scholarly journals Bone density measurements adjacent to acetabular cups in total hip arthroplasty using dual-energy CT: an in vivo reliability and agreement study

2018 ◽  
Vol 7 (9) ◽  
pp. 205846011879653 ◽  
Author(s):  
Bo Mussmann ◽  
Poul Erik Andersen ◽  
Trine Torfing ◽  
Søren Overgaard
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Intraclass Correlation ◽  
Dual Energy ◽  
Dual Energy Ct ◽  
Mineral Density ◽  
Metal Artifacts ◽  
Total Hip ◽  
Complex Anatomy ◽  
The Mean

Background Measuring bone mineral density (BMD) around acetabular prosthetic components with computed tomography (CT) is challenged by the complex anatomy and metal artifacts. Three-dimensional (3D) segmentation is required for the analysis, but it is usually not practically applicable on current CT workstations Purpose To test the between-scan agreement and reliability of custom segmentation software for BMD measurements adjacent to cemented and uncemented acetabular cups in dual-energy CT (DECT). Material and Methods Twenty-four male patients with total hip arthroplasty were scanned and rescanned using 130-keV virtual monochromatic DECT images. Hemispherical regions of interest were defined slice-by-slice and BMD was calculated around the acetabular cup using custom segmentation software. Results In the uncemented cup, the mean BMD was 153 mg/cm3 with a between-scan difference of 10 mg/cm3 ( P < 0.0001). In the cemented cup, the mean BMD was 186 mg/cm3 with a between-scan difference of 6 mg/cm3 ( P = 0.15). In both uncemented and cemented cups the intraclass correlation coefficient between repeated measurements was >0.95 and narrow Bland–Altman Limits of Agreement. Conclusion BMD can be measured with high absolute between-scan agreement and good reliability adjacent to acetabular cemented and uncemented cups using DECT and segmentation software.

scholarly journals An evaluation of proximal femur bone density in young, active patients undergoing total hip arthroplasty at one year postoperatively

2018 ◽  
Vol 29 (1) ◽  
pp. 51-57
Author(s):  
Denis Nam ◽  
Rondek Salih ◽  
Robert L Barrack ◽  
Ryan M Nunley
Keyword(s):  
Bone Density ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Proximal Femur ◽  
Mineral Density ◽  
Stem Design ◽  
Ucla Activity Score ◽  
Total Hip ◽  
The Mean ◽  
Active Patients

Background: Prior investigations have shown a decrease in periprosthetic bone mineral density (BMD) of the calcar following total hip arthroplasty (THA). The purpose of this investigation was to study proximal femur BMD in a cohort of young, active patients following THA at 1 year postoperatively using a recently introduced stem design. Methods: This was a prospective, IRB-approved investigation of patients with an age <65 years, BMI <35 kg/m2, and presymptomatic UCLA score of >6 undergoing a primary THA for a diagnosis of osteoarthritis. All patients received a titanium, proximally coated, tapered cementless femoral stem (ACCOLADE II, Stryker Inc, Mahwah, NJ, USA). Dual energy X-ray absorptiometry scans were performed at 6 weeks, 6 months, and 1 year postoperatively. Bone density was analyzed for 7 traditional Gruen zones with BMD ratios calculated for change in BMD compared with the baseline. Results: 31 patients (mean age of 52.6 + 6.5 years, BMI of 27.9 + 3.9 kg/m2, and UCLA activity score of 7.3 + 1.9) were included. The mean BMD ratio decreased at the 6 months and 1 year interval in zones 1 and 2. However, the mean BMD ratio was maintained in Gruen zones 3 thru 7 with zone 7 (medial calcar) demonstrating 100% maintenance of the baseline BMD at 1 year. Conclusion: This study demonstrates the maintenance of medial calcar bone density at 1 year postoperatively in young, active patients undergoing THA. Further longitudinal analysis of this stem design is necessary to elucidate the significance of this finding.

COMPARING COMMUNITY-PREFERENCE–BASED AND DIRECT STANDARD GAMBLE UTILITY SCORES: EVIDENCE FROM ELECTIVE TOTAL HIP ARTHROPLASTY

2003 ◽  
Vol 19 (2) ◽  
pp. 362-372 ◽  
Author(s):  
David Feeny ◽  
Christopher Blanchard ◽  
Jeffrey L. Mahon ◽  
Robert Bourne ◽  
Cecil Rorabeck ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Standard Gamble ◽  
Intraclass Correlation ◽  
Individual Level ◽  
Total Hip ◽  
The Mean ◽  
The Individual ◽  
Community Preferences ◽  
Utility Scores

Objectives: Do utility scores based on patient preferences and scores based on community preferences agree? The purpose is to assess agreement between directly measured standard gamble (SG) utility scores and utility scores from the Health Utilities Index Mark 2 (HUI2) and Mark 3 (HUI3) systems.Methods: Patients were assessed repeatedly throughout the process of waiting to see a surgeon, waiting for surgery, and recovery after total hip arthroplasty (THA). Group mean scores are compared using paired t-tests. Agreement is assessed using the intraclass correlation coefficient (ICC).Results: The mean SG, HUI2, and HUI3 (SD) scores at assessment 1 are 0.62 (0.31), 0.62 (0.19), and 0.52 (0.21); n=103. At assessment 2, the means are 0.67 (0.30), 0.68 (0.30), and 0.58 (0.22); n=84. There are no statistically significant differences between group mean SG and HUI2 scores. Mean SG and HUI3 scores are significantly different. ICCs are low.Conclusions: At the mean level for the group, SG and HUI2 scores match closely. At the individual level, agreement is poor. HUI2 scores were greater than HUI3 scores. HUI2 and HUI3 are appropriate for group level analyses relying on community preferences but are not a good substitute for directly measured utility scores at the individual leve.

scholarly journals Evaluation of intra- and interobserver reliability in the assessment of the ‘critical trochanter angle’

2020 ◽  
Vol 25 (1) ◽  
Author(s):  
Sebastian Serong ◽  
Moritz Schutzbach ◽  
Ivica Zovko ◽  
Marcus Jäger ◽  
Stefan Landgraeber ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Preoperative Risk Assessment ◽  
Total Hip ◽  
Intraclass Correlation Coefficients ◽  
The Mean ◽  
The Given

Abstract Background The recently described ‘critical trochanter angle’ (CTA) is a novel parameter in the preoperative risk assessment of stem malalignment in total hip arthroplasty. As its reproducibility needs to be evaluated, the given study aims to investigate intra- and interobserver reliability. It is hypothesized that both analyses justify the clinical use of the CTA. Methods A total of 100 pelvic radiographs obtained prior to total hip arthroplasty were retrospectively reviewed by four observers with different levels of clinical experience. The CTA was measured twice by each observer at different occasions in the previously described technique. Intra- and interobserver reliability was evaluated using intraclass correlation coefficients (ICC) with confidence intervals (CI) and the Bland–Altman approach. Results The mean CTA in both measuring sequences was 20.58° and 20.78°. The observers’ means ranged from 17.76° to 25.23°. Intraobserver reliability showed a mean difference of less than 0.5° for all four observers (95% limit of agreement: − 7.70–6.70). Intraobserver ICCs ranged from 0.92 to 0.99 (CI 0.88–0.99). For interobserver variation analysis, ICCs of 0.83 (CI 0.67–0.90) and 0.85 (CI 0.68–0.92) were calculated. Conclusion Analyses concerning intra- and interobserver reliability in the assessment of the CTA showed ‘very good’ and ‘good’ results, respectively. In view of these findings, the use of the CTA as an additional preoperative parameter to assess the risk of intraoperative stem malalignment seems to be justified.

scholarly journals Outpatient Total Hip Arthroplasty: A Meta-Analysis

2021 ◽  
Vol 11 (15) ◽  
pp. 6853
Author(s):  
Filippo Migliorini ◽  
Lucio Cipollaro ◽  
Francesco Cuozzo ◽  
Francesco Oliva ◽  
Andrea Valerio Marino ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Meta Analysis ◽  
Readmission Rates ◽  
Total Hip ◽  
Vein Thrombosis ◽  
Outpatient Group ◽  
Operative Planning ◽  
The Mean ◽  
And Gender

Introduction: Outpatient total hip arthroplasty (THA) is increasingly popular. This meta-analysis investigated the potential advantages of outpatient regimes for THA. Methods: This study followed the PRISMA guidelines. PubMed, Web of Science, Google Scholar, Embase, and Scopus databases were accessed in June 2021. All clinical studies investigating outpatient THA were considered. The outcomes of interest were pain, infection, mortality, revision, dislocation, readmission rates, and deep vein thrombosis (DVT). Results: Data from 102,839 patients were included. A total of 52% (153,168 of 102,839 patients) were women. The mean age of patients was 62.6 ± 4.6 years, the mean BMI was 29.1 ± 1.8 kg/m2. Good comparability was found in age, BMI, and gender (p > 0.1). No difference was found in pain (p = 0.4), infections (p = 0.9), mortality (p = 0.9), rate of revision (p = 0.1), dislocation (p = 0.9), and readmission (p = 0.8). The outpatient group demonstrated a greater rate of DVT (OR 3.57; 95% CI 2.47 to 5.18; p < 0.0001). Conclusions: In selected patients, outpatient THA can be performed safely with optimal outcomes comparable with inpatient THA. Clear and comprehensive pre-operative planning should involve a multi-disciplinary group composed of orthopaedic surgeons, anaesthesia and rehabilitation specialists, and physiotherapists. Each centre performing outpatient THA should implement continuous homecoming welfare activity, to supervise physiotherapy and monitor anticoagulant therapy.

scholarly journals A Novel Measurement Using Digital Radiography to Minimize Fluoroscopy in Total Hip Arthroplasty

2021 ◽  
Author(s):  
Andrew G. Yun ◽  
Marilena Qutami ◽  
Kory B. Dylan Pasko
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Radiation Exposure ◽  
Hip Arthroplasty ◽  
Fluoroscopy Time ◽  
Lesser Trochanter ◽  
Total Hip ◽  
Preoperative Templating ◽  
The Mean ◽  
Templating Technique

AbstractPreoperative templating for total hip arthroplasty (THA) is fraught with uncertainty. Specifically, the conventional measurement of the lesser trochanter to the center (LTC) of the femoral head used in preoperative planning is easily measured on a template but not measurable intraoperatively. The purpose of this study was to examine the utility of a novel measurement that is reproducible both on templating and in surgery as a more accurate and practical guide. We retrospectively reviewed 201 patients with a history of osteoarthritis who underwent primary THA. For preoperative templating, the distance from the top of the lesser trochanter to the equator (LeTE) of the femoral head was measured on a calibrated digital radiograph with a neutral pelvis. This measurement was used intraoperatively to guide the choice of the trial neck and head. As with any templating technique, the goal was to construct a stable, impingement-free THA with equivalent leg lengths and hip offset. In evaluating this novel templating technique, the primary outcomes measured were the number of trial reductions and the amount of fluoroscopic time, exposures, and radiation required to obtain a balanced THA reconstruction. Using the LeTE measurement, the mean number of trial reductions was 1.21, the mean number of intraoperative fluoroscopy images taken was 2.63, the mean dose of radiation exposure from fluoroscopy was 0.02 mGy, and the mean fluoroscopy time per procedure was 0.6 seconds. In hips templated with the conventional LTC prior to the LeTE, the mean fluoroscopy time was 0.9 seconds. There was a statistically significant difference in fluoroscopy time (p < 0.001). The LeTE is a reproducible measurement that transfers reliably from digital templating to surgery. This novel preoperative templating metric reduces the fluoroscopy time and consequent radiation exposure to the surgical team and may minimize the number of trial reductions.

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 Cementless one-stage bilateral total hip arthroplasty in osteoarthritis patients: functional outcomes and complications

2017 ◽  
Vol 9 (2) ◽  
Author(s):  
Afshin Taheriazam ◽  
Amin Saeidinia
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Functional Outcomes ◽  
Hip Osteoarthritis ◽  
Harris Hip Score ◽  
Superficial Infection ◽  
Total Hip ◽  
One Stage ◽  
The Mean ◽  
Hardinge Approach

Total hip arthroplasty (THA) is one of the successful and cost-benefit surgical treatments. One-stage bilateral THA (BTHA) has a large number of advantages, although there are concerns about the higher complications in this procedure. Aim of our study was to evaluate the complications and outcomes of cementless one-stage BTHA in osteoarthritis patients. A total of 147 patients from 2009 till 2012, underwent one-stage BTHA in Milad and Erfan hospitals, Tehran, Iran. A prospective analysis of the functional outcomes and complications of one-stage BTHA through Hardinge approach in patients with osteoarthritis was performed. We evaluated all patients clinically and radiologically with serial followups. A clinical hip score based upon the modified Harris Hip Score (MHHS) was performed preoperatively and again postoperatively. During the period of study 89 men (60.5%) and 58 women (39.4%) with a mean age of 54.67±7.08 years at the time of presentation were recruited. The mean surgical time was 2.8±0.25 hrs. The mean hospital stay was 3.83±0.65 days. Hemoglobin level decreased significantly after operation (P=0.038). There was two deep venous thromboses, one superficial infection and one temporal proneal palsy but no pulmonary embolism, dislocation, periprosthetic fracture or heterotrophic ossification. The mean preoperative MHHS score was 41.64±5.42 in patients. MHHS score improved to 89.26±4.68 in the last followup (P=0.0001). Our results recommended the use of cementless one-stage BTHA through Hardinge approach in patients with bilateral hip osteoarthritis.

scholarly journals 5-Year Clinical and Radiographic Results of the Direct Anterior Approach for Total Hip Arthroplasty Using a Collared Cementless Femoral Short-Stem Prosthesis

2022 ◽  
Vol 11 (2) ◽  
pp. 346
Author(s):  
Ali Darwich ◽  
Kim Pankert ◽  
Andreas Ottersbach ◽  
Marcel Betsch ◽  
Sascha Gravius ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Clinical Outcome ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Hip Osteoarthritis ◽  
Direct Anterior Approach ◽  
Short Stem ◽  
Total Hip ◽  
The Mean

The aim of this study was to investigate the radiological and clinical outcome of the direct anterior approach (DAA) in total hip arthroplasty (THA) using a collared cementless femoral short-stem. This retrospective study included 124 patients with 135 THAs operated from 2014 to 2016 using a collared cementless triple tapered hydroxyapatite-coated femoral short-stem (AMIStem H Collared®, Medacta International, Castel San Pietro, Switzerland) implanted with a DAA. Follow-up was performed at three months, 12 months, and five years. Clinical outcome was assessed using the hip osteoarthritis outcome score (HOOS) and radiological analysis was done using conventional radiographs, which included evaluation of the femur morphology based on Dorr classification, of radiolucencies based on the Gruen zone classification and of stem subsidence. The mean age was 67.7 ± 11.3 years and the mean body mass index (BMI) was 27.4 ± 4.4 kg/m2. The stem survival rate at five years was 99.1% with one revision due to recurrent dislocations. Mean HOOS score improved from 40.9 ± 18.3 preoperatively to 81.5 ± 19.7 at three months, 89.3 ± 10.9 at 12 months, and 89.0 ± 14.0 at five years (all with p < 0.001). No significant correlations were found between age, femoral bone morphology, BMI and HOOS, and the appearance of relevant radiolucencies.

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