Artroplastia de cadera con vástago femoral recubierto de biovidrio / Hip arthroplasty with a bioactive glass-coated femoral stem

Objetivo. Evaluar el resultado del vástago femoral CRM recubierto de biovidrio (Seipi-Bioimplant, Italia) después de 8 años de seguimiento. Material y método. Se han revisado de forma retrospectiva 67 pacientes a los que se había implantado 70 prótesis totales de cadera con un vástago femoral no cementado y recubierto de biovidrio durante los años 1994 y 1995 con un seguimiento de 8 años. El análisis de supervivencia se realizó por el método actuarial y se calculó también el intervalo de confianza del 95 por ciento (IC 95 por ciento). Se pudo realizar una revisión completa tanto clínica como radiográfica en 59 pacientes con 62 vástagos implantados. Resultados. La valoración clínica se realizó conforme a la escala de Merle D'Aubigné con 19 casos (30 por ciento) excelentes, 17 casos (28 por ciento) muy buenos, 12 casos (20 por ciento) buenos y 14 casos (22 por ciento) entre regulares y malos. Para la valoración radiográfica se utilizaron los criterios de Engh para los vástagos no cementados, apreciando 56 vástagos estables (90,4 por ciento) y un vástago inestable (1,6 por ciento). Se habían realizado 5 recambios (8 por ciento): uno por aflojamiento séptico y 4 por aflojamiento aséptico. La curva de supervivencia a los 8 años es del 91,9 por ciento y el IC 95 por ciento tiene valores de 85,2 por ciento98,7 por ciento. Conclusiones. Teniendo en cuenta que en 1996 ya existían publicaciones sobre vástagos femorales recubiertos de hidroxiapatita (HA) con seguimiento de 7 años y con una curva de supervivencia cercana al 100 por ciento y coincidiendo también con los resultados de la tesis doctoral realizada por uno de nosotros sobre el implante de cilindros de titanio recubiertos de HA y otros recubiertos de biovidrio en fémures de oveja, se desistió de continuar implantando vástagos recubiertos de biovidrio, por considerar que los resultados de supervivencia no son equiparables a los vástagos recubiertos de HA (AU)

The patient-specific index: asking patients what they want.

The Patient-Specific Index is used to assess the outcome of total hip arthroplasty by evaluating the preferences of the individual patient. The purpose of this study was to determine the reliability, validity, and responsiveness of this index and to compare different methods of combining patients' ratings of the severity and importance of their complaints, to obtain Patient-Specific Index summary scores. All patients who were scheduled to have a total hip arthroplasty performed by one surgeon at a single institution were eligible for the study. The patients completed the Harris hip score form, the McMaster-Toronto Arthritis (MACTAR) Patient Preference Disability Questionnaire, the Short Form-36, the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and the Patient-Specific Index. With use of the Patient-Specific Index, patients rated the severity and importance of each complaint. These ratings were summed in four different ways to derive severity-importance scores. The questionnaires were completed twice (two weeks apart) before the total hip arthroplasty and twice (two weeks apart) six months after the total hip arthroplasty by a subset of the patients. The seventy-eight participating patients had a mean age of 62.2 years (range, twenty-five to eighty-seven years) at the time of the operation. Forty-three patients (55 per cent) were men, and sixty-three (81 per cent) had osteoarthrosis. The inter-rater and intra-rater test-retest random-effects intraclass correlation coefficients of the Patient-Specific Index were 0.77 or greater (greater than 0.75 is considered excellent). Construct validity was shown by correlations of the Patient-Specific Index with other scales. The additive versions of the Patient-Specific Index (with a responsiveness statistic of 3.3 or greater and a standardized response mean of 1.6 or greater) were more responsive than the other scales. We concluded that the Patient-Specific Index is reliable, valid, and responsive. The additive versions were the most responsive and are recommended for future applications. Such indices need to be tested in studies of patients who have osteoarthrosis of the hip and other musculoskeletal diseases, to ensure generalizability of the results.

In search of therapeutic nursing: subacute care.

A form of 'intermediate' care exists in the USA which parallels the work of nurse-led units in the UK. This article describes subacute care, the term used for in-patient facilities for post-operative care and rehabilitation, and looks at its application in the USA. The work of such units is detailed and compared with similar units in the UK.

Inter-rater reliability for function and strength measurements in the acute care hospital after elective hip and knee arthroplasty.

OBJECTIVE: To determine the inter-rater reliability of function and strength measurements in patients undergoing elective hip and knee arthroplasty in an acute care setting. METHOD: Forty-four patients underwent either total hip or knee arthroplasty. Patients were rated by 4 occupational therapists and 7 physical therapists on their performance of 5 functional tasks: lower extremity dressing, toilet transfer, supine-to-sit transfer, sit-to-stand transfer, and ambulation to 100 feet. Strength measurements of the quadriceps femoris muscle were measured quantitatively with a Microfet hand-held dynamometer. Data were analyzed to determine the interrater reliability using the Kappa statistic (K) for the functional tasks and the intra-class correlation coefficient (ICC) for the strength measurements. RESULTS: A high level of inter-rater reliability was achieved for lower extremity dressing, toilet transfer, supine-to-sit transfer, sit-to-stand transfer, and ambulation to 100 feet, as evidenced by K values between 0.75 and 0.99. Reliability was also excellent for quantitative strength measurements using the dynamometer, with an ICC of 0.94. CONCLUSION: This study demonstrated excellent interrater reliability with measurements of function and strength post-operatively after elective hip and knee arthroplasty. The practical implication is that by using a standardized measurement tool in the acute care setting, the treatment team can more reliably assess patients' progress, which may aid clinical decision making.

Effect of preparatory information prior to elective total hip replacement on post-operative physical coping outcomes.

The aim of the study was to evaluate the effect of preparatory information on a patient's post-operative physical coping outcomes following a Total Hip Replacement (THR). The research design was quasi-experimental. Eighty-two healthy individuals, scheduled for an elective THR were used and selected using non-random techniques, and placed into one of two groups on an alternating basis. The subjects in the experimental group were given procedural, sensory and coping information relating to the whole surgical procedure of a THR. In addition, written information was provided for each experimental subject to support the verbal information. Subjects in the control group only received the advice and support that would routinely be given to THR patients by ward, medical and nursing staff. The study measured a number of physical outcomes using a "Physical Indicators of Coping Questionnaire" developed to measure physiological and physical outcomes post-operatively. In addition, a Linear Analogue Coping Scale was developed to assess a patient's personal perception of their overall coping ability with the THR. The study demonstrated that preparatory information, given pre-operatively, post-operatively and pre-discharge had positive effects on the physical recovery and coping outcomes measured. Subjects in the experimental group had significantly less post-operative intramuscular analgesia, mobilized sooner with a Zimmer frame and walking sticks and lastly, their length of stay was on average, 2 days less than the control group. The Linear Analogue Coping Scale demonstrated that patients in the experimental group did perceive they were coping more effectively post-operatively. Preparatory information of various types and in different forms appear to have positive effects on the ability of patients to cope with and recover physically from a THR in the immediate post-operative period.

A study of the factors in hip replacement dislocation. Part 1.

This is the first of two articles which describe a clinical and radiographic review of the reasons for dislocation in patients who have received customised total hip replacements. The researchers compared the alignment of 19 arthroplasties which had dislocated with 347 which had not. A number of factors were considered including pre- and post-operative factors, femoral component placement, component head size, and acetabular position and orientation. It was found the the femoral head size had the greatest influence on dislocation. However, the researchers point out that dislocation on these patients is a multifactoral problem and that prevention, through effective pre-operative and post-operative patient education in relation to care of the hip and mobilising, should be encouraged. They also advocate a multidisciplinary approach to improve patient outcomes. The second article will appear next week.

Multidisciplinary discharge planning.

Patients undergoing total hip replacement need careful rehabilitation to avoid complications. Communication is essential for effective discharge planning. The named nurse is ideally placed to co-ordinate the activities of the health-care team.

Prehospital education: effectiveness with total hip replacement surgery patients.

In-hospital education can reduce anxiety, improve coping and shorten hospital stays of surgical patients. However, hospitals are containing costs by shortening pre- and postoperative stays and reducing the time available for in-hospital teaching. This study evaluated prehospital education for total hip replacement (THR) surgery. Half of the patients waiting for admission for THR surgery were randomly selected to receive a THR education booklet in the mail 4-6 weeks before their scheduled THR surgery. Compared to the No-Booklet patients, patients who had received the booklet were less anxious at the time of hospital admission and at discharge, were more likely to have practised physiotherapy exercises prior to hospitalization, and required significantly less occupational therapy and physiotherapy while in hospital. There were no group differences for length of hospital stay.

Fresh look at rehabilitation of hip-replacement patients. Elderly care counts.

This article describes a charity-funded scheme in which patients who have had elective hip and knee replacement are discharged directly into nursing homes for rehabilitation. The patients are given appropriate support services and appear to benefit. Other positive outcomes were lower costs and reduced waiting lists.

Clinical and radiographic outcome of a cementless, titanium, plasma spray-coated total hip arthroplasty femoral component. Justification for continuance of use.

Between 1984 and 1986, 177 nonconsecutive, primary total hip arthroplasties were performed in 150 patients using the Mallory-Head Porous femoral component (Biomet, Warsaw, IN) inserted without cement. Average time to follow-up evaluation for the entire population (including all early revisions) was 76 months (6.3 years). There were 10 revisions (6%) with an average time to revision of 50 months (4.2 years). Two revisions were for component undersizing; three revisions were for aseptic loosening; four revisions were for acetabular component failure and one revision was due to a femoral fracture secondary to trauma. At the most recent follow-up visit, the average Harris hip score for all hips increased from 41.5 before surgery to 86.8 (P < .001). Radiographic assessments yielded an average Engh fixation score of 20.7. The Kaplan-Meier survival estimate for the average time to follow-up evaluation was 0.98. Based on our patient selection criteria and excellent intermediate clinical and radiographic results, the initial design strategies of the Mallory-Head Porous femoral prosthesis have been confirmed.

Sports after total joint replacement.

Functional return after total joint replacement is the goal of the patient and orthopedic surgeon. Return to sports is possible and encouraged following replacement surgery. However, appropriate guidelines need to be followed to prevent complications. Overuse or a too rapid return to strenuous activity has been shown to result in an increased tendency for loosening of the prosthetic components. Recommendations for a safe return to sport activity are outlined.

Short-term recovery from hip and knee arthroplasty.

There are many studies of long-term recovery from major point arthroplasty, but little is known about the first days and weeks after operation. We measured function, emotional state and life evaluation before arthroplasty and at seven and 50 days after in a consecutive series of 40 hip and 23 knee replacements. Pain was relieved significantly at seven days after hip arthroplasty and even more at 50 days. In knee patients, pain relief was modest and was not apparent until 50 days. Functional ability was much improved by 50 days in hip patients, but hardly changed in knee patients. Positive mood and life satisfaction did not improve in either group. Our findings will help with more accurate information for patients before operation and also in judging the rate of recovery.

Revision of failed total hip replacement.

The treatment of the patient with a failed total hip replacement has become an ever increasing problem. The incidence and aetiology of failure, and its clinical presentation, are reviewed. The planning and performance of complex revision surgery, including the use of modern bone grafting techniques and specialist implants, are outlined. Postoperative rehabilitation, current research and predictions for the future are also discussed.

[Risk and prognosis of hip para-articular fractures. A comparison of treatment results of femoral neck and pertrochanteric femoral fractures]. / Risiko und Prognose hüftgelenknaher Frakturen. Ein Vergleich der Behandlungsergebnisse von Schenkelhals- und pertrochantären Femurfrakturen.

Fractures of the femoral neck and the intertrochanteric region account for 7.2% of our surgically treated trauma-patients. Thanks to gentle anaesthetic methods, pre- and postoperative intensive care, and using dynamic hip screws for stabilizing intertrochanteric fractures or total hip replacement in hybrid technique for fractures of the femoral neck, hospital mortality has decreased to 4.8%. A rate of 8.5% local complications, 5% of them needing revisional surgery, did not influence the final outcome. However, success of rehabilitation of the elderly patients is limited by pre-existing multimorbidity. Despite of achieved weight bearing strength of reconstruction, the number of people confined to bed increases from preoperative 4.9% to postoperative 11.5% at the end of 4 weeks hospitalization and up to 22.6% after 1 year. The need for permanent help in daily life activities, provided by the family or nursing homes increases from 50% to 80% after hospital discharge, usually with an increasing need for care. In the future--besides more and better organized out-patient physiotherapy--only more possibilities to look after the patients in their own families or the supply with an increasing number of places in nursing homes will give a chance, to provide a maximum of rehabilitation for these patients.

Factors influencing the return to work of patients after hip replacement and rehabilitation.

OBJECTIVE: To determine the incidence of medical and sociocultural factors on the return to work of patients after hip replacement and rehabilitation treatment. DESIGN: Case review. Frequency and association of variables' analysis. SETTING: The rehabilitation unit of a general hospital in Oviedo (Spain). This setting is a part of an institutional referral center and is the only state-owned hospital that provides rehabilitation treatment for hospitalized patients from a rural and urban area of about 1,000,000 inhabitants. PATIENTS: 747 patients of both sexes, all of them working before receiving treatment, age range 18 to 64 years. MAIN OUTCOME MEASURES: Relationship of several variables: age, sex, habitat, level of education, type of work, underlying illness, walking ability, pain, and type of social security versus return to work. RESULTS: At discharge, 25% of patients return to work. There is a significant association (p < .001) between return to work and any of the following variables: underlying illness, kind of work, walking ability, habitat, and educational level. CONCLUSION: This physiopathology of symptoms and signs of the patients is not the unique indicator of whether a person will continue working after hip replacement and rehabilitation treatment. Extramedical factors, such as social status, kind of work, and cultural background, are very influential.