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1.
Ortop Traumatol Rehabil ; 23(5): 361-374, 2021 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-34734562

RESUMO

BACKGROUND: Total cementless hip joint arthroplasty is universally recognized as a method of treatment of ad-vanced hip osteoarthritis. Multifaceted research by a wide group of implant specialists has led to the development of special implants that fulfill their purpose even in the most severe deformities of the hip joint. The aim of the study is to present and analyse the results of hip joint arthroplasty with the Antega anatomical stem. MATERIALS AND METHODS: The study enrolled 533 patients (342 women and 191 men) who underwent a total of 595 hip joint arthroplasties with the Antega anatomical stem. The mean age of the patients at surgery was 56.2 years (range: 20-87 years). The mean follow-up period was 7.3 years (range: 5-15.5 years). RESULTS: Pre-operative Merle d'Aubigne-Postel scores (modified by Charnley) were poor in all patients. Mean post-operative improvement was 6.1 points. The outcomes were classified as excellent in 419 cases (70.4%), good in 102 cases (17.1%), satisfactory in 39 (6.6%) and poor in 34 cases. Poor results were usually associated with loosening of one of the prosthetic components. Heterotopic ossification was noted in 37 cases (6.2%). According to the Kaplan-Meier estimator, 10 years' survival probability was 89.9% for the whole implant and 96.1% for the stem alone. CONCLUSIONS: 1. Our follow-up data (from a mean follow-up period of more than 10 years) indicate that the Antega anatomical stem affords excellent clinical and functional results. 2. With good surgical technique and in the absence of complications, the risk of aseptic loosening is minimal. 3. Modification of the Antega stem implantation technique significantly reduces the risk of so-called unexplained thigh pain, which sometimes occurs following hip replacement surgery. 4. As only medium-term follow-up data are available, there may be more cases of loosening (mainly of the acetabular cup) over time, requiring regular long-term follow-up.


Assuntos
Artroplastia de Quadril , Prótese de Quadril , Osteoartrite do Quadril , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/cirurgia , Desenho de Prótese , Reoperação , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
2.
Acta Biomed ; 92(S1): e2021259, 2021 11 04.
Artigo em Inglês | MEDLINE | ID: mdl-34747388

RESUMO

BACKGROUND: The increase in the incidence of osteoarthritis of the hip (coxarthrosis) in young patients with high functionality requirements and the development of new materials in the last twenty years have resulted in an increase in the number of surgeries involving hip resurfacing procedures. There has also been an increase in associated periprosthetic fractures, which currently occur in 1%-2% of cases. According to the medical literature, fractures of this type can be treated conservatively, using reduction and synthesis or through prosthetic revision. CASE REPORT: Patient aged 69 years who had undergone resurfacing of the right hip ten years previously, who came to our attention as a result of direct contusion trauma with x-ray evidence of a periprosthetic fracture in the subtrochanteric region. We treated the fracture by preserving the prosthesis and performing osteosynthesis using a plate and screws. After two months the synthesis was complicated by breakage of a proximal screw and varus collapse of the fracture. We treated this complication conservatively by adjusting the weight-bearing regime and administering physical and drug therapy. Six months after the fracture, despite the residual varus displacement and the less than stellar x-ray result, the clinical outcome was satisfactory. Discussion and conclusions: Treatment of periprosthetic fractures following hip resurfacing is often technically complex. The major difficulties arise from the presence of prosthetic components and the limited bone stock available. Fractures often affect the neck of the femur and the trochanteric region, and in rare cases there is involvement of the subtrochanteric region. Our review confirms this trend and raises the question as to which method of synthesis is ideal for a fracture pattern so rarely described in the literature.


Assuntos
Artroplastia de Quadril , Fraturas do Fêmur , Fraturas do Quadril , Osteoartrite do Quadril , Fraturas Periprotéticas , Artroplastia de Quadril/efeitos adversos , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas , Consolidação da Fratura , Fraturas do Quadril/diagnóstico por imagem , Fraturas do Quadril/etiologia , Fraturas do Quadril/cirurgia , Humanos , Osteoartrite do Quadril/diagnóstico por imagem , Osteoartrite do Quadril/etiologia , Osteoartrite do Quadril/cirurgia , Fraturas Periprotéticas/diagnóstico por imagem , Fraturas Periprotéticas/etiologia , Fraturas Periprotéticas/cirurgia
3.
Medicina (Kaunas) ; 57(11)2021 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-34833437

RESUMO

Background and objectives: The influence of changes in spinal alignment after total hip arthroplasty (THA) on improvement in lower back pain (LBP) remains controversial. To evaluate how changes in spinal malalignment correlate with improvement in preoperative LBP in patients who underwent THA for hip osteoarthritis. Materials and Methods: From November 2015 to January 2017, 104 consecutive patients who underwent unilateral THA were prospectively registered. Whole spine X-rays and patient-reported outcomes (PROs) were obtained preoperatively and 12 months postoperatively. The PROs used were the Numerical Rating Scale (NRS) for back pain, EuroQol 5 Dimension, and Short Form-12. Results: Seventy-four (71%) patients with complete data were eligible for the analysis. The sagittal parameters changed slightly but significantly. Coronal alignment significantly improved. Twenty-six (37%) patients had LBP preoperatively. These patients had smaller lumbar lordosis (LL), larger PT, and larger PI minus LL than the patients without LBP. Fourteen (54%) of the 26 patients with preoperative LBP showed pain improvement, but there were no significant differences in the radiographic parameters. Conclusions: Although preoperative LBP was likely to be resolved after THA, there were no significant correlations between alignment changes and LBP improvement. The cause of LBP in patients with hip osteoarthritis (OA) patients might be multifactorial.


Assuntos
Artroplastia de Quadril , Lordose , Dor Lombar , Osteoartrite do Quadril , Humanos , Dor Lombar/etiologia , Dor Lombar/cirurgia , Osteoartrite do Quadril/complicações , Osteoartrite do Quadril/diagnóstico por imagem , Osteoartrite do Quadril/cirurgia , Coluna Vertebral
4.
BMC Musculoskelet Disord ; 22(1): 887, 2021 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-34666727

RESUMO

BACKGROUND: To examine the association between circulating 25(OH)D concentrations and incidence of total hip replacement for osteoarthritis in a prospective cohort study. METHODS: This study examined a random sample of 2651 participants in the Melbourne Collaborative Cohort Study who had 25(OH)D concentrations measured from dried blood spots collected in 1990-1994. Participants who underwent total hip replacement for osteoarthritis between January 2001 and December 2018 were identified by linking the cohort records to the Australian Orthopaedic Association National Joint Replacement Registry. Cox proportional hazard regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) of total hip replacement for osteoarthritis in relation to 25(OH)D concentrations, adjusted for confounders. RESULTS: Eighty-six men and eighty-seven women had a total hip replacement for osteoarthritis. Compared with men in the lowest (1st) quartile of 25(OH)D concentration, the HR for total hip replacement was 2.32 (95% CI 1.05, 5.13) for those in the 2nd quartile, 2.77 (95% CI 1.28, 6.00) for those in the 3rd quartile, and 1.73 (95% CI 0.75, 4.02) for those in the highest quartile of 25(OH)D concentrations (p for trend 0.02). There was little evidence of an association in women. CONCLUSIONS: Higher circulating 25(OH)D concentrations were associated with an increased risk of total hip replacement for osteoarthritis in men but not in women. Although the underlying mechanism warrants further investigation, our findings highlight the need to determine the optimal levels of circulating 25(OH)D to reduce the risk of hip osteoarthritis.


Assuntos
Artroplastia de Quadril , Osteoartrite do Quadril , Artroplastia de Quadril/efeitos adversos , Austrália/epidemiologia , Estudos de Coortes , Feminino , Humanos , Masculino , Osteoartrite do Quadril/diagnóstico , Osteoartrite do Quadril/epidemiologia , Osteoartrite do Quadril/cirurgia , Estudos Prospectivos , Fatores de Risco , Vitamina D/análogos & derivados
5.
BMJ Open ; 11(10): e051392, 2021 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-34686555

RESUMO

INTRODUCTION: Hip osteoarthritis (OA) is the leading cause for total hip arthroplasty (THA). Although, being considered as the surgery of the century up to 23% of the patients report long-term pain, and deficits in physical function and muscle strength may persist after THA. Progressive resistance training (PRT) appears to improve multiple outcomes moderately in patients with hip OA. Current treatment selection is based on low-level evidence as no randomised controlled trials have compared THA to non-surgical treatment. The primary aim of this trial is to investigate whether THA followed by standard care is superior to 12 weeks of supervised PRT followed by 12 weeks of optional unsupervised PRT for improving hip pain and function in patients with severe hip OA. METHODS AND ANALYSIS: This is a protocol for a multicentre, parallel-group, assessor-blinded, randomised controlled superiority trial conducted at four hospitals across three healthcare regions in Denmark. 120 patients aged ≥50 years with clinical and radiographic hip OA found eligible for THA by an orthopaedic surgeon will be randomised to THA followed by standard care, or 12 weeks of PRT (allocation 1:1). The primary outcome will be change in patient-reported hip pain and function, measured using the Oxford Hip Score, from baseline to 6 months after initiating the treatment. Key secondary outcomes will be change in the Hip disability and Osteoarthritis Outcome Score subscales, University of California Los Angeles Activity Score, 40 m fast-paced walk test, 30 s chair stand test and occurrence of serious adverse events. Patients declining participation in the trial will be invited into a prospective observational cohort study. ETHICS AND DISSEMINATION: The trial has been approved by The Regional Committees on Health Research Ethics for Southern Denmark (Project-ID: S-20180158). All results will be presented in peer-reviewed scientific journals and international conferences. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov (NCT04070027).


Assuntos
Artroplastia de Quadril , Osteoartrite do Quadril , Treinamento de Força , Quadril/cirurgia , Humanos , Estudos Multicêntricos como Assunto , Estudos Observacionais como Assunto , Osteoartrite do Quadril/cirurgia , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
6.
Orthop Surg ; 13(6): 1882-1889, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34605608

RESUMO

OBJECTIVE: To investigate the relief of low back pain after hip arthroplasty in patients with hip joint and spinal degenerative diseases, and to discuss the effects of unilateral and bilateral hip surgery on the relief of low back pain. METHODS: In this retrospective study, we followed 153 patients (69 males and 84 females, age: 43-88 years) who had undergone total hip arthroplasty (THA) via a posterolateral approach and also suffered from lumbar degenerative diseases in the period of 2009 to 2019. The inclusion criteria were: (i) patients who had been diagnosed with severe hip degenerative disease and also been diagnosed with lumbar degenerative disease; (ii) patients who had undergone THA surgery; and (iii) patients who were retrospectively recruited. The exclusion criteria were: (i) patients who had undergone lumbar fusion or internal fixation surgery; or (ii) patients who had vascular claudication, history of major trauma, diabetic polyneuropathy, lumbar and pelvic infections, tumor diseases; (iii) or patients who had undergone THA because of femoral neck fracture or ankylosing spondylitis. The improvement of hip joint function and the relief of low back pain (LBP) were studied, and the effect of unilateral and bilateral THA on the relief of LBP were discussed. Hip pain and function were evaluated by the Harris Hip Score (HHS), LBP was evaluated by Visual Analog Scale (VAS), and lumbar function was evaluated by the Japanese Orthopaedic Association (JOA) scoring system. RESULTS: The average follow-up time was 44.3 months (24-108 months). All patients recovered smoothly without complications. The LBP VAS of 153 patients decreased from 4.13 ± 1.37 preoperatively to 1.90 ± 1.44 postoperatively. The average HHS increased from 45.33 ± 13.23 preoperatively to 86.44 ± 7.59 postoperatively at the latest follow-up. According to Japanese Orthopaedic Association scoring system, the proportion of patients with good response to treatment in these 153 patients reached 93.46%. LBP VAS decreased from 4.18 ± 1.38 preoperatively to 1.95 ± 1.49 postoperatively in unilateral group and from 3.94 ± 1.32 preoperatively to 1.73 ± 1.23 postoperatively in bilateral group, respectively. There were only nine patients with persistent or aggravated LBP after operation. Among them, six patients underwent subsequent lumbar surgery (five patients had pain relieved after reoperation and one patient had not) and the other three patients chose conservative treatment for pain. CONCLUSION: THA can relieve LBP while relieving hip pain and restoring hip function in patients with both hip and lumbar degenerative disease, thus possibly avoiding further spinal surgery.


Assuntos
Artroplastia de Quadril/métodos , Degeneração do Disco Intervertebral/terapia , Dor Lombar/terapia , Osteoartrite do Quadril/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Medidas de Resultados Relatados pelo Paciente , Período Pós-Operatório , Estudos Retrospectivos
7.
Medicina (Kaunas) ; 57(9)2021 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-34577813

RESUMO

Background and Objectives: The degenerative pathology of the hip joint appears in young age groups, related to fem-oroacetabular impingement, and in advanced age, due to other inflammatory causes, with greater potential for severity in the presence of comorbidities. Objectives: To evaluate the participation of the main causes of osteoarthritis in relation to physical activities, s Body Mass Index (BMI) and television time (TV). Materials and Methods: 54 patients with surgical indication treated at an orthopedic referral university hospital were stratified into groups (Impact: I, Osteonecrosis/rheumatic: II, Infectious/traumatic: III), and the influence of comorbidities on physical activity performance, relative to BMI and TV time. Results: It was observed that the impact group was the most frequent (51.8%), with 79.6% under the age of 60 years. This group followed the general mean (p < 0.05), using the variables of comorbidity and the level of physical activity. Pain intensity, TV time, BMI showed no correlation with physical activity. Conclusion: Morphostructural changes (group I) represented the most frequent etiological group, and severe pain was common in almost the entire sample. Unlike BMI, comorbidity showed a significant relationship with the level of physical activity.


Assuntos
Osteoartrite do Quadril , Comorbidade , Estudos Transversais , Exercício Físico , Humanos , Pessoa de Meia-Idade , Osteoartrite do Quadril/epidemiologia , Osteoartrite do Quadril/cirurgia , Dor/epidemiologia , Dor/etiologia
8.
BMC Musculoskelet Disord ; 22(1): 827, 2021 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-34579703

RESUMO

BACKGROUND: Identifying populations with poor muscle recovery after total hip arthroplasty (THA) is important for postoperative physical therapy. Preoperative muscle strength is a strong factor that determines postoperative muscle strength. However, this effect may depend on other factors. Thus, predictive models with interaction terms are important for accurately predicting postoperative muscle strength. This study aimed to develop a predictive model for lower muscle strength 12 months after THA which incorporates interaction terms. METHODS: Subjects were female patients with hip osteoarthritis who underwent unilateral THA. Patients with locomotor disorders, neurological disorders, or postoperative complications were excluded. Hip abductor and knee extensor strength were measured, and a generalized linear model approach with preoperative muscle strength, age, body weight, height, disease duration, physical activity, and leg extension as explanatory variables was used to identify factors that determine muscle strength 12 months after THA. Models with interaction terms between preoperative muscle strength and other explanatory variables were also examined. RESULTS: A total of 82 patients were analyzed. Preoperative muscle strength, age, body weight, physical activity, and disease duration were extracted as factors that significantly and independently determine hip abductor and knee extensor strength. The interaction term between preoperative muscle strength and age was identified as a factor that significantly determines knee extensor strength. Regression coefficients for preoperative knee extensor strength and postoperative muscle strength were significant when age was +1 SD, but not when age was -1 SD. CONCLUSIONS: The predictive model demonstrated that lower muscle strength 12 months after THA is determined by preoperative muscle strength, age, weight, physical activity, disease duration, and preoperative muscle strength, with the effect of preoperative muscle strength on knee extensor strength being dependent on age. When predicting postoperative knee extensor strength using preoperative muscle strength, it is important to consider the effect of age.


Assuntos
Artroplastia de Quadril , Osteoartrite do Quadril , Artroplastia de Quadril/efeitos adversos , Feminino , Humanos , Lactente , Joelho , Articulação do Joelho , Força Muscular , Osteoartrite do Quadril/cirurgia
9.
Orthop Clin North Am ; 52(4): 323-333, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34538345

RESUMO

Optimal management of acetabular fractures (AF) in the elderly has not been defined clearly. The incidence of such fractures is rising in the aging population. Advancements in implant technology have improved the longevity of combined or staggered total hip arthroplasty procedures for this patient population, thus allowing earlier weight bearing and continued functional independence. Perioperative/postoperative complication rates remain significantly high in all treatment arms. Overall, the best outcomes with the lowest complication rates are achieved when AF are treated by a surgeon or a team of surgeons who specialize in both orthopedic traumatology and adult reconstruction.


Assuntos
Acetábulo/lesões , Artroplastia de Quadril/métodos , Fraturas Ósseas/cirurgia , Redução Aberta/métodos , Acetábulo/cirurgia , Idoso , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/complicações , Humanos , Pessoa de Meia-Idade , Osteoartrite do Quadril/complicações , Osteoartrite do Quadril/cirurgia , Osteoporose/complicações , Osteoporose/cirurgia , Resultado do Tratamento
10.
Arthritis Res Ther ; 23(1): 235, 2021 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-34493331

RESUMO

BACKGROUND: Evidence on prognostic factors associated with progression to total hip replacement (THR) in hip osteoarthritis (OA) is for the most patient- and disease-specific characteristics either conflicting or inconclusive. Therefore, the objectives of this study of participants with hip OA enrolled in a structured program of supervised education and exercise therapy were to describe the rate of THR and to identify prognostic factors for receiving THR within the following 2 years. METHODS: Participants aged ≥ 45 years with hip OA enrolled in Good Life with osteoArthritis in Denmark (GLA:D®) from July 2014 to March 2017 were included. Potential prognostic factors included demographic and disease-specific baseline characteristics and measures of physical activity and quality of life (QoL). Information on THR was retrieved from The Danish National Patient Registry. A multivariable Cox proportional hazards model was developed. RESULTS: Of 3657 included participants, 30% received a THR within 2 years. Of the 100 participants already wait-listed for THR, 60% had the procedure. Of 22 candidate prognostic factors, 14 were statistically significant for receiving THR. Factors associated with a faster rate of THR included being "male" (HR 1.43), having "self-reported radiographic hip OA" (HR 2.32), being "wait-listed for THR" (HR 2.17), and having a higher "pain intensity" (HR 1.01). In contrast, faster "walking speed" (HR 0.64), better "hip-related QoL" (HR 0.98), and having "three or more comorbidities" (HR 0.62) were predictive of a slower rate of THR. CONCLUSION: During the 2-year follow-up period, 30% of the cohort received a THR. Notably, 40% of those wait-listed for THR when entering the program did not receive THR within 2 years. A number of baseline prognostic factors for receiving THR were identified.


Assuntos
Artroplastia de Quadril , Osteoartrite do Quadril , Terapia por Exercício , Humanos , Osteoartrite do Quadril/cirurgia , Prognóstico , Qualidade de Vida
11.
BMJ Open ; 11(9): e046712, 2021 09 23.
Artigo em Inglês | MEDLINE | ID: mdl-34556506

RESUMO

Total hip arthroplasty (THA) surgery for elderly people with multimorbidity increases the risk of serious health hazards including mortality. Whether such background morbidity reduces the clinical benefit is less clear. OBJECTIVE: To evaluate how pre-existing health status, using multiple approaches, influences risks of, and quality of life benefits from, THA. SETTING: Longitudinal record linkage study of a UK sample linking their primary care to their secondary care records. PARTICIPANTS: A total of 6682 patients were included, based on the recording of the diagnosis of hip osteoarthritis in a national primary care register and the recording of the receipt of THA in a national secondary care register.Data were extracted from the primary care register on background health and morbidity status using five different constructs: Charlson Comorbidity Index, Electronic Frailty Index (eFI) and counts of comorbidity disorders (from list of 17), prescribed medications and number of primary care visits prior to recording of THA. OUTCOME MEASURES: (1) Postoperative complications and mortality; (2) postoperative hip pain and function using the Oxford Hip Score (OHS) and health-related quality of life using the EuroQoL (EQ)-5D score. RESULTS: Perioperative complication rate was 3.2% and mortality was 0.9%, both increased with worse preoperative health status although this relationship varied depending on the morbidity construct: the eFI showing the strongest relationship but number of visits having no predictive value. By contrast, the benefits were not reduced in those with worse preoperative health, and improvement in both OHS and EQ-5D was observed in all the morbidity categories. CONCLUSIONS: Independent of preoperative morbidity, THA leads to similar substantial improvements in quality of life. These are offset by an increase in medical complications in some subgroups of patients with high morbidity, depending on the definition used. For most elderly people, their other health disorders should not be a barrier for THA.


Assuntos
Artroplastia de Quadril , Osteoartrite do Quadril , Idoso , Artroplastia de Quadril/efeitos adversos , Humanos , Morbidade , Osteoartrite do Quadril/cirurgia , Estudos Prospectivos , Qualidade de Vida , Medição de Risco
12.
BMJ Open ; 11(9): e046713, 2021 09 23.
Artigo em Inglês | MEDLINE | ID: mdl-34556507

RESUMO

The median age for total hip arthroplasty (THA) is over 70 years with the corollary that many individuals have multiple multimorbidities. Despite the predicted improvement in quality of life, THA might be denied even to those with low levels of multimorbidity. OBJECTIVE: To evaluate how pre-existing levels of multimorbidity influence the likelihood and timing of THA. SETTING: Longitudinal record linkage study of a UK sample linking their primary care to their secondary care records. PARTICIPANTS: A total of 28 025 patients were included, based on the recording of the diagnosis of hip osteoarthritis in a national primary care register, Clinical Practice Research Datalink. Data were extracted from the database on background health and morbidity status using five different constructs: Charlson Comorbidity Index, Electronic Frailty Index and counts of chronic diseases (from list of 17), prescribed medications and number of primary care visits prior to recording of osteoarthritis. OUTCOME MEASURES: The record of having received a THA as recorded in the primary care record and the linked secondary care database: Hospital Episode Statistics. RESULTS: 40% had THA: median follow 10 months (range 1-17 years). Increased multimorbidity was associated with a decreased likelihood of undergoing THA, irrespective of the method of assessing multimorbidity although the impact varied by approach. CONCLUSION: Markers of pre-existing ill health influence the decision for THA in the elderly with end-stage hip osteoarthritis, although these effects are modest for indices of multimorbidity other than eFI. There is evidence of this influence being present even in people with moderate decrements in their health, despite the balance of benefits to risk in these individuals being positive.


Assuntos
Artroplastia de Quadril , Osteoartrite do Quadril , Idoso , Estudos de Coortes , Humanos , Multimorbidade , Osteoartrite do Quadril/epidemiologia , Osteoartrite do Quadril/cirurgia , Atenção Primária à Saúde , Qualidade de Vida , Reino Unido/epidemiologia
13.
J Med Internet Res ; 23(9): e28320, 2021 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-34473068

RESUMO

BACKGROUND: Osteoarthritis is a disabling condition that is often associated with other comorbidities. Total hip or knee arthroplasty is an effective surgical treatment for osteoarthritis when indicated, but comorbidities can impair their results by increasing complications and social and economic costs. Integrated care (IC) models supported by eHealth can increase efficiency through defragmentation of care and promote patient-centeredness. OBJECTIVE: This study aims to assess the effectiveness and cost-effectiveness of implementing a mobile health (mHealth)-enabled IC model for complex chronic patients undergoing primary total hip or knee arthroplasty. METHODS: As part of the Horizon 2020 Personalized Connected Care for Complex Chronic Patients (CONNECARE) project, a prospective, pragmatic, two-arm, parallel implementation trial was conducted in the rural region of Lleida, Catalonia, Spain. For 3 months, complex chronic patients undergoing total hip or knee arthroplasty and their caregivers received the combined benefits of the CONNECARE organizational IC model and the eHealth platform supporting it, consisting of a patient self-management app, a set of integrated sensors, and a web-based platform connecting professionals from different settings, or usual care (UC). We assessed changes in health status (12-item short-form survey [SF-12]), unplanned visits and admissions during a 6-month follow-up, and the incremental cost-effectiveness ratio. RESULTS: A total of 29 patients were recruited for the mHealth-enabled IC arm, and 30 patients were recruited for the UC arm. Both groups were statistically comparable for baseline characteristics, such as age; sex; type of arthroplasty; and Charlson index, American Society of Anesthesiologists classification, Barthel index, Hospital Anxiety and Depression scale, Western Ontario and McMaster Universities Osteoarthritis Index, and Pfeiffer mental status questionnaire scores. Patients in both groups had significant increases in the SF-12 physical domain and total SF-12 score, but differences in differences between the groups were not statistically significant. IC patients had 50% fewer unplanned visits (P=.006). Only 1 hospital admission was recorded during the follow-up (UC arm). The IC program generated savings in different cost scenarios, and the incremental cost-effectiveness ratio demonstrated cost-effectiveness. CONCLUSIONS: Chronic patients undergoing hip or knee arthroplasty can benefit from the implementation of patient-centered mHealth-enabled IC models aimed at empowering patients and facilitating transitions from specialized hospital care to primary care. Such models can reduce unplanned contacts with the health system and reduce overall health costs, proving to be cost-effective. Overall, our findings support the notion of system-wide cross-organizational care pathways supported by mHealth as a successful way to implement IC for patients undergoing elective surgery.


Assuntos
Artroplastia do Joelho , Prestação Integrada de Cuidados de Saúde , Osteoartrite do Quadril , Osteoartrite do Joelho , Osteoartrite , Telemedicina , Humanos , Osteoartrite do Quadril/cirurgia , Osteoartrite do Joelho/cirurgia , Estudos Prospectivos , Resultado do Tratamento
14.
Int Orthop ; 45(11): 2805-2810, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34402950

RESUMO

PURPOSE: The American Academy of Orthopaedic Surgeons (AAOS) developed the appropriate use criteria (AUC) for the management of hip osteoarthritis (OA) to guide surgeons in making decisions based on the best available evidence. This study aimed to assess the applicability of the AUC by comparing the actual treatment provided at our institution with the AUC recommendations. METHODS: A retrospective review of 115 patients who were diagnosed and treated for hip OA at our institution between December 2017 and December 2019 was performed. Data were collected and entered into the AUC application to determine the rate of appropriateness of the provided treatment according to the AUC recommendations. Then, the actual provided treatments were compared with the AUC recommendations to determine the agreement between the two. RESULTS: There were 115 patients, with a mean age of 50.08 years (range, 30-80 years). The most frequent patient characteristics were middle age (40-65 years) with function-limiting pain at moderate to long distances, minimal hip OA on X-ray examination, mild range of motion limitation, and presence of modifiable risk factors for negative outcomes. The overall rate of appropriateness and in agreement with the AUC recommendations was 100% for conservative treatments and 80.1% for surgical treatments. CONCLUSIONS: This study shows that the majority of the hip OA treatments provided at our institution were appropriate and in agreement with the AUC recommendations. Furthermore, the AUC can be easily accessed through a free web application using a computer or smartphone to obtain the recommended treatment for any patient with hip OA.


Assuntos
Cirurgiões Ortopédicos , Osteoartrite do Quadril , Adulto , Idoso , Humanos , Pessoa de Meia-Idade , Osteoartrite do Quadril/diagnóstico , Osteoartrite do Quadril/cirurgia , Amplitude de Movimento Articular , Estudos Retrospectivos , Inquéritos e Questionários , Estados Unidos/epidemiologia
15.
Ugeskr Laeger ; 183(27)2021 07 05.
Artigo em Dinamarquês | MEDLINE | ID: mdl-34219643

RESUMO

Training may relieve symptoms in patients with mild to severe hip osteoarthritis and in patients who have received a total hip arthroplasty. Patients may train like healthy individuals. The effectiveness of training is dependent on sufficient dose and intensity. In this review, we suggest to prioritise research performed in the pre-clinical or in the mild to moderate stage of hip osteoarthritis where there is insufficient evidence on whether training has a disease-modifying effect or not. We also suggest that trials with long-term follow-up are performed for these patient groups.


Assuntos
Artroplastia de Quadril , Osteoartrite do Quadril , Nível de Saúde , Humanos , Osteoartrite do Quadril/cirurgia
16.
Can J Surg ; 64(4): E391-E402, 2021 07 23.
Artigo em Inglês | MEDLINE | ID: mdl-34296707

RESUMO

Background: The objective of this study was to compare the cost-effectiveness of minimally invasive surgery (MIS) for patients with degenerative lumbar spondylolisthesis (DLS) relative to failed medical management with the cost-effectiveness of hip and knee arthroplasty for matched cohorts of patients with osteoarthritis. Methods: A cohort of patients with DLS undergoing MIS procedures with decompression alone or decompression and instrumented fusion between 2008 and 2014 was matched to cohorts of patients with hip osteoarthritis (OA) and knee OA undergoing total joint replacement. Incremental cost-utility ratios (ICURs) were calculated from the perspective of the Ontario Ministry of Health, using prospectively collected Short Form-6 Dimension utility data. Costs and quality-adjusted life years (QALYs) were discounted at 3% and sensitivity analyses were performed. Results: Sixty-six patients met the inclusion criteria for the DLS cohort (n = 35 for decompression alone), with a minimum follow-up time of 1 year (mean 1.7 yr). The mean age of patients in the DLS cohort was 64.76 years, and 45 patients (68.2%) were female. For each cohort, utility scores improved from baseline to follow-up and the magnitude of the gain did not differ by group. Lifetime ICURs comparing surgical with nonsurgical care were Can$7946/QALY, Can$7104/QALY and Can$5098/QALY for the DLS, knee OA and hip OA cohorts, respectively. Subgroup analysis yielded an increased ICUR for the patients with DLS who underwent decompression and fusion (Can$9870/QALY) compared with that for the patients with DLS who underwent decompression alone (Can$5045/QALY). The rank order of the ICURs by group did not change with deterministic or probabilistic sensitivity analyses. Conclusion: Lifetime ICURs for MIS procedures for DLS are similar to those for total joint replacement. Future research should adopt a societal perspective and potentially capture further economic benefits of MIS procedures.


Assuntos
Artroplastia de Quadril/economia , Artroplastia do Joelho/economia , Descompressão Cirúrgica/economia , Procedimentos Cirúrgicos Minimamente Invasivos/economia , Fusão Vertebral/economia , Canadá , Estudos de Coortes , Análise Custo-Benefício , Descompressão Cirúrgica/métodos , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/cirurgia , Osteoartrite do Joelho/cirurgia , Anos de Vida Ajustados por Qualidade de Vida , Fusão Vertebral/métodos , Estenose Espinal/cirurgia , Espondilolistese/cirurgia
17.
J Orthop Surg Res ; 16(1): 431, 2021 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-34217346

RESUMO

BACKGROUND: When approaching a joint replacement procedure, pre-surgical planning is essential to predict an accurate estimation of implant size and position. There are currently two methods to achieve it, analog and digital. The present study aims to demonstrate how the hybrid technique is accurate and precise for pre-surgical planning in a non-cemented total hip replacement. METHODS: Concordance-type study is used against a gold standard, as well as inter- and intra-observer consistency evaluation of two orthopedic surgeons and two orthopedic surgery residents. Accuracy was calculated with the intra-class correlation coefficient (ICC). Afterwards, the same calculation was done considering a margin of error with one size more and one less. RESULTS: Thirty-eight patients were included in the study: 19 women and 19 men. Twenty-two prostheses (57.89%) were right-sided and 16 were left (42.11%). Twelve prostheses (31.57%) were Stryker and 26 Johnson & Johnson (68.43%). Acetabular cup correlation compared with the gold standard was moderate: ICC reported 0.45 (95% CI, 0.15-0.76). When adjusted by ± 1 size, ICC was 0.48 (95% CI, 0.18-0.79). On the other hand, results from the femoral stem reported ICC 0.85 (95% CI, 0.07-0.98). When adjusted by ± 1 size, ICC was 0.86 (95% CI, 0.06-0.99). CONCLUSIONS: Hybrid templating is a reliable substitute for analog or digital planning. It is quick, inexpensive, accurate, and better results are observed in the femoral component regardless the level of expertise of the evaluator. LEVEL OF EVIDENCE: Grade IV.


Assuntos
Artroplastia de Quadril , Prótese de Quadril , Processamento de Imagem Assistida por Computador/métodos , Medicina de Precisão/métodos , Cuidados Pré-Operatórios/métodos , Desenho de Prótese/métodos , Acetábulo/cirurgia , Acetatos , Feminino , Fêmur/cirurgia , Humanos , Masculino , Variações Dependentes do Observador , Osteoartrite do Quadril/cirurgia , Modelagem Computacional Específica para o Paciente , Técnicas de Planejamento , Reprodutibilidade dos Testes , Estudos Retrospectivos
18.
J Pediatr Orthop ; 41(Suppl 1): S47-S52, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34096537

RESUMO

INTRODUCTION: This paper aims to review the indications criteria for the surgical treatment of adolescents with hip osteoarthritis and summarize the contemporary techniques that orthopaedic surgeons can apply for hip reconstruction. DISCUSSION: Hip osteoarthritis remains a concerning burden to North American society. While the rate of total hip replacement (THR) in younger patients has increased in the last decades, younger patients may have a higher risk of revision hip replacement because of their increased level of activity and expected patient longevity compared with the elderly. Increased demand for multiple revision surgeries is a concern for the adolescent patient. Although in general THR has been increasingly recommended for the treatment of end-stage osteoarthritis secondary to pediatric hip disorders, hip arthrodesis remains a beneficial alternative for the treatment of severe hip disease secondary to infection and for patients who desire to engage in a very active lifestyle. Hip preservation procedures are ideally performed in the prearthritic stage or in hips with minimal degeneration to preserve the joint and achieve the most optimal outcomes. However, adolescents and young adults with moderate and rarely advanced arthritis may benefit from surgical treatment using hip preservation techniques. CONCLUSIONS: Treatment of adolescents with pain and dysfunction because of end-stage hip disease is challenging and controversial. THR and arthrodesis are the 2 principal alternatives. However, in particular circumstances, hip reconstruction may be recommended.


Assuntos
Artrodese , Artroplastia de Quadril , Osteoartrite do Quadril , Complicações Pós-Operatórias , Adolescente , Fatores Etários , Artrodese/efeitos adversos , Artrodese/métodos , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Humanos , Tratamentos com Preservação do Órgão/métodos , Osteoartrite do Quadril/diagnóstico , Osteoartrite do Quadril/cirurgia , Seleção de Pacientes , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Reoperação/métodos , Índice de Gravidade de Doença
19.
Ann R Coll Surg Engl ; 103(7): 514-519, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34192490

RESUMO

INTRODUCTION: The aims of this study were threefold: first, to review the surgical performance of trainees in our departments by reviewing postoperative radiographs and operative times; second, to investigate the effect of supervision and assistant grade on postoperative radiographs and operative times; and third, to monitor trainees over a 6-month period looking for changes in postoperative radiograph appearances and operative times to assess whether these parameters reflect a trainee's learning curve. METHODS: A retrospective evaluation of a continuous series of primary hip arthroplasty procedures performed by 12 trainee orthopaedic surgeons (StR) during their arthroplasty rotation. In total, 348 primary total hip replacement (pTHR) operations were performed by StRs. Operative time, acetabular cup inclination, radiological leg length discrepancy (rLLD), femoral stem alignment (FSA) and the Barrack score for cementation were evaluated. The mean number of pTHRs performed per 6-month placement was 29 (range 15-51). Operative times were available for 292 cases and all postoperative imaging was evaluated. RESULTS: The mean operative time for StRs as first-surgeon was 84.3 minutes (range 42-174 minutes). Significant differences in operative times were observed between individual StRs. As a cohort, the operative times were not affected by the level of supervision but were significantly slower when StRs were assisted by other StRs. Significant differences in rLLD, FSA and Barrack score for cementation were observed across the cohort of StRs, although this did not change at a group or individual level between the first and second halves of the 6-month placement. CONCLUSIONS: Used in isolation, postoperative radiographs and operative time are not an effective measure of the learning curve in primary hip arthroplasty, however, they may be a useful adjunct in assessing the performance of orthopaedic trainees when learning primary hip arthroplasty.


Assuntos
Artroplastia de Quadril/educação , Competência Clínica/estatística & dados numéricos , Curva de Aprendizado , Cirurgiões Ortopédicos/estatística & dados numéricos , Osteoartrite do Quadril/cirurgia , Artroplastia de Quadril/estatística & dados numéricos , Competência Clínica/normas , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Humanos , Internato e Residência/estatística & dados numéricos , Duração da Cirurgia , Cirurgiões Ortopédicos/educação , Cirurgiões Ortopédicos/normas , Período Pós-Operatório , Estudos Retrospectivos , Resultado do Tratamento
20.
BMC Musculoskelet Disord ; 22(1): 517, 2021 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-34090409

RESUMO

BACKGROUND: Osteoarthritis (OA) of the hip rarely develops in the early second decade. As the incidence of this disease is low, no treatment method has been established. We report two patients with unilateral OA in their early teens in whom the anteversion angle of the femoral neck on the affected side was greater than that on the unaffected side. CASE PRESENTATION: Case 1 was an 11-year-old girl with left coxalgia and limited range of motion. There was no history of femoroacetabular impingement (FAI) or developmental dysplasia of the hip (DDH). Plain X-rays revealed the disappearance of the Y cartilage, joint space narrowing of the left hip, and acetabular/femoral head osteosclerosis. In CT images, the anteversion angle of the femoral neck (lt/rt) was 45/35 degrees. As osteoarthritis was severe, proximal femoral flexional derotational varus osteotomy (PFFDVO) and triple pelvic osteotomy (TPO) were performed. Case 2 was a 13-year-old girl with left coxalgia and limited range of motion. There was no history of FAI or DDH. Plain X-ray revealed irregularity of the left anterolateral femoral head, and a subcartilaginous cyst. In CT images, the anteversion angle of the femoral neck (lt/rt) was 30/20 degrees. As osteoarthritis was severe, PFFDVO was performed. In addition, we resected bone spurs on the femoral head because flexion was limited owing to the presence of osteophytes. In both patients, coxalgia and claudication/gait disorder resolved postoperatively, and joint space narrowing and osteosclerosis improved. However, in Case 1, there was a 3-cm difference in the leg length, and in Case 2, range-of-motion limits remained. CONCLUSIONS: We present the findings in two patients with unilateral OA in their early second decade in whom the femoral anteversion angle on the affected side was greater than that on the unaffected side. PFFDVO + TPO was performed in Case 1, and PFFDVO + bone spur resection on the femoral head was performed in Case 2. Coxalgia resolved, and plain X-ray demonstrated improvements in OA; however, a difference in the leg length and range-of-motion limits remained.


Assuntos
Colo do Fêmur , Osteoartrite do Quadril , Acetábulo , Adolescente , Criança , Feminino , Colo do Fêmur/diagnóstico por imagem , Colo do Fêmur/cirurgia , Humanos , Osteoartrite do Quadril/diagnóstico por imagem , Osteoartrite do Quadril/etiologia , Osteoartrite do Quadril/cirurgia , Amplitude de Movimento Articular , Tomografia Computadorizada por Raios X
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