Cemented femoral stem fixation through the anterior approach has fewer early complications than cementless fixation.

AIMS: To achieve the functional benefits of the direct anterior (DA) approach and the fixation benefits of cemented replacement, this study combined the two techniques posing the following questions: does the limited access of the DA approach adversely affect the cement technique?; and does such a cementing technique reduce the incidence of cementless complications? METHODS: A consecutive series of 341 patients (360 hips) receiving the DA approach between 2016 and 2018 were reviewed. There were 203 cementless stems and 157 cemented stems. Mean age was 75 years (70 to 86) in the cementless group and 76 years (52 to 94) in the cemented group, with 239 (70%) females in the whole series. Femoral complications were compared between the two groups. Mean follow-up was 1.5 years (0.1 to 4.4) for patients in the cementless group and 1.3 years (0.0 to 3.9) for patients in the cemented group. RESULTS: The cementless group had a higher rate of femoral complications (8 vs 0; p = 0.011). There were two loose stems and six fractures, all requiring revision. Fractures occurred a mean 14.5 days (2 to 31) postoperatively and loosening at 189 days and 422 days postoperatively. Femoral cementing can be done using the DA approach safely and reduces the number of complications compared with a contemporary cementless series. CONCLUSION: A higher rate of early fractures and loosening occurred with cementless stems. This was not observed in our cemented stem cohort and cementing was safely accomplished through the DA approach. The modern femoral cementing process with the DA approach does not add to surgical complexity or time, has fewer early complications, and is a safer option for older patients compared to cementless femoral arthroplasties. Cite this article: Bone Joint J 2021;103-B(7 Supple B):33-37.

The AAHKS Clinical Research Award: No Evidence for Superior Patient-Reported Outcome Scores After Total Hip Arthroplasty With the Direct Anterior Approach at 1.5 Months Postoperatively, and Through a 5-Year Follow-Up.

BACKGROUND: The direct anterior approach to total hip arthroplasty (THA) may result in superior early postoperative patient-reported outcome measures (PROMs). This study compared PROMs between THA patients treated with the direct anterior or posterolateral approach between 1.5 months and 5 years, using literature-derived patient acceptable symptom state (PASS) and minimal clinically important improvement (MCII) thresholds. METHODS: A propensity score match of 93 direct anterior patients to 93 posterolateral patients from a multicenter US collaboration (6 centers, 398 patients) was performed. The Harris Hip Score (HHS), the Short-Form 36, and a Numerical Rating Scale for Pain were collected preoperatively, postoperatively (mean days: 47), and at 1, 3, and 5 years. The proportion of patients reaching the HHS PASS, Pain MCII, and Function MCII in the direct anterior and posterolateral groups was compared using binary logistic regressions, controlling for age, gender, body mass index, and Charnley score. RESULTS: Direct anterior patients were less likely to reach the HHS PASS at the postoperative visit (P = .015; odds ratio = 0.454), but not at later visits (P > .082). Direct anterior patients had no difference from posterolateral patients in their tendency to reach the Pain MCII postoperatively or at 1 year (P > .090). The direct anterior patients were less likely to reach the Function MCII at the postoperative visit (P = .011; odds ratio = 0.422), but not at 1 year (P = .958). CONCLUSION: No evidence was found of superior early postoperative PROM scores in THA patients treated with the direct anterior approach. No PROM differences were found at or beyond 1 year, indicating that patients reach similar final symptom states, regardless of surgical approach.

Complication, Survival, and Reoperation Rates Following Girdlestone Resection Arthroplasty.

Failed hip arthroplasty patients unsuitable for reimplantation may be offered Girdlestone resection arthroplasty (GRA). The purpose of this study was to detail complication and failure rates following GRA. Our results show that 66% (25/38), 34% (13/38), and 76% (29/38) of GRA patients experienced minor, major, and overall complications, respectively. Within 90 days of surgery, three patients required additional surgery and four died. Reoperation or death occurred an average of 26.3 (SD=3.5) and 55.6 (SD=76) months after surgery, respectively. Male gender and increasing comorbidity significantly predicted higher reoperation and mortality rates, P=0.01 and P=0.04, respectively. Complication and mortality rates following GRA are among the highest reported succeeding elective hip surgery for non-traumatic etiology.

Validity of patient-reported comorbidities before total knee and hip arthroplasty in patients older than 65 years.

Obtaining preoperative medical histories in elderly patients can be challenging, and tools have been developed to aid in history gathering. The purpose of this study is to determine the agreement between patient- and physician-reported histories before total knee or hip arthroplasty. Three hundred eighty-two patients older than 65 years completed a preoperative morbidity assessment form preoperatively. Sensitivity, specificity, κ, and agreement were calculated for each dichotomous response. Diabetes (κ = 0.77) and lung disease (κ = 0.68) had substantial agreement. Fourteen comorbidities ranged from slight to moderate agreement. Osteoarthritis and peripheral vascular disease had no agreement. These results highlight the incongruence between patient- and physician-reported comorbidities and emphasizes the need for detailed histories by health care professionals for medically complicated elderly patients preoperatively.

Influence of technique with distally fixed modular stems in revision total hip arthroplasty.

Distally fixed modular implants have seen a recent increase in use, to manage proximal femoral bone loss often encountered during revision total hip arthroplasty (THA). Forty-three distally fixed modular stems implanted at our institution between 1999 and 2006 were clinically and radiographically reviewed. These patients had either a minimum 2-year follow-up (average, 2.4 years; range, 2-5.6 years) or failure (ie, explant or rerevision required). Eleven stems subsided, and 4 were rerevised (n = 4), for a rate of 9.3%. All revised stems were radiographically undersized, emphasizing the importance of the technique. Although being a valuable option in revision THA, these stems are not free of complications. The high rate of subsidence encountered in our early experience shows that there is a learning curve. This complication is preventable by avoiding undersizing.