Management of bleeding with a temporary arterial occlusion balloon in revision total hip arthroplasty

2021 ◽  
pp. 112070002110113
Author(s):  
Gösta Ullmark ◽  
Hanna Ribers ◽  
Olov Haller
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Reference Group ◽  
Insertion Site ◽  
Arterial Occlusion ◽  
Occlusion Time ◽  
Occlusion Balloon ◽  
Revision Thas ◽  
Total Hip ◽  
Perioperative Bleeding

Purpose: Perioperative bleeding is an undesirable surgical phenomenon. An effective way of diminishing bleeding is by use of a temporary arterial occlusion balloon (TAOB) to produce regional hypotension. We analysed TAOB-related complications at our institution occurring with total hip arthroplasties between years 2000 and 2016. We also compared the effect on bleeding for a TAOB group and a matched group during this same time. Patients and methods: 76 consecutive cases had a total hip arthroplasty (THA) combined with a TAOB. In an analysis of all complications connected to the use of TAOB, 48 of them were revision THAs. The matched reference group consisted of 20 patients with revision surgery, but without TAOB. We analysed and compared perioperative bleeding, surgery, and balloon occlusion time for these 2 groups. Results: No thromboembolic complications or other severe complications were recorded. 1 case had bleeding from the insertion site after catheter removal. 3 cases had balloon failure without the consequences of this complication. The TAOB group had significantly less haemoglobin loss, total perioperative bleeding, bleeding per minute, and total transfusion than the matched reference group. Interpretation: The use of TAOB in elective THA surgery is safe and effective in reducing intraoperative bleeding.

scholarly journals Freedom Constrained Liner for the Treatment and Prevention of Dislocation in Total Hip Arthroplasty

2016 ◽  
Vol 106 (2) ◽  
pp. 165-172 ◽  
Author(s):  
M. Karvonen ◽  
H. Karvonen ◽  
M. Seppänen ◽  
A. Liukas ◽  
M. Koivisto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Hip Arthroplasty ◽  
Failure Rate ◽  
Hip Arthroplasty ◽  
Mechanical Failure ◽  
University Hospital ◽  
Revision Thas ◽  
Total Hip ◽  
Locking Mechanism ◽  
Constrained Liner

Background and Purpose: Dislocation is one of the most common complications following total hip arthroplasty. The aim of our study was to assess failure rate of the Biomet Freedom constrained liner (Biomet, Warsaw, IN, USA) either in revision surgery for recurrent dislocation, or as a preventive method in high dislocation risk patients. Patients and Methods: We assessed retrospectively 105 consecutive surgical procedures in 103 patients where a Freedom constrained liner or cup was used in Turku University Hospital over a 7-year period from 2007 to 2014. The mechanical failure rate of the device was assessed based on medical records. The average age of the patients was 73.4 years. The number of male patients was 53 (51%). Mean follow-up time was 2.5 years. The association between failure of the device and potential risk factors—age, gender, indication, and approach—was analyzed with logistic regression. Results were expressed by odd ratios and 95% confidence intervals. Results: The mechanical failure rate of the Freedom device was 6 out of 105 (5.7%). None of the 11 preventive primary THAs against dislocation failed, 4 out of 52 (7.7%) preventive revision THAs against dislocation failed, and 2 out of 42 (4.8%) of the treated dislocation cases failed. Four out of six failures were dislocations due to impingement and failure of the locking mechanism. Two liners failed because of loosening. The risk factors assessed were not associated with failure of the device. Interpretation: We found out that the mechanical failure rate of a Freedom constrained device was low. These results encourage us to continue using the device.

Outcomes of dual mobility components in total hip arthroplasty

2018 ◽  
Vol 100-B (1) ◽  
pp. 11-19 ◽  
Author(s):  
B. Darrith ◽  
P. M. Courtney ◽  
C. J. Della Valle
Keyword(s):  
Total Hip Arthroplasty ◽  
Femoral Neck ◽  
Aseptic Loosening ◽  
Hip Arthroplasty ◽  
English Language ◽  
Final Analysis ◽  
Dual Mobility ◽  
Revision Thas ◽  
Total Hip ◽  
Intraprosthetic Dislocation

Aims Instability remains a challenging problem in both primary and revision total hip arthroplasty (THA). Dual mobility components confer increased stability, but there are concerns about the unique complications associated with these designs, as well as the long-term survivorship. Materials and Methods We performed a systematic review of all English language articles dealing with dual mobility THAs published between 2007 and 2016 in the MEDLINE and Embase electronic databases. A total of 54 articles met inclusion criteria for the final analysis of primary and revision dual mobility THAs and dual mobility THAs used in the treatment of fractures of the femoral neck. We analysed the survivorship and rates of aseptic loosening and of intraprosthetic and extra-articular dislocation. Results For the 10 783 primary dual mobility THAs, the incidence of aseptic loosening was 1.3% (142 hips); the rate of intraprosthetic dislocation was 1.1% (122 hips) and the incidence of extra-articular dislocation was 0.46% (41 hips). The overall survivorship of the acetabular component and the dual mobility components was 98.0%, with all-cause revision as the endpoint at a mean follow-up of 8.5 years (2 to 16.5). For the 3008 revision dual mobility THAs, the rate of aseptic acetabular loosening was 1.4% (29 hips); the rate of intraprosthetic dislocation was 0.3% (eight hips) and the rate of extra-articular dislocation was 2.2% (67 hips). The survivorship of the acatabular and dual mobility components was 96.6% at a mean of 5.4 years (2 to 8). For the 554 dual mobility THAs which were undertaken in patients with a fracture of the femoral neck, the rate of intraprosthetic dislocation was 0.18% (one hip), the rate of extra-articular dislocation was 2.3% (13 hips) and there was one aseptic loosening. The survivorship was 97.8% at a mean of 1.3 years (0.75 to 2). Conclusion Dual mobility articulations are a viable alternative to traditional bearing surfaces, with low rates of instability and good overall survivorship in primary and revision THAs, and in those undertaken in patients with a fracture of the femoral neck. The incidence of intraprosthetic dislocation is low and limited mainly to earlier designs. High-quality, prospective, comparative studies are needed to evaluate further the use of dual mobility components in THA. Cite this article: Bone Joint J 2018;100-B:11–19.

scholarly journals High survivorship of highly cross-linked polyethylene in revision Total hip Arthroplasty: a minimum 10-year follow-up study

Arthroplasty ◽  
2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Seung-Jae Lim ◽  
Ingwon Yeo ◽  
Chan-Woo Park ◽  
Kyung-Jae Lee ◽  
Byung-Woo Min ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Polyethylene Liner ◽  
Harris Hip Score ◽  
Revision Total Hip Arthroplasty ◽  
Revision Thas ◽  
Total Hip ◽  
The Mean

Abstract Purpose Highly cross-linked polyethylene has been introduced to decrease osteolysis secondary to polyethylene wear debris generation. However, few long-term data on revision total hip arthroplasty (THA) using highly cross-linked polyethylene liners are available. The objective of this study was to determine long-term outcomes of a highly cross-linked polyethylene liner in revision THA. Materials & methods We evaluated 63 revision THAs performed in 63 patients using a highly cross-linked polyethylene liner between April 2000 and February 2005. Of these, nine died and four were lost to follow-up. Thus, the final study cohort consisted of 50 patients (50 hips), including 26 males and 24 females with a mean age of 53 years (range, 27–75 years). Mean follow-up was 11 years (range, 10–14 years). Results The mean Harris hip score improved from 44 points preoperatively to 85 points at the final follow-up. No radiographic evidence of osteolysis was found in any hip. The mean rate of polyethylene liner wear was 0.029 mm/year (range, 0.003 to 0.098 mm/year). A total of 5 hips (10%) required re-revision arthroplasty, including one cup loosening, one recurrent dislocation, and three deep infections. Kaplan-Meier survivorship with an end point of re-revision for any reason was 91.1% and for aseptic cup loosening was 97.9% at 11 years. Conclusion At a minimum of 10 years, the highly cross-linked polyethylene liners showed excellent clinical performance and implant survivorship, and were not associated with osteolysis in our patients with revision THAs.

Revision Total Hip Arthroplasty Performed with a Contemporary Alumina-on-Alumina Bearing Surface; Minimum 5-Year Follow-Up Study

2006 ◽  
Vol 309-311 ◽  
pp. 1353-1356 ◽  
Author(s):  
Jeong Joon Yoo ◽  
Hee Joong Kim ◽  
Young Min Kim ◽  
Kang Sup Yoon ◽  
Kyung Hoi Koo ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Activity Level ◽  
Physiological Age ◽  
Bearing Surface ◽  
Acetabular Bone ◽  
Revision Thas ◽  
Total Hip ◽  
Revision Tha

Limitation in liner and head options available to the surgeon may be the most practical disadvantage of alumina-on-alumina total hip arthroplasty (THA). This may be more problematic in the revision THA. We evaluated the results of 57 revision THAs (average, 46.2 years old) performed with a contemporary alumina-on-alumina bearing surface after a 5-year minimum follow-up (average, 67 months; range, 60-85 months). A third generation alumina-on-alumina bearing (BIOLOX® forte, CeramTec AG) and a cementless PLASMACUP®-BiCONTACT® hip revision system (AESCULAP AG & Co.) had been used in all patients. Alumina bearing was chosen for a relatively young active patient in whom an acetabular bone defect was not severe and an extremely long neck of artificial head was not required for the restoration of hip joint mechanics. The average Harris hip score improved from 65.0 points to 88.9 points. No implant loosened, no stem or cup was re-revised, and no additional reoperations were required. Ceramic wear was undetectable in 14 hips where differentiation of the femoral head from the cup was possible on radiographs and no osteolysis was observed. During the follow-up period, no hip demonstrated signs of infection or ceramic failure. Short-term results of revision THAs performed with analumina-on-alumina bearing are encouraging. We believe that physiological age and activity level of a patient, severity of acetabular bone loss, and availability of alumina head and liner options required for the restoration of proper limb length and joint stability should be considered to choose this alumina bearing surface during the revision THA.

scholarly journals Causes of Revision Total Hip Arthroplasty in Twenty Years: an Analysis of 1,353 Revisions 

2020 ◽  
Author(s):  
Jianming Gu ◽  
Xiao Feng ◽  
Hongyi Shao ◽  
Yixin Zhou
Keyword(s):  
Total Hip Arthroplasty ◽  
Aseptic Loosening ◽  
Infection Rate ◽  
Hip Arthroplasty ◽  
Periprosthetic Fracture ◽  
National Database ◽  
Revision Total Hip Arthroplasty ◽  
Revision Thas ◽  
Total Hip ◽  
Revision Tha

Abstract BackgroundWith the increase in revision total hip arthroplasty (THA) cases, understanding its causes is essential for a surgeons' clinical decision-making. Studies have reported on revision THA epidemiology in developed countries; however, its epidemiology in China remains unclear. We reviewed revision THA causes in a tertiary center in China. MethodsWe retrospectively identified 1,353 revision THAs at our institution from January 1999 to December 2018 (20 years). The causes for revision THA were compared among patients who were grouped based on the time of revision surgery, age at revision, and number of revisions, using the Student's t-test. ResultsAseptic loosening (826 hips, 61.0%) and infection (151 hips, 11.2%) were the most common reasons for revision THA. Compared with the number of cases from January 1999 to December 2008, the number of cases from January 2009 to December 2018 increased 2.4-fold; the proportion of revisions due to aseptic loosening, periprosthetic fracture, instability, and osteolysis increased, and infection rate decreased. The infection rate was higher among patients aged over 60 years, whereas the incidence rate of aseptic loosening, periprosthetic fracture, and instability was higher among those aged 60 years or less. Infections (52.8%) were more common than aseptic loosening (37.4%) in second or subsequent revisions.ConclusionAseptic loosening and infection remain the most common causes of revision THAs at our center. Although the proportion of infections has decreased in the recent decade, a national database is necessary for a more comprehensive understanding of the causes of revision THAs in China. This work provides an understanding and comparison of the causes of revision THA in an orthopedic center among the Chinese population. This may reveal a potential change in revision THAs causes in the future, reminding surgeons to find a proper way to treat them.

scholarly journals Is convention hip precaution necessary after total hip arthroplasty?

2021 ◽  
Vol 28 ◽  
pp. 221049172110068
Author(s):  
Vincent WK Chan ◽  
MT Chan ◽  
PK Chan ◽  
CH Yan ◽  
KY Chiu
Keyword(s):  
Total Hip Arthroplasty ◽  
Internal Rotation ◽  
Hip Arthroplasty ◽  
Posterolateral Approach ◽  
Health Perceptions ◽  
P Value ◽  
Revision Thas ◽  
Total Hip ◽  
Hip Flexion ◽  
Hip Precautions

Background: Dislocation is one of the most common causes of revision after total hip arthroplasty (THA). Standard hip precautions are thought to enhance soft-tissue healing and reduce dislocations. However, lifestyle restrictions affect a patient’s rehabilitation, quality of life (QOL), and satisfactions. We aim to compare conventional (CP) and minimal hip precautions (MP) after THA. Methods: Retrospective review of prospectively collected data in posterolateral approach THA. Chief surgeon assigns patients to CP or MP group. CP group had to sleep supine, used elevated toilet seats and chairs, avoid hip flexion greater than 90°, and no internal rotation or adduction for 6 weeks. MP group had no restrictions in hip movements, except for the combined flexion, adduction and internal rotation. All had a minimum 1-year follow-up. The number of dislocations, length of stay (LOS), time to independent toileting, Harris Hip Scores, QOL, and health perceptions, assessed by EuroQol 5D-5L, was compared between CP and MP groups. Results: Fifty-five THAs were included. CP group consisted of 17 primary and 12 revision THAs; MP group consisted of 21 primary and 5 revision THAs. There were two dislocations and both are revisions in CP group. Overall rate of dislocation was 6.9% in CP group and no dislocation in MP group (p-value > 0.05). MP group had shorter LOS (12 vs 19 days, p-value 0.04), higher EQ5D-5L health perception scores at 1-year (81.7 vs 70.9, p-value 0.01). Conclusion: MP group had shorter LOS and better health perceptions 1-year after THA with no increase in dislocation rates.

scholarly journals Changes in coagulation status as measured by thromboelastography in patients undergoing revision total hip arthroplasty

2020 ◽  
Author(s):  
Jingye Yang ◽  
Sizheng Zhu ◽  
Leilei Qin ◽  
Jiawei Wang ◽  
Jiaxing Huang ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Perioperative Period ◽  
Revision Hip Arthroplasty ◽  
Hypercoagulable State ◽  
Revision Total Hip Arthroplasty ◽  
Total Hip ◽  
Perioperative Bleeding ◽  
Duration Of Surgery ◽  
The Mean

Abstract Background: Venous thromboembolism events (VTEs) continue to be of the most widespread severe complication following total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, there are no optimal accurate monitoring methods to assess the changes in coagulability after anticoagulation and anti-fibrinolysis during the perioperative period. Therefore, the objective of this study is to determine changes in coagulability as measured by thromboelastography (TEG) following revision total hip arthroplasty when the patients received rivaroxaban and tranexamic acid in perioperative period during enhanced recovery after surgery (ERAS). Methods: We retrospectively reviewed 70 revision TKA patients (mean age 63.69±10.17 years). Perioperative management of each patient was conducted in accordance with ERAS. The patients received tranexamic (TXA) to control perioperative bleeding. TEG was performed pre-operatively and on post-operative days (POD) 1, 3, 5 and 7. TEG-hypercoagulability was classified into three types: enzymatic hypercoagulability, platelet hypercoagulability and mixed hypercoagulability. Screening for coagulation-related complications at three months of follow-up. Results: The mean duration of surgery was 2.91±0.99 h. the mean intraoperative blood loss of patients was 486.43±346.92 ml. And 55.71% (39) patients received transfusion, the mean blood transfusion volume was 482.86 ± 458.79 ml. There only were 4 (5.71%) patients who suffered postoperative coagulation-related complications. 1 patient with hypercoagulable on preoperative developed intramuscular venous thrombosis at 1 month postoperatively. 1 patient with hypercoagulability at POD5 and POD7 suffered melena at POD5. 2 patients with hypocoagulability developed ecchymosis at POD3. The proportion of postoperative hypercoagulable state is gradually increasing. The distribution of different hypercoagulable states on the postoperative day (POD) 5 and 7 were significantly different from that pre-operation (Pre) and POD1 (POD5 vs Pre: p=0.011; POD5 vs POD1: p=0.001; POD7 vs Pre: p=0.001; POD7 vs POD5: p<0.001). We found 32.86%(23) revision THA with hypercoagulable state on POD7.For 78.26%(18) of these patients there was mixed hypercoagulability. Conclusions: In ERAS, thromboelastography was an effective way to identify hypercoagulable state in patients undergoing revision hip arthroplasty, and mixed hypercoagulability is the predominant hypercoagulable state following revision hip arthroplasty. In addition, it is very important to develop an individualized coagulation management program.

Primary and revision total hip arthroplasty with uncemented acetabular components in patients with Paget’s disease

2020 ◽  
pp. 112070002092017
Author(s):  
Meagan E Tibbo ◽  
Timothy S Brown ◽  
Arlen D Hanssen ◽  
David G Lewallen ◽  
Franklin H Sim ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Aseptic Loosening ◽  
Hip Arthroplasty ◽  
Paget’S Disease ◽  
Paget's Disease ◽  
Harris Hip Score ◽  
Revision Thas ◽  
Total Hip ◽  
Component Loosening ◽  
Acetabular Components

Introduction: Paget’s disease affects 3–4% of the population; however, literature describing outcomes of total hip arthroplasty (THA) in this population are limited. Given the known concerns with bleeding, heterotopic ossification (HO), and component loosening, we describe our results with primary and revision THAs in Paget’s disease with emphasis on implant survivorship, radiographic results, and clinical outcomes. Methods: We identified 25 THAs performed with contemporary uncemented acetabular components in patients with Paget’s disease from 1999 to 2014. Mean age and follow-up were 78 and 7 years. Results: In primary THAs, survivorship free from aseptic acetabular and femoral loosening was 100% and 94% at 8 years. 7 patients (41%) received blood transfusions. HO was seen in 9 (53%). Mean Harris Hip Score (HHS) improved from 49 to 76. In revision THAs, survivorship free from acetabular and/or femoral aseptic loosening was 100% at 5 years. 3 patients (38%) received a transfusion. HO was seen in 5 (63%). Mean HHS improved from 52 to 77. There were no radiographic signs of aseptic loosening among unrevised cases in either group. Discussion: Our investigation demonstrates that concerns with acetabular fixation in Paget’s disease have been mitigated with contemporary uncemented acetabular components. Complications previously noted, namely intraoperative bleeding and HO, continue to be of concern.

scholarly journals Dynamic trial fitting of the cup in press-fit total hip arthroplasty, a feasibility study

2021 ◽  
Vol 87 (2) ◽  
pp. 327-331
Author(s):  
Daniël Hoornenborg ◽  
Justin Van Loon ◽  
Sheryl De Waard ◽  
Inger N. Sierevelt ◽  
Kim T.M. Opdam ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Total Hip Arthroplasty ◽  
Feasibility Study ◽  
Hip Arthroplasty ◽  
Screw Fixation ◽  
The Real ◽  
Revision Thas ◽  
Total Hip ◽  
Press Fit ◽  
Potential Association

Trial fitting of the cup during total hip arthroplasty (THA) is done by trial cups, which do not resemble the real press-fit obtained by the definitive implant. Our goal is to judge feasibility of the X-pander® in clinical practice ; a device developed to mimic the real press-fit obtained by the definitive cup, to ensure satisfactory press-fit. In this feasibility study 45 experienced orthopaedic surgeons from 7 European countries filled in a structured survey after 78 primary THA and 31 revision surgeries, using the X-pander instead of traditional trial cups. Primary outcomes were decision change concerning cup size or further reaming and increased confidence regarding cup insertion and size. Additionally, potential association between the primary outcomes and procedure (primary or revi- sion), bone quality and experience of the surgeon were evaluated. In 33.3% of the primary and 32.2% of the revision cases the X-pander measurement changed the deci- sion and further reaming or change of cup size was decided. In 61.5% and 58.1% of respectively the primary and revision THAs the X-pander was judged to give fairly to much more reliable information than traditional trial cups. The X-pander could lead to less additional screw fixation, as stated in 37.2% of the primary and 25.8% of the revision cases and to better cup insertion in respectively 50.0% and 51.6%. This study validates that the X-pander may be a suitable option for accurate sizing and assessment of the reamed acetabulum and could replace traditional trial cups in THA.

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