Preoperative Oral Hydration Is Safe in Rapid Recovery Total Hip Arthroplasty

2021 ◽  
pp. 007-011
Author(s):  
Afshin A. Anoushiravani ◽  
Vivek Singh ◽  
James E. Feng ◽  
Andrew Posner ◽  
Kimberly Jean-Louis ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Clear Fluid ◽  
Level Of Evidence ◽  
Oral Hydration ◽  
Total Hip ◽  
Same Day Discharge ◽  
Observational Cohort ◽  
Perioperative Aspiration ◽  
The Impact

AbstractFluid and food restrictions prior to surgery are thought to reduce the risk for perioperative aspiration pneumonia. However, the recent anesthesia literature suggests that clear fluids up to 2 hours before surgery may be tolerated. Here we investigate the safety and efficacy of a standardized hydration protocol among same-day discharge total hip arthroplasty (SDD-THA) candidates. All patients scheduled to undergo primary SDD THA between January 2017 and October 2018 were included. Surgical recipients between January 2017 and August 2017 were used as historical controls. Surgical recipients between September 2017 and October 2018 participated in the hydration initiative which allowed for the consumption of 32 oz of clear fluid 2 hours prior to surgery. Baseline demographics and quality metrics were prospectively collected and analyzed to define the impact of a hydration protocol in SDD THA. In total, 585 consecutive SDD-THA candidates were included in this study, of which 309 and 276 patients were in the control and hydration cohorts, respectively. Univariable analysis of postoperative outcomes demonstrated that a similar number of THA recipients failed SDD (7.44 vs. 7.97%; p = 0.88); however, a clinically meaningful reduction in hypotensive episodes was observed among the hydration cohort (0.4 vs. 1.9%; p = 0.08). Multivariable regression demonstrated similar outcomes after controlling for all collected patient risk factors (odds ratio 0.95; 95% confidence interval 0.48–1.88; p = 0.89). Our study suggests hydration protocols are safe and may reduce the clinical incidence of postoperative hypotension when compared with standard nil per os restrictions. Future studies are needed to better elucidate the role of perioperative hydration before THA. The level of evidence of the study is level II, prospective observational cohort.

scholarly journals Are the First and Second Hip in Staged Bilateral Total Hip Arthroplasty Equal? A Hospital Adverse Event and Perioperative Risk Comparison

2021 ◽  
Author(s):  
Jesus M. Villa ◽  
Tejbir S. Pannu ◽  
Carlos A. Higuera ◽  
Juan C. Suarez ◽  
Preetesh D. Patel ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Adverse Events ◽  
Hip Arthroplasty ◽  
Retrospective Chart Review ◽  
Consecutive Series ◽  
Level Of Evidence ◽  
Exact Test ◽  
Total Hip ◽  
Discharge Disposition ◽  
The Mean

AbstractHospital adverse events remain a significant issue; even “minor events” may lead to increased costs. However, to the best of our knowledge, no previous investigation has compared perioperative events between the first and second hip in staged bilateral total hip arthroplasty (THA). In the current study, we perform such a comparison. A retrospective chart review was performed on a consecutive series of 172 patients (344 hips) who underwent staged bilateral THAs performed by two surgeons at a single institution (2010–2016). Based on chronological order of the staged arthroplasties, two groups were set apart: first-staged THA and second-staged THA. Baseline-demographics, length of stay (LOS), discharge disposition, hospital adverse events, and hospital transfusions were compared between groups. Statistical analyses were performed using independent t-tests, Fisher's exact test, and/or Pearson's chi-squared test. The mean time between staged surgeries was 465 days. There were no significant differences in baseline demographics between first-staged THA and second-staged THA groups (patients were their own controls). The mean LOS was significantly longer in the first-staged THA group than in the second (2.2 vs. 1.8 days; p < 0.001). Discharge (proportion) to a facility other than home was noticeably higher in the first-staged THA group, although not statistically significant (11.0 vs. 7.6%; p = 0.354). The rate of hospital adverse events in the first-staged THA group was almost twice that of the second (37.2 vs. 20.3%; p = 0.001). There were no significant differences in transfusion rates. However, these were consistently better in the second-staged THA group. When compared with the first THA, our findings suggest overall shorter LOS and fewer hospital adverse events following the second. Level of Evidence Level III.

scholarly journals The influence of bone quality on radiological outcome in 50 consecutive acetabular fractures treated with a pre-contoured anatomic suprapectineal plate

2021 ◽  
Author(s):  
Maximilian J. Hartel ◽  
Tareq Naji ◽  
Florian Fensky ◽  
Frank O. Henes ◽  
Darius M. Thiesen ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Bone Mass ◽  
Bone Quality ◽  
Hip Arthroplasty ◽  
Mass Density ◽  
Acetabular Fractures ◽  
Bone Mass Density ◽  
Radiological Outcome ◽  
Total Hip ◽  
The Impact

Abstract Purpose To investigate the range of indications of an anatomical-preshaped three-dimensional suprapectineal plate and to assess the impact of the bone mass density on radiologic outcomes in different types of acetabular fractures. Patients and methods A consecutive case series of 50 acetabular fractures (patient age 69 ± 23 years) treated with suprapectineal anatomic plates were analyzed in a retrospective study. The analysis included: Mechanism of injury, fracture pattern, surgical approach, need for additional total hip arthroplasty, intra- or postoperative complications, as well as bone mass density and radiological outcome on postoperative computed tomography. Results Most frequently, anterior column fracture patterns with and without hemitransverse components as well as associated two column fractures were encountered. The anterior intrapelvic approach (AIP) was used in 98% (49/50) of the cases as primary approach with additional utilization of the first window of the ilioinguinal approach in 13/50 cases (26%). Determination of bone density revealed impaired bone quality in 70% (31/44). Postoperative steps and gaps were significantly greater in this subgroup (p < 0.05). Fracture reduction quality for postoperative steps revealed anatomic results in 92% if the bone quality was normal and in 46% if impaired (p < 0.05). In seven cases (14%), the plate was utilized in combination with acute primary arthroplasty. Conclusion A preshaped suprapectineal plate provides good radiological outcomes in a variety of indications in a predominantly geriatric cohort. Impaired bone quality has a significantly higher risk of poor reduction results. In cases with extensive joint destruction, the combination with total hip arthroplasty was a valuable option.

scholarly journals Comparison of short-term outcomes of anterolateral supine approach and posterolateral approach for primary total hip arthroplasty: a retrospective study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Taku Ukai ◽  
Goro Ebihara ◽  
Masahiko Watanabe
Keyword(s):  
Total Hip Arthroplasty ◽  
Hospital Stay ◽  
Clinical Outcomes ◽  
Hip Arthroplasty ◽  
External Rotation ◽  
Posterolateral Approach ◽  
Level Of Evidence ◽  
Total Hip ◽  
Hip Flexion ◽  
Primary Total Hip Arthroplasty

Abstract Background This study aims to evaluate postoperative pain and functional and clinical outcomes of anterolateral supine (ALS) and posterolateral (PL) approaches for primary total hip arthroplasty. Materials and methods We retrospectively examined the joints of 110 patients who underwent primary total hip arthroplasty (THA). The ALS group was compared with the PL group using the pain visual analog scale (VAS) and narcotic consumption as pain outcomes. Functional outcomes included postoperative range of motion (ROM) of hip flexion, day on which patients could perform straight leg raising (SLR), day on which patients began using a walker or cane, duration of hospital stay, rate of transfer, and strength of hip muscles. Clinical outcomes included pre and postoperative Harris Hip Scores. Results No significant differences were found in the pain VAS scores or narcotic consumption between the two groups. The PL group could perform SLR earlier than the ALS group (P < 0.01). The ALS group started using a cane earlier (P < 0.01) and had a shorter hospital stay (P < 0.01) than the PL group. Degrees of active ROM of flexion at postoperative day (POD) 1 were significantly lower in the ALS group than in the PL group (P < 0.01). Regarding hip muscle strength, hip flexion was significantly weaker in the ALS group than in the PL group until 1-month POD (P < 0.01). External rotation from 2 weeks to 6 months postoperatively was significantly weaker in the PL group than in the ALS group (P < 0.01). Conclusion The ALS approach was more beneficial than the PL approach because ALS enabled better functional recovery of the strength of external rotation, improved rehabilitation, and involved a shorter hospital stay. Level of Evidence Level IV retrospective observational study.

scholarly journals The impact of reducing the femoral stem length in total hip arthroplasty during gait

2021 ◽  
Author(s):  
Anatole Vilhelm Wiik ◽  
Adeel Aqil ◽  
Bilal Al-Obaidi ◽  
Mads Brevadt ◽  
Justin Peter Cobb
Keyword(s):  
Total Hip Arthroplasty ◽  
Gait Analysis ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
Short Stem ◽  
Stem Length ◽  
Practical Consideration ◽  
Total Hip ◽  
Long Stem ◽  
The Impact

Abstract Aim The length of the femoral stem in total hip arthroplasty (THA) is a practical consideration to prevent gait impairment. The aim of this study was to determine if reducing the femoral stem length in THA would lead to impaired gait biomechanics. Methods Patients uniformly with the same brand implant of differing lengths (100 mm vs 140–166 mm) were taken retrospectively from a prospective trial introducing a new short stem. Twelve patients without any other disorder to alter gait besides contralateral differing length stem THA were tested at differing gradients and speed on a validated instrumented treadmill measuring ground reaction forces. An anthropometrically similar group of healthy controls were analysed to compare. Results With the same posterior surgical approach, the offset and length of both hips were reconstructed within 5 mm of each other with an identical mean head size of 36 mm. The short stem was the last procedure for all the hips with gait analysis occurring at a mean of 31 and 79 months postoperatively for the short and long stem THA, respectively. Gait analysis between limbs of both stem lengths demonstrated no statistical difference during any walking condition. In the 90 gait assessments with three loading variables, the short stem was the favoured side 51% of the time compared 49% for the long stem. Conclusion By testing a range of practical walking activities, no lower limb loading differences can be observed by reducing the femoral stem length. A shorter stem demonstrates equivalence in preference during gait when compared to a reputable conventional stem in total hip arthroplasty.

scholarly journals Augmented Rehabilitation Program for Young Patients Following Total Hip Arthroplasty

2021 ◽  
Author(s):  
Ahmed Negm ◽  
Milad Yavarai ◽  
Gian Jhangri ◽  
Robert Haennel ◽  
Allyson Jones
Keyword(s):  
Physical Activity ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Intervention Group ◽  
Young Patients ◽  
Rehabilitation Program ◽  
Control Group ◽  
Total Hip ◽  
The Impact

Abstract BackgroundThe increase rate seen in Total Hip Arthroplasty (THA) for younger patients has implications for future rehabilitation demands for primary and revision THA surgery. This study aims to determine the impact of a 6-week post-operative rehabilitation program designed for THA patients ≤ 60 years on physical activity (PA) and function compared to age- and a sex-matched control group received usual postoperative care at 12-week post-THA. MethodsIn this quasi-experimental study, a cohort of THA candidates was recruited during their 6-week postoperative visit to their surgeons. The out-patient rehabilitation program consisted of 12 structured exercise classes (2 hrs/class) over 6 weeks. Physical activity was assessed using Sense Wear Pro ArmbandTM [SWA]. Participants completed the Hip Osteoarthritis Outcome Score (HOOS), and THA satisfaction questionnaire before and immediately after the intervention. ResultsThe intervention group took significantly more steps/day at the follow-up compared to baseline. The intervention group had a higher mean change in the number of weekly PA bouts than the control group. Within the intervention groups, all HOOS subscales were significantly higher at the follow-up compared to baseline. ConclusionThe augmented rehabilitation program may have immediate effects on pain relief and symptom reduction for patients (≤60 years) following THA.

scholarly journals The influence of bearing surfaces on revisions due to dislocations in total hip arthroplasty

2021 ◽  
Vol 32 (9) ◽  
Author(s):  
Francesco Castagnini ◽  
Barbara Bordini ◽  
Monica Cosentino ◽  
Cristina Ancarani ◽  
Federica Mariotti ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Lower Risk ◽  
Time Distribution ◽  
Total Hip ◽  
Arthroplasty Registry ◽  
Metal On Metal ◽  
The Impact ◽  
Frequent Reason ◽  
Ceramic On Ceramic

Abstract Introduction Recurrent dislocations are still the most frequent reason for revision in total hip arthroplasty (THA). The impact of bearing surfaces on dislocations is still controversial. We hypothesized that: (1) bearing surfaces influence the revisions due to dislocations; (2) ceramic-on-ceramic reduced the revisions for dislocations in adjusted models; (3) Delta-on-Delta bearings reduced the revisions for dislocations in comparison to surfaces with cross-linked polyethylene. Materials and methods The regional arthroplasty registry was enquired about bearing surfaces and revisions for dislocations and instability. Unadjusted and adjusted rates were provided, including sex, age (<65 years or ≥65 years), head diameter (≤28 mm or >28 mm; <36 mm or ≥36 mm) as variables. 44,065 THAs were included. Results The rate of revisions for dislocations was significantly lower in ceramic-on-ceramic and metal-on-metal bearings (unadjusted rates). After adjusting for age, sex, and head size (36 and 28 mm), hard-on-hard bearings were protective (p < 0.05): ceramic-on-ceramic had a lower risk of revisions due to dislocation than ceramic-on-polyethylene (HR 1.6, 95% CI 1.2–2.2 p = 0.0009). The rate of revisions for dislocation was similar in bearings with cross-linked polyethylene and Delta-on-Delta articulations, in unadjusted and adjusted models. Conclusion Bearings with conventional polyethylene were more predisposed to dislocations. Currently adopted bearings exerted no significant influence on revisions due to dislocations. These findings could be primarily related to wear, but due to the time distribution, soft tissue envelopes and surface tension may also play a role. Pre-clinical biomechanical evaluations and prospective matched cohort studies are required to draw definitive conclusions.

The Impact of Modularity in Total Hip Arthroplasty

1995 ◽  
Vol &NA; (319) ◽  
pp. 77???84 ◽  
Author(s):  
Michael J. Chmell ◽  
David Rispler ◽  
Robert Poss
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Total Hip ◽  
The Impact

scholarly journals Short Term Results of Total Hip Arthroplasty using the Impact Modular Hip System.

1995 ◽  
Vol 44 (4) ◽  
pp. 1229-1232
Author(s):  
Masatoshi Yamada ◽  
Masatoshi Naito ◽  
Minoru Ikeda ◽  
Kazuhiko Imai ◽  
Kousuke Ogata
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Short Term ◽  
Total Hip ◽  
The Impact
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