Barbed sutures reduce arthrotomy closure duration and suture utilisation compared to interrupted conventional sutures for primary total hip arthroplasty: a randomised controlled trial

Introduction: The broad aim of this study was to compare the safety and efficacy of using barbed sutures and running closure versus interrupted placement of standard of care sutures for closure of the arthrotomy during total hip arthroplasty (THA). Specifically, we compared duration of arthrotomy closure, the number of sutures utilised for arthrotomy closure, and 90-day outcomes including wound-related readmission, reoperation, and complications. Methods: A total of 60 patients undergoing 60 THAs were enrolled in a prospective, single-blinded trial and randomised to receive either running closure of the arthrotomy with barbed sutures ( n = 30) or interrupted closure with standard of care sutures ( n = 30). Patients were eligible if they were undergoing primary THA for osteoarthritis and excluded if they had a BMI > 45 kg/m2 or age > 80 years or <18 years. Results: Arthrotomy closure duration was significantly shorter in the barbed suture group (3 minutes ± 9 seconds) versus the standard of care group (8 minutes ± 26 seconds, p < 0.001). The suture utilisation for arthrotomy closure was 1 suture in the barbed sutured group 28/30 (93%) patients versus 2–4 sutures in 27/30 (90%) in the standard of care group ( p < 0.001). The overall number of wound-related complications in the barbed suture group was 1/30 (3%) versus 1/30 (3%) in the standard of care group ( p = 1.00). The rate of suture abscesses was 1/30 (3%) in barbed suture group versus the standard of care ( p = 1.00). There was trochanter bursitis 1/30 (3%) in the standard of care group versus zero in the barbed suture group ( p = 1.00). Conclusions: These results suggest that barbed suture utilisation may be faster and more resource efficient than use of standard of care sutures for arthrotomy closure in THA. ClinicalTrials.gov Identifier: NCT03285555

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Abstract 17269: Incidence of Atrial Fibrillation in Patients With Cobalt and Chromium Containing Hip Arthroplasty

Circulation ◽

10.1161/circ.138.suppl_1.17269 ◽

2018 ◽

Vol 138 (Suppl_1) ◽

Author(s):

Sunita Sharma ◽

Shiva Ponamgi ◽

Christopher Desimone ◽

Cody Wyles ◽

Philip Sun ◽

...

Keyword(s):

Atrial Fibrillation ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Group Versus ◽

True Incidence ◽

Total Hip ◽

Metal On Metal ◽

All Cause Mortality ◽

Metal Group ◽

Serum Cobalt

Background: Worldwide, approximately one million patients have had total hip arthroplasty with 35% being cobalt and chromium Metal-on-Metal (MoM) or Metal-on-Polythelene (MoP) implants. Animal models have suggested that cobalt and chromium can affect all chambers, but there seems to be an atrial predilection. There are several case reports of metal containing hip arthroplasty causing atrial arrhythmias but the true incidence of atrial fibrillation associated with metal hip arthroplasty remains undefined. Objective: We sought to determine the incidence of atrial fibrillation in patients with metal containing hip arthroplasty. We also examined the association between serum cobalt and chromium levels and arrhythmias in this cohort and all cause mortality. Methods: We retrospectively examined the records of patients from the Mayo Clinic total hip arthroplasty registry (Metal group - Metal-on-Metal: MoM and Metal-on-Polyethylene: MoP, Non-Metal group - Ceramic-on-Ceramic: CoC and Ceramic-on-Polyethylne: CoP) to obtain demographic data, comorbidities, laboratory, ECG, and echocardiographic data. Out of a total of 1756 patients, Cobalt and Chromium levels were available in 138 patients. Results: The mean age of patients with metal containing hip replacement was 50 years and were predominantly male. During a follow up period of 10 years, the incidence of atrial fibrillation in our study population was 8% in metal group compared to 2% (p=0.11) in non-metal group. There was no association between cobalt or chromium levels with the incidence of atrial fibrillation. All-cause mortality was significantly higher in metal group versus non-metal group (p=0.005). Conclusion: The incidence of atrial fibrillation was relatively more in patients with metal versus non-metal hip arthroplasty but there was no association of serum cobalt or chromium levels with incidence of atrial fibrillation in the subset of patients. In addition, all-cause mortality was significantly higher in the metal group suggesting potential toxic effects of metal containing hip arthroplasty.

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An eHealth Program for Patients Undergoing a Total Hip Arthroplasty: Protocol for a Randomized Controlled Trial (Preprint)

10.2196/preprints.9654 ◽

2017 ◽

Author(s):

Rosemary Saunders ◽

Karla Seaman ◽

Catherine Ashford ◽

Trudy Sullivan ◽

Judith McDowall ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Patient Outcomes ◽

Hip Arthroplasty ◽

Standard Care ◽

Controlled Trial ◽

Intervention Group ◽

Primary Outcome Measure ◽

Secondary Outcome ◽

Care Group ◽

Total Hip

BACKGROUND Total hip arthroplasty is an effective surgical procedure commonly used worldwide for patients suffering the disabling effects of osteoarthritis when medical therapy is unsuccessful. Traditionally pre- and postoperative information for patients undergoing a hip arthroplasty has been provided by paper-based methods. Electronic health (eHealth) programs to support individualized patient education on preoperative preparation, in-patient care, and home rehabilitation have the potential to increase patient engagement, enhance patient recovery, and reduce potential postoperative complications. OBJECTIVE The aim of this study is to compare the addition of an eHealth program versus standard care for pre- and postoperative education on patient outcomes for primary total hip arthroplasty. METHODS One hundred patients undergoing a primary elective total hip arthroplasty will be recruited from a metropolitan hospital in Western Australia to participate in a 6-month parallel randomized control trial. Participants will be randomized to either the standard care group (n=50) and will be given the education booklet and enrolled to attend a 1-hour education session, or the intervention group (n=50), and will receive the same as the standard care plus access to an eHealth program titled “My Hip Journey.” The eHealth program encourages the patient to log in daily, from 2 weeks prior to surgery to 30 days postsurgery. The information on the platform will be aligned with the patient's individual surgical journey and will include exercises to be completed each day for the duration of the program. The primary outcome measure is the Hip Dysfunction and Osteoarthritis Outcome Score, version LK 2.0. Secondary outcome measures include the EuroQoL EQ-5D-5L, a 5-level 5-dimension quality of life measure, and the Self-Efficacy for Managing Chronic Disease Scale. Data will be collected at pre-admission (presurgery) and at 6 weeks, 3 months, and 6 months postsurgery. A patient satisfaction survey will be completed 6 weeks postsurgery and Web-based analytics will be collected 6 months postsurgery. A cost-effectiveness analysis, using the intention-to-treat principle, will be conducted from the hospital’s perspective. RESULTS Enrollment in the study commenced in January 2018 with recruitment due for completion towards the end of the year. The first results are expected to be submitted for publication in 2019. CONCLUSIONS The outcomes and cost of using an eHealth program to support a patient’s recovery from a hip arthroplasty will be compared with standard care in this study. If the eHealth program is found to be effective, further implementation across clinical practice could lead to improvement in patient outcomes and other surgical areas could be incorporated. CLINICALTRIAL Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12617001433392; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373657&isReview=true (Archived by WebCite at http://www.webcitation.org/6yzoTuggx). REGISTERED REPORT IDENTIFIER RR1-10.2196/9654

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Barbed sutures versus staples for closure in total hip arthroplasty using wound ooze as a primary outcome measure: A prospective study

Journal of Orthopaedic Surgery ◽

10.1177/2309499019857166 ◽

2019 ◽

Vol 27 (2) ◽

pp. 230949901985716 ◽

Cited By ~ 1

Author(s):

Thomas D Knapper ◽

Mark Dahill ◽

Stephen Eastaugh-Waring ◽

Richard P Baker ◽

Jason CJ Webb ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Prospective Study ◽

Hip Arthroplasty ◽

Primary Outcome ◽

Outcome Measure ◽

Primary Outcome Measure ◽

Barbed Sutures ◽

Total Hip ◽

A Prospective Study

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Modular junction may be more problematic than bearing wear in metal-on-metal total hip arthroplasty

Hip International ◽

10.1177/1120700018808696 ◽

2018 ◽

Vol 29 (3) ◽

pp. 262-269 ◽

Cited By ~ 6

Author(s):

Pascal-André Vendittoli ◽

Vincent Massé ◽

Marc-Olivier Kiss ◽

Daniel Lusignan ◽

Martin Lavigne

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Metal Ion ◽

Modular Group ◽

Group Versus ◽

Femoral Stem ◽

Total Hip ◽

Wear And Corrosion ◽

Metal On Metal ◽

Metal Ion Release

Introduction: In total hip arthroplasty (THA), local adverse reaction to metal debris (ARMD) may be caused by abnormal metal ion release from a metal-on-metal (MoM) bearing, or by wear and corrosion of the implant’s modular junction. The aim of this study was to compare ion levels and rate of ARMD between patients sharing the same MoM bearing but 1 group having monoblock stems versus another having modular stems. Materials and methods: Whole blood cobalt (Co) and chromium (Cr) ion concentrations, ARMD rate, revision rate, and function measured by UCLA and WOMAC scores were compared between groups. Results: ARMD rate was significantly higher in the modular group (46%) compared with the monoblock group (16%, p = 0.031). Revision for ARMD was performed at 52.8 ± 8.1 months in the modular group versus 98.2 ± 15.5 months after primary THA in the monoblock group. ARMD originated from wear and corrosion of the junction between stem and femoral head adapter sleeve in all monoblock cases, and the junction between stem and modular neck in all the modular ones. Cr and Co ions levels were significantly higher in the modular stem group ( p < 0.001 for both). Conclusions: Although both groups had MoM bearings, corrosion at stem/neck or neck/head junctions combining dissimilar metal (Ti and Cr-Co) was seen as the source of excess metal ions release leading to ARMD. Poor performance of the modular junction may be more deleterious than wear of the bearing. To avoid such complications, THA femoral stem modular junctions should be eliminated (return to a full monoblock implant) or have improved junction design.

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Oral dabigatran versus enoxaparin for thromboprophylaxis after primary total hip arthroplasty (RE-NOVATE II)

Thrombosis and Haemostasis ◽

10.1160/th10-10-0679 ◽

2011 ◽

Vol 105 (04) ◽

pp. 721-729 ◽

Cited By ~ 260

Author(s):

Ola Dahl ◽

Michael Huo ◽

Andreas Kurth ◽

Stefan Hantel ◽

Karin Hermansson ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Group Versus ◽

Primary Efficacy ◽

Once Daily ◽

Primary Efficacy Outcome ◽

Total Hip ◽

Efficacy Outcome ◽

Enoxaparin Group ◽

Subcutaneous Enoxaparin

SummaryThis trial compared the efficacy and safety of oral dabigatran, a direct thrombin inhibitor, versus subcutaneous enoxaparin for extended thromboprophylaxis in patients undergoing total hip arthroplasty. A total of 2,055 patients were randomised to 28–35 days treatment with oral dabigatran, 220 mg once-daily, starting with a half-dose 1–4 hours after surgery, or subcutaneous enoxaparin 40 mg once-daily, starting the evening before surgery. The primary efficacy outcome was a composite of total venous thromboembolism [VTE] (venographic or symptomatic) and death from all-causes. The main secondary composite outcome was major VTE (proximal deep-vein thrombosis or non-fatal pulmonary embolism) plus VTE-related death. The main safety outcome was major bleeding. In total, 2,013 were treated, of whom 1,577 operated patients were included in the primary efficacy analysis. The primary efficacy outcome occurred in 7.7% of the dabigatran group versus 8.8% of the enoxaparin group, risk difference (RD) –1.1% (95%CI –3.8 to 1.6%); p<0.0001 for the pre-specified non-inferiority margin. Major VTE plus VTE-related death occurred in 2.2% of the dabigatran group versus 4.2% of the enoxaparin group, RD –1.9% (-3.6% to –0.2%); p=0.03. Major bleeding occurred in 1.4% of the dabigatran group and 0.9% of the enoxaparin group (p=0.40). The incidence of adverse events, including liver enzyme elevations and cardiac events, during treatment was similar between the groups. Extended prophylaxis with oral dabigatran 220 mg once-daily was as effective as sub-cutaneous enoxaparin 40 mg once-daily in reducing the risk of VTE after total hip arthroplasty, and superior to enoxaparin for reducing the risk of major VTE. The risk of bleeding and safety profiles were similar.

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