosthesis.

A 77-year-old woman underwent metal-on-polyethylene total hip arthroplasty for osteoarthritis of the right hip at another institution. During surgery, the greater trochanter was broken and internal fixation was performed with a trochanteric cable grip reattachment. Although postoperative recovery was uneventful, approximately 6 years later, the patient had severe right hip pain with apparent swelling, and she was referred to the authors' institution. Plain radiographs showed evidence of severe osteolysis in the proximal femur and cable breakage; however, preoperative aspiration culture findings were negative for bacterial growth. Magnetic resonance imaging showed a well-circumscribed mass, presumed to be a pseudotumor. Serum cobalt and chromium levels were within normal limits, and the serum titanium level was high. During surgery, the mass was excised and removal of the cable system revealed a sharp deficit in the bare femoral stem. Gross surgical findings showed no obvious evidence of infection and no corrosion at the head-neck junction; therefore, all components were retained besides the cable system, which resulted in clinical recovery. All of the cultures from specimens were negative for bacterial growth, and histologic findings were compatible with a pseudotumor, such as histiocytes containing metal particles, abundant plasma cells, and CD8-positive cells. Quantitative analysis by inductively coupled plasma atomic emission spectrometry showed that the main source of metal debris in the pseudotumor was the femoral stem, which was made of titanium alloy, not the broken cable, which was made of cobalt-chromium alloy. The findings suggest that titanium particles can form symptomatic solid pseudotumors.

Titanium alloy stem as a cause for adverse reaction to metal debris after bipolar hemiarthroplasty.

A 68-year-old male with failure of bipolar hemiarthroplasty consistent with adverse reaction to metal debris (ARMD) who presented with a painful cystic lesion and lower extremity swelling was encountered. However, revision surgical findings showed no apparent cause of ARMD previously described in the literature, such as corrosion at the head-neck junction and articular abrasion. Therefore, it was difficult to make a definite diagnosis of failure secondary to ARMD, which consequently led to the decision to perform two-stage revision procedure, though the stem was firmly fixed. Postoperative analysis in the retrieval tissues showed that the metal debris mainly originated from the titanium alloy stem itself. Although this is a very rare case, one should be aware that even the well-fixed femoral components themselves have the potential to be the cause of ARMD.