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1.
Bone Joint J ; 102-B(9): 1113-1121, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32862675

RESUMO

AIMS: We conducted a systematic review and meta-analysis to compare the mortality, morbidity, and functional outcomes of cemented versus uncemented hemiarthroplasty in the treatment of intracapsular hip fractures, analyzing contemporary and non-contemporary implants separately. METHODS: PubMed, Medline, EMBASE, CINAHL, and Cochrane Library were searched to 2 February 2020 for randomized controlled trials (RCTs) comparing the primary outcome, mortality, and secondary outcomes of function, quality of life, reoperation, postoperative complications, perioperative outcomes, pain, and length of hospital stay. Relative risks (RRs) and mean differences (with 95% confidence intervals (CIs)) were used as summary association measures. RESULTS: A total of 18 studies corresponding to 16 non-overlapping RCTs with a total of 2,819 intracapsular hip fractures were included. Comparing contemporary cemented versus uncemented hemiarthroplasty, RRs (95% CIs) for mortality were 1.32 (0.44 to 3.99) perioperatively, 1.01 (0.48 to 2.10) at 30 days, and 0.90 (0.71 to 1.15) at one year. The use of contemporary cemented hemiarthroplasty reduced the risk of intra- and postoperative periprosthetic fracture. There were no significant differences in the risk of other complications, function, pain, and quality of life. There were no significant differences in perioperative outcomes except for increases in operating time and overall anaesthesia for contemporary cemented hemiarthroplasty with mean differences (95% CIs) of 6.67 (2.65 to 10.68) and 4.90 (2.02 to 7.78) minutes, respectively. The morbidity and mortality outcomes were not significantly different between non-contemporary cemented and uncemented hemiarthroplasty. CONCLUSION: There are no differences in the risk of mortality when comparing the use of contemporary cemented with uncemented hemiarthroplasty in the management of intracapsular hip fractures. Contemporary cemented hemiarthroplasty is associated with a substantially lower risk of intraoperative and periprosthetic fractures. Cite this article: Bone Joint J 2020;102-B(9):1113-1121.


Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Cimentos para Ossos , Hemiartroplastia/efeitos adversos , Fraturas do Quadril/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Humanos , Complicações Pós-Operatórias/mortalidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Resultado do Tratamento
2.
Bone Joint J ; 102-B(10): 1289-1296, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32993340

RESUMO

AIMS: Hip resurfacing arthroplasty (HRA) is typically indicated for young and active patients. Due to the longevity of arthroplasty, these patients are likely to undergo revision surgery during their lifetime. There is a paucity of information on the long-term outcome of revision surgeries performed after failed HRA. The aim of our study was to provide survivorship data as well as clinical scores after HRA revisions. METHODS: A total of 42 patients (43 hips) were revised after HRA at our centre to a variety of devices, including four HRA and 39 total hip arthroplasties (THAs). In addition to perioperative complications, University of California, Los Angeles (UCLA) hip scores and 12-Item Short-Form Health Survey questionnaire (SF-12) quality of life scores were collected at follow-up visits after the primary HRA and after revision surgery. RESULTS: The mean follow-up time after revision surgery was 8.3 years (0.3 to 19.1). The mean UCLA pain and function scores post-revision were comparable with the best scores achieved by the patients after the index HRA, but UCLA activity scores were lower after revision. SF-12 physical component scores were comparable between timepoints, but the mental component score decreased after revision. Six patients underwent unilateral re-revision surgery at a mean follow-up time of 7.8 years (0.3 to 13.7). Using the time to any re-revision as endpoint, the Kaplan-Meier survivorship was 85.3% at 13 years. CONCLUSION: Patients undergoing revision after HRA can expect to achieve function and quality of life similar to their best after their primary surgery, while the risk of re-revision is low. Cite this article: Bone Joint J 2020;102-B(10):1289-1296.


Assuntos
Artroplastia de Quadril/métodos , Complicações Pós-Operatórias/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Inquéritos e Questionários , Resultado do Tratamento
3.
Medicine (Baltimore) ; 99(37): e22158, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925776

RESUMO

BACKGROUND: Pain management after the total joint arthroplasty is still challenging, but worthy of attention, because good pain management can improve the outcomes of patient. It is still controversial whether fascia iliaca compartment block (FICB) can effectively decrease the opioid consumption and pain after total hip replacement (THR) owing to the number of published investigations is small. The purpose of this present study is to assess the efficacy and safety of FICB for postoperative analgesia after THR. METHODS: This is a single center, placebo-controlled randomized trial which is performed in accordance with the SPIRIT Checklist for randomized studies. It was authorized via the Chifeng Municipal Hospital institutional review committee (H2020-19-8). 100 patients undergoing THR will be included in this study. Patients are randomly divided into 2 groups: FICB group or Non-FICB group, FICB with 5mgmL of epinephrine and 40 mL of ropivacaine 0.2%. Primary outcomes are pain score at different time point. Visual analog scale is used to assess the pain (10: the maximum possible pain and 0: absent pain). The secondary outcomes are the postoperative complications, length of hospital stay and total consumption of opioid. All the needed analyses are implemented through utilizing SPSS for Windows Version 15.0. RESULTS: Figure 1 will show the primary and secondary outcomes. CONCLUSION: This trial can provide an evidence for the use of FICB for analgesia after THR.


Assuntos
Artroplastia de Quadril/métodos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Analgésicos Opioides/administração & dosagem , Artroplastia de Quadril/efeitos adversos , Epinefrina/administração & dosagem , Humanos , Tempo de Internação , Complicações Pós-Operatórias/epidemiologia , Ropivacaina/administração & dosagem
4.
Bone Joint J ; 102-B(8): 1003-1009, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32731818

RESUMO

AIMS: There is evidence that prior lumbar fusion increases the risk of dislocation and revision after total hip arthroplasty (THA). The relationship between prior lumbar fusion and the effect of femoral head diameter on THA dislocation has not been investigated. We examined the relationship between prior lumbar fusion or discectomy and the risk of dislocation or revision after THA. We also examined the effect of femoral head component diameter on the risk of dislocation or revision. METHODS: Data used in this study were compiled from several Finnish national health registers, including the Finnish Arthroplasty Register (FAR) which was the primary source for prosthesis-related data. Other registers used in this study included the Finnish Health Care Register (HILMO), the Social Insurance Institutions (SII) registers, and Statistics Finland. The study was conducted as a prospective retrospective cohort study. Cox proportional hazards regression and Kaplan-Meier survival analysis were used for analysis. RESULTS: Prior lumbar fusion surgery was associated with increased risk of prosthetic dislocation (hazard ratio (HR) = 2.393, p < 0.001) and revision (HR = 1.528, p < 0.001). Head components larger than 28 mm were associated with lower dislocation rates compared to the 28 mm head (32 mm: HR = 0.712, p < 0.001; 36 mm: HR = 0.700, p < 0.001; 38 mm: HR = 0.808, p < 0.140; and 40 mm: HR = 0.421, p < 0.001). Heads of 38 mm (HR = 1.288, p < 0.001) and 40 mm (HR = 1.367, p < 0.001) had increased risk of revision compared to the 28 mm head. CONCLUSION: Lumbar fusion surgery was associated with higher rate of hip prosthesis dislocation and higher risk of revision surgery. Femoral head component of 32 mm (or larger) associates with lower risk of dislocation in patients with previous lumbar fusion. Cite this article: Bone Joint J 2020;102-B(8):1003-1009.


Assuntos
Artroplastia de Quadril/efeitos adversos , Prótese de Quadril/efeitos adversos , Desenho de Prótese , Falha de Prótese , Sistema de Registros , Fusão Vertebral/efeitos adversos , Idoso , Artroplastia de Quadril/métodos , Estudos de Coortes , Feminino , Cabeça do Fêmur/cirurgia , Finlândia , Humanos , Estimativa de Kaplan-Meier , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Modelos de Riscos Proporcionais , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco , Fusão Vertebral/métodos , Resultado do Tratamento
5.
Bone Joint J ; 102-B(8): 997-1002, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32731820

RESUMO

AIMS: The aim of this study was to investigate whether the use of antibiotic-loaded bone cement influenced the risk of revision surgery after primary total hip arthroplasty (THA) for osteoarthritis. METHODS: The study involved data collected by the National Joint Registry (NJR) for England and Wales, Northern Ireland and the Isle of Man between 1 September 2005 and 31 August 2017. Cox proportional hazards were used to investigate the association between use of antibiotic-loaded bone cement and the risk of revision due to prosthetic joint infection (PJI), with adjustments made for the year of the initial procedure, age at the time of surgery, sex, American Society of Anesthesiologists (ASA) grade, head size, and body mass index (BMI). We looked also at the association between use of antibiotic-loaded bone cement and the risk of revision due to aseptic loosening or osteolysis. RESULTS: The cohort included 418,857 THAs of whom 397,896 had received antibiotic-loaded bone cement and 20,961 plain cement. After adjusting for putative confounding factors, the risk of revision for PJI was lower in those in whom antibiotic-loaded bone cement was used (hazard ration (HR) 0.79; 95% confidence interval (CI) 0.64 to 0.98). There was also a protective effect on the risk of revision due to aseptic loosening or osteolysis, in the period of > 4.1 years after primary THA, HR 0.57, 95% CI 0.45, 0.72. CONCLUSION: Within the limits of registry analysis, this study showed an association between the use of antibiotic-loaded bone cement and lower rates of revision due to PJI. The findings support the continued use of antibiotic-loaded bone cement in cemented THA. Cite this article: Bone Joint J 2020;102-B(8):997-1002.


Assuntos
Antibacterianos/farmacologia , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Cimentos para Ossos/farmacologia , Infecções Relacionadas à Prótese/prevenção & controle , Reoperação/estatística & dados numéricos , Adulto , Idoso , Inglaterra , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Irlanda do Norte , Osteoartrite do Quadril/cirurgia , Falha de Prótese , Infecções Relacionadas à Prótese/cirurgia , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento , País de Gales
6.
Bone Joint J ; 102-B(7): 832-837, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32600130

RESUMO

AIMS: We have previously demonstrated raised cobalt and chromium levels in patients with larger diameter femoral heads, following metal-on-polyethylene uncemented total hip arthroplasty. Further data have been collected, to see whether these associations have altered with time and to determine the long-term implications for these patients and our practice. METHODS: Patients from our previous study who underwent Trident-Accolade primary total hip arthroplasties using a metal-on-polyethylene bearing in 2009 were reviewed. Patients were invited to have their cobalt and chromium levels retested, and were provided an Oxford Hip Score. Serum ion levels were then compared between groups (28 mm, 36 mm, and 40 mm heads) and over time. RESULTS: Metal ion levels were repeated in 33 patients. When comparing the results of serum metal ion levels over time, regardless of head size, there was a significant increase in both cobalt and chromium levels (p < 0.001). Two patients with larger head sizes had undergone revision arthroplasty with evidence of trunnion damage at surgery. Two patients within the 40 mm subgroup had metal ion levels above the MHRA (Medicines and Healthcare Products Regulatory Agency) threshold for detailed investigation. The increase in cobalt and chromium, when comparing the 36 mm and 40 mm groups with those of the 28 mm group, was not significant (36 mm vs 28 mm; p = 0.092/p = 0.191; 40 mm vs 28 mm; p = 0.200/p = 0.091, respectively). There was no difference, between femoral head sizes, when comparing outcome as measured by the Oxford Hip Score. CONCLUSION: This study shows an increase in cobalt and chromium levels over time for all modular femoral head sizes in patients with metal-on-polyethylene bearings, with two patients demonstrating ion levels above the MHRA threshold for failure, and a further two patients requiring revision surgery. These results may have clinical implications regarding longer term follow-up of patients and future implant choice, particularly among younger patients. Cite this article: Bone Joint J 2020;102-B(7):832-837.


Assuntos
Artroplastia de Quadril/métodos , Cromo/sangue , Cobalto/sangue , Prótese de Quadril , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/instrumentação , Feminino , Humanos , Íons , Masculino , Pessoa de Meia-Idade , Polietileno , Desenho de Prótese
7.
Bone Joint J ; 102-B(7_Supple_B): 11-19, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32600194

RESUMO

AIMS: Failure of irrigation and debridement (I&D) for prosthetic joint infection (PJI) is influenced by numerous host, surgical, and pathogen-related factors. We aimed to develop and validate a practical, easy-to-use tool based on machine learning that may accurately predict outcome following I&D surgery taking into account the influence of numerous factors. METHODS: This was an international, multicentre retrospective study of 1,174 revision total hip (THA) and knee arthroplasties (TKA) undergoing I&D for PJI between January 2005 and December 2017. PJI was defined using the Musculoskeletal Infection Society (MSIS) criteria. A total of 52 variables including demographics, comorbidities, and clinical and laboratory findings were evaluated using random forest machine learning analysis. The algorithm was then verified through cross-validation. RESULTS: Of the 1,174 patients that were included in the study, 405 patients (34.5%) failed treatment. Using random forest analysis, an algorithm that provides the probability for failure for each specific patient was created. By order of importance, the ten most important variables associated with failure of I&D were serum CRP levels, positive blood cultures, indication for index arthroplasty other than osteoarthritis, not exchanging the modular components, use of immunosuppressive medication, late acute (haematogenous) infections, methicillin-resistant Staphylococcus aureus infection, overlying skin infection, polymicrobial infection, and older age. The algorithm had good discriminatory capability (area under the curve = 0.74). Cross-validation showed similar probabilities comparing predicted and observed failures indicating high accuracy of the model. CONCLUSION: This is the first study in the orthopaedic literature to use machine learning as a tool for predicting outcomes following I&D surgery. The developed algorithm provides the medical profession with a tool that can be employed in clinical decision-making and improve patient care. Future studies should aid in further validating this tool on additional cohorts. Cite this article: Bone Joint J 2020;102-B(7 Supple B):11-19.


Assuntos
Desbridamento , Prótese de Quadril/efeitos adversos , Prótese do Joelho/efeitos adversos , Infecções Relacionadas à Prótese/terapia , Irrigação Terapêutica , Falha de Tratamento , Fatores Etários , Idoso , Algoritmos , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Proteína C-Reativa/análise , Feminino , Infecções por Bactérias Gram-Negativas/terapia , Infecções por Bactérias Gram-Positivas/terapia , Humanos , Imunossupressores/efeitos adversos , Aprendizado de Máquina , Masculino , Infecções Relacionadas à Prótese/microbiologia , Estudos Retrospectivos , Dermatopatias Bacterianas/complicações
8.
Bone Joint J ; 102-B(7_Supple_B): 57-61, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32600202

RESUMO

AIMS: To establish whether there was a consensus among the members of the Hip Society (HS) on the role of direct anterior approach (DAA) contemporary primary total hip arthroplasty (THA). METHODS: An online survey was sent to all 112 active and senior members of the HS, to which 71 members responded. The survey was constructed to determine whether they believed that evidence-based medicine proves, in modern clinical practice, that the DAA has significant benefits compared to risks when contrasted with other approaches. In addition, they were asked if they currently used the DAA. RESULTS: While only 16.9% (12/71) of respondents had been trained in a generic anterior approach during residency, 49.3% (35/71) had used the DAA in their clinical practice in the past or were using it at the present time. Unexpectedly, 42.9% (15/35) of respondents who had used the DAA in the past had abandoned it by the time of this survey. Only 22.5% (16/71) of all respondents believed that evidence-based medicine proves that the DAA has significant benefits compared to risks in contrast to other approaches. CONCLUSION: A comprehensive literature review found only three prospective randomized clinical trials (RCT) comparing the DAA with another approach with greater than one-year follow-up. Two showed minor benefits within the early postoperative period only, and one of those showed poorer mid-term results. Most of the published comparison studies with short follow-up show longer surgical times and greater blood loss for the DAA, and many three-month comparison studies show higher complication rates for the DAA using a proprietary traction table. The complications included problems with wound healing, lateral femoral cutaneous nerve injury, femoral component loosening, and femoral fractures. Because of the lack of evidence from RCTs showing superiority of the DAA over other approaches and reports of higher complications, the opinion of a large majority (77.5%; 55/71) of HS surgeons was that the DAA lacks sufficient evidence to warrant its use. Cite this article: Bone Joint J 2020;102-B(7 Supple B):57-61.


Assuntos
Artroplastia de Quadril/métodos , Padrões de Prática Médica/estatística & dados numéricos , Cirurgiões , Medicina Baseada em Evidências , Humanos , Sociedades Médicas , Inquéritos e Questionários
9.
Bone Joint J ; 102-B(7_Supple_B): 122-128, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32600203

RESUMO

AIMS: Earlier studies dealing with trends in the management of osteonecrosis of the femoral head (ONFH) identified an increasing rate of total hip arthroplasties (THAs) and a decreasing rate of joint-preserving procedures between 1992 and 2008. In an effort to assess new trends in the management of this condition, this study evaluated the annual trends of joint-preserving versus arthroplasties for patients aged < or > 50 years old, and the incidence of specific operative management techniques. METHODS: A total of 219,371 patients with ONFH were identified from a nationwide database between 1 January 2009 and 31 December 2015. The mean age was 54 years (18 to 90) and 105,298 (48%) were female. The diagnosis was made using International Classification of Disease, Ninth revision, Clinical Modification (ICD-9-CM) and Tenth Revision, Clinical Modification (ICD-10-CM) procedure codes. The percentage of patients managed using each procedure during each year was calculated and compared between years. The trends in the use of the types of procedure were also evaluated. RESULTS: The rate of joint-preserving procedures was significantly higher in patients aged < 50 years compared with those aged > 50 years (4.93% vs 1.52%; p < 0.001). For the overall cohort, rates of arthroplasty were far greater than those for joint-preserving procedures. THA was the most commonly performed procedure (291,114; 94.03%), while osteotomy (3,598; 1.16%), partial arthroplasty (9,171; 2.96%), core decompression (1,200; 0.39%), and bone graft (3,026; 0.98%) were performed markedly less frequently. The annual percentage of patients managed using a THA (93.56% to 89.52%; p < 0.001), resurfacing (1.22% to 0.19%; p < 0.001), and osteotomy (1.31% to 1.05%; p < 0.001) also decreased during the study period. CONCLUSION: We found that patients with ONFH have been most commonly managed with non-joint-preserving procedures. Our findings provide valuable insight into the current management of this condition and should increase efforts being made to save the hip joint. Cite this article: Bone Joint J 2020;102-B(7 Supple B):122-128.


Assuntos
Necrose da Cabeça do Fêmur/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia/estatística & dados numéricos , Artroplastia de Quadril/métodos , Artroplastia de Quadril/estatística & dados numéricos , Transplante Ósseo/estatística & dados numéricos , Bases de Dados Factuais , Descompressão Cirúrgica/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos , Adulto Jovem
10.
Bone Joint J ; 102-B(9): 1136-1145, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32634023

RESUMO

AIMS: During the COVID-19 pandemic, many patients continue to require urgent surgery for hip fractures. However, the impact of COVID-19 on perioperative outcomes in these high-risk patients remains unknown. The objectives of this study were to establish the effects of COVID-19 on perioperative morbidity and mortality, and determine any risk factors for increased mortality in patients with COVID-19 undergoing hip fracture surgery. METHODS: This multicentre cohort study included 340 COVID-19-negative patients versus 82 COVID-19-positive patients undergoing surgical treatment for hip fractures across nine NHS hospitals in Greater London, UK. Patients in both treatment groups were comparable for age, sex, body mass index, fracture configuration, and type of surgery performed. Predefined perioperative outcomes were recorded within a 30-day postoperative period. Univariate and multivariate analysis were used to identify risk factors associated with increased risk of mortality. RESULTS: COVID-19-positive patients had increased postoperative mortality rates (30.5% (25/82) vs 10.3% (35/340) respectively, p < 0.001) compared to COVID-19-negative patients. Risk factors for increased mortality in patients with COVID-19 undergoing surgery included positive smoking status (hazard ratio (HR) 15.4 (95% confidence interval (CI) 4.55 to 52.2; p < 0.001) and greater than three comorbidities (HR 13.5 (95% CI 2.82 to 66.0, p < 0.001). COVID-19-positive patients had increased risk of postoperative complications (89.0% (73/82) vs 35.0% (119/340) respectively; p < 0.001), more critical care unit admissions (61.0% (50/82) vs 18.2% (62/340) respectively; p < 0.001), and increased length of hospital stay (mean 13.8 days (SD 4.6) vs 6.7 days (SD 2.5) respectively; p < 0.001), compared to COVID-19-negative patients. CONCLUSION: Hip fracture surgery in COVID-19-positive patients was associated with increased length of hospital stay, more admissions to the critical care unit, higher risk of perioperative complications, and increased mortality rates compared to COVID-19-negative patients. Risk factors for increased mortality in patients with COVID-19 undergoing surgery included positive smoking status and multiple (greater than three) comorbidities. Cite this article: Bone Joint J 2020;102-B(9):1136-1145.


Assuntos
Artroplastia de Quadril/efeitos adversos , Infecções por Coronavirus/epidemiologia , Fraturas do Quadril/cirurgia , Mortalidade Hospitalar , Pneumonia Viral/epidemiologia , Complicações Pós-Operatórias/mortalidade , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Artroplastia de Quadril/métodos , Causas de Morte , Estudos de Coortes , Feminino , Fraturas do Quadril/epidemiologia , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pandemias , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/fisiopatologia , Valores de Referência , Medição de Risco , Reino Unido
11.
Orthopade ; 49(8): 737-748, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32710138

RESUMO

Gluteal insufficiency or hip abductor mechanism deficiency mainly following (revision) total hip replacement is associated with highly painful complaints and severe suffering of patients. It represents a great diagnostic and therapeutic challenge. Differentiated conservative treatment pathways, open surgical and endoscopic anatomic repair techniques with intact gluteal musculature and muscle transfer are available as salvage procedures for chronic not anatomically reconstructable mass ruptures. A stepwise diagnostic and therapeutic approach is required for restoration of the quality of life and painless or almost painless mobility of affected patients in occupation and daily life.


Assuntos
Artralgia/etiologia , Artroplastia de Quadril/métodos , Artroplastia de Quadril/psicologia , Nádegas/lesões , Músculo Esquelético/lesões , Músculo Esquelético/cirurgia , Qualidade de Vida , Procedimentos Cirúrgicos Reconstrutivos/métodos , Traumatismos dos Tendões/etiologia , Artralgia/diagnóstico , Artralgia/cirurgia , Nádegas/cirurgia , Endoscopia , Humanos , Traumatismos dos Nervos Periféricos/diagnóstico , Traumatismos dos Nervos Periféricos/epidemiologia , Traumatismos dos Nervos Periféricos/etiologia , Traumatismos dos Nervos Periféricos/terapia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Reoperação , Ruptura , Traumatismos dos Tendões/diagnóstico , Traumatismos dos Tendões/epidemiologia , Traumatismos dos Tendões/terapia , Resultado do Tratamento
12.
J Am Acad Orthop Surg ; 28(14): e586-e594, 2020 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-32692094

RESUMO

Notable advances in hip arthroplasty implants and techniques over the past 60 years have yielded excellent survivorship of fully cemented, hybrid, and reverse hybrid total hip replacements as demonstrated in joint registries worldwide. Major advances in noncemented implants have reduced the use of cement, particularly in North America. Noncemented implants predominate today based on procedural efficiency, concern related to thromboembolic risk, and a historic belief that cement was the primary cause of osteolysis and implant loosening. With the decline of cemented techniques, press-fit fixation has become common even in osteoporotic elderly patients. Unfortunately, there is a troubling rise in intraoperative, as well as early and late postoperative periprosthetic fractures associated with the use of noncemented implants. Despite the success of noncemented fixation, an understanding of modern cement techniques and cemented implant designs is useful to mitigate the risk of periprosthetic fractures. Cemented acetabular components can be considered in elderly patients with osteoporotic or pathologic bone. Cemented stems should be considered with abnormal proximal femoral morphology, conversion of failed hip fixation, inflammatory arthritis, patient age over 75 (especially women), osteoporotic bone (Dorr C), and in the treatment of femoral neck fractures.


Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Cimentos para Ossos , Fraturas do Colo Femoral/cirurgia , Prótese de Quadril/efeitos adversos , Fraturas Periprotéticas/etiologia , Fraturas Periprotéticas/prevenção & controle , Desenho de Prótese , Idoso , Feminino , Fraturas Espontâneas/cirurgia , Humanos , Masculino , Osteoporose , Falha de Prótese
13.
Bone Joint J ; 102-B(6): 699-708, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32475246

RESUMO

AIMS: Short, bone-conserving femoral components are increasingly used in total hip arthroplasty (THA). They are expected to allow tissue-conserving implantation and to render future revision surgery more straightforward but the long-term data on such components is limited. One such component is the global tissue-sparing (GTS) stem. Following the model for stepwise introduction of new orthopaedic implants, we evaluated early implant fixation and clinical outcome of this novel short-stem THA and compared it to that of a component with established good long-term clinical outcome. METHODS: In total, 50 consecutive patients ≤ 70 years old with end-stage symptomatic osteo-arthritis were randomized to receive THA with the GTS stem or the conventional Taperloc stem using the anterior supine intermuscular approach by two experienced hip surgeons in two hospitals in the Netherlands. Primary outcome was implant migration. Patients were followed using routine clinical examination, patient reported outcome using Harris Hip Score (HHS), Hip Disability And Osteoarthritis Outcome Score (HOOS), EuroQol five-dimension questionnaire (EQ5D), and Roentgen Stereophotogrammetric Analysis (RSA) at three, six, 12, and 24 months. This study evaluated the two-year follow-up results. RESULTS: In addition to the initial migration pattern of distal migration (subsidence, Y-translation) and retroversion (Y-rotation) also exhibited by the Taperloc stem, the GTS stem showed an initial migration pattern of varization (X-translation combined with Z-rotation) and posterior translation (Z-translation). However, all components stabilized aside from one Taperloc stem which became loose secondary to malposition and was later revised. Clinical outcomes and complications were not statistically significantly different with the numbers available. CONCLUSION: A substantially different and more extensive initial migration pattern was seen for the GTS stem compared to the Taperloc stem. Although implant stabilization was achieved, excellent long-term survival similar to that of the Taperloc stem should not be inferred. Especially in the absence of clinically proven relevant improvement, widespread usage should be postponed until long-term safety has been established. Cite this article: Bone Joint J 2020;102-B(6):699-708.


Assuntos
Artroplastia de Quadril/métodos , Prótese de Quadril , Osteoartrite do Quadril/cirurgia , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese
14.
Anaesthesia ; 75(8): 1050-1058, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32500530

RESUMO

In the UK, tranexamic acid is recommended for all surgical procedures where expected blood loss exceeds 500 ml. However, the optimal dose, route and timing of administration are not known. This study aimed to evaluate current practice of peri-operative tranexamic acid administration. Patients undergoing primary total hip arthroplasty, total knee arthroplasty or unicompartmental knee arthroplasty during a 2-week period were eligible for inclusion in this prospective study. The primary outcome was the proportion of patients receiving tranexamic acid in the peri-operative period. Secondary outcomes included: dose, route and timing of tranexamic acid administration; prevalence of pre- and postoperative anaemia; estimated blood loss; and red blood cell transfusion rates. In total, we recruited 1701 patients from 56 NHS hospitals. Out of these, 1523 (89.5%) patients received tranexamic acid and of those, 1052 (69.1%) received a single dose of 1000 mg intravenously either pre- or intra-operatively. Out of the 1701 patients, 571 (33.6%) and 1386 (81.5%) patients were anaemic (haemoglobin < 130 g.l-1 ) in the pre- and postoperative period, respectively. Mean (SD) estimated blood loss for all included patients was 792 (453) ml and 54 patients (3.1%) received a red blood cell transfusion postoperatively. The transfusion rate for patients with pre-operative anaemia was 6.5%, compared with 1.5% in patients without anaemia. Current standard of care in the UK is to administer 1000 mg of tranexamic intravenously either pre- or intra-operatively. Approximately one-third of patients present for surgery with anaemia, although the overall red blood cell transfusion rate is low. These data provide useful comparators when assessing the efficacy of tranexamic acid and other patient blood management interventions in future studies.


Assuntos
Antifibrinolíticos/uso terapêutico , Artroplastia de Substituição/métodos , Ácido Tranexâmico/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Anemia/complicações , Artroplastia de Quadril/métodos , Artroplastia do Joelho/métodos , Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue , Estudos de Coortes , Transfusão de Eritrócitos , Feminino , Humanos , Extremidade Inferior , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos
16.
PLoS One ; 15(6): e0233035, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32574168

RESUMO

BACKGROUND: Modular stems are widely used in revision total hip arthroplasty (THA) with aseptic loosening being a common reason for revision. Despite the good results reported on the use of modular stem designs, there are only few studies focusing on aseptic revisions and few studies on a hexagonal stem design. The goal of this study is to determine stem survival, clinical and functional outcome along with possible risk factors for implant failure in aseptic revision THA. METHODS: We retrospectively identified 53 patients with aseptic THA revision using a modular hexagonal stem with a minimum follow-up of two years. Femoral bone loss, radiographic and clinical outcomes as well as function measured using the Harris Hip Score (HHS) was assessed. Patients' previous medical history was analyzed for comorbidities and the body mass index. Stem survival was calculated using the Kaplan-Meier method. Possible risk factors for implant failure were analyzed using the log-rank test. The median age at revision was 69 (IQR 62-73) with a median follow up of 74 months. RESULTS: Implant survival rates amounted to 90.4% at 3 and 5 years. The median HHS improved by 47 points (34 (IQR 22-47) vs 81 (IQR 59-90) p<0.001). There was a reduced implant survival after 5 years when the revision stem was used following a previous cemented stem (83.4% vs 100%, p = 0.04). CONCLUSION: A modular, hexagonal stem can be successfully used in aseptic revision THA with remarkable functional results and excellent survivorship. Revision of a cemented stem using this implant might result in reduced survival which must be considered when planning treatment.


Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Desenho de Prótese/instrumentação , Idoso , Feminino , Fêmur/cirurgia , Articulação do Quadril/fisiopatologia , Articulação do Quadril/cirurgia , Prótese de Quadril/efeitos adversos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Falha de Prótese , Reoperação/métodos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
17.
Value Health ; 23(6): 719-726, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32540229

RESUMO

OBJECTIVES: To estimate threshold prices for computer- and robot-assisted knee and hip replacement. METHODS: A lifetime cohort Markov model provided the framework for analysis. Linked primary care and inpatient hospital records informed estimates of outcomes under current practice. Outcomes were estimated under a range of hypothetical relative improvements in quality of life if unrevised and in revision risk after computer or robot-assisted surgery. Threshold prices, a price at which the net health benefit from funding the intervention would be zero, for these improvements were estimated for a cost-effectiveness threshold of £20 000 per additional quality-adjusted life-year (QALY) gained. RESULTS: For average patient profiles under current knee and hip replacement practice, lifetime QALYs were 10.3 (9.9 to 10.7) and 11.0 (10.6 to 11.4), with costs of £6060 (£5947 to £6203) and £6506 (£6335 to £6710) for knee and hip replacement, respectively. A combined 50% relative reduction in risk of revision and 5% improvement in postoperative quality of life if unrevised would, for example, result in QALYs increasing to 10.9 (10.4 to 11.3) and 11.6 (11.2 to 12.0), and costs falling to £5880 (£5816 to £5956) and £6258 (£6149 to £6376) after knee and hip replacement, respectively. These particular improvements would have an associated threshold price of £11 182 (£10 691 to £11 721) for knee replacement and £12 134 (£11 616 to £12 701) for hip replacement. The 50% reduction in revision rate alone would have associated threshold prices of £1094 (£788 to £1488) and £1347 (£961 to £1842), and the 5% improvement in quality of life alone would have associated threshold prices of £9911 (£9476 to £10 296) and £10 578 (£10 171 to £10 982). CONCLUSIONS: At current prices, computer- and robot-assisted knee and hip replacement will likely need to lead to improvements in patient-reported outcomes in addition to any reduction in the risk revision.


Assuntos
Artroplastia de Quadril/métodos , Artroplastia do Joelho/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Cirurgia Assistida por Computador/métodos , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/economia , Artroplastia do Joelho/economia , Análise Custo-Benefício , Inglaterra , Feminino , Humanos , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Procedimentos Cirúrgicos Robóticos/economia , Cirurgia Assistida por Computador/economia
18.
Medicine (Baltimore) ; 99(20): e20259, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443366

RESUMO

BACKGROUND: Femoral head avascular necrosis (FHAN) is a very common condition among elderly population. Previous studies have reported that total hip arthroplasty (THAP) can benefit patients with such condition. However, no study systematically addressed this topic. Thus, this study will systematically explore the efficacy and safety of THAP for the treatment of patients with FHAN. METHODS: We will search the following electronic bibliographic databases from inception to the February 29, 2020: MEDLINE, EMBASE, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, China National Knowledge Infrastructure, and Chinese Scientific Journal Database. Randomized controlled trials of THAP for the treatment of patients with FHAN will be included, which were reported in any language. All process of study selection, data collection, and study quality assessment will be performed independently by 2 authors independently. Any divergences will be solved by discussion with another author. RevMan 5.3 software will be carried out for data synthesis and analysis. RESULTS: This study will provide a detailed summary of current evidence related to the efficacy and safety of THAP for the treatment of patients with FHAN through assessing pain intensity of hip or knee joints, function and limitation of attacked femoral head, health-related quality of life, and complications. CONCLUSION: The findings of this study may provide helpful guidance of THAP for the treatment of patients with FHAN. SYSTEMATIC REVIEW REGISTRATION: INPLASY202040067.


Assuntos
Artroplastia de Quadril/métodos , Necrose da Cabeça do Fêmur/cirurgia , Artroplastia de Quadril/efeitos adversos , Humanos , Dor , Desempenho Físico Funcional , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
19.
Can J Surg ; 63(3): E202-E207, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32356947

RESUMO

Background: Fibrous dysplasia (FD) results from an abnormality in lamellar bone formation and most frequently involves the proximal femur. This can lead to the development of osteoarthritis requiring total hip arthroplasty (THA). Such cases are challenging, and there is a lack of information guiding best management. As such, we devised a study assessing the outcomes and complications in patients with FD undergoing THA with modern implant technology, and we outlined our preferred surgical technique. Methods: A search of our institutional arthroplasty database was performed to identify patients who underwent THA for FD between January 2001 and July 2018 at Mount Sinai Hospital in Toronto, Canada. Data regarding implants used and the use of allograft material or metal augments or both were obtained. Complications and revision requirements were noted. Radiographic and clinical leg length discrepancies were assessed. Results: A total of 10 hips in 9 patients who underwent THA for FD were identified. Mean follow-up time was 6.0 years (range 0.5 to 10.3 yr). The majority of patients underwent THA using uncemented femoral and acetabular components with large femoral heads on highly cross-linked polyethylene liners. Most cases (80% of hips) required allograft to the proximal femur. A single complication requiring revision was noted. In 90% of hip surgeries, the patient required transfusion of packed red blood cells. Mean radiographic and clinical leg length discrepancies were 0.9 cm (range -2.4 to 2.4 cm) and 0.9 cm (range -4 to 0 cm), respectively. Conclusion: Contrary to previous reports, low complication and revision rates were observed with cementless components and routine use of allograft material. The challenging nature of such cases warrants use of an experienced arthroplasty treatment team.


Assuntos
Artroplastia de Quadril/métodos , Fêmur/diagnóstico por imagem , Previsões , Prótese de Quadril , Osteoartrite do Quadril/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/diagnóstico , Desenho de Prótese , Falha de Prótese , Radiografia , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
20.
Medicine (Baltimore) ; 99(19): e20018, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384460

RESUMO

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).


Assuntos
Artroplastia de Quadril/efeitos adversos , Osteoartrite do Quadril , Doença de Parkinson/complicações , Complicações Pós-Operatórias , Recuperação de Função Fisiológica , Reoperação , Idoso , Artroplastia de Quadril/métodos , Estudos de Casos e Controles , Protocolos Clínicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Osteoartrite do Quadril/complicações , Osteoartrite do Quadril/cirurgia , Avaliação de Resultados em Cuidados de Saúde , Preferência do Paciente , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Amplitude de Movimento Articular , Reoperação/métodos , Reoperação/estatística & dados numéricos
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