Do patients with well-functioning total hip arthroplasty achieve typical sagittal plane hip kinematics? A proof of concept study

Background: Total hip arthroplasty (THA) patients have been shown to not achieve normal sagittal plane hip kinematics. However, previous studies have only conducted group level analysis and as such lack the sensitivity to highlight whether individual patients do achieve normal hip kinematics. As such this study looked to determine whether some patients with well-functioning THA achieve typical sagittal plane hip kinematics. Methods: Sagittal plane hip kinematics were collected on 11 well-functioning THA patients (Oxford Hip Score = 46 ± 3) and 10 asymptomatic controls using a 3-dimensional motion analysis system during self-paced walking. High-functioning THA patients were identified as those who displayed sagittal plane hip kinematics that were within the variance of the control group on average, and low-functioning patients as those who did not. Results: 5 THA patients were identified as high-functioning, displaying hip kinematics within the variance of the control group. High-functioning THA patients displayed peak hip flexion and extension values more closely aligned to asymptomatic control group than low-functioning patients. However, hip range of motion was comparable between high- and low-functioning total hip arthroplasty patients and reduced compared to controls. Conclusion: The presence of high-functioning THA patients who display comparable sagittal plane hip kinematics to controls suggests these patients do achieve normative function and challenges the conclusions of previous group level analysis. Understanding why some patients achieve better function post-operatively will aid pre- and post-operative practices to maximise functional recovery.

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Effects of rehabilitation and arthroplasty on the hip isometric muscle strength in patients with osteoarthritis of the hip

Medicinski pregled ◽

10.2298/mpns0906236j ◽

2009 ◽

Vol 62 (5-6) ◽

pp. 236-240 ◽

Cited By ~ 1

Author(s):

Slavica Jandric

Keyword(s):

Muscle Strength ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Gluteus Medius ◽

Treated Group ◽

Early Rehabilitation ◽

Control Group ◽

Osteoarthritis Of The Hip ◽

Total Hip ◽

Tensor Fasciae Latae

Introduction Periarticular muscles have a significant role in keeping the mobility and integrity of the hip joint. The aim of this article was to investigate the effects of the total hip arthroplasty and early rehabilitation on the muscle strength. Patients Three groups of examined persons (matched in relation to musculosceletal conditions, sex, age and occupation) were included in the investigation. The first group (40 of the involved hip) and the second group (with 33 involved hips) were groups of patients with late-stage of osteoarthritis of the hip. The first group of patients was managed conservatively and the second group operatively (total cemented hip endoprosthesis was performed). The third group was control group with 123 healthy hips. Material and methods The maximal voluntary isometric strength was measured with dynamometer. The muscle strength was tested in all three groups: in the first group of patients at the beginning and at the end of the therapy and in patients of the second group 6?3 months postoperatively. Results A significant improvement of the muscle strength was noted for the flexors (t=2.45, p<0.05), musculus tensor fasciae latae (t=2.35, p<0.05), extensors (t=2.85, p<0.01), adductors (t=3.02, p<0.01), external rotators (t=3.1, p<0.01), m. gluteus medius (t=5.28, p<0.001) and internal rotators (t=5.77, p<0.001) after total hip arthroplasty and early rehabilitation in comparison to the conservatively treated group. Conclusion The muscle strength in the patients with osteoarthritis of the hip after arthroplasty was significantly higher than after rehabilitation for all hip muscles but did not reach values of the strength of the muscles in the corresponding control group.

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The association between cannabis use disorder and the outcome following primary total hip arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.103b7.bjj-2020-2424.r1 ◽

2021 ◽

Vol 103-B (7 Supple B) ◽

pp. 111-115

Author(s):

Rushabh M. Vakharia ◽

Angelo Mannino ◽

Hytham S. Salem ◽

Martin W. Roche ◽

Che Hang J. Wong ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Cannabis Use ◽

Hospital Length Of Stay ◽

Medical Complications ◽

Control Group ◽

Study Group ◽

Cannabis Use Disorder ◽

Total Hip ◽

Primary Total Hip Arthroplasty

Aims Although there is increasing legalization of the use of cannabis in the USA, few well-powered studies have evaluated the association between cannabis use disorder and outcomes following primary total hip arthroplasty (THA). Thus, the aim of this study was to determine whether patients who use cannabis and undergo primary THA have higher rates of in-hospital length of stay (LOS), medical complications, implant-related complications, and costs. Methods Using an administrative database, patients with cannabis use disorder undergoing primary THA were matched to a control group in a 1:5 ratio by age, sex, and various medical comorbidities. This yielded 23,030 patients (3,842 in the study group matched with 19,188 in the control group). The variables which were studied included LOS, 90-day medical complications, two-year implant-related complications, and 90-day costs of care. Mann-Whitney U tests were used to compare LOS and costs. Multivariate logistic regression analyses were used to calculate the odds ratios (ORs) of developing complications. Results We found that patients in the study group had a significantly longer mean LOS compared with the controls (four days vs three days; p < 0.0001).The study group also had a significantly higher incidence and odds of developing medical (23.0 vs 9.8%, OR 1.6; p < 0.0001) and implant-related complications (16 vs 7.4%, OR 1.6; p < 0.0001) and incurred significantly higher mean 90-day costs ($16,938.00 vs $16,023.00; p < 0.0001). Conclusion With the increasing rates of cannabis use, these findings allow orthopaedic surgeons and other healthcare professionals to counsel patients with cannabis use disorder about the possible outcomes following their THA, with increased hospital stays, complications, and costs. Cite this article: Bone Joint J 2021;103-B(7 Supple B):111–115.

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Augmented Rehabilitation Program for Young Patients Following Total Hip Arthroplasty

10.21203/rs.3.rs-138081/v1 ◽

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.

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Preventing Loss of Femoral Periprosthetic Bone Mineral Density in Cementless Total Hip Arthroplasty Using a Tapered Wedge Stem in Patients With Osteoporosis Treated With Denosumab: a Retrospective, Cohort Study

10.21203/rs.3.rs-736895/v1 ◽

2021 ◽

Author(s):

Keiji Kamo ◽

Hiroaki Kijima ◽

Koichiro Okuyama ◽

Tetsuya Kawano ◽

Nobutoshi Seki ◽

...

Keyword(s):

Bone Mineral Density ◽

Total Hip Arthroplasty ◽

Bone Mineral ◽

Hip Arthroplasty ◽

Stress Shielding ◽

Control Group ◽

Mineral Density ◽

Total Hip ◽

Cementless Total Hip Arthroplasty ◽

Periprosthetic Bone Mineral Density

Abstract Background: Bone mineral density (BMD) of the proximal femur around the stem decreases due to stress shielding after cementless total hip arthroplasty (THA). When severe stress shielding occurs, the risk of periprosthetic femoral fractures increases, and this bone loss can also increase the difficulty of future revision THA. Denosumab is known to improve the quality and strength of cortical bone in the proximal femurs of patients with osteoporosis. The purpose of this study was to investigate whether denosumab prevents loss of proximal femoral periprosthetic BMD in cementless THA using a tapered wedge stem in patients with osteoporosis.Methods: Sixty-three consecutive patients who had undergone unilateral primary THA using a tapered wedge stem were included in this retrospective study. Twenty-four patients who received denosumab for osteoporosis were the denosumab group, and the 39 without denosumab were the control group. At 2 weeks, 6 months, and 12 months after THA, bone turnover markers and femoral periprosthetic BMD were measured.Results: BMD in zone 1 was significantly increased from baseline at both 6 and 12 months after THA in the denosumab group and significantly decreased in the control group. BMD in zone 7 was significantly decreased compared to baseline at both 6 and 12 months after THA in the control group, but not in the denosumab group. The use of denosumab for THA patients with osteoporosis was independently related to preventing loss of periprosthetic BMD of the femur at 12 months after surgery in zones 1 and 7 on multivariate analysis.Conclusions: Denosumab significantly increased proximal femoral periprosthetic BMD in zone 1 and prevented loss of BMD in zone 7 in patients with osteoporosis after cementless THA using a tapered wedge stem at both 6 and 12 months after surgery.

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Subchondral drilling for chondral flaps reduces the risk of total hip arthroplasty in femoroacetabular impingement surgery at minimum five years follow-up

Hip International ◽

10.1177/1120700018781807 ◽

2018 ◽

Vol 29 (2) ◽

pp. 191-197 ◽

Cited By ~ 2

Author(s):

Pascal C Haefeli ◽

Moritz Tannast ◽

Martin Beck ◽

Klaus A Siebenrock ◽

Lorenz Büchler

Keyword(s):

Los Angeles ◽

Total Hip Arthroplasty ◽

Femoroacetabular Impingement ◽

Hip Arthroplasty ◽

Hip Dislocation ◽

Harris Hip Score ◽

Control Group ◽

Total Hip ◽

Tönnis Grade

Introduction: The best treatment of acetabular chondral flaps during surgery for femoroacetabular impingement (FAI) is unknown. We asked if subchondral drilling improves clinical and radiographic outcome and if there are factors predicting failure. Methods: We treated 79 patients with symptomatic FAI and acetabular chondral flaps with surgical hip dislocation between January 2000 and December 2007. Exclusion of all patients with previous hip pathology or trauma resulted in 62 patients (80 hips). The chondral flap was slightly debrided in 43 patients/51 hips (control group). In 28 patients/29 hips (study group), additional osseous drilling was performed. 4 patients (5 hips, 6%) were lost to follow-up. Mean follow-up was 9 years (5–13 years). The groups did not differ in demographic data, radiographic parameters or follow-up. Clinical outcome was assessed with the Merle d’Aubigné score, modified Harris Hip Score and University of California Los Angeles activity score and progression of osteoarthritis with the Tönnis grade. Results: No patient underwent conversion to total hip arthroplasty (THA) in the drilling group compared to 7 patients (8 hips, 16%) in the control group ( p = 0.005); in the remaining hips, clinical scores and progression of Tönnis grade did not differ. Increased acetabular coverage, age and body mass index were univariate predictive factors for conversion to THA. No drilling was as an independent predictive factor for conversion to THA (hazard ratio 58.07, p = 0.009). Conclusion: Subchondral drilling under acetabular chondral flaps during surgical treatment of FAI is an effective procedure to reduce the rate of conversion to THA.

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Metal on Metal Bearing in Total Hip Arthroplasty and Its Impact on Synovial Cell Count

Journal of Clinical Medicine ◽

10.3390/jcm9103349 ◽

2020 ◽

Vol 9 (10) ◽

pp. 3349

Author(s):

Henrik C. Bäcker ◽

Chia H. Wu ◽

David Krüger ◽

Clemens Gwinner ◽

Carsten Perka ◽

...

Keyword(s):

Synovial Fluid ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Periprosthetic Joint Infection ◽

Joint Infection ◽

Control Group ◽

Total Hip ◽

Metal On Metal ◽

Matching Criteria ◽

The Impact

Introduction: The effect of different bearings on synovial white blood cell (WBC) count and polymorphonuclear percentage (PMN%) in aspirations remains unclear. Therefore, this study investigates the impact of aseptic Metal-on-Metal (MoM) bearing on synovial fluid. Methods: We searched our arthroplasty registry for aseptic painful THAs with MoM bearings between 2011 and 2018. Then, a case-matched control group was selected with septic and aseptic Total Hip Arthroplasty (THA) with ceramic on a polyethylene (PE) bearing. The matching criteria consisted of gender, age +/−10 years, and time of aspiration (+/−2years). Periprosthetic Joint Infection (PJI) was defined according to the Infectious Diseases Society of America (IDSA), and Musculoskeletal Infection Society (MSIS) using bacterial cultures, sonication and histology. Results: In total, 19 patients who underwent hip aspiration with MoM bearing were identified. Five patients had to be excluded due to insufficient synovial fluid obtained (n = 2) or bacterial growth after sonication that was initially negative with the standard microbiological cultures (n = 3). As such, 14 were included. These patients were matched with 14 aseptic and 14 septic THAs with ceramic on a PE bearing, which constituted the control group. The mean serum chrome level was 20.0 ± 15.5 nmol/L and cobalt level 18.4 ± 22.1 nmol/L. The synovial WBC and PMN% varied significantly between MoM bearing group and the aseptic THA ceramic PE group (both p < 0.001), as well as the septic THA group (WBC p = 0.016, PMN% p < 0.001). Furthermore, the septic THA group had significantly higher CRP values than the aseptic MoM group (p = 0.016). Conclusion: MoM bearing shows significantly higher synovial WBC and PMN% when compared to aseptic THA with ceramic on PE bearing above the MSIS cut-off. This is an important consideration when diagnosing periprosthetic joint infection using the MSIS guidelines.

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Effect of Multiple Doses of Oral Tranexamic Acid on Haemostasis and Inflammatory Reaction in Total Hip Arthroplasty: A Randomized Controlled Trial

Thrombosis and Haemostasis ◽

10.1055/s-0038-1676625 ◽

2018 ◽

Vol 119 (01) ◽

pp. 092-103 ◽

Cited By ~ 7

Author(s):

Duan Wang ◽

Yang Yang ◽

Chuan He ◽

Ze-Yu Luo ◽

Fu-Xing Pei ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Blood Loss ◽

Inflammatory Response ◽

Tranexamic Acid ◽

Hip Arthroplasty ◽

Multiple Dose ◽

Control Group ◽

Total Hip ◽

Estimated Blood Loss ◽

Significant Difference

AbstractTranexamic acid (TXA) reduces surgical blood loss and alleviates inflammatory response in total hip arthroplasty. However, studies have not identified an optimal regimen. The objective of this study was to identify the most effective regimen of multiple-dose oral TXA in achieving maximum reduction of blood loss and inflammatory response based on pharmacokinetic recommendations. We prospectively studied four multiple-dose regimens (60 patients each) with control group (group A: matching placebo). The four multiple-dose regimens included: 2-g oral TXA 2 hours pre-operatively followed by 1-g oral TXA 3 hours post-operatively (group B), 2-g oral TXA followed by 1-g oral TXA 3 and 7 hours post-operatively (group C), 2-g oral TXA followed by 1-g oral TXA 3, 7 and 11 hours post-operatively (group D) and 2-g oral TXA followed by 1-g oral TXA 3, 7, 11 and 15 hours post-operatively (group E). The primary endpoint was estimated blood loss on post-operative day (POD) 3. Secondary endpoints were thromboelastographic parameters, inflammatory components, function recovery and adverse events. Groups D and E had significantly less blood loss on POD 3, with no significant difference between the two groups. Group E had the most prolonged haemostatic effect, and all thromboelastographic parameters remained within normal ranges. Group E had the lowest levels of inflammatory cytokines and the greatest range of motion. No thromboembolic complications were observed. The post-operative four-dose regimen brings about maximum efficacy in reducing blood loss, alleviating inflammatory response and improving analgaesia and immediate recovery.

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Importance of Retaining Sufficient Acetabular Depth: Successful 2-Year Outcomes of Hip Arthroscopy for Patients With Pincer Morphology as Compared With Matched Controls

The American Journal of Sports Medicine ◽

10.1177/0363546520937301 ◽

2020 ◽

Vol 48 (10) ◽

pp. 2471-2480 ◽

Cited By ~ 1

Author(s):

Claudia R. Brick ◽

Catherine J. Bacon ◽

Matthew J. Brick

Keyword(s):

Total Hip Arthroplasty ◽

Femoroacetabular Impingement ◽

Hip Arthroplasty ◽

Hip Arthroscopy ◽

Patient Reported Outcomes ◽

Control Group ◽

Total Hip ◽

Patient Reported ◽

Acetabular Overcoverage

Background: Patients with pincer-type femoroacetabular impingement are commonly treated with arthroscopic reduction of acetabular depth as measured by the lateral center-edge angle (LCEA). The optimal amount of rim reduction has not been established, although large resections may increase contact pressures through the hip. A recent publication demonstrated inferior surgical outcomes in patients with acetabular overcoverage as compared with normal acetabular coverage. Casual observation of our database suggested equivalent improvements, prompting a similar analysis. Purpose: To analyze patient-reported outcomes after hip arthroscopy for femoroacetabular impingement in patients with acetabular overcoverage who were matched with controls with normal coverage, as well as to analyze associations with reduction in LCEA. Study Design: Cohort study; Level of evidence, 3. Methods: Data were collected prospectively from patients with a minimum 2-year follow-up after receiving hip arthroscopy for femoroacetabular impingement by a single surgeon. Cases were reviewed to identify those with pincer-type morphology (LCEA >40°) and matched according to sex, age, chondral damage, and surgery date in a 1:1 ratio with controls with an LCEA of 25° to 40°. The surgical goal was to reduce the LCEA to the upper end of the normal range with minimal rim resection, usually 35° to 37°. Radiographic measurements of coverage, intraoperative findings, procedures, and patient-reported outcomes were recorded, including the 12-Item International Hip Outcome Tool, Non-arthritic Hip Score, Hip Disability and Osteoarthritis Outcome Score, visual analog scale for pain, rates of revision or reoperation, and conversion to total hip arthroplasty. Results: A total of 114 hips (93 patients) for the pincer group were matched 1:1 from 616 hips (541 patients) for the control group. The pincer group (mean ± SD age, 34.5 ± 12.2 years) did not differ in age, body mass index, or follow-up from controls. LCEA was reduced in both groups pre- to postoperatively: the pincer group from 44.0° ± 2.8° to 34.2° ± 3.5° and the controls from 32.9° ± 3.9° to 31.0° ± 3.0°. No differences in improvement were observed: iHOT-12 improved by 35.7 points in both groups ( P = .9 for analysis of variance interaction) and Nonarthritic Hip Score by 22.3 points ( P = .6). From all eligible surgical procedures, 2-year follow up rates were 2.5% and 2.6% for the pincer and control cohorts, respectively, and 1.2% and 0.3% for conversion to total hip arthroplasty. Conclusion: Arthroscopic management of acetabular overcoverage can achieve excellent results, equivalent to arthroscopy for other causes of symptomatic femoroacetabular impingement. A key finding was smaller rim resections producing a mean postoperative LCEA of 34.2° with a small standard deviation.

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Total Hip Arthroplasty after Vascularized Fibular Grafting

The Duke Orthopaedic Journal ◽

10.5005/jp-journals-10017-1012 ◽

2012 ◽

Vol 2 (1) ◽

pp. 12-17

Author(s):

Thomas P Vail ◽

Apostolos Dimitroulias ◽

Jeff Hodrick ◽

Rusty Brand ◽

Nicholas Viens ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Acetabular Component ◽

Hip Arthroplasty ◽

Perioperative Complications ◽

Harris Hip Score ◽

Control Group ◽

Total Hip ◽

Uncemented Total Hip Arthroplasty ◽

Significant Difference ◽

Fibular Grafting

ABSTRACT Background Vascularized fibular grafting has been reported as a successful joint preserving surgery for patients with femoral head osteonecrosis. Few reports exist regarding the outcomes associated with total hip arthroplasty after failed vascularized fibular grafting. This study aims to highlight the early results and complications associated with this procedure. Materials and methods We retrospectively reviewed charts and radiographs of 30 patients (38 hips) who underwent conversion of prior vascularized fibular grafting to an uncemented total hip arthroplasty utilizing modern bearings (highly cross-linked polyethylene-on-metal or metal-on-metal). Mean follow-up was 41 months. A control group of 15 osteonecrosis patients (19 hips) was used who had a history of total hip arthroplasty without previous surgery. Outcome measures used were perioperative complications, clinical and radiological findings. Results The prior vascularized fibular grafting group had longer surgical times and more perioperative complications (calcar fracture and persistent wound drainage requiring early reoperation). In the prior vascularized fibular grafting group there were two cases requiring revision for aseptic loosening (one femoral and one acetabular component) and three cases of asymptomatic radiographic loosening (two femoral and one acetabular component). Furthermore, three patients reported symptoms of trochanteric bursitis. None of the above complications were seen in the control group. There was one dislocation in each group; and both were treated successfully with closed reduction. There was no significant difference between the two groups in the final postoperative Harris Hip Score (HHS). Conclusion Despite an increased complication rate, comparable clinical outcomes can be expected after conversion of vascularized fibular grafting to total hip arthroplasty. Dimitroulias A, Hodrick J, Brand R, Viens N, Attarian DE Vail TP, Bolognesi MP. Total Hip Arthroplasty after Vascularized Fibular Grafting. The Duke Orthop J 2012; 2(1):12-17.

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Incorporating Neuromuscular Reeducation Techniques During Postoperative Rehabilitation Improves Functional Performance After Total Hip Arthroplasty: A Preliminary Study

10.31487/j.jsr.2020.01.02 ◽

2020 ◽

pp. 1-9

Author(s):

Dana Judd ◽

Bradley S. Davidson ◽

Dana Judd ◽

Douglas A. Dennis ◽

Jennifer E. Stevens-Lapsley ◽

...

Keyword(s):

Muscle Strength ◽

Total Hip Arthroplasty ◽

Postural Control ◽

Hip Arthroplasty ◽

Functional Performance ◽

Preliminary Investigation ◽

Outpatient Rehabilitation ◽

Control Group ◽

Total Hip ◽

Minute Walk

Introduction: Total hip arthroplasty is a common procedure in end-stage hip osteoarthritis. Yet, following hip arthroplasty, deficits in functional performance, possibly due to movement compensations, persist. The purposes of this study are to provide conceptual basis for improving functional performance following hip arthroplasty by addressing movement compensation, present a unique rehabilitation protocol developed from this conceptual framework, and present findings from a preliminary investigation. Methods: This study was a prospective, randomized, controlled preliminary trial with concealed allocation and intention-to-treat analysis. Twenty participants undergoing primary, posterior approach THA were randomized into a neuromuscular reeducation and a control group. The neuromuscular reeducation group completed an 8-week, outpatient rehabilitation program after total hip arthroplasty utilizing neuromuscular reeducation techniques to promote pelvic stability and strength to improve movement quality. The control group was supervised by the study therapist weekly for 8 weeks after surgery but did not attend outpatient rehabilitation. Outcomes, assessed before and after surgery, included stair climb test, gait speed, 6-minute walk test, assessments of postural control and pelvic stability, muscle strength, and self-reported function. Results: Following the intervention, the neuromuscular reeducation group demonstrated statistically and clinically significant improvements in the stair climb test, 4-meter walk, 6-minute walk, postural control, and in some patient-reported outcomes. Further, there were trends toward improvement in pelvic stability during functional tasks and muscle strength, but these improvements were not statistically significant. Conclusions: Findings of this preliminary investigation support the use of neuromuscular reeducation techniques to improve functional performance after total hip arthroplasty, yet more information may be needed to determine efficacy. Therefore, this preliminary work has set the stage for future investigations to explore whether neuromuscular reeducation training after total hip arthroplasty should be considered in clinical practice.

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