Incompliance of total hip arthroplasty (THA) patients to limited weight bearing

As the population ages, the incidence of osteoporotic fractures, including those of the pelvis and acetabulum, continues to rise. Treatment of the elder patients with an acetabular fracture is much more controversial than the treatment of younger patients with similar injuries, where prevention of posttraumatic arthritis and total hip replacement remains optimal to limit need for revision arthroplasty. Arthroplasty for fractures of the proximal femur is commonplace in an older population and is a mainstay of treatment to promote early mobilization and weight-bearing. However, even with acute total hip arthroplasty for a geriatric acetabular fracture, most surgeons do not permit immediate weight-bearing postoperatively. Therefore, controversy regarding optimal treatment of these challenging fractures persists. Four treatment options have emerged: nonoperative treatment with early mobilization, open reduction and internal fixation (ORIF), limited open reduction and percutaneous screw fixation, and acute total hip arthroplasty. The exact indications and benefits of each treatment remain unknown. This article serves as a review of these four treatments and the data existing to support them.

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Immediate unrestricted versus graduated weight bearing following primary cementless total hip arthroplasty: a randomized controlled trial

Annals of Joint ◽

10.21037/aoj.2017.01.03 ◽

2017 ◽

Vol 2 ◽

pp. 6-6

Author(s):

Magdy Shabana ◽

Mahmoud A. Hafez ◽

Khaled Ayad ◽

Mohamed Abd Elfatah ◽

Lilian Albert Zaky

Keyword(s):

Randomized Controlled Trial ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Controlled Trial ◽

Weight Bearing ◽

Total Hip ◽

Cementless Total Hip Arthroplasty ◽

Randomized Controlled

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Outcome of an “Enhanced Recovery” Program in Contemporary Total Hip Arthroplasty in Germany

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-0946-2523 ◽

2019 ◽

Vol 158 (02) ◽

pp. 214-220

Author(s):

Karl Philipp Kutzner ◽

Alexander Meyer ◽

Marie Bausch ◽

Michael Schneider ◽

Philipp Rehbein ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Enhanced Recovery ◽

Weight Bearing ◽

Hemoglobin Concentration ◽

Inpatient Rehabilitation ◽

Clinical Results ◽

Total Hip ◽

Recovery Program ◽

Inpatient Length Of Stay

Abstract Background An inpatient hospital stay of up to 10 days after total hip arthroplasty (THA) is still common in Germany, mostly followed by inpatient rehabilitation. Internationally already widespread concepts for enhanced recovery are increasingly gaining popularity in Germany. Objectives The presentation of content and results of a newly implemented enhanced recovery concept in THA. Materials and Methods In this single-center, prospective observational study of a consecutive patient collective of a single surgeon, between January 2016 and July 2016, 103 short-stem THA patients were enrolled and treated using a newly introduced enhanced recovery concept. After 6 weeks and 6 months clinical examination was performed regarding function, pain, satisfaction and possible complications. Results The goal of discharge on day 4 after operation was reached in 61.2% of the patients with a mean postoperative inpatient stay of 4.9 days. After 6 weeks and 6 months respectively, excellent clinical results were achieved with high patient satisfaction. The complication rate was found to be low. Mean hemoglobin concentration decreased by 2.1 g/dl. A fissure of the femur below the implant healed conservatively applying no weight bearing for a total of 6 weeks. A pulmonary embolism that occurred during rehabilitation was also successfully treated. After 6 months one case showed a bursitis trochanterica. Conclusions Inpatient length of stay can be reduced by enhanced recovery concepts without increasing the risks to patients. Thus, in Germany these concepts will be applied increasingly.

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Cement Removal from the Femur Using the ROBODOC System in Revision Total Hip Arthroplasty

Advances in Orthopedics ◽

10.1155/2013/347358 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 6

Author(s):

Mitsuyoshi Yamamura ◽

Nobuo Nakamura ◽

Hidenobu Miki ◽

Takashi Nishii ◽

Nobuhiko Sugano

Keyword(s):

Total Hip Arthroplasty ◽

Bone Cement ◽

Hip Arthroplasty ◽

Weight Bearing ◽

Full Weight Bearing ◽

Revision Total Hip Arthroplasty ◽

Total Hip ◽

Revision Tha ◽

Cement Removal

Introduction. The perforation and fracture of the femur during the removal of bone cement in revision total hip arthroplasty (THA) are serious complications. The ROBODOC system has been designed to selectively remove bone cement from the femoral canal, but results have not been reported yet. The purpose of our study was to evaluate the clinical and radiographic results of revision THA using the ROBODOC system for cement removal.Materials and Methods. The subjects comprised 19 patients who underwent revision THA using the ROBODOC system. The minimum duration of follow-up was 76 months (median, 109 months; range, 76–150 months). The extent of remaining bone cement on postoperative radiography, timing of weight bearing, and the complications were evaluated.Results. The mean Merle d’Aubigne and Postel score increased from 10 points preoperatively to 14 points by final follow-up. Bone cement was completely removed in all cases. Full weight bearing was possible within 1 week after surgery in 9 of the 19 cases and within 2 months in all remaining cases. No instances of perforation or fracture of the femur were encountered.Conclusions. Bone cement could be safely removed using the ROBODOC system, and no serious complications occurred. Full weight bearing was achieved early in the postoperative course because of circumferential preservation of the femoral cortex.

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Accuracy of Image-less Navigation for Functional Cup Positioning in Total Hip Arthroplasty

10.29007/3lbz ◽

2019 ◽

Author(s):

Morteza Meftah ◽

Vinnay Siddappa ◽

Jeffery Muir ◽

Peter White

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Weight Bearing ◽

Safe Zone ◽

Computer Assisted ◽

Acetabular Cup ◽

Assisted Navigation ◽

Total Hip ◽

Significant Difference ◽

Cup Positioning

Computer-assisted navigation has the potential to improve the accuracy of cup positioning during total hip arthroplasty (THA) and prevent leg length discrepancy (LLD). The purpose of this study was to compare acetabular cup position and post- operative LLD after primary THA using posterolateral approach. Between August 2016 to December 2017, 57 THAs using imageless navigation were matched with 57 THA without navigation, based on age, gender and BMI. Post-operative weight-bearing radiographs were assessed using for anteversion, inclination and LLD. Goal for functional cup placement was 40° inclination and 20° anteversion based on preoperative weight bearing pelvic images. Functional LLD was measured as compared to pre- operative radiographs and contralateral side. Proportion of cups within Lewinnek’s safe zone, proximity to a pre-operative target of and the LLD >5 mm was assessed. The mean age was 54.9 ± 9.6 years (30 – 72) and 57.6 ± 12.5 years (20 – 85) in control and navigated groups, respectively. Mean cup orientation in the navigated group was 20.6°± 3.3° (17 - 25) of anteversion and 41.9°± 4.8° (30 - 51) of inclination, vs. 25.0°± 11.1° (10 - 31) and 45.7°± 8.7° (29 – 55) in control group, where were statistically significant (p=0.005 and p=0.0001), respectively. In the navigated group, significantly more acetabular cups were placed within Lewinnek’s safe zone (anteversion: 78% vs. 47%, p=0.005; inclination: 92% vs. 67%, p=0.002). There was no significant difference in mean LLD in navigation and control groups (3.1 ± 1.5 mm vs. 4.6 ± 3.4 mm, p=0.36), although fewer LLDs >5 mm were reported in the navigated group (7.1%) than in controls (31.4%, p=0.007). The use of this image-less computer-assisted navigation improved the accuracy with which acetabular cup components were placed and may represent an important method for limiting post-operative complications related to cup malpositioning and LLD.

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Stand up! Are normal weight-bearing forces sufficient for a 12/14 Morse taper locking in total hip arthroplasty?

Hip International ◽

10.1177/1120700020967000 ◽

2020 ◽

pp. 112070002096700

Author(s):

Suleman Qurashi ◽

Matthew H Pelletier ◽

Tian Wang ◽

Nicholas Bramich ◽

Jason Chinnappa ◽

...

Keyword(s):

Surface Roughness ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Weight Bearing ◽

Normal Weight ◽

Total Hip ◽

Ceramic Femoral Head ◽

Head Surface ◽

Cyclical Loading

Background: The aim of this study was to investigate total hip arthroplasty (THA) Morse taper pull-off strengths after impaction prior to cyclical loading compared to cyclical loading alone. The practical relevance of the experiment is to provide a perspective on what may be clinically satisfactory taper assembly given the spectrum of head tapping patterns used by surgeons, as well as compare traditional impaction performed in standard THA with alternate methods of taper engagement such as ‘ in situ assembly’ used in micro-invasive techniques. Methods: 36 taper constructs utilising a combination of cobalt-chrome alloy and ceramic-titanium alloy junctions were investigated in vitro in wet and dry conditions with cyclical loading of the constructs. Taper disengagement strengths with and without impaction were compared. Secondary investigation of the surface roughness of the heads and tapers was also assessed. Results: An impaction to a wet taper resulted in a greater pull off force compared to a dry taper with a CoCr head and taper combination. Impacting the head and dryness of the taper did not affect pull off forces of a ceramic femoral head on titanium taper. Pulling a head off a taper significantly alters the head surface roughness. Conclusion: Impaction of a taper does not provide any benefit over cyclical loading of a taper assembly alone for pull-off strength.

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Utility of Upright Weight-bearing Imaging in Total Hip Arthroplasty

Seminars in Musculoskeletal Radiology ◽

10.1055/s-0039-1697935 ◽

2019 ◽

Vol 23 (06) ◽

pp. 603-608 ◽

Cited By ~ 1

Author(s):

Edward M. DelSole ◽

John J. Mercuri

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Surgical Planning ◽

Weight Bearing ◽

Component Position ◽

Hip Instability ◽

Imaging Technology ◽

Early Component ◽

Total Hip ◽

Full Body

AbstractPlanning for total hip arthroplasty (THA) has traditionally been performed using static supine anteroposterior radiographs of the pelvis. Recent advances in imaging technology and the understanding of human spinopelvic kinematics have made weight-bearing radiography an important adjunct to supine imaging. Hip surgeons can use weight-bearing imaging to optimize THA component position to prevent hip instability and early component wear. The goal of this narrative review is to delineate the fundamentals of spinopelvic kinematics, the benefits of surgical planning using weight-bearing radiography, and the underpinnings of upright full-body stereoradiography as a useful adjunct to traditional supine radiographs.

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