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1.
Medicine (Baltimore) ; 99(19): e20018, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32384460

RESUMEN

BACKGROUND: Parkinson disease (PD) is a progressive neuromuscular disease associated with bradykinesia, tremor, and postural instability. We aimed to compare outcomes and complications of total hip arthroplasty (THA) between patients with PD and those without. METHODS: A single institution retrospective cohort from 2000 to 2018 was reviewed. PD patients were matched 1:2 with non-PD control patients for age, gender, American Society of Anesthesiologists score, and body mass index using a propensity score matching procedure. The primary outcome measures were postoperative complications and revision between PD and cohort groups. Secondary outcome measures were Harris Hip Score, hip range of motion, patient satisfaction, and surgery time. Univariable and multivariable logistic regression were used to determine the relationship between PD and surgical outcomes in the matched cohort. RESULTS: Using prospectively collated data, we identified 35 PD patients after primary THA. A control cohort of 70 primary THA patients was matched. CONCLUSION: Our hypothesis was that PD would have adverse impact on complication rates, range of movement, or improvement in functional outcome after subsequent THA. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5446).


Asunto(s)
Artroplastia de Reemplazo de Cadera/efectos adversos , Osteoartritis de la Cadera , Enfermedad de Parkinson/complicaciones , Complicaciones Posoperatorias , Recuperación de la Función , Reoperación , Anciano , Artroplastia de Reemplazo de Cadera/métodos , Estudios de Casos y Controles , Protocolos Clínicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tempo Operativo , Osteoartritis de la Cadera/complicaciones , Osteoartritis de la Cadera/cirugía , Evaluación de Resultado en la Atención de Salud , Prioridad del Paciente , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Rango del Movimiento Articular , Reoperación/métodos , Reoperación/estadística & datos numéricos
2.
Bone Joint J ; 102-B(4): 463-469, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32228083

RESUMEN

AIMS: Prosthetic joint infection (PJI) remains a major clinical challenge. Neutrophil CD64 index, Fc-gamma receptor 1 (FcγR1), plays an important role in mediating inflammation of bacterial infections and therefore could be a valuable biomarker for PJI. The aim of this study is to compare the neutrophil CD64 index in synovial and blood diagnostic ability with the standard clinical tests for discrimination PJI and aseptic implant failure. METHODS: A total of 50 patients undergoing revision hip and knee arthroplasty were enrolled into a prospective study. According to Musculoskeletal Infection Society (MSIS) criteria, 25 patients were classified as infected and 25 as not infected. In all patients, neutrophil CD64 index and percentage of polymorphonuclear neutrophils (PMN%) in synovial fluid, serum CRP, ESR, and serum CD64 index levels were measured preoperatively. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were analyzed for each biomarker. RESULTS: Serum CD64 index showed no significant difference between the two groups (p = 0.091). Synovial fluid CD64 index and PMN% discriminated good differentiation between groups of PJI and aseptic failure with AUC of 0.946 (95% confidence interval (CI) 0.842 to 0.990) and 0.938 (95% CI 0.832 to 0.987) separately. The optimal threshold value of synovial CD64 index for the diagnosis of PJI was 0.85, with a sensitivity of 92.00%, a specificity of 96.00%, and diagnostic odds ratio (DOR) of 227.11. CONCLUSION: The present study demonstrates that CD64 index in synovial fluid could be a promising laboratory marker for screening PJI. The cut-off values of 0.85 for synovial CD64 index has the potential to distinguish aseptic failure from PJI. Cite this article: Bone Joint J 2020;102-B(4):463-469.


Asunto(s)
Prótesis de Cadera/efectos adversos , Prótesis de la Rodilla/efectos adversos , Neutrófilos/inmunología , Infecciones Relacionadas con Prótesis/diagnóstico , Receptores de IgG/análisis , Líquido Sinovial/inmunología , Artroplastia de Reemplazo de Cadera , Artroplastia de Reemplazo de Rodilla , Biomarcadores/análisis , Sedimentación Sanguínea , Proteína C-Reactiva/análisis , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Osteoartritis de la Cadera/cirugía , Osteoartritis de la Rodilla/cirugía , Estudios Prospectivos , Falla de Prótesis/etiología , Infecciones Relacionadas con Prótesis/etiología , Curva ROC , Reoperación , Sensibilidad y Especificidad
4.
JAMA ; 323(11): 1070-1076, 2020 03 17.
Artículo en Inglés | MEDLINE | ID: mdl-32181847

RESUMEN

Importance: Controversy exists about the preferred surgical approach for total hip arthroplasty (THA). Objective: To determine whether an anterior approach is associated with lower risk of complications than either a lateral or posterior approach. Design, Setting, and Participants: Population-based retrospective cohort study of all adults in Ontario, Canada, who had undergone primary THA for osteoarthritis between April 1, 2015, and March 31, 2018. All patients were followed up over a 1-year period (study end date, March 31, 2019). Exposures: Surgical approach (anterior vs lateral/posterior) for THA. Main Outcomes and Measures: Major surgical complications within 1 year (composite of deep infection requiring surgery, dislocation requiring closed or open reduction, or revision surgery). Outcomes were compared among propensity-score matched groups using Cox proportional hazards regression. Results: Of the 30 098 patients (mean [SD] age, 67 years [10.7 years]; 16 079 women [53.4%]) who underwent THA, 2995 (10%) underwent the anterior approach; 21 248 (70%), the lateral approach; and 5855 (20%) the posterior approach performed at 1 of 73 hospitals by 1 of 298 surgeons. All patients were followed up for 1 year. Compared with those undergoing the lateral or posterior approach, patients undergoing an anterior approach were younger (mean age, 65 vs 67 years; standardized difference, 0.17); had lower rates of morbid obesity (4.8% vs 7.6%; standardized difference, 0.12), diabetes (14.2% vs 19.9%; standardized difference, 0.15), and hypertension (53.4% vs 62.9%; standardized difference, 0.19); and were treated by higher-volume surgeons (median range, 111 procedures; interquartile range, 69-172 vs 77 procedures, interquartile range, 50-119 in the prior year; standardized difference, 0.55). Compared with 2993 propensity-score matched patients undergoing a lateral or posterior approach, the 2993 matched patients undergoing anterior approaches had a significantly greater risk of a major surgical complication (61 patients [2%] vs 29 patients [1%]; absolute risk difference, 1.07%; 95% CI, 0.46%-1.69%; hazard ratio, 2.07; 95% CI, 1.48 to 2.88). Conclusions and Relevance: Among patients undergoing total hip arthroplasty, an anterior surgical approach compared with a posterior or lateral surgical approach was associated with a small but statistically significant increased risk of major surgical complications. The findings may help inform decisions about surgical approach for hip arthroplasty, although further research is needed to understand pain and functional outcomes.


Asunto(s)
Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/métodos , Osteoartritis de la Cadera/cirugía , Complicaciones Posoperatorias/epidemiología , Anciano , Femenino , Estudios de Seguimiento , Luxación de la Cadera/epidemiología , Luxación de la Cadera/etiología , Prótesis de Cadera , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Ontario , Tempo Operativo , Complicaciones Posoperatorias/etiología , Puntaje de Propensión , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Riesgo
5.
PLoS One ; 15(1): e0222370, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31914126

RESUMEN

A significant proportion of osteoarthritis (OA) patients continue to experience moderate to severe pain after total joint replacement (TJR). Preoperative factors related to pain persistence are mainly studied using individual predictor variables and distinct pain outcomes, thus leading to a lack of consensus regarding the influence of preoperative parameters on post-TJR pain. In this prospective observational study, we evaluated knee and hip OA patients before, 3 and 6 months post-TJR searching for clinical predictors of pain persistence. We assessed multiple measures of quality, mood, affect, health and quality of life, together with radiographic evaluation and performance-based tasks, modeling four distinct pain outcomes. Multivariate regression models and network analysis were applied to pain related biopsychosocial measures and their changes with surgery. A total of 106 patients completed the study. Pre-surgical pain levels were not related to post-surgical residual pain. Although distinct pain scales were associated with different aspects of post-surgical pain, multi-factorial models did not reliably predict post-surgical pain in knee OA (across four distinct pain scales) and did not generalize to hip OA. However, network analysis showed significant changes in biopsychosocial-defined OA personality post-surgery, in both groups. Our results show that although tested clinical and biopsychosocial variables reorganize after TJR in OA, their presurgical values are not predictive of post-surgery pain. Derivation of prognostic markers for pain persistence after TJR will require more comprehensive understanding of underlying mechanisms.


Asunto(s)
Osteoartritis de la Cadera/cirugía , Osteoartritis de la Rodilla/cirugía , Manejo del Dolor , Dolor Postoperatorio/terapia , Anciano , Artroplastia de Reemplazo/efectos adversos , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/métodos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Artroplastia de Reemplazo de Rodilla/métodos , Femenino , Humanos , Articulación de la Rodilla/fisiopatología , Articulación de la Rodilla/cirugía , Masculino , Persona de Mediana Edad , Osteoartritis de la Cadera/fisiopatología , Osteoartritis de la Rodilla/fisiopatología , Dimensión del Dolor/métodos , Dolor Postoperatorio/epidemiología , Dolor Postoperatorio/fisiopatología , Índice de Severidad de la Enfermedad
6.
Acta Orthop ; 91(2): 159-164, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31928120

RESUMEN

Background and purpose - The uncemented Symax hip stem has shown early proximal ingrowth as result of the BONIT-hydroxyapatite (HA) coating and the distal DOTIZE surface treatment. We evaluated 2-year postoperative radiostereometric analysis (RSA) migration of the Symax hip stem in THA patients. We also investigated the correlation between migration at 4 weeks and clinical outcomes after 2 years.Patients and methods - Patients in a 2-year clinical follow-up single-centre RSA randomized controlled trial were randomized to 2 different cup designs. All 45 patients received a Symax hip stem. RSA migration patterns of the Symax hip stem is presented here as a single cohort. RSA examinations were performed postoperatively, but before weight-bearing, and subsequently after 1, 3, 6, 12, and 24 months. Clinical outcomes and radiographic evaluations were assessed 3, 6, 12, and 24 months postoperatively.Results - During the first 4 weeks, the Symax hip stem subsided, rotated into retroversion, and translated posteriorly, after which the migration ceased and the prosthesis stabilized. All clinical outcomes improved from preoperatively to 2 years. There was no clinically or statistically significant correlation between subsidence and retroversion at 4 weeks and clinical outcomes after 2 years.Interpretation - RSA evaluation of the uncemented Symax hip stem confirms that the design principles and coating properties lead to early stabilization of the stem, as early as 4 weeks postoperatively. There was no correlation between subsidence and retroversion at 4 weeks and clinical outcomes after 2 years. Based on the predictive potential of the RSA technique, we anticipate excellent long-term survival of this hip stem.


Asunto(s)
Artroplastia de Reemplazo de Cadera/métodos , Prótesis de Cadera/efectos adversos , Falla de Prótesis/etiología , Adulto , Anciano , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/instrumentación , Cementación , Materiales Biocompatibles Revestidos , Durapatita , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Cadera/cirugía , Complicaciones Posoperatorias/diagnóstico por imagen , Diseño de Prótesis , Radiografía , Análisis Radioestereométrico , Rotación , Resultado del Tratamiento
7.
Orthop Clin North Am ; 51(1): 37-53, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31739878

RESUMEN

In situ pinning of slipped capital femoral epiphysis (SCFE) is a safe and effective treatment modality, but often results in residual deformity leading to femoroacetabular impingement, which may limit patient activities and predispose to early onset arthritis. Enhanced understanding of the implications of femoroacetabular impingement and new surgical techniques have prompted interest in treating post-slipped capital femoral epiphysis deformity to both improve current symptoms and delay or prevent hip arthrosis.


Asunto(s)
Coxa Magna/cirugía , Cadera/diagnóstico por imagen , Osteoartritis de la Cadera/prevención & control , Epífisis Desprendida de Cabeza Femoral/cirugía , Artroscopía/métodos , Clavos Ortopédicos/efectos adversos , Clavos Ortopédicos/normas , Pinzamiento Femoroacetabular/etiología , Pinzamiento Femoroacetabular/cirugía , Fémur/cirugía , Cadera/cirugía , Luxación de la Cadera/cirugía , Humanos , Procedimientos Ortopédicos/métodos , Osteoartritis de la Cadera/cirugía , Osteotomía/métodos , Cuidados Posoperatorios , Estudios Retrospectivos , Resultado del Tratamiento
8.
Bone Joint J ; 101-B(11): 1423-1430, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31674240

RESUMEN

AIMS: The aim of this study was to assess the functional gain achieved following hip resurfacing arthroplasty (HRA). PATIENTS AND METHODS: A total of 28 patients (23 male, five female; mean age, 56 years (25 to 73)) awaiting Birmingham HRA volunteered for this prospective gait study, with an age-matched control group of 26 healthy adults (16 male, ten female; mean age, 56 years (33 to 84)). The Oxford Hip Score (OHS) and gait analysis using an instrumented treadmill were used preoperatively and more than two years postoperatively to measure the functional change attributable to the intervention. RESULTS: The mean OHS improved significantly from 27 to 46 points (p < 0.001) at a mean of 29 months (12 to 60) after HRA. The mean metal ion levels at a mean 32 months (13 to 60) postoperatively were 1.71 (0.77 to 4.83) µg/l (ppb) and 1.77 (0.68 to 4.16) µg/l (ppb) for cobalt and chromium, respectively. When compared with healthy controls, preoperative patients overloaded the contralateral good hip, limping significantly. After HRA, patients walked at high speeds, with symmetrical gait, statistically indistinguishable from healthy controls over almost all characteristics. The control group could only be distinguished by an increased push-off force at higher speeds, which may reflect the operative approach. CONCLUSION: Patients undergoing HRA improved their preoperative gait pattern of a significant limp to a symmetrical gait at high speeds and on inclines, almost indistinguishable from normal controls. HRA with an approved device offers substantial functional gains, almost indistinguishable from healthy controls. Cite this article: Bone Joint J 2019;101-B:1423-1430.


Asunto(s)
Artroplastia de Reemplazo de Cadera/métodos , Marcha/fisiología , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Femenino , Análisis de la Marcha/instrumentación , Análisis de la Marcha/métodos , Articulación de la Cadera/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Cadera/fisiopatología , Osteoartritis de la Cadera/cirugía , Medición de Resultados Informados por el Paciente , Cuidados Posoperatorios/instrumentación , Cuidados Posoperatorios/métodos , Estudios Prospectivos , Radiografía , Velocidad al Caminar/fisiología
9.
Bone Joint J ; 101-B(11): 1431-1437, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31674251

RESUMEN

AIMS: It is not known whether change in patient-reported outcome measures (PROMs) over time can be predicted by factors present at surgery, or early follow-up. The aim of this study was to identify factors associated with changes in PROM status between two-year evaluation and medium-term follow-up. PATIENTS AND METHODS: Patients undergoing Birmingham Hip Resurfacing completed the Veteran's Rand 36 (VR-36), modified Harris Hip Score (mHHS), Tegner Activity Score, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at two years and a minimum of three years. A change in score was assessed against minimal clinically important difference (MCID) and patient-acceptable symptom state (PASS) thresholds. Binary logistic regression was used to assess the relationship between patient factors and deterioration in PASS status between follow-ups. RESULTS: Overall, 18% of patients reported reductions in mHHS total score exceeding MCID, and 21% reported similar reductions for WOMAC function scores. Nonetheless, almost all patients remained above PASS thresholds for WOMAC function (98%) and mHHS (93%). Overall, 66% of patients with mHHS scores < PASS at two years reported scores > PASS at latest follow-up. Conversely, 6% of patients deteriorated from > PASS to < PASS between follow-ups. Multivariable modelling indicated body mass index (BMI) > 27 kg/m2, VR-36 Physical Component Score (PCS) < 51, VR-36 Mental Component Score (MCS) > 55, mHHS < 84 at two years, female sex, and bone graft use predicted these deteriorating patients with 79% accuracy and an area under the curve (AUC) of 0.84. CONCLUSION: Due to largely acceptable results at a later follow-up, extensive monitoring of multiple PROMs is not recommended for Birmingham Hip Resurfacing patients unless they report borderline or unacceptable hip function at two years, are female, are overweight, or received a bone graft during surgery. Cite this article: Bone Joint J 2019;101-B:1431-1437.


Asunto(s)
Artroplastia de Reemplazo de Cadera/rehabilitación , Estado de Salud , Actividades Cotidianas , Adulto , Cuidados Posteriores/estadística & datos numéricos , Artroplastia de Reemplazo de Cadera/métodos , Trasplante Óseo/estadística & datos numéricos , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Cadera/rehabilitación , Osteoartritis de la Cadera/cirugía , Medición de Resultados Informados por el Paciente , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios
11.
Wiad Lek ; 72(9 cz 1): 1621-1632, 2019.
Artículo en Polaco | MEDLINE | ID: mdl-31586974

RESUMEN

OBJECTIVE: Introduction: Osteoarthritis (OA) is the most common and burdensome illness in the elderly patients. It is the main cause of locomotor impairment and disability resulting in significant decrease of the quality of life (QL) in highly developed countries. Sf-36v2 questionnaire was standardized in the United States by J.E. Ware et al. in the years 1985-1992 and at present SF-36v2 is the most commonly used questionnaire for investigations in patients with various conditions. The aim: To compare two cohorts of post-menopausal female patients with the predominantly clinically active one-site advanced osteoarthritis of the hip and knee joint prior to the replacement surgery. PATIENTS AND METHODS: Material and methods: Two cohorts of fifty female postmenopausal patients aged from sixty to eighty were investigated. The inclusion criteria relied on sex, age and clinically single joint predominant OA disease prior to hip and knee joint replacement. The Polish version of SF-36v2 for the quality of life was accomplished by the patient under direct supervision of a trained nurse. The sets of obtained data were analyzed with the use of Statistica 10.0 (Shapiro-Wilk test, U - Mann-Whitney test, Spearmann, Kruskall-Wallis, Friedmann's ANOVA and Chi 2 Pearson). p <0.05 was regarded as significant. RESULTS: Results: It was found that patients with advanced knee OA demonstrated significantly lower QL than these with hip OA in Vitality (p=0,004), Functioning in Social Roles (p=0,0001), General Health (p <0,000001) and Pain (p <0,000001). No significant differences within the cohorts were observed as the other scales were concerned (p >0,05). In the general assessment as for the QL in the Physical domain significant difference was found with lower scoring in the knee group (p=0.00001). In the assessment of the general QL two domains were considered -Physical and Mental Health. Highly significant difference was recorded for the Physical better in regard for hip OA (p <0,00001). In the Mental Health domain no significant difference was found (p=0,09). CONCLUSION: Conclusions: 1. Quality of life of postmenopausal women with hip OA is predominantly lowered by the local disease whereas lower quality of life of these females with knee OA is related to the general poor health, low index of vitality and decrease of function in social functioning resulting from co-existence of chronic illnesses due to overweight and obesity. 2. Reduction of overweight or obesity in the group of patients with knee arthritis could improve their quality of life and general health.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Artroplastia de Reemplazo de Rodilla , Osteoartritis de la Cadera/cirugía , Osteoartritis de la Rodilla/cirugía , Anciano , Femenino , Humanos , Calidad de Vida , Encuestas y Cuestionarios
12.
Medicine (Baltimore) ; 98(39): e16774, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31574793

RESUMEN

BACKGROUND: Total hip arthroplasty (THA) relieves pain and restores function in patients with severe rheumatoid arthritis and osteoarthritis. Over the past few decades, several authors have attempted to assess the efficacy and safety of simultaneous bilateral THA compared with staged bilateral THA. The purpose of this meta-analysis is to compare the mortalities and complications between simultaneous bilateral THA and staged bilateral THA. METHODS: A literature search to identify eligible studies was undertaken to identify all relevant articles published until August 2018. We included studies that compared simultaneous bilateral THA and staged bilateral THA and their effects on mortality and complications. The outcomes included mortality, the occurrence of deep venous thrombosis (DVT), the occurrence of pulmonary embolism (PE), respiratory complications, cardiovascular complications, digestive system complications and the occurrence of dislocation. Stata 12.0 was used for the meta-analysis. RESULTS: Nineteen studies involving 59,257 patients were identified; among them, 16,758 patients were selected for treatment with simultaneous bilateral THA, and 42,499 patients were chosen for the purpose of staged bilateral THA. The meta-analysis results demonstrated that there was no significant difference between simultaneous bilateral THA and staged bilateral THA in terms of mortality (risk ratio [RR] = 1.15, 95% CI = 0.76, 1.74; P = .520). Compared with staged bilateral THA, simultaneous bilateral THA was associated with a reduction in the occurrence of DVT, PE and respiratory complications (P < .05). There were no significant differences in the cardiovascular complications, digestive system complications or the occurrence of dislocation and infection (P = .057). CONCLUSIONS: We observed that the prevalence of DVT, PE and respiratory complications was considerably lower with the use of simultaneous bilateral THA than with the use of staged bilateral THA. Thus, simultaneous bilateral THA is a considerably safer procedure than staged bilateral THA in selected THA patients.


Asunto(s)
Artritis Reumatoide/cirugía , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/métodos , Osteoartritis de la Cadera/cirugía , Complicaciones Posoperatorias/epidemiología , Artroplastia de Reemplazo de Cadera/mortalidad , Enfermedades del Sistema Digestivo/epidemiología , Cardiopatías/epidemiología , Humanos , Luxaciones Articulares/epidemiología , Prevalencia , Embolia Pulmonar/epidemiología , Trastornos Respiratorios/epidemiología , Trombosis de la Vena/epidemiología
13.
J Bone Joint Surg Am ; 101(18): 1645-1653, 2019 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-31567801

RESUMEN

BACKGROUND: As guidelines and payers increasingly recommend use of patient decision aids (DAs), evidence about the comparative effectiveness of available DAs is critical for organizations interested in implementing them. The primary purpose of this study was to compare 2 DAs with regard to their ability to help patients become informed and receive their preferred treatment (that is, make an informed patient-centered decision), shared decision-making, surgical rates, and surgeon satisfaction. METHODS: We performed a multisite factorial randomized trial enrolling patients with hip or knee osteoarthritis. Patients were randomly assigned to use a long, detailed DA (long DA) or short, interactive DA (short DA). Eight surgeons were randomly assigned to receive a patient preference report detailing the patient's goals and treatment preferences or to administer usual care. RESULTS: We distributed 1,636 pre-visit surveys, 1,220 of which were returned (75% response rate), and 1,124 post-visit surveys, 967 of which were returned (86% response rate). The patients in the sample had a mean age (and standard deviation) of 65 ± 10 years, 57% were female, 89% were white non-Hispanic, and 67% had knee osteoarthritis. The majority (67.2%) made informed patient-centered decisions, and the rate did not vary significantly between the DA groups (p = 0.97) or between the surgeon groups (p = 0.23). Knowledge scores were higher for the short-DA group (mean difference = 9%; p < 0.001). More than half of the sample (60.5%) had surgery within 6 months after the visit, and rates did not differ significantly by DA or surgeon group. Overall, the surgeons were highly satisfied and reported that the majority (88.7%) of the visits were of normal duration or shorter. CONCLUSIONS: The DECIDE-OA study is, to our knowledge, the first randomized comparative effectiveness study of 2 orthopaedic DAs. The short DA outperformed the long DA with regard to knowledge scores and was comparable with respect to other outcomes. The surgeons reported high satisfaction and normal visit duration with both DAs. CLINICAL RELEVANCE: Surgeons need to ensure that patients with osteoarthritis are well-informed and have a clear preference regarding whether to undergo hip or knee replacement surgery. The DAs used in this study may help surgeons involve patients in elective surgery decisions and meet the requirements of informed consent.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Artroplastia de Reemplazo de Rodilla , Toma de Decisiones Clínicas/métodos , Osteoartritis de la Cadera/cirugía , Osteoartritis de la Rodilla/cirugía , Participación del Paciente , Anciano , Anciano de 80 o más Años , Investigación sobre la Eficacia Comparativa , Femenino , Humanos , Consentimiento Informado , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto , Prioridad del Paciente
14.
Bone Joint J ; 101-B(10): 1192-1198, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31564144

RESUMEN

AIMS: Radiostereometric analysis (RSA) studies of vitamin E-doped, highly crosslinked polyethylene (VEPE) liners show low head penetration rates in cementless acetabular components. There is, however, currently no data on cemented VEPE acetabular components in total hip arthroplasty (THA). The aim of this study was to evaluate the safety of a new cemented VEPE component, compared with a conventional polyethylene (PE) component regarding migration, head penetration, and clinical results. PATIENTS AND METHODS: We enrolled 42 patients (21 male, 21 female) with osteoarthritis and a mean age of 67 years (sd 5), in a double-blinded, noninferiority, randomized controlled trial. The subjects were randomized in a 1:1 ratio to receive a reverse hybrid THA with a cemented component of either argon-gas gamma-sterilized PE component (controls) or VEPE, with identical geometry. The primary endpoint was proximal implant migration of the component at two years postoperatively measured with RSA. Secondary endpoints included total migration of the component, penetration of the femoral head into the component, and patient-reported outcome measurements. RESULTS: In total, 19 control implants and 18 implants in the VEPE group were analyzed for the primary endpoint. We found a continuous proximal migration of the component in the VEPE group that was significantly higher with a difference at two years of a mean 0.21 mm (95% confidence interval (CI) 0.05 to 0.37; p = 0.013). The total migration was also significantly higher in the VEPE group, but femoral head penetration was lower. We found no difference in clinical outcomes between the groups. CONCLUSION: At two years, this cemented VEPE component, although having a low head penetration and excellent clinical results, failed to meet noninferiority compared with the conventional implant by a proximal migration above the proposed safety threshold of RSA. The early proximal migration pattern of the VEPE component is a reason for continued monitoring, although a specific threshold for proximal migration and risk for later failure cannot be defined and needs further study. Cite this article: Bone Joint J 2019;101-B:1192-1198.


Asunto(s)
Artroplastia de Reemplazo de Cadera/efectos adversos , Migración de Cuerpo Extraño/diagnóstico por imagen , Osteoartritis de la Cadera/cirugía , Polietilenos/química , Diseño de Prótesis , Falla de Prótesis/tendencias , Factores de Edad , Anciano , Artroplastia de Reemplazo de Cadera/métodos , Método Doble Ciego , Femenino , Migración de Cuerpo Extraño/epidemiología , Prótesis de Cadera , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Osteoartritis de la Cadera/diagnóstico por imagen , Pronóstico , Análisis Radioestereométrico , Medición de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , Estadísticas no Paramétricas , Suecia , Vitamina E/farmacología
15.
Bone Joint J ; 101-B(10): 1199-1208, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31564148

RESUMEN

AIMS: We compared implant and patient survival following intraoperative periprosthetic femoral fractures (IOPFFs) during primary total hip arthroplasty (THA) with matched controls. PATIENTS AND METHODS: This retrospective cohort study compared 4831 hips with IOPFF and 48 154 propensity score matched primary THAs without IOPFF implanted between 2004 and 2016, which had been recorded on a national joint registry. Implant and patient survival rates were compared between groups using Cox regression. RESULTS: Ten-year stem survival was worse in the IOPFF group (p < 0.001). Risk of revision for aseptic loosening increased 7.2-fold following shaft fracture and almost 2.8-fold after trochanteric fracture (p < 0.001). Risk of periprosthetic fracture of the femur revision increased 4.3-fold following calcar-crack and 3.6-fold after trochanteric fracture (p < 0.01). Risk of instability revision was 3.6-fold after trochanteric fracture and 2.4-fold after calcar crack (p < 0.001). Risk of 90-day mortality following IOPFF without revision was 1.7-fold and 4.0-fold after IOPFF with early revision surgery versus uncomplicated THA (p < 0.001). CONCLUSION: IOPFF increases risk of stem revision and mortality up to ten years following surgery. The risk of revision depends on IOPFF subtype and mortality risk increases with subsequent revision surgery. Surgeons should carefully diagnose and treat IOPFF to minimize fracture progression and implant failure. Cite this article: Bone Joint J 2019;101-B:1199-1208.


Asunto(s)
Artroplastia de Reemplazo de Cadera/efectos adversos , Osteoartritis de la Cadera/cirugía , Fracturas Periprotésicas/cirugía , Sistema de Registros , Reoperación/métodos , Factores de Edad , Anciano , Artroplastia de Reemplazo de Cadera/métodos , Estudios de Casos y Controles , Inglaterra , Femenino , Fracturas del Fémur/diagnóstico por imagen , Fracturas del Fémur/cirugía , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Irlanda del Norte , Osteoartritis de la Cadera/diagnóstico por imagen , Fracturas Periprotésicas/diagnóstico por imagen , Fracturas Periprotésicas/epidemiología , Modelos de Riesgos Proporcionales , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Medición de Riesgo , Factores Sexuales , Factores de Tiempo , Resultado del Tratamiento , Reino Unido , Gales
16.
Rev. esp. anestesiol. reanim ; 66(8): 439-442, oct. 2019. ilus, tab
Artículo en Español | IBECS | ID: ibc-187561

RESUMEN

La artroplastia de cadera se asocia a una elevada incidencia de eventos embólicos que, si bien normalmente no tienen trascendencia a nivel clínico, pueden suponer una causa importante de morbimortalidad en determinadas situaciones. En el caso de pacientes con defectos cardiacos que favorezcan la comunicación entre la circulación pulmonar y la sistémica, deberemos extremar toda precaución, puesto que presentan un gran riesgo de sufrir complicaciones. Exponemos el caso de una paciente de 72 años que sufrió un embolismo paradójico durante la realización de la intervención, con devastadoras consecuencias


Hip arthroplasty is associated with a high incidence of embolic events that, although usually not relevant at a clinical level, may be an important cause of morbidity and mortality in certain situations. Extreme caution should be taken in patients with cardiac defects that favor communication between the pulmonary and systemic circulation, due to their greater risk of complications. We present the case of a 72-year-old patient who suffered a paradoxical embolism during the intervention, with devastating consequences


Asunto(s)
Humanos , Femenino , Anciano , Embolia Paradójica/etiología , Complejo de Eisenmenger/complicaciones , Artroplastia de Reemplazo de Cadera/métodos , Anestesia de Conducción/métodos , Complicaciones Intraoperatorias , Accidentes por Caídas , Osteoartritis de la Cadera/cirugía , Plexo Lumbosacro , Monitoreo Intraoperatorio/métodos
17.
BMC Musculoskelet Disord ; 20(1): 422, 2019 Sep 12.
Artículo en Inglés | MEDLINE | ID: mdl-31510993

RESUMEN

BACKGROUND: In obese patients, total hip arthroplasty (THA) can be technically demanding with increased perioperative risks. The aim of this prospective cohort study is to evaluate the effect of body mass index (BMI) on radiological restoration of femoral offset (FO) and leg length as well as acetabular cup positioning. METHODS: In this prospective study, patients with unilateral primary osteoarthritis (OA) treated with THA between September 2010 and December 2013 were considered for inclusion. The perioperative plain radiographs were standardised and used to measure the preoperative degree of hip osteoarthritis, postoperative FO, leg length discrepancy (LLD), acetabular component inclination and anteversion. RESULTS: We included 213 patients (74.5% of those considered for inclusion) with a mean BMI of 27.7 (SD 4.5) in the final analysis. The postoperative FO was improper in 55% and the LLD in 15%, while the cup inclination and anteversion were improper in 13 and 23% of patients respectively. A multivariable logistic regression model identified BMI as the only factor that affected LLD. Increased BMI increased the risk of LLD (OR 1.14, 95% CI 1.04 to 1.25). No other factors included in the model affected any of the primary or secondary outcomes. CONCLUSION: Increased BMI showed a negative effect on restoration of post-THA leg length but not on restoration of FO or positioning of the acetabular cup. Age, gender, OA duration or radiological severity and surgeon's experience showed no relation to post-THA restoration of FO, leg length or cup positioning.


Asunto(s)
Artroplastia de Reemplazo de Cadera/efectos adversos , Índice de Masa Corporal , Diferencia de Longitud de las Piernas/epidemiología , Obesidad/complicaciones , Osteoartritis de la Cadera/cirugía , Anciano , Artroplastia de Reemplazo de Cadera/instrumentación , Femenino , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/cirugía , Prótesis de Cadera/efectos adversos , Humanos , Diferencia de Longitud de las Piernas/diagnóstico por imagen , Diferencia de Longitud de las Piernas/etiología , Masculino , Persona de Mediana Edad , Osteoartritis de la Cadera/diagnóstico por imagen , Periodo Posoperatorio , Estudios Prospectivos , Radiografía , Resultado del Tratamiento
18.
J Bone Joint Surg Am ; 101(17): 1563-1568, 2019 Sep 04.
Artículo en Inglés | MEDLINE | ID: mdl-31483399

RESUMEN

BACKGROUND: Osteonecrosis of the hip is the underlying etiology for 3% to 12% of total hip arthroplasties (THAs). Compared with patients who undergo THA because of osteoarthritis, those who do so because of osteonecrosis typically are younger, have a greater number of underlying diagnoses, and have inferior clinical outcomes and implant survivorship. The purpose of this study was to compare the long-term implant survivorship (median follow-up, 10 years), functional outcomes, and radiographic results of contemporary THAs with a highly cross-linked polyethylene (HXLPE) liner between patients with osteonecrosis and those with osteoarthritis. METHODS: All patients who underwent primary THA with an HXLPE liner from 1999 to 2007 were identified from our institutional total joint registry. Patients with a primary diagnosis of osteonecrosis were matched 1:1, on the basis of age, sex, and body mass index (BMI), to patients with a diagnosis of osteoarthritis. This resulted in 461 hips in 413 patients with osteonecrosis matched to 461 hips in 427 patients with osteoarthritis (mean age, 59 years; 47% female; and mean BMI, 29 kg/m). Long-term implant survivorship, patient-reported outcomes, and radiographic findings were compared. In addition, a subgroup analysis of the osteonecrosis group was performed to see whether certain underlying etiologies portended poor outcomes. The median follow-up was 10 years. RESULTS: The 15-year cumulative rates of revision were 6.6% and 4.5% in the osteonecrosis and osteoarthritis groups, respectively (hazard ratio [HR] = 1.8, p = 0.09). The 15-year cumulative rates of any reoperation were 10.5% and 6.4% in the osteonecrosis and osteoarthritis groups, respectively (HR = 2.2, p = 0.008). There were no radiographic signs of component loosening or osteolysis in the entire cohort. Despite a lower median preoperative Harris hip score (HHS) for patients with osteonecrosis, both groups had marked improvements in their scores, which were similar at all time points after surgery. The cumulative rate of reoperations at 15 years was 0% for hips with radiation-induced osteonecrosis, 6.3% for those with alcohol-induced osteonecrosis, 9.0% for those with posttraumatic osteonecrosis, 12.1% for those with steroid-induced osteonecrosis, and 25% for those with idiopathic osteonecrosis. CONCLUSIONS: Contemporary THA with an HXLPE liner offers excellent long-term implant survivorship and functional outcomes for patients with osteonecrosis; however, the risk of a reoperation is higher when compared with patients with osteoarthritis. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.


Asunto(s)
Artroplastia de Reemplazo de Cadera/instrumentación , Osteonecrosis/cirugía , Polietileno/uso terapéutico , Artroplastia de Reemplazo de Cadera/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Cadera/cirugía , Estudios Prospectivos , Falla de Prótesis , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Resultado del Tratamiento
19.
Bull Hosp Jt Dis (2013) ; 77(3): 164-170, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31487480

RESUMEN

BACKGROUND: Little is known about the factors that drive hospital-switching behavior of patients when they seek a second total joint arthroplasty (TJA) surgery. METHODS: We analyzed the population-based, all-payer California Healthcare Cost and Utilization Project (HCUP) data for a cohort undergoing sequential TJAs for osteoarthritis (N = 48,800) from 2006 to 2011, excluding TJA for fracture. We used multivariable logistic regression analysis to identify factors associated with returning to the same hospital for each surgery, including rural or urban, surgery sequence and timing, Deyo-Charlson comorbidity index, age, sex, race and ethnicity, and insurance. RESULTS: Overall, 15.1% of subjects (7,364/48,000) utilized a different hospital for their second surgery. Increasing years between TJAs was associated with decreasing odds of going to the same hospital for the second TJA (p < 0.05). Subjects switching from private insurance to Medicare between surgeries were much less likely to return to same hospital (OR: 0.53; 95% CI: 0.47-0.59), as were those with alternate-joint sequencing (e.g., hip-knee). Those with Medicaid were somewhat less likely to return for the second surgery (OR: 0.87; 95% CI: 0.75-1.01). Urban and rural residents were equally likely to return to the same hospital (p > 0.05). Increasing age was associated with increasing likelihood of returning to the same hospital [e.g., ages 75- 79, OR: 1.36 (95% CI: 1.19-1.56) and ages 80+, OR: 1.41 (95% CI: 1.22-1.63)]. CONCLUSION: Fifteen percent of patients switched hospitals for their second TJA within the 6-year study period. Those with Medicare or who had surgery on the alternate joint for second surgery were more likely to switch hospitals as were those who waited longer between surgeries and those living in a rural environment.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Artroplastia de Reemplazo de Rodilla , Hospitalización/estadística & datos numéricos , Osteoartritis de la Cadera/cirugía , Aceptación de la Atención de Salud/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Factores de Edad , Anciano , Artroplastia de Reemplazo de Cadera/métodos , Artroplastia de Reemplazo de Cadera/estadística & datos numéricos , Artroplastia de Reemplazo de Rodilla/métodos , Artroplastia de Reemplazo de Rodilla/estadística & datos numéricos , Femenino , Humanos , Masculino , Medicare/estadística & datos numéricos , Persona de Mediana Edad , Osteoartritis de la Rodilla/cirugía , Prioridad del Paciente/estadística & datos numéricos , Características de la Residencia , Factores Sexuales , Estados Unidos
20.
J Orthop Surg Res ; 14(1): 301, 2019 Sep 05.
Artículo en Inglés | MEDLINE | ID: mdl-31488177

RESUMEN

BACKGROUND: To date, few knowledge is available about safety and effectiveness of one-staged combined hip and knee arthroplasty. The aim of our study was to evaluate, in a comparative fashion, complications and outcomes in patients who underwent one-staged hip and knee arthroplasty. METHODS: Forty-two patients were enrolled and allocated into two groups of 21 patients each: one-staged hip and knee arthroplasty (group A) and two-staged hip and knee arthroplasty (group B). The follow-up averaged 50.2 months. Postoperative complications and implant survivorship were assessed prospectively. Outcomes were evaluated with Harris Hip score (HSS), Western Ontario Mc-Ministry score for the hip (h-WOMAC), Knee Society score (KSS), and Western Ontario Mc-Ministry knee score (k-WOMAC). Hip and knee range of motion (ROM) were measured both preoperatively and at the last follow-up. RESULTS: Two (9.5%) patients in group A and three (14.3%) patients in group B developed complications (P = 0.8). Although a significant decrease in postoperative haemoglobin (Hgb) values was found in group A patients during the hospital stay, no differences in blood transfusions were found (P = 0.8). No significant differences were found comparing clinical-functional outcomes between the two groups, while a significant reduction of hospital length of stay was shown in group A patients. CONCLUSIONS: One-staged combined hip and knee arthroplasty could be considered in patients with co-existing severe hip and knee osteoarthritis, providing similar complications and mid-term outcomes of two-staged procedures. However, the reproducibility safety and reliability of these procedures should be confirmed in prospective comparative randomised trials with more numerous patients. TRIAL REGISTRATION: Retrospectively registered.


Asunto(s)
Artroplastia de Reemplazo de Cadera/métodos , Artroplastia de Reemplazo de Rodilla/métodos , Osteoartritis de la Cadera/cirugía , Osteoartritis de la Rodilla/cirugía , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/tendencias , Artroplastia de Reemplazo de Rodilla/tendencias , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Cadera/epidemiología , Osteoartritis de la Rodilla/epidemiología , Estudios Prospectivos , Estudios Retrospectivos
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