Total Hip Replacement Provokes Endothelial Dysfunction

Angiology ◽  
2018 ◽  
Vol 69 (10) ◽  
pp. 871-877 ◽  
Author(s):  
Peter Poredos ◽  
Ana Mavric ◽  
Lara Leben ◽  
Pavel Poredos ◽  
Mateja Kaja Jezovnik
Keyword(s):  
Endothelial Dysfunction ◽  
Endothelial Function ◽  
Total Hip Replacement ◽  
Postoperative Period ◽  
Hip Replacement ◽  
Hospital Length Of Stay ◽  
Average Hospital ◽  
Total Hip ◽  
Increased Risk ◽  
Cardiovascular Homeostasis

Surgery represents an increased risk of different perioperative complications. Endothelial function (EF) is a key mechanism responsible for cardiovascular homeostasis and is involved in thromboembolic complications. We aimed to follow changes of EF in an early postoperative period in patients undergoing total hip replacement (THR). Endothelial function was assessed noninvasively in 70 consecutive patients who underwent an elective THR under spinal anesthesia. Flow-mediated dilation (FMD) and low flow-mediated constriction capability of the brachial artery, which are indicators of EF were measured before the operation (baseline), 24 hours after the operative procedure, and 5 to 7 days postoperatively. Baseline FMD was 12.3% and decreased a day after surgery to 7.3% ( P < .001). After 5 to 7 days, it gradually increased to 9.2%. However, on average, it was lower than before surgery ( P < .001). The median duration of THR was 85.0 (65.0-100.0) minutes, the average hospital length of stay was 7 days. Total hip replacement is associated with an immediate decrease in FMD which remains significantly decreased 5 to 7 days after the surgery compared with the preoperative value. These results indicate that surgery provokes endothelial dysfunction and deteriorates cardiovascular homeostasis. This effect could be involved in cardiovascular complications in the postoperative period.

scholarly journals Profiles of Biomarkers of Excess Alcohol Consumption in Patients Undergoing Total Hip Replacement: Correlation with Function

2011 ◽  
Vol 11 ◽  
pp. 1804-1811 ◽  
Author(s):  
Paul J. Jenkins ◽  
Andrew D. Duckworth ◽  
Francis P. C. Robertson ◽  
Colin R. Howie ◽  
James S. Huntley
Keyword(s):  
Total Hip Replacement ◽  
Hip Replacement ◽  
Alcohol Misuse ◽  
Future Research ◽  
Total Hip ◽  
Increased Risk ◽  
Functional Scores ◽  
Hip Function ◽  
One Year ◽  
General Physical

Aims. Patients who misuse alcohol may be at increased risk of surgical complications and poorer function following hip replacement. Identification and intervention may lead to harm reduction and improve the outcomes of surgery. The aim of this study was to determine the prevalence of biomarker elevation in patients undergoing hip replacement and to investigate any correlation with functional scores and complications.Methods. We performed a retrospective study that examined the profile of biomarkers of alcohol misuse in 1049 patients undergoing hip replacement.Results. Gamma-glutamyltransferase was elevated in 150 (17.6%), and mean corpuscular volume was elevated in 23 (4%). At one year general physical health was poorer where there was elevation ofγGT, and the mental health and hip function was poorer with elevation of MCV. There were no differences in complications.Discussion. Raised biomarkers can alert clinicians to potential problems. They also provide an opportunity to perform further investigation and offer intervention. Future research should focus on the use in orthopaedic practice of validated screening questionnaires and more sensitive biomarkers of alcohol misuse.Conclusion. This study demonstrates a potential substantial proportion of unrecognised alcohol misuse that is associated with poorer functional scores in patients after total hip replacement.

scholarly journals Association between circulating 25-hydroxyvitamin D concentrations and hip replacement for osteoarthritis: a prospective cohort study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Sultana Monira Hussain ◽  
Yuanyuan Wang ◽  
Alicia K. Heath ◽  
Graham G. Giles ◽  
Dallas R. English ◽  
...  
Keyword(s):  
Cohort Study ◽  
Total Hip Replacement ◽  
Prospective Cohort Study ◽  
Hip Replacement ◽  
Prospective Cohort ◽  
Hip Osteoarthritis ◽  
Underlying Mechanism ◽  
Dried Blood Spots ◽  
Total Hip ◽  
Increased Risk

Abstract 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.

scholarly journals Complex primary hips for total hip replacement surgery at a tertiary institution in Nigeria

SICOT-J ◽  
2018 ◽  
Vol 4 ◽  
pp. 22 ◽  
Author(s):  
Udo Ego Anyaehie ◽  
Gabriel Okey Eyichukwu ◽  
Cajetan Uwatoronye Nwadinigwe ◽  
Amechi Uchenna Katchy
Keyword(s):  
Sickle Cell Disease ◽  
Blood Loss ◽  
Total Hip Replacement ◽  
Sickle Cell ◽  
Hip Replacement ◽  
Hip Dislocation ◽  
Cell Disease ◽  
Total Hip ◽  
Increased Risk ◽  
Duration Of Surgery

Introduction: Total hip replacement (THR) surgery is still evolving in Nigeria with increasing awareness as more cases are being done. This has attraction for individuals who hitherto had no solutions for their hip pathologies. These are mostly complex primary hips which present challenging technical difficulties with increased risk of complications, thus requiring detailed planning to ensure successful operation. This work aims to present the pattern of complex primary hips presenting for THR, the challenges and complications. Methodology: Data collected over a seven year period, of patients who presented for THR, were analyzed for age, sex, diagnosis, type of hip, complications, duration of surgery, blood loss and transfusions, challenges and outcome. Results: Fifty-nine (43.4%) of the 136 cases of THR done were complex primary hip replacement surgeries. Avascular necrosis of femoral head amongst sickle cell disease patients (23.7%) was the commonest cause of complex primary hips in our series. Most of them had absent/tight medullary canals. This is followed by old unreduced hip dislocation and non-united hip fractures with an incidence of 10.1% each. The major peri operative complication noted was calcar split in 10 patients (16.9%) Discussion: Sickle cell disease patients presented more with complex primary hips and the commonest difficulty was recreating medullary canals. Increased operation time and blood loss alongside technical difficulties should be anticipated and measures put in place to avert complications.

scholarly journals 1279 Does Multimorbidity Influence the Outcomes of Total Hip Replacement for Osteoarthritis?

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
R Ferguson ◽  
D Prieto-Alhambra ◽  
G Peat ◽  
K Jordan ◽  
J Valderas ◽  
...  
Keyword(s):  
Total Hip Replacement ◽  
Hip Replacement ◽  
Frailty Index ◽  
Hip Osteoarthritis ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Total Hip ◽  
Functional Benefit ◽  
Increased Risk ◽  
The Uk

Abstract Introduction Limited data are available on the influence of multimorbidity on the outcomes of total hip replacement for patients with hip osteoarthritis, including the rate of complications and degree of functional benefit. The aim of this study was to investigate the influence of multimorbidity on the outcomes of total hip replacement in the UK. Method A cohort study was performed, with cohort comprised of all patients over 65 years with a diagnosis of hip osteoarthritis recorded in Clinical Practice Research Datalink and receipt of primary total hip replacement recorded in Hospital Episode Statistics Admitted Patient Care. Severity of multimorbidity burden was measured using four different scores (Charlson Comorbidity Index, Electronic Frailty Index, count of drugs prescribed, count of primary care interactions). The outcomes were (i) the risks of total hip replacement, assessed by serious post-operative complications within 90 days (analysed with logistic regression), and (ii) the benefits of surgery, assessed by post-operative Oxford Hip Score (OHS) and EQ-5D quality of life score (analysed with linear regression). Results 6,682 patients were included. The rate of complications was 3.2%. Patients with severe multimorbidity burden were at 1.5 to 2.5 times increased risk of complications than patients without multimorbidity. There was no clinically meaningful difference in the benefits of surgery between patients with and without multimorbidity, irrespective of the method of scoring multimorbidity. Conclusions Even for patients with severe multimorbidity burden, the potential benefits of total hip replacement for osteoarthritis remain substantial, while the increase in risk is relatively small.

scholarly journals High body mass index is associated with increased risk of implant dislocation following primary total hip replacement: 2,106 patients followed for up to 8 years

2008 ◽  
Vol 79 (1) ◽  
pp. 141-147 ◽  
Author(s):  
Omid Sadr Azodi ◽  
Johanna Adami ◽  
David Lindström ◽  
Karl O Eriksson ◽  
Andreas Wladis ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
High Body Mass Index ◽  
Total Hip ◽  
High Body ◽  
Increased Risk ◽  
Implant Dislocation

Effect of weekend physiotherapy provision on physiotherapy and hospital length of stay after total knee and total hip replacement

2014 ◽  
Vol 38 (3) ◽  
pp. 265 ◽  
Author(s):  
Zoe L. Maidment ◽  
Brenton G. Hordacre ◽  
Christopher J. Barr
Keyword(s):  
Length Of Stay ◽  
Hospital Discharge ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Total Hip ◽  
Physiotherapy Service ◽  
Medical Issues ◽  
Total Knee

Objective The aim of the present study was to investigate a change in physiotherapy provision from a 5- to 7-days-a-week service on both physiotherapy and hospital length of stay (LOS) after total knee (TKR) and total hip (THR) replacement. Methods A retrospective analysis of a clinical database was conducted for patients who received either a TKR or THR between July 2010 and June 2012 in one regional hospital. Results There was a significant decrease in physiotherapy LOS from 5.0 days (interquartile range (IQR) 5.0–6.0 days) for a 5-day physiotherapy service, to 5.0 days (IQR 4.0–5.0 days) for 7-day physiotherapy service (U = 1443.5, z = –4.62, P = 0.001). However, hospital LOS was not reduced (P = 0.110). For TKR, physiotherapy LOS decreased significantly by 1 day with a 7-day physiotherapy service (U = 518.0, z = –4.20, P = 0.001). However, hospital LOS was again no different (P = 0.309). For THR there was no difference in physiotherapy LOS (P = 0.060) or hospital LOS (P = 0.303) between the 5- and 7-day physiotherapy services. Where physiotherapy LOS was less than hospital LOS, delayed discharge was due primarily to non-medical issues (72%) associated with hospital organisational aspects. Conclusions Increasing the provision of physiotherapy service after TKR provides an increase in physiotherapy sessions and has the potential to reduce hospital LOS. To be effective this must align with other administrative aspects of hospital discharge. What is known about the topic? Previous studies have investigated the effect of increasing physiotherapy services following total hip replacement (THR) and total knee replacement (TKR) surgery, with varying reports of decreased or unaffected hospital length of stay (LOS). What does this paper add? This study investigates both hospital and physiotherapy LOS individually for THR and TKR patients following an increase from a 5- to 7-day physiotherapy service. Where physiotherapy LOS decreased and hospital LOS did not, delays in hospital discharge were investigated. What are the implications for practitioners? Additional physiotherapy services decrease physiotherapy LOS for TKR patients, but administrative aspects of hospital discharge must improve to reduce hospital LOS.

scholarly journals Subjective Cognitive Decline May Be Associated With Post-operative Delirium in Patients Undergoing Total Hip Replacement: The PNDABLE Study

2021 ◽  
Vol 13 ◽  
Author(s):  
Xu Lin ◽  
Fanghao Liu ◽  
Bin Wang ◽  
Rui Dong ◽  
Lixin Sun ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Trial ◽  
Cognitive Decline ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Protective Factor ◽  
Subjective Cognitive Decline ◽  
Total Hip ◽  
Increased Risk ◽  
T Tau

Objective: Subjective cognitive decline (SCD) is associated with an increased risk of clinical cognitive disorders. Post-operative delirium (POD) is a common complication after total hip replacement. We aimed to investigate the relationship between SCD and POD in patients undergoing total hip replacement.Methods: Our study recruited 214 cognitively intact individuals from the Perioperative Neurocognitive Disorder And Biomarker Lifestyle (PNDABLE) study in the final analysis. SCD was diagnosed with Subjective Cognitive Decline Scale (SCDS), Mini-Mental State Examination (MMSE), and Montreal Cognitive Assessment (MoCA). The incidence of POD was evaluated by using Confusion Assessment Method (CAM), and POD severity was measured by using the Memorial Delirium Assessment Scale (MDAS). Preoperative cerebrospinal fluid (CSF) Aβ40, Aβ42, T-tau, and P-tau levels were measured by enzyme-linked immune-sorbent assay (ELISA).Results: Overall, the incidence of POD was 26.64% (57/214), including 32.43% (36/111) in the SCD group and 20.39% (21/103) in the NC group. With the increase of age, the incidence of POD in all age groups increased (P &lt; 0.05). Logistic regression analysis showed that after adjusting for SCD, Aβ42, Aβ40, P-tau, and T-tau, SCD (OR 2.32, CI 1.18–4.55, P = 0.01) and the increased CSF level of P-tau (OR 1.04, CI 1.01–1.06, P &lt; 0.001) were risk factors for POD, while the level of aβ42 (OR 0.99, CI 0.99–1.00, P &lt; 0.001) was a protective factor for POD.Conclusion: SCD is one of the preoperative risk factors for POD.Clinical Trial Registration: This study was registered at China Clinical Trial Registry (Chictr200033439).

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