Effect of transcutaneous electrical acupoint stimulation on postoperative urinary function in elderly patients undergoing total hip arthroplasty. / ç»çš®ç©´ä½ç”µåˆºæ¿€å¯¹è€å¹´æ‚£è€ å ¨é«‹å ³èŠ‚ç½®æ¢æœ¯åŽæŽ’å°¿åŠŸèƒ½çš„å½±å“.

OBJECTIVES: To observe the effect of transcutaneous electrical acupoint stimulation (TEAS) on postoperative urinary function in elderly patients undergoing total hip arthroplasty (THA). METHODS: One hundred and eighty elderly patients undergoing unilateral THA without indwelling urinary catheters were randomly assigned to a TEAS group (90 cases, 3 cases dropped out, 4 cases were eliminated) and a sham TEAS group (90 cases, 1 case dropped out, 4 cases were eliminated). Both groups received fascia iliac block and subarachnoid block anesthesia under ultrasound guidance. The patients in the TEAS group were treated with TEAS at Zhongji (CV 3), Guanyuan (CV 4), and bilateral Huiyang (BL 35), Ciliao (BL 32) 30 minutes before anesthesia initiation, with dissperse-dense wave, frequency of 2 Hz/100 Hz, until 30 minutes after surgery. The patients in the sham TEAS group underwent the same procedure with the device applied at the same acupoints but without electrical stimulation. The incidence of postoperative urinary retention (POUR), time to first void, voiding threshold, urinary adenosine triphosphate (ATP) level, postoperative abnormal voiding status (bladder residual volume, re-catheterization rate, nocturia occurrence), and postoperative incidence of urinary tract infection (UTI) and prosthetic joint infection (PJI) were observed in both groups. RESULTS: The incidence of POUR in the TEAS group was lower than that in the sham TEAS group (P<0.05); the time to first void in the TEAS group was shorter than that in the sham TEAS group (P<0.05); the voiding threshold in the TEAS group was lower than that in the sham TEAS group (P<0.05); the urinary ATP level in the TEAS group was higher than that in the sham TEAS group (P<0.05); the bladder residual volume in the TEAS group was lower than that in the sham TEAS group (P<0.05); the nocturia occurrence in the TEAS group was lower than that in the sham TEAS group (P<0.05). However, there was no statistically significant difference in re-catheterization rate, incidence of UTI, and incidence of PJI between the two groups (P>0.05). CONCLUSIONS: TEAS could effectively reduce the occurrence of postoperative urinary retention and improve the postoperative urinary function in elderly patients undergoing THA, which might be related with increasing the urinary ATP level.

Non-opioid analgesic combinations following total hip arthroplasty (RECIPE): a randomised, placebo-controlled, blinded, multicentre trial.

BACKGROUND: Multimodal postoperative analgesia following total hip arthroplasty is recommended, but the optimal combination of drugs remains uncertain. The aim of the RECIPE trial was to investigate the relative benefit and harm of the different combinations of paracetamol, ibuprofen, and the analgesic adjuvant dexamethasone for treatment of postoperative pain following total hip arthroplasty. METHODS: The RECIPE trial was a randomised, blinded, placebo-controlled trial conducted at nine Danish hospitals. Adults scheduled for total hip arthroplasty were randomly assigned (1:1:1:1) using a computer-generated list with stratification by site to receive combinations of oral paracetamol 1000 mg every 6 h, oral ibuprofen 400 mg every 6 h, or a single-dose of intravenous dexamethasone 24 mg in the following groups: paracetamol plus ibuprofen, ibuprofen plus dexamethasone, paracetamol plus dexamethasone, and paracetamol plus ibuprofen plus dexamethasone. The primary outcome was 24 h intravenous morphine consumption, analysed in a modified intention-to-treat population, defined as all randomly assigned participants who underwent total hip arthroplasty. The predefined minimal important difference was 8 mg. Safety outcomes included serious and non-serious adverse events within 90 days and 24 h. The trial was registered with ClinicalTrials.gov, NCT04123873. FINDINGS: Between March 5, 2020, and Nov 15, 2022, we randomly assigned 1060 participants, of whom 1043 (589 [56%] women and 454 [44%] men) were included in the modified intention-to-treat population. 261 were assigned to paracetamol plus ibuprofen, 262 to ibuprofen plus dexamethasone, 262 to paracetamol plus dexamethasone, and 258 to paracetamol plus ibuprofen plus dexamethasone. Median 24 h morphine consumption was 24 mg (IQR 12-38) in the paracetamol plus ibuprofen group, 20 mg (12-32) in the paracetamol plus dexamethasone group, 16 mg (10-30) in the ibuprofen plus dexamethasone group, and 15 mg (8-26) in the paracetamol plus ibuprofen plus dexamethasone group. The paracetamol plus ibuprofen plus dexamethasone group had a significantly reduced 24 h morphine consumption compared with paracetamol plus ibuprofen (Hodges-Lehmann median difference -6 mg [99% CI -10 to -3]; p<0·0001) and paracetamol plus dexamethasone (-4 mg [-8 to -1]; p=0·0013), however, none of the comparisons showed differences reaching the minimal important threshold of 8 mg. 91 (35%) of 258 participants in the paracetamol plus ibuprofen plus dexamethasone group had one or more adverse events, compared with 99 (38%) of 262 in the ibuprofen plus dexamethasone group, 103 (39%) of 262 in the paracetamol plus dexamethasone group, and 165 (63%) of 261 in the paracetamol plus ibuprofen group. INTERPRETATION: In adults undergoing total hip arthroplasty, a combination of paracetamol, ibuprofen, and dexamethasone had the lowest morphine consumption within 24 h following surgery and the most favourable adverse event profile, with a lower incidence of serious and non-serious adverse events (primarily driven by differences in nausea, vomiting, and dizziness) compared with paracetamol plus ibuprofen. FUNDING: The Novo Nordisk Foundation and Næstved-Slagelse-Ringsted Hospitals' Research Fund.

How modular porous metal augments have changed the management of acetabular bone loss at primary or revision total hip arthroplasty.

The advent of modular porous metal augments has ushered in a new form of treatment for acetabular bone loss. The function of an augment can be seen as reducing the size of a defect or reconstituting the anterosuperior/posteroinferior columns and/or allowing supplementary fixation. Depending on the function of the augment, the surgeon can decide on the sequence of introduction of the hemispherical shell, before or after the augment. Augments should always, however, be used with cement to form a unit with the acetabular component. Given their versatility, augments also allow the use of a hemispherical shell in a position that restores the centre of rotation and biomechanics of the hip. Progressive shedding or the appearance of metal debris is a particular finding with augments and, with other radiological signs of failure, should be recognized on serial radiographs. Mid- to long-term outcomes in studies reporting the use of augments with hemispherical shells in revision total hip arthroplasty have shown rates of survival of > 90%. However, a higher risk of failure has been reported when augments have been used for patients with chronic pelvic discontinuity.

Unexpected early loosening of rectangular straight femoral Zweymüller stems with an alumina-reduced surface after total hip arthroplasty-a prospective, double-blind, randomized controlled trial.

BACKGROUND: Alumina particles from the grit blasting of Ti-alloy stems are suspected to contribute to aseptic loosening. An alumina-reduced stem surface was hypothesized to improve osseointegration and show comparable short-term outcomes to those of a standard stem. METHODS: In this prospective, double-blind, randomized trial, 26 standard (STD) and 27 experimental new technology (NT) stems were implanted. The latter were additionally treated by acid etching and ice blasting to remove alumina particles from the grit-blasting process. Follow-up occurred at 12 and 24 months. Bone mineral density (BMD) around the stem was measured by a dual-energy x-ray absorptiometry device (DEXA). Radiographs were reviewed for alterations. Clinical scoring comprised the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Harris Hip Score (HHS). Survival rates were calculated up to 50 months. RESULTS: Lower mean BMD and more severe cortical hypertrophies were found in the NT group. At 12 months, radiolucent lines were observed mostly in the metaphyseal zone for both groups, with a progression tendency in the NT group at 24 months. At 12 months, pain scores and the WOMAC total and physical activity scores were significantly lower in the NT group, without any differences thereafter. The number of NT stem revisions amounted to 6 (24%) and 11 (41%) at 24 and 50 months, respectively. CONCLUSION: In the NT group, unexpected catastrophic failure rates of 41% caused by early aseptic loosening were noted within 50 months. Compared with the STD stems, NT stems lead to poor clinical and radiographic results. LEVEL OF EVIDENCE: II. TRIAL REGISTRATION: NCT05053048.

Statistical analysis of VEXLPE wear against alumina produced by a new 200-station, multidirectional pin-on-disk device.

With low wear rates shown by contemporary bearing materials of total hip prostheses, the standard deviation of wear rate is relatively high. Therefore, large sample sizes are needed for an adequate power of test. Because wear tests take a long time, it is practical to test several samples simultaneously. A new high-capacity, multidirectional wear test device, called the SuperCTPOD-200, was introduced. A 3 million-cycle wear test with an unprecedented sample size of 200 was performed for VEXLPE. The duration of the test was 6 weeks. The wear factor was normally distributed with a mean ± SD of 1.64 × 10-7 mm3/Nm ± 0.22 × 10-7 mm3/Nm (n = 200). The observation that SD was 13.1% of the mean can be useful in power analyses of future tests with other highly cross-linked polyethylenes. Burnishing was the most typical feature on the worn pins, which was in agreement with clinical findings on retrieved acetabular liners. The present study emphasizes statistics that often plays a minor role only in wear studies.

Explainable artificial intelligence for predicting red blood cell transfusion in geriatric patients undergoing hip arthroplasty: Machine learning analysis using national health insurance data.

This study uses machine learning and population data to analyze major determinants of blood transfusion among patients with hip arthroplasty. Retrospective cohort data came from Korea National Health Insurance Service claims data for 19,110 patients aged 65 years or more with hip arthroplasty in 2019. The dependent variable was blood transfusion (yes vs no) in 2019 and its 31 predictors were included. Random forest variable importance and Shapley Additive Explanations were used for identifying major predictors and the directions of their associations with blood transfusion. The random forest registered the area under the curve of 73.6%. Based on random forest variable importance, the top-10 predictors were anemia (0.25), tranexamic acid (0.17), age (0.16), socioeconomic status (0.05), spinal anesthesia (0.05), general anesthesia (0.04), sex (female) (0.04), dementia (0.03), iron (0.02), and congestive heart failure (0.02). These predictors were followed by their top-20 counterparts including cardiovascular disease, statin, chronic obstructive pulmonary disease, diabetes mellitus, chronic kidney disease, peripheral vascular disease, liver disease, solid tumor, myocardial infarction and hypertension. In terms of max Shapley Additive Explanations values, these associations were positive, e.g., anemia (0.09), tranexamic acid (0.07), age (0.09), socioeconomic status (0.05), spinal anesthesia (0.05), general anesthesia (0.04), sex (female) (0.02), dementia (0.03), iron (0.04), and congestive heart failure (0.03). For example, the inclusion of anemia, age, tranexamic acid or spinal anesthesia into the random forest will increase the probability of blood transfusion among patients with hip arthroplasty by 9%, 7%, 9% or 5%. Machine learning is an effective prediction model for blood transfusion among patients with hip arthroplasty. The high-risk group with anemia, age and comorbid conditions need to be treated with tranexamic acid, iron and/or other appropriate interventions.

Osteoporosis and cement usage in total hip arthroplasty.

PURPOSE: Cement usage in total hip arthroplasty (THA) is increasingly common. However, osteoporosis-related fracture risk in cemented vs uncemented THA patients is poorly characterized. We aim to analyze the usage of metabolic bone care and osteoporosis fracture risk in cemented vs uncemented THA patients using FRAX and radiographic bone measurements. METHODS: Chart review on 250 THA patients was performed retrospectively. Demographics, FRAX scores, hip radiograph measurements, osteoporosis diagnosis, treatment and screening were compared between cemented and uncemented THA patients. Logistic regression model was used to analyze factors influencing cement usage. RESULTS: Cemented THA patients have significantly higher osteoporosis-related fracture risk as measured by FRAX major (20% vs 13%) and FRAX hip (8% vs 5%). There is no significant difference in osteoporosis treatment, vitamin D / calcium supplementation, or metabolic bone disease screening based on patients' cement status. Female sex and rheumatoid arthritis status significantly predict cement usage, but FRAX scores do not predict cement usage. Additionally, 50% (10/20) of patients with Dorr C classification were uncemented. CONCLUSION: Although some patients undergoing THA with high osteoporosis-related fracture risk were identified and cemented, some risk factors including poor proximal femur shape (by Dorr classification) and poor bone quality (as measured by FRAX score) were potentially overlooked. Cemented patients had an increased risk for fractures but did not receive appropriately increased osteoporosis screening or treatment. LEVEL OF EVIDENCE: III.

The effectiveness of hydrotherapy on return to play in sports following hip arthroscopic surgery: a comparative study.

BACKGROUND: The postoperative management of femoroacetabular impingement (FAI) is variable with favourable surgical outcomes. Yet there is no evidence on the efficacy of hydrotherapy in athletes undergoing hip arthroscopy for FAI. The purpose of this study was to evaluate the role and the impact of hydrotherapy on return to sports following hip arthroscopy for symptomatic FAI. METHODS: 2 cohorts of mixed level of athletes from various sports: a hydrotherapy group that followed land-based exercises in combination with hydrotherapy exercises and a control group that followed solely the same land-based exercises. Pre- and postoperative pain and hip-specific outcome scores were completed, and patient satisfaction was rated. RESULTS: A total of 88 hip arthroscopies were included with a minimum of 2 years follow-up; the hydrotherapy group comprised of 36 hips and the control group, 52 hips. There was a significant improvement in time to return to previous performance (HR 1.91, 95% CI, 1.21-3.01; p = 0.005) in the hydrotherapy group compared with the control. The hip-specific scores and patient satisfaction were considerably improved in the hydrotherapy group. CONCLUSIONS: The analysis of our data indicates that the incorporation of hydrotherapy into postoperative rehabilitation for hip arthroscopy for FAI accelerates the return of athletes to their pre-injury performance, since recovery time decreased significantly.

Application of Elastic Traction Band Combined with Pain Assessment in Elderly Patients After Hip Replacement.

Objective: This study aims to investigate the use of an elastic traction band in conjunction with pain evaluation in geriatric patients after hip replacement. Methods: Eighty hip arthroplasty cases involving senior patients at our institution were chosen for this study, covering the period from February 2021 to January 2022. They were separated into the control and observation groups using the premise of comparing and contrasting the two groups' shared fundamental characteristics. Traditional nursing care was given to the control group, while the observation group got an elastic stretch traction belt and pain assessment nursing care. The application effect of the two groups was observed. Results: Before surgery, there was no statistically significant difference in the Harris hip function score between the two groups (P > .05). Harris scores for research items in both groups improved 6 months after surgery, compared to scores obtained before surgery (P < .05), and the increase was greater in the observation group than in the control group (P < .05). Self-efficacy for physical activity, coping, and the overall SER scale were all greater in the observation group than in the control group (P < .05). There was no statistically significant difference between the two groups on any measure of material wellbeing (P > .05). Mental and physical health scores were better in the observation group than in the control group (P < .05). Patients' social dimensions were compared to those of two control groups, and the results showed no statistically significant difference in terms of social function aspects (P > .05), although the control group reported much lower levels of enjoyment, learning, and work, the observation group reported significantly greater levels (P < .05). Patient treatment compliance study using a rank sum test revealed that the observation group's postoperative exercise compliance was considerably greater than that of the control group. Observation group members were more compliant than control group members, with an average rank of 30.829 compared to 40.171 for both groups (P < .05). Conclusion: Patients who have had hip arthroplasty may benefit from using an elastic traction belt in conjunction with pain assessment to increase the likelihood that they would participate in rehabilitation exercises, so enhancing their self-efficacy, hip function, and quality of life.

Effect of Taiwan's Diabetes Shared Care Program on the risk of periprosthetic joint infection after total joint arthroplasty in patients with type 2 diabetes mellitus: an eight-year population-based study.

BACKGROUND: Periprosthetic joint infection (PJI) is a significant post-arthroplasty complication for diabetic patients, with uncontrolled diabetes identified as a PJI risk factor. Taiwan's Diabetes Shared Care Program (DSCP) was established for holistic diabetes care. AIM: To evaluate the DSCP's impact on PJI incidence and patients' medical costs. METHODS: Data were analysed from Taiwan's National Health Insurance Research Database from 2010 to 2020, focusing on type 2 diabetes mellitus (DM) patients who had undergone arthroplasty. The study group involved DSCP participants, while a comparison group comprised non-participants with matched propensity scores for age, sex, and comorbidities. The primary outcome was the PJI incidence difference between the groups; the secondary outcome was the medical expense difference. FINDINGS: The study group consisted of 11,908 type 2 DM patients who had arthroplasty and joined the DSCP; PJI occurred in 128 patients. Among non-participants, 184 patients had PJI. The PJI incidence difference between the groups was statistically significant (1.07% vs 1.55%). The study group's medical costs were notably lower, regardless of PJI incidence. Multivariate regression showed higher PJI risk in patients in comparison group, aged >70 years, male, or who had obesity, anaemia. CONCLUSION: The study indicates that DSCP involvement reduces PJI risks and decreases annual medical costs for diabetic patients after arthroplasty. Consequently, the DSCP is a recommendable option for such patients who are preparing for total joint arthroplasty.

Hyaluronic acid-British anti-Lewisite as a safer chelation therapy for the treatment of arthroplasty-related metallosis.

Cobalt-containing alloys are useful for orthopedic applications due to their low volumetric wear rates, corrosion resistance, high mechanical strength, hardness, and fatigue resistance. Unfortunately, these prosthetics release significant levels of cobalt ions, which was only discovered after their widespread implantation into patients requiring hip replacements. These cobalt ions can result in local toxic effects-including peri-implant toxicity, aseptic loosening, and pseudotumor-as well as systemic toxic effects-including neurological, cardiovascular, and endocrine disorders. Failing metal-on-metal (MoM) implants usually necessitate painful, risky, and costly revision surgeries. To treat metallosis arising from failing MoM implants, a synovial fluid-mimicking chelator was designed to remove these metal ions. Hyaluronic acid (HA), the major chemical component of synovial fluid, was functionalized with British anti-Lewisite (BAL) to create a chelator (BAL-HA). BAL-HA effectively binds cobalt and rescues in vitro cell vitality (up to 370% of cells exposed to IC50 levels of cobalt) and enhances the rate of clearance of cobalt in vivo (t1/2 from 48 h to 6 h). A metallosis model was also created to investigate our therapy. Results demonstrate that BAL-HA chelator system is biocompatible and capable of capturing significant amounts of cobalt ions from the hip joint within 30 min, with no risk of kidney failure. This chelation therapy has the potential to mitigate cobalt toxicity from failing MoM implants through noninvasive injections into the joint.

Efficacy and Related Factors of Artificial Femoral Head Replacement for Femoral Intertrochanteric Fracture and Nonunion: A Systematic Review and Meta-Analysis.

Background: An intertrochanteric fracture can cause ischemic necrosis in the femoral head, leading to negative effects. There are many types of implants for this fracture procedure, including metal-on-metal, metal-on-polyethylene, ceramic-on-ceramic, and ceramic-on-polyethylene, that are currently in use. The current modification is a hybrid prosthetic implant with high functional capacity compared with predecessors. This study aims to determine the procedure's efficacy in recovery, function restoration, complications, and cost-effectiveness. Methods: Our study used a total of 200 patients undergoing total hip arthroplasty and 135 patients undergoing semi-hip arthroplasty to determine the effectiveness of total hip arthroplasty and femoral head arthroplasty From May 2022 to May 2023. Using the RAOSOFT sampling technique, 132 and 101 in the observation and control group, respectively, the sample is obtained with a confidence interval of 95%, an error margin of 1%, and response interval confidence of 50%. This is a descriptive type of research that relies on a meta-analysis of the available data from PubMed, scholarly articles, and the Chinese biomedical database to gather the fundamental data needed to conduct the research. Data obtained is analyzed using SSPS and STATA and presented in tables showing a summary of the objective measured value. Result: In this study, the Harris joint score of patients in the total hip arthroplasty group was significantly higher than that of the control group, indicating that total hip arthroplasty can restore femoral head function, but still lacks absolute strength like half hip arthroplasty. Conclusions: Femoral head replacement is a complex procedure, but the efficacy in restoring the function is better. In conclusion, despite slow healing and regeneration, the efficacy of complete artificial femoral head replacement is higher in restoring function for various fractures.

Dexamethasone as additive of local infiltration analgesia reduces opioids consumption after simultaneous bilateral total hip or knee arthroplasty: a randomized controlled double-blind trial.

PURPOSE: A randomized controlled double-blind trial was conducted to evaluate the effects of adding dexamethasone to the local infiltration analgesia (LIA) mixture on frequency of patient controlled analgesia (PCA) and opioids consumption after simultaneous bilateral total hip or knee arthroplasty (THA or TKA). METHODS: 108 patients who received simultaneous bilateral THA or TKA were randomly divided into dexamethasone group and normal saline (NS) group. The main difference between two groups was whether or not dexamethasone was added to the LIA mixture. The main outcome was the cumulative consumption of opioids within 24 h. The secondary outcome were the total cumulative consumption of opioids during postoperative hospitalization, consumption of opioids drug for rescue analgesia, frequency of PCA, postoperative Visual Analogue Scale (VAS), and complications. RESULTS: Cumulative consumption of opioids in the 24 h was similar between two groups (P = 0.17). Total cumulative consumption of opioids in the dexamethasone group during postoperative hospitalization was significantly lower (P = 0.03). No significant difference in the consumption of opioids drug for rescue analgesia between two groups within 24 h, while the frequency of PCA was significantly different (P = 0.04). VAS of dexamethasone group and NS group were similar during postoperative hospitalization, while the incidence of postoperative nausea and vomiting (PONV) in dexamethasone group was lower than that in NS group. CONCLUSIONS: Adding dexamethasone to LIA in the simultaneous bilateral THA or TKA can effectively reduce the total cumulative consumption of opioids and the frequency of PCA, as well as reduce the incidence of PONV. Trial Registration The trial has been registered in the Chinese Clinical Trial Registry (Registration Number: ChiCTR2100042551, Date: 23/01/2021).

Study on the Effect of Pain Programmed Care Based on the Concept of Prehabilitation on the Recovery of Joint Function and WHOQOL-BREF Score in Elderly Patients after Total Hip Arthroplasty.

Objective: To assess the impact of pain-programmed care, utilizing the concept of prehabilitation, on the postoperative recovery of joint function and WHOQOL-BREF score in elderly patients following total hip arthroplasty. Methods: Ninety cases of elderly patients with total hip arthroplasty admitted to our hospital from January to December 2022 were selected as the observation sample, and the 90 elderly patients with total hip arthroplasty were divided into 45 control groups and 45 control groups by random number table method. The pain assessment, functional exercise compliance, hip joint function and quality of life of the two groups were compared after the intervention. Results: The nursing intervention led to a significant reduction in pain scores and improvement in quality of life for elderly patients undergoing total hip joint replacement. The observation group showed a greater reduction in resting pain scores (6.20 ± 0.63 vs. 3.78 ± 0.67, P < .05) and activity pain scores (8.78 ± 0.64 vs. 4.89 ± 0.68, P < .05) compared to the control group. Additionally, the observation group demonstrated significant improvements in physiology (55.73 ± 2.14 vs. 71.87 ± 21.59, P < .05), psychology (55.71 ± 2.13 vs. 72.60 ± 2.20, P < .05), social relations (55.73 ± 2.13 vs. 71.96 ± 1.57, P < .05), and environmental effect (55.60 ± 2.15 vs. 68.62 ± 1.51, P < .05) after care, whereas the control group exhibited lesser improvements in these areas (physiology: 55.60 ± 2.24 vs. 64.53±2.02, P < .05; psychology: 55.60 ± 2.22 vs. 66.33±1.99, P < .05; social relations: 55.82 ± 2.09 vs. 67.84 ± 1.73, P < .05; environmental effect: 55.89 ± 2.18 vs. 62.09 ± 51.49, P < .05). These findings demonstrate the significant impact of nursing intervention on pain reduction and improved quality of life for elderly patients undergoing total hip joint replacement. Conclusion: Pain programmed care based on the concept of prehabilitation for elderly patients undergoing total hip arthroplasty has a significant positive impact on pain control, compliance with functional exercise, recovery of hip function, and improvement of quality of life. These findings highlight the benefits of implementing pain management strategies and rehabilitation programs in the field of total hip arthroplasty and elderly care.

Utilization of Total Joint Arthroplasty by Rural-Urban Designation in Patients With Osteoarthritis in a Universal Coverage System.

BACKGROUND: Utilization of total joint arthroplasty (TJA) is affected by differences linked to sex, race, and socioeconomic status; there is little information about how geographic variation contributes to these differences. We sought to determine whether discrepancies in TJA utilization exist in patients diagnosed with osteoarthritis (OA) based upon urban-rural designation in a universal coverage system. METHODS: We conducted a cohort study using data from a US-integrated healthcare system (2015 to 2019). Patients aged ≥50 years who had a diagnosis of hip or knee OA were included. Total hip arthroplasty and total knee arthroplasty utilization (in respective OA cohorts) was evaluated by urban-rural designation (urban, mid, and rural). Incidence rate ratios (IRRs) for urban-rural regions were modeled using multivariable Poisson regressions. RESULTS: The study cohort included 93,642 patients who have hip OA and 275,967 patients who had knee OA. In adjusted analysis, utilization of primary total hip arthroplasty was lower in patients living in urban areas (IRR = 0.87, 95% confidence interval = 0.81 to 0.94) compared to patients in rural regions. Similarly, total knee arthroplasty was used at a lower rate in urban areas (IRR = 0.88, 95% confidence interval = 0.82 to 0.95) compared with rural regions. We found no differences in the hip and knee groups within the mid-region. CONCLUSIONS: In hip and knee OA patients enrolled in a universal coverage system, we found patients living in urban areas had lower TJA utilization compared to patients living in rural areas. Further research is needed to determine how patient location contributes to differences in elective TJA utilization. LEVEL OF EVIDENCE: III.

Advantages of Total Hip Arthroplasty Using the Posterolateral Approach Combined with Phased Rehabilitation Management for Patients with Femoral Neck Fractures.

Background: Total hip arthroplasty (THA) has emerged as a pivotal approach for addressing femoral neck fractures (FNFs), a prevalent type of fracture in older people. Restoring joint functionality following surgery significantly contributes to patients' overall well-being. Therefore, the implementation of rational and effective rehabilitation exercises is crucial. Objective: This study aims to investigate the impact of phased rehabilitation management on patients with FNFs who have undergone THA. Methods: In this prospective comparative study, a total of 89 patients were enrolled. Among them, 49 patients underwent phased rehabilitation management, while 40 patients received conventional postoperative rehabilitation. The evaluation encompassed a range of assessments, including the Harris Hip Score (HHS) for the evaluation of hip joint function, the Five-Times-Sit-to-Stand Test (FTSST) to quantify lower limb muscle strength, the Barthel Index to assess activities of daily living, and the Visual Analog Scale (VAS) to measure pain intensity. Furthermore, preoperative and postoperative serum levels of interleukin-6 (IL-6), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were diligently measured to provide a comprehensive understanding of the patient's inflammatory responses. Results: Overall, the study group exhibited a significantly higher average HHS after surgery compared to the control group. Notably, the VAS scores at 1 day and 3 days post-surgery in both groups demonstrated a reduced trend compared to preoperative values. This trend was more significant in the study group compared to the control group. The time taken for the FTSST in patients undergoing phased rehabilitation management was less compared to the control group. Furthermore, phased rehabilitation management was associated with more significant improvements in activities of daily living. Notably, IL-6 levels were higher in both the study and control groups at 1 day postoperatively than before surgery, while they decreased at 3 days postoperatively compared to the 1-day mark. The study group exhibited significantly lower levels of CRP (mg/L) and ESR (mm/h) compared to the control group. Conclusions: Implementing phased rehabilitation management for patients with FNFs following THA improves hip joint function, lower limb muscle strength, daily living activities, pain intensity, and inflammatory response.

Analgesic efficacy of anterior iliopsoas muscle space block combined with local infiltration analgesia after total hip arthroplasty: A prospective, double-blind, placebo-controlled study.

BACKGROUND: The present study aimed to evaluate the efficacy of ultrasound-guided anterior iliopsoas muscle space block (AIMSB) combined with local infiltration analgesia (LIA) for pain management and recovery in patients who have undergone total hip arthroplasty (THA) via a posterolateral approach. METHODS: In this prospective, double-blind, placebo-controlled study, 80 patients undergoing primary THA under general anesthesia were included in the final analysis between March 22, 2022, and June 1, 2022. All patients were randomly assigned to receive AIMSB combined with LIA (AIMSB group, n = 40) or sham AIMSB and LIA (Sham group, n = 40). The primary outcome was cumulative morphine consumption (mg) within 24 h after surgery. Secondary outcomes were pain scores on a visual analog scale (VAS) at rest or during motion after surgery, time to first rescue analgesia, cumulative morphine consumption during hospitalization, intraoperative consumption of opioids, postoperative recovery, and postoperative adverse effects. RESULTS: Patients in the AIMSB group consumed significantly less morphine than the Sham group within the first 24 h and throughout hospitalization, as well as smaller amounts of intraoperative opioids. Also, significantly lower pain scores were recorded at rest or during motion within 24 h after surgery in AIMSB patients. Patients in the AIMSB group recovered more quickly than Sham patients. No significant difference was observed in quadriceps strength and postoperative complications between the two groups. CONCLUSIONS: Compared to treatment with LIA alone, ultrasound-guided AIMSB combined with LIA can provide better postoperative pain relief, decrease opioid consumption, promote motor sparing, and enhance the recovery of THA patients.

The Use of Lavender Aromatherapy for Pain After Total Hip and Total Knee Arthroplasty: A Randomized Trial.

A randomized clinical trial was conducted over a threemonth period with 102 participants undergoing a total hip arthroplasty (THA) or total knee arthroplasty (TKA). The study purpose was to assess whether there was a reduction in the use of opioids in the postoperative period for THA or TKA participants that utilized lavender aromatherapy as an adjunct to pain medication. The participants in the control and intervention group were administered nonopioid pain medication around the clock and opioids as needed after surgery. However, the intervention group also received a pre-packaged lavender essential oil inhaler. Total oral morphine equivalents (OME) were calculated for each participant to determine opioid usage. Although the total OME was similar for the groups overall, the total OME was slightly lower for THA patients that were enrolled in the intervention group (median 22.5) compared to THA patients that were enrolled in the control group (median 31.2). In the intervention group, 58% of participants reported that the lavender inhaler was a useful tool for pain management and 76% indicated they would continue to use the lavender inhaler after discharge.

Fretting corrosion behavior of Ti6Al4V alloy against zirconia-toughened alumina ceramic in simulated body fluid.

The fretting corrosion at the head-neck interface of artificial hip joints is an important reason for the failure of prostheses. The Ti6Al4V alloy-zirconia-toughened alumina (ZTA) ceramic combination has been widely used to make the head and neck of artificial hip joints. In this study, its fretting corrosion behavior in simulated body fluid was studied by electrochemical monitoring, surface morphology characterization, and chemical composition analysis. A running condition fretting map (RCFM) of load and displacement was established, including three regimes, namely partial slip regime (PSR), mixed fretting regime (MFR), and gross slip regime (GSR). The friction dissipation energy increased gradually from the PSR to MFR and GSR. In the PSR, the damage mechanisms were slight abrasive wear and tribocorrosion at the edge of contact area, as well as extremely slight adhesive wear at the center. In the MFR, the damage mechanisms were mainly adhesive wear, abrasive wear, and corrosive wear. In the GSR, the damage mechanism was serious abrasive wear, fatigue wear, and corrosive wear combined with slight adhesive wear. Finally, an ion-concentration map was created, displaying the material-loss transition of different displacements and loads. The material loss increased with the increased displacement, and increased first and then decreased with the increased load.