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1.
Orthop Clin North Am ; 51(1): 13-26, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31739876

RESUMO

Open reduction and internal fixation of displaced acetabular fractures has been the gold standard for treatment of these complex injuries. The subset of older patients with dome impaction, femoral head impaction, or a posterior wall component are considered for treatment with concomitant open reduction and internal fixation and total hip arthroplasty. Little has been written on the surgical techniques to perform concomitant open reduction and internal fixation plus total hip arthroplasty safely. This article describes the important intrinsic factors for acetabular component stability, choice of surgical approach for management of these injuries, and surgical technique for anterior and posterior approaches.


Assuntos
Acetábulo/cirurgia , Cabeça do Fêmur/cirurgia , Fixação Interna de Fraturas/métodos , Redução Aberta/métodos , Acetábulo/lesões , Idoso , Artroplastia de Quadril/métodos , Cadáver , Cabeça do Fêmur/lesões , Fixação Interna de Fraturas/normas , Fraturas Ósseas/cirurgia , Fraturas do Quadril/cirurgia , Humanos , Redução Aberta/normas , Cuidados Pós-Operatórios , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Resultado do Tratamento
2.
Bone Joint J ; 101-B(11): 1438-1446, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31674243

RESUMO

AIMS: This study aimed to explore whether intraoperative nerve monitoring can identify risk factors and reduce the incidence of nerve injury in patients with high-riding developmental dysplasia. PATIENTS AND METHODS: We conducted a historical controlled study of patients with unilateral Crowe IV developmental dysplasia of the hip (DDH). Between October 2016 and October 2017, intraoperative nerve monitoring of the femoral and sciatic nerves was applied in total hip arthroplasty (THA). A neuromonitoring technician was employed to monitor nerve function and inform the surgeon of ongoing changes in a timely manner. Patients who did not have intraoperative nerve monitoring between September 2015 and October 2016 were selected as the control group. All the surgeries were performed by one surgeon. Demographics and clinical data were analyzed. A total of 35 patients in the monitoring group (ten male, 25 female; mean age 37.1 years (20 to 46)) and 56 patients in the control group (13 male, 43 female; mean age 37.9 years (23 to 52)) were enrolled. The mean follow-up of all patients was 13.1 months (10 to 15). RESULTS: The two groups had no significant differences in preoperative data. In the monitoring group, ten nerve alerts occurred intraoperatively, and no neural complications were detected postoperatively. In the control group, six patients had neural complications. The rate of nerve injury was lower in the monitoring group than in the control group, but this did not achieve statistical significance. The degree of leg lengthening was significantly greater in the monitoring group than in the control group. In further analyses, patients who had previous hip surgery were more likely to have intraoperative nerve alerts and postoperative nerve injury. CONCLUSION: Nerve injury usually occurred during the processes of exposure and reduction. The use of intraoperative nerve monitoring showed a trend towards reduced nerve injury in THA for Crowe IV DDH patients. Hence, we recommend its routine use in patients undergoing leg lengthening, especially in those with previous hip surgery. Cite this article: Bone Joint J 2019;101-B:1438-1446.


Assuntos
Artroplastia de Quadril/métodos , Nervo Femoral/fisiologia , Luxação Congênita de Quadril/cirurgia , Tratamentos com Preservação do Órgão/métodos , Nervo Isquiático/fisiologia , Adulto , Feminino , Nervo Femoral/lesões , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Nervo Isquiático/lesões , Traumatismos do Sistema Nervoso/prevenção & controle , Adulto Jovem
3.
Bone Joint J ; 101-B(11): 1447-1458, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31674248

RESUMO

AIMS: We investigated patient characteristics and outcomes of Vancouver type B periprosthetic fractures treated with femoral component revision and/or osteosynthesis. PATIENTS AND METHODS: The study utilized data from the Swedish Hip Arthroplasty Register (SHAR) and information from patient records. We included all primary total hip arthroplasties (THAs) performed in Sweden since 1979, and undergoing further surgery due to Vancouver type B periprosthetic femoral fracture between 2001 and 2011. The primary outcome measure was any further reoperation between 2001 and 2013. Cross-referencing with the National Patient Register was performed in two stages, in order to identify all surgical procedures not recorded on the SHAR. RESULTS: Out of 1381 Vancouver type B fractures that fulfilled the inclusion criteria, 257 underwent further reoperation by the end of 2013. Interprosthetic and Type B1 fractures had a higher risk for reoperation. For B1 fractures, the rate of reoperation did not differ (p = 0.322) after use of conventional (26%) or locking plate osteosynthesis (19%). No significant differences were observed between cemented, cementless monoblock, and cementless modular revision components for the treatment of type B2 and B3 fractures. CONCLUSION: In this country-specific study, the choice of locking or conventional plates for the treatment of type B1, and cemented or cementless femoral components fixation for B2 and B3 fractures, had no significant influence on risk for reoperation. Interprosthetic fractures adversely affected the outcome of treatment of type B fractures. Differences in the patient characteristics of the compared groups were observed. Cite this article: Bone Joint J 2019;101-B:1447-1458.


Assuntos
Artroplastia de Quadril/métodos , Fraturas do Quadril/cirurgia , Prótese de Quadril , Fraturas Periprotéticas/cirurgia , Acidentes por Quedas , Idoso , Artroplastia do Joelho/métodos , Feminino , Humanos , Masculino , Sistema de Registros , Reoperação/estatística & dados numéricos , Suécia
4.
Bone Joint J ; 101-B(11): 1431-1437, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31674251

RESUMO

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.


Assuntos
Artroplastia de Quadril/reabilitação , Nível de Saúde , Atividades Cotidianas , Adulto , Assistência ao Convalescente/estatística & dados numéricos , Artroplastia de Quadril/métodos , Transplante Ósseo/estatística & dados numéricos , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/reabilitação , Osteoartrite do Quadril/cirurgia , Medidas de Resultados Relatados pelo Paciente , Índice de Gravidade de Doença , Inquéritos e Questionários
5.
Zhonghua Wai Ke Za Zhi ; 57(11): 804-806, 2019 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-31694126

RESUMO

Femoral neck fracture is a frequently occurring and dangerous disease of elderly patient, whose morbidity is increasing gradually with the aging of population and has become a serious social problem. Prosthetic joint replacement can relief pain and restore joint function effectively, so that more and more doctors consider it a main option for the treatment of displaced femoral neck fractures in the elderly. However, the extensive operation and high cost are burdens for patients and society. As medical technology development, the surgery strategy for fracture neck of femur should be redefined. The choice of treatment should be varied individually depend on therapeutic indication and patients' clinical condition. The treatment of aged patients with femoral neck fractures should be developed into personalized therapeutic strategies.


Assuntos
Fraturas do Colo Femoral/cirurgia , Idoso , Artroplastia de Quadril , Fixação Interna de Fraturas , Humanos
6.
Bone Joint J ; 101-B(11): 1423-1430, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31674240

RESUMO

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.


Assuntos
Artroplastia de Quadril/métodos , Marcha/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Análise da Marcha/instrumentação , Análise da Marcha/métodos , Articulação do Quadril/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/fisiopatologia , Osteoartrite do Quadril/cirurgia , Medidas de Resultados Relatados pelo Paciente , Cuidados Pós-Operatórios/instrumentação , Cuidados Pós-Operatórios/métodos , Estudos Prospectivos , Radiografia , Velocidade de Caminhada/fisiologia
7.
Medicine (Baltimore) ; 98(41): e17547, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593135

RESUMO

RATIONALE: Leakage of bone cement from femoral medullary cavity is a rare complication after hip arthroplasty, and there is no report on the leaked bone cement entering into iliac vessels. PATIENT CONCERNS: An 89-year-old woman presented with a fracture in the right femoral neck. She had well-fixed right femoral head replacement after careful preoperative examinations, and no adverse reactions appeared. She was able to get off bed to walk at the 2nd day after surgery. DIAGNOSES: Postoperative radiograph showed leakage of bone cement into the joint through femoral medullary cavity entering into iliac vessels, but the patient complained no discomforts. She received a treatment with low-molecular weight heparin and rivaroxaban. OUTCOMES: The patient was able to walk with normal gait, without swelling in both lower extremities and discomfort in the hip. There was no other complication concerning intravascular foreign bodies. LESSONS: This case calls into the phenomenon of leakage of injected bone cement in femoral head replacement regardless of complete and nonfractured femur, which may be into the lower limb and pelvic veins, given that, dangerous consequences will not occur.


Assuntos
Artroplastia de Quadril/efeitos adversos , Cimentos para Ossos/efeitos adversos , Cabeça do Fêmur/cirurgia , Veia Ilíaca/patologia , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Inibidores do Fator Xa/uso terapêutico , Feminino , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Veia Ilíaca/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Radiografia/métodos , Rivaroxabana/uso terapêutico , Resultado do Tratamento
8.
Wiad Lek ; 72(9 cz 1): 1621-1632, 2019.
Artigo em Polonês | MEDLINE | ID: mdl-31586974

RESUMO

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.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Osteoartrite do Quadril/cirurgia , Osteoartrite do Joelho/cirurgia , Idoso , Feminino , Humanos , Qualidade de Vida , Inquéritos e Questionários
9.
Bone Joint J ; 101-B(10): 1192-1198, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31564144

RESUMO

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.


Assuntos
Artroplastia de Quadril/efeitos adversos , Migração de Corpo Estranho/diagnóstico por imagem , Osteoartrite do Quadril/cirurgia , Polietilenos/química , Desenho de Prótese , Falha de Prótese/tendências , Fatores Etários , Idoso , Artroplastia de Quadril/métodos , Método Duplo-Cego , Feminino , Migração de Corpo Estranho/epidemiologia , Prótese de Quadril , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/diagnóstico por imagem , Prognóstico , Análise Radioestereométrica , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Estatísticas não Paramétricas , Suécia , Vitamina E/farmacologia
11.
Bone Joint J ; 101-B(10): 1292-1299, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31564146

RESUMO

AIMS: This study explores data quality in operation type and fracture classification recorded as part of a large research study and a national audit with an independent review. PATIENTS AND METHODS: At 17 centres, an expert surgeon reviewed a randomly selected subset of cases from their centre with regard to fracture classification using the AO system and type of operation performed. Agreement for these variables was then compared with the data collected during conduct of the World Hip Trauma Evaluation (WHiTE) cohort study. Both types of surgery and fracture classification were collapsed to identify the level of detail of reporting that achieved meaningful agreement. In the National Hip Fracture Database (NHFD), the types of operation and fracture classification were explored to identify the proportion of "highly improbable" combinations. RESULTS: The records were reviewed for 903 cases. Agreement for the subtypes of extracapsular fracture was poor; most centres achieved no better than "fair" agreement. When the classification was collapsed to a single option for "extracapsular" fracture, only four centres failed to have at least "moderate" agreement. There was only "moderate" agreement for the subtypes of intracapsular fracture, which improved to "substantial" when collapsed to "intracapsular". Subtrochanteric fracture types were well reported with "substantial" agreement. There was near "perfect" agreement for internal fixation procedures. "Perfect" or "substantial" agreement was achieved when the type of arthroplasty surgery was reported at the level of "hemiarthroplasty" and "total hip replacement". When reviewing data submitted to the NHFD, a minimum of 5.2% of cases contained "highly improbable" procedures for the stated fracture classification. CONCLUSION: The complexity of collecting fracture classification data at a national scale compromises the accuracy with which detailed classification systems can be reported. Data around type of surgery performed show similar tendencies. Data capture, reporting, and interpretation in future studies must take this into account. Cite this article: Bone Joint J 2019;101-B:1292-1299.


Assuntos
Artroplastia de Quadril/métodos , Fixação Interna de Fraturas/métodos , Hemiartroplastia/métodos , Fraturas do Quadril/classificação , Fraturas do Quadril/cirurgia , Reoperação/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/efeitos adversos , Estudos de Coortes , Confiabilidade dos Dados , Inglaterra , Feminino , Fixação Interna de Fraturas/efeitos adversos , Consolidação da Fratura/fisiologia , Hemiartroplastia/efeitos adversos , Humanos , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Prognóstico , Amplitude de Movimento Articular/fisiologia , Reoperação/métodos , Resultado do Tratamento , País de Gales
12.
Bone Joint J ; 101-B(10): 1199-1208, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31564148

RESUMO

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.


Assuntos
Artroplastia de Quadril/efeitos adversos , Osteoartrite do Quadril/cirurgia , Fraturas Periprotéticas/cirurgia , Sistema de Registros , Reoperação/métodos , Fatores Etários , Idoso , Artroplastia de Quadril/métodos , Estudos de Casos e Controles , Inglaterra , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/cirurgia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Irlanda do Norte , Osteoartrite do Quadril/diagnóstico por imagem , Fraturas Periprotéticas/diagnóstico por imagem , Fraturas Periprotéticas/epidemiologia , Modelos de Riscos Proporcionais , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Fatores de Tempo , Resultado do Tratamento , Reino Unido , País de Gales
13.
Bone Joint J ; 101-B(10): 1186-1191, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31564149

RESUMO

AIMS: In previous studies, we identified multiple factors influencing the survivorship of hip resurfacing arthroplasties (HRAs), such as initial anatomical conditions and surgical technique. In addition, the University of California, Los Angeles (UCLA) activity score presents a ceiling effect, so a better quantification of activity is important to determine which activities may be advisable or detrimental to the recovered patient. We aimed to determine the effect of specific groups of sporting activities on the survivorship free of aseptic failure of a large series of HRA. PATIENTS AND METHODS: A total of 661 patients (806 hips) representing 77% of a consecutive series of patients treated with metal-on-metal hybrid HRA answered a survey to determine the types and amounts of sporting activities they regularly participated in. There were 462 male patients (70%) and 199 female patients (30%). Their mean age at the time of surgery was 51.9 years (14 to 78). Their mean body mass index (BMI) was 26.5 kg/m2 (16.7 to 46.5). Activities were regrouped into 17 categories based on general analogies between these activities. Scores for typical frequency and duration of the sessions were used to quantify the patients' overall time spent engaging in sporting activities. Impact and cycle scores were computed. Multivariable models were used. RESULTS: We found no association between any category of activity and a decrease in survivorship. Impact and hip cycle scores also failed to show any association with revision for aseptic failure or wear. CONCLUSION: Return to sporting activities after surgery is safe for patients treated with well-designed and well-implanted HRA. Cite this article: Bone Joint J 2019;101-B:1186-1191.


Assuntos
Artroplastia de Quadril/métodos , Exercício/fisiologia , Próteses Articulares Metal-Metal , Segurança do Paciente/estatística & dados numéricos , Volta ao Esporte/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Artroplastia de Quadril/reabilitação , California , Estudos Transversais , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Falha de Prótese , Qualidade de Vida , Medição de Risco , Fatores Sexuais , Inquéritos e Questionários , Sobrevivência , Fatores de Tempo
14.
Bone Joint J ; 101-B(10): 1285-1291, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31564154

RESUMO

AIMS: Currently, periprosthetic fractures are excluded from the American Society for Bone and Mineral Research (ASBMR) definition of atypical femoral fracture (AFFs). This study aims to report on a series of periprosthetic femoral fractures (PFFs) that otherwise meet the criteria for AFFs. Secondary aims were to identify predictors of periprosthetic atypical femoral fractures (PAFFs) and quantify the complications of treatment. PATIENTS AND METHODS: This was a retrospective case control study of consecutive patients with periprosthetic femoral fractures between 2007 and 2017. Two observers identified 16 PAFF cases (mean age 73.9 years (44 to 88), 14 female patients) and 17 typical periprosthetic fractures in patients on bisphosphonate therapy as controls (mean age 80.7 years (60 to 86, 13 female patients). Univariate and multivariate analysis was performed to identify predictors of PAFF. Management and complications were recorded. RESULTS: Interobserver agreement for the PAFF classification was excellent (kappa = 0.944; p < 0.001). On univariate analysis compared with controls, patients with PAFFs had higher mean body mass indices (28.6 kg/m2 (sd 8.9) vs 21.5 kg/m2 (sd 3.3); p = 0.009), longer durations of bisphosphonate therapy (median 5.5 years (IQR 3.2 to 10.6) vs 2.4 years (IQR 1.0 to 6.4); p = 0.04), and were less likely to be on alendronate (50% vs 94%; p = 0.02) with an indication of secondary osteoporosis (19% vs 0%; p = 0.049). Duration of bisphosphonate therapy was an independent predictor of PAFF on multivariate analysis (R2 = 0.733; p = 0.05). Following primary fracture management, complication rates were higher in PAFFs (9/16, 56%) than controls (5/17, 29%; p = 0.178) with a relative risk of any complication following PAFF of 1.71 (95% confidence interval (CI) 0.77 to 3.8) and of reoperation 2.56 (95% CI 1.3 to 5.2). CONCLUSION: AFFs do occur in association with prostheses. Longer duration of bisphosphonate therapy is an independent predictor of PAFF. Complication rates are higher following PAFFs compared with typical PFFs, particularly of reoperation and infection. Cite this article: Bone Joint J 2019;101-B:1285-1291.


Assuntos
Artroplastia de Quadril/efeitos adversos , Difosfonatos/efeitos adversos , Osteoporose/tratamento farmacológico , Fraturas Periprotéticas/induzido quimicamente , Fraturas Periprotéticas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/métodos , Estudos de Casos e Controles , Intervalos de Confiança , Difosfonatos/uso terapêutico , Relação Dose-Resposta a Droga , Feminino , Fraturas do Fêmur/induzido quimicamente , Fraturas do Fêmur/cirurgia , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Variações Dependentes do Observador , Osteoporose/complicações , Fraturas Periprotéticas/diagnóstico por imagem , Estudos Retrospectivos , Medição de Risco , Fatores de Tempo , Estados Unidos
15.
Bone Joint J ; 101-B(10): 1209-1217, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31564156

RESUMO

AIMS: There is an increasing demand for hip arthroplasty in China. We aimed to describe trends in in-hospital mortality after this procedure in China and to examine the potential risk factors. PATIENTS AND METHODS: We included 210 450 patients undergoing primary hip arthroplasty registered in the Hospital Quality Monitoring System in China between 2013 and 2016. In-hospital mortality after hip arthroplasty and its relation to potential risk factors were assessed using multivariable Poisson regression. RESULTS: During the study period, 626 inpatient deaths occurred within 30 days after hip arthroplasty. Mortality decreased from 2.9% in 2013 to 2.6% in 2016 (p for trend = 0.02). Compared with their counterparts, old age, male sex, and divorced or widowed patients had a higher rate of mortality (all p < 0.05). Risk ratio (RR) for mortality after arthroplasty for fracture was two-fold higher (RR 2.0, 95% confidence interval (CI) 1.5 to 2.6) than that for chronic disease. RRs for mortality were 3.3 (95% CI 2.7 to 3.9) and 8.2 (95% CI 6.5 to 10.4) for patients with Charlson Comorbidity Index (CCI) of 1 to 2 and CCI ≥ 3, respectively, compared with patients with CCI of 0. The rate of mortality varied according to geographical region, the lowest being in the East region (1.8%), followed by Beijing (2.1%), the North (2.9%), South-West (3.6%), South-Central (3.8%), North-East (4.1%), and North-West (5.2%) regions. CONCLUSION: While in-hospital mortality after hip arthroplasty in China appears low and declined during the study period, discrepancies in mortality after this procedure exist according to sociodemographic factors. Healthcare resources should be allocated more to underdeveloped regions to further reduce mortality. Cite this article: Bone Joint J 2019;101-B:1209-1217.


Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/mortalidade , Causas de Morte , Mortalidade Hospitalar/tendências , Sistema de Registros , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/métodos , China , Estudos de Coortes , Bases de Dados Factuais , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Distribuição de Poisson , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/fisiopatologia , Falha de Prótese , Estudos Retrospectivos , Fatores Sexuais , Fatores de Tempo , Resultado do Tratamento
16.
Unfallchirurg ; 122(11): 885-900, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31650191

RESUMO

The incidence of periprosthetic hip fractures is increasing due to the increase in endoprosthetic hip replacements. These fractures require a staged and individual treatment concept with the aim of mobilization of the patient as early as possible. The special challenge in the diagnostics is to identify pre-existing signs of loosening of the prosthesis. When the prosthesis is still firmly fixed femoral fractures can be treated with angular stable osteosynthesis. Loosened stems usually have to be revised, mostly in combination with osteosynthesis. Fractures around the acetabulum with a fixed cup can be treated nonoperatively or with osteosynthesis, while loosened cups have to be revised. In revision surgery the stabilization of the dorsal column is crucial for a successful outcome.


Assuntos
Artroplastia de Quadril/efeitos adversos , Fraturas do Fêmur , Fraturas do Quadril , Fraturas Periprotéticas/etiologia , Acetábulo/lesões , Artroplastia de Quadril/métodos , Fraturas do Fêmur/diagnóstico , Fraturas do Fêmur/etiologia , Fraturas do Fêmur/terapia , Fraturas do Quadril/diagnóstico , Fraturas do Quadril/etiologia , Fraturas do Quadril/terapia , Humanos , Fraturas Periprotéticas/diagnóstico , Fraturas Periprotéticas/terapia , Falha de Prótese , Reoperação
17.
Zhongguo Gu Shang ; 32(9): 785-791, 2019 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-31615171

RESUMO

OBJECTIVE: To assess the clinical efficacy of Tri-Lock bio-short prosthesis in artificial total hip arthroplasty(THA) in young patients with Dorr type C femoral medullary cavity. METHODS: From January 2010 to January 2014, 35 young patients(37 hips) with in the chimney-like femoral medullary cavity received Tri-Lock BPS prosthesis of THA, including 18 males(20 hips) and 17 females with an average age of (32.2±3.0) years old ranging from 21.2 to 38.5 years old. There were 16 cases of rheumatoid hip arthritis (17 hips), 8 cases of rheumatoid arthritis (9 hips), and 11 cases of aseptic necrosis of femoral head (11 hips). All cases were complicated with different degrees of osteoporosis. According to Singh index, 26 cases were classified as Grade III and 9 cases as Grade II. Biological prostheses were used for the acetabulum, with ceramic lining and full ceramic femoral head. The proximal femoral medullary cavity was Dorr type C on anteroposterior X-ray. After replacement, X-ray examination was performed to locate the prosthesis stem. Engh and Harris criteria were used to evaluate the stability of bone-prosthesis interface and hip function, respectively. Changes of hip movement pre-operation and at last follow-up were compared. RESULTS: All patients were followed up for 18 to 45 months(means 33.8 months). Harris hip scores in 35 cases (37 hips) increased significantly from preoperative 61.8±3.0 (51.2 to 73.5) to 93.3±6.5 (92.5 to 98.8) points at last follow-up (t=54.745, P<0.01). The hip mobility increased from (46.5±8.0)°(0° to 55°) before surgery to(101.2±10.5)°(85° to 130°) at the last follow-up, the difference was statistically significant(t=133.091, P<0.01). Immediately after surgery, the prostheses were tightly packed with the medullary cavity. At the final follow-up, 17 hips had significant femur cortical bone thickening;12 hips had varying degrees of stress occlusal bone resorption at proximal femoral, including 9 degree I(low femur density, round and blunt) and 3 degree II(involving small rotor) hips. Meanwhile, 15 hips had significant femur cortical bone thickening without thigh pain. CONCLUSIONS: The cone-shaped short Tri-lock biological short-stem can fill Dorr C chimney-like medullary cavity and effectively retain good proximal femoral bone mass. Titanium microporous coating on the surface can effectively increase the friction of the prosthesis. The short-stem end in the medullary cavity can effectively avoid the occurrence of coxa varus.


Assuntos
Artroplastia de Quadril , Prótese de Quadril , Acetábulo , Adulto , Feminino , Fêmur , Cabeça do Fêmur , Seguimentos , Humanos , Masculino , Resultado do Tratamento , Adulto Jovem
18.
Zhongguo Gu Shang ; 32(9): 792-797, 2019 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-31615172

RESUMO

OBJECTIVE: To compare the clinical effects of total hip arthroplasty(THA) with non-osteotomy and subtrochanteric osteotomy in the treatment of Crowe type IV hip dysplasia (DDH) in adults. METHODS: Data of 35 Crowe type IV DDH patients who underwent THA were analyzed retrospectively, the patients were divided into two groups:15 cases of non-osteotomy and 20 cases of subtrochanteric osteotomy. There was no significant difference in age, gender, body mass index between two groups (P>0.05). The operative time, bleeding volume, hospitalization duration, Harris hip score and the limb length discrepancy (LLD) were evaluated. RESULTS: All of the patients were followed up for 12 to 48 months, no prosthesis loosening or infection occurred by the end of follow-up. In non-osteotomy group, 1 case had occurred by sciatic nerve injury and 1 case developed cutaneous branch injury of the femoral nerve, both of which were spontaneously recovered completely without treatment after 3 months. One case of dislocation occurred in subtrochanteric osteotomy group, after closed reduction, dislocation did not recur; three cases had proximal femoral crack fractures and received steel plate fixation; no reoperation was needed. There was significant difference in operation duration, bleeding volume, and hospitalization days between two groups(P<0.05). The Harris score at last follow-up was significantly increased compared with preoperative score in two groups(P<0.05), but there was no significant difference between two groups(P>0.05). The postoperative discrepancy of bilateral lower limbs had significant difference(P<0.05). CONCLUSIONS: THA with no femoral shortening osteotomy can achieve good clinical results in patients with unilateral Crowe IV developmental dysplasia of hip. Comparing with subtrochanteric osteotomy, the procedure of no femoral shortening osteotomy is easier technically. For unilateral high dislocation DDH patients with limb lengthening <=4 cm and good tissue conditions, THA without femoral osteotomy may be considered.


Assuntos
Artroplastia de Quadril , Luxação Congênita de Quadril , Adulto , Fêmur , Luxação Congênita de Quadril/cirurgia , Humanos , Osteotomia , Estudos Retrospectivos
19.
Zhongguo Gu Shang ; 32(9): 797-801, 2019 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-31615173

RESUMO

OBJECTIVE: To study the effect of pelvic rotation in three-dimensional direction on the actual placement angle of acetabular prosthesis in total hip arthroplasty. METHODS: Pelvic CT imaging data of normal adults were collected, and three-dimensional reconstruction of pelvic acetabulum was performed with computer software to simulate the rotation of the pelvis around X, Y and Z axes perpendicular to the sagittal, transverse and coronal planes of the human body. Radiographic inclination(RI) and radiographic anteversion (RA) of the acetabular cup were measured when the acetabular prosthesis was implanted at a standard angle. The correlation analysis was used to quantify the relationship between the rotation angle of each axis and the actual angle of acetabulum. RESULTS: The pelvic rotation along the X-axis and Y-axis had little effect on the RA of the acetabulum, but had a great influence on the RI and showed a linear correlation. The regression equations were RA=0.682 4X+10.256(r²=0.308 4) and RA=-0.714 1Y+10.424(r²=0.999 8). The pelvic rotation along the Z-axis had little effect on the RA, but had a linear correlation with the RI, and the regression equation was RI=1.0Z+46(r²=1.0). CONCLUSIONS: The anteroposterior rotation of the pelvis or the longitudinal rotation along the body significantly affected the acetabular anteversion, but had little effect on the abduction angle. On the contrary, the left and right deviation of the pelvis on the coronal plane could significantly affect the acetabular anteversion angle, but did not affect its anteversion angle.


Assuntos
Artroplastia de Quadril , Prótese de Quadril , Acetábulo , Adulto , Humanos , Pelve , Rotação
20.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 50(4): 604-608, 2019 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-31642243

RESUMO

OBJECTIVE: To evaluate the clinical effect and rehabilitation benefit of enhanced recovery after surgery (ERAS) model in perioperative management of total hip arthroplasty (THA). METHODS: A retrospective study were conducted in THA patients from the database of big data Research Center of Biomedicine, West China Hospital of Sichuan University from 2013 to 2016. The differences of rehabilitation quality, rehabilitation efficiency and hospitalization cost between ERAS model (ERAS group) and traditional model (traditional group) were compared. RESULTS: 915 THA patients were included in the study, of which 497 patients were given ERAS peri-operative management and 418 patients in the traditional group. The rate of overall complications in the ERAS group was significantly lower than that in the traditional group (4.8% vs. 8.6%, P < 0.05), with lower rate of deep venous thrombosis (0.8% vs. 3.1%) and pulmonary infection (0.6% vs. 2.4%) in the ERAS group. Compared with the traditional group, the average length of stay in hospital was shorter in the ERAS group 〔(7.6±2.0) d vs. (10.9±2.9) d, P=0.039〕, as well as postoperative length of stay in hospital 〔(5.6±0.9) d vs. (8.6±2.0) d, P=0.028)〕. And the ERAS model reduced the total hospitalization cost by 4.8% to 7.1% (P < 0.05), of which the drug cost decreased by 17.2% to 24.9% (P < 0.05). CONCLUSIONS: ERAS model in THA is safe and effective. It can reduce hospitalization cost and help to control medical cost.


Assuntos
Artroplastia de Quadril/reabilitação , China , Custos de Cuidados de Saúde , Hospitalização/economia , Humanos , Tempo de Internação , Período Pós-Operatório , Estudos Retrospectivos
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