Operative approach influences functional outcome after DAIR for infected total hip arthroplasty

2020 ◽  
Vol 102-B (12) ◽  
pp. 1662-1669
Author(s):  
Christian T. Pollmann ◽  
Jan-Erik Gjertsen ◽  
Håvard Dale ◽  
Truls M. Straume-Næsheim ◽  
Eva Dybvik ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Total Hip Arthroplasty ◽  
Functional Outcome ◽  
Hip Arthroplasty ◽  
Posterior Approach ◽  
Deep Infection ◽  
Operative Approach ◽  
Function Score ◽  
Womac Function ◽  
Approach Group

Aims To compare the functional outcome, health-related quality of life (HRQoL), and satisfaction of patients who underwent primary total hip arthroplasty (THA) and a single debridement, antibiotics and implant retention (DAIR) procedure for deep infection, using either the transgluteal or the posterior surgical approach for both procedures. Methods The study was registered at clinicaltrials.gov (ID: NCT03161990) on 15 May 2017. Patients treated with a single DAIR procedure for deep infection through the same operative approach as their primary THA (either the transgluteal or the posterior approach) were identified in the Norwegian Arthroplasty Register and given a questionnaire. Median follow-up after DAIR by questionnaire was 5.5 years in the transgluteal group (n = 87) and 2.5 years in the posterior approach group (n = 102). Results Patients in the posterior approach group were less likely to limp after the DAIR procedure (17% vs 36% limped all the time; p = 0.005), had a higher mean Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function score (80 vs 71; p = 0.013), and were more likely to achieve a patient acceptable symptom state for the WOMAC function score (76% vs 55%; p = 0.002). In a multivariable analysis, the point estimate for the increase in WOMAC function score using the posterior approach was 10.2 (95% CI 3.1 to 17.2; p = 0.005), which is above the minimal clinically important improvement. The patients in the posterior approach group also reported better mean HRQoL scores and were more likely to be satisfied with their hip arthroplasty (77% vs 55%; p = 0.001). Conclusion In patients treated with a single, successful DAIR procedure for deep infection of a primary THA, the use of the posterior approach in both primary surgery and DAIR was associated with less limping, better functional outcome, better HRQoL, and higher patient satisfaction compared with cases where both were performed using the transgluteal approach. The observed differences in functional outcome and patient satisfaction were clinically relevant. Cite this article: Bone Joint J 2020;102-B(12):1662–1669.

scholarly journals Excellent Functional Outcome and Quality of Life after Primary Cementless Total Hip Arthroplasty (THA) Using an Enhanced Recovery Setup

2021 ◽  
Vol 10 (4) ◽  
pp. 621
Author(s):  
Franziska Leiss ◽  
Julia Sabrina Götz ◽  
Günther Maderbacher ◽  
Matthias Meyer ◽  
Jan Reinhard ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Patient Satisfaction ◽  
Total Hip Arthroplasty ◽  
Functional Outcome ◽  
Hip Arthroplasty ◽  
Enhanced Recovery ◽  
Harris Hip Score ◽  
Total Hip ◽  
Cementless Total Hip Arthroplasty

Background: Total hip arthroplasty combined with the concept of enhanced recovery is of continued worldwide interest, as it is reported to improve early functional outcome and treatment quality without increasing complications. The aim of the study was to investigate functional outcome and quality of life 4 weeks and 12 months after cementless total hip arthroplasty in combination with an enhanced recovery concept. Methods: A total of 109 patients underwent primary cementless Total Hip Arthroplasty (THA) in an enhanced recovery concept and were retrospectively analyzed. After 4 weeks and 12 months, clinical examination was analyzed regarding function, pain and satisfaction; results were evaluated using Harris Hip score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), EQ-5D-5L, EQ-VAS and subjective patient-related outcome measures (PROMs). Preoperatively, HADS (Hospital Anxiety and Depression Scale) was collected. A correlation analysis of age, American Society of Anesthesiologists (ASA), HADS and comorbidities (diabetes mellitus, art. hypertension, cardiovascular disease) with WOMAC, Harris Hip score (HHS) and EQ-5D was performed. Results: Patients showed a significant improvement in Harris Hip score 4 weeks and 12 months postoperatively (p < 0.001). WOMAC total score, subscale pain, subscale stiffness and subscale function improved significantly from preoperative to 12 months postoperative (p < 0.001). EQ-5D showed a significant improvement preoperative to postoperative (p < 0.001). The influence of anxiety or depression (HADS-A or HADS-D) on functional outcome could not be determined. There was a high patient satisfaction postoperatively, and almost 100% of patients would choose enhanced recovery surgery again. Conclusion: Cementless THA with the concept of enhanced recovery improves early clinical function and quality of life. PROMs showed a continuous improvement over a follow-up of 12 months after surgery. PROMs can help patients and surgeons to modify expectations and improve patient satisfaction.

Surgical approach significantly affects the complication rates associated with total hip arthroplasty

2019 ◽  
Vol 101-B (6) ◽  
pp. 646-651 ◽  
Author(s):  
V. K. Aggarwal ◽  
A. Elbuluk ◽  
J. Dundon ◽  
C. Herrero ◽  
C. Hernandez ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Surgical Approach ◽  
Periprosthetic Fracture ◽  
Anterior Approach ◽  
Posterior Approach ◽  
Deep Infection ◽  
Surgical Approaches ◽  
Complication Rates ◽  
Wound Drainage

Aims A variety of surgical approaches are used for total hip arthroplasty (THA), all with reported advantages and disadvantages. A number of common complications can occur following THA regardless of the approach used. The purpose of this study was to compare five commonly used surgical approaches with respect to the incidence of surgery-related complications. Patients and Methods The electronic medical records of all patients who underwent primary elective THA at a single large-volume arthroplasty centre, between 2011 and 2016, with at least two years of follow-up, were reviewed. After exclusion, 3574 consecutive patients were included in the study. There were 1571 men (44.0%) and 2003 women (56.0%). Their mean age and body mass index (BMI) was 63.0 years (sd 11.8) and 29.1 kg/m2 (sd 6.1), respectively. Data gathered included the age of the patient, BMI, the American Society of Anesthesiologists (ASA) score, estimated blood loss (EBL), length of stay (LOS), operating time, the presence of intra- or postoperative complications, type of complication, and the surgical approach. The approaches used during the study were posterior, anterior, direct lateral, anterolateral, and the northern approach. The complications that were recorded included prolonged wound drainage without infection, superficial infection, deep infection, dislocation, aseptic loosening, and periprosthetic fracture. Finally, the need for re-operation was recorded. Means were compared using analysis of variance (ANOVA) and Student’s t-tests where appropriate and proportions were compared using the chi-squared test. Results A total of 248 patients had 263 complications related to the surgery, with an incidence of 6.94%. The anterior approach had the highest incidence of complications (8.5% (113/1329)) and the posterior approach had the lowest, at 5.85% (97/1657; p = 0.006). Most complications were due to deep infection (22.8%), periprosthetic fracture (22.4%), and prolonged wound drainage (21.3%). The rate of dislocation was 0.84% (14/1657) with the posterior approach and 1.28% (17/1329) with the anterior approach (p = 0.32). Conclusion Overall, THA has a relatively low complication rate. However, the surgical approach plays a role in the incidence of complications. We found that the posterior approach had a significantly lower overall complication rate compared with the anterior approach, with an equal dislocation rate. Periprosthetic fracture and surgical site infection contributed most to the early complication rates. Cite this article: Bone Joint J 2019;101-B:646–651

Outcomes of total hip arthroplasty in haemodialysis and renal transplant patients: systematic review

2019 ◽  
pp. 112070001987783 ◽  
Author(s):  
Ravi Popat ◽  
Adam M Ali ◽  
Ian P Holloway ◽  
Khaled M Sarraf ◽  
Sammy A Hanna
Keyword(s):  
Systematic Review ◽  
Renal Failure ◽  
Renal Transplantation ◽  
Renal Transplant ◽  
Total Hip Arthroplasty ◽  
Functional Outcome ◽  
Hip Arthroplasty ◽  
Revision Rate ◽  
Deep Infection ◽  
Transplant Patients

Background: Chronic renal failure is increasing in prevalence and reported to have deleterious effects on the outcome of total hip arthroplasty (THA). Aim: To investigate the clinical and functional outcomes of THA in patients receiving haemodialysis or who have previously undergone renal transplantation. Methods: Systematic review of the literature using bibliographic databases up to July 2018 to determine the functional outcome, complications and revision rates of THA in patients receiving haemodialysis for end-stage renal failure and those with a previous renal transplant. Results: 25 studies were identified with a total of 797 THAs. 166 patients (20.8%) were receiving haemodialysis and 631 patients (79.2%) had undergone transplantation. All studies reported a marked improvement in hip function following THA. There were 27 failures (15.7% revision rate) in the haemodialysis group and 101 failures (16.0% revision rate) in the transplant group. The revision rate for cemented implants was higher in haemodialysis versus transplant patients (23% vs. 15%), with the converse being true for uncemented implants (3.8% vs. 6.9%). The deep infection rate was higher in the haemodialysis group (10.8% vs. 2.1%). Conclusions: Patients receiving haemodialysis or with a history of renal transplantation can expect good functional outcome following THA. However, the revision rate and deep infection rate are higher than would be expected in patients receiving THA for primary OA. Aseptic loosening is the most common reason for revision. Uncemented implants appear to be associated with lower failure rates both in haemodialysis patients and those who have had a transplant.

scholarly journals Robotic arm-assisted versus manual total hip arthroplasty

2021 ◽  
Vol 10 (1) ◽  
pp. 22-30
Author(s):  
Nicholas D. Clement ◽  
Paul Gaston ◽  
Allison Bell ◽  
Philip Simpson ◽  
Gavin Macpherson ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Total Hip Arthroplasty ◽  
Functional Outcome ◽  
Hip Arthroplasty ◽  
Health Improvement ◽  
Leg Length ◽  
Total Hip ◽  
Oxford Hip Score ◽  
Five Dimension ◽  
Safe Zones

Aims The primary aim of this study was to compare the hip-specific functional outcome of robotic assisted total hip arthroplasty (rTHA) with manual total hip arthroplasty (mTHA) in patients with osteoarthritis (OA). Secondary aims were to compare general health improvement, patient satisfaction, and radiological component position and restoration of leg length between rTHA and mTHA. Methods A total of 40 patients undergoing rTHA were propensity score matched to 80 patients undergoing mTHA for OA. Patients were matched for age, sex, and preoperative function. The Oxford Hip Score (OHS), Forgotten Joint Score (FJS), and EuroQol five-dimension questionnaire (EQ-5D) were collected pre- and postoperatively (mean 10 months (SD 2.2) in rTHA group and 12 months (SD 0.3) in mTHA group). In addition, patient satisfaction was collected postoperatively. Component accuracy was assessed using Lewinnek and Callanan safe zones, and restoration of leg length were assessed radiologically. Results There were no significant differences in the preoperative demographics (p ≥ 0.781) or function (p ≥ 0.383) between the groups. The postoperative OHS (difference 2.5, 95% confidence interval (CI) 0.1 to 4.8; p = 0.038) and FJS (difference 21.1, 95% CI 10.7 to 31.5; p < 0.001) were significantly greater in the rTHA group when compared with the mTHA group. However, only the FJS was clinically significantly greater. There was no difference in the postoperative EQ-5D (difference 0.017, 95% CI -0.042 to 0.077; p = 0.562) between the two groups. No patients were dissatisfied in the rTHA group whereas six were dissatisfied in the mTHA group, but this was not significant (p = 0.176). rTHA was associated with an overall greater rate of component positioning in a safe zone (p ≤ 0.003) and restoration of leg length (p < 0.001). Conclusion Patients undergoing rTHA had a greater hip-specific functional outcome when compared to mTHA, which may be related to improved component positioning and restoration of leg length. However, there was no difference in their postoperative generic health or rate of satisfaction. Cite this article: Bone Joint Res 2021;10(1):22–30.

The Impact of Leg Length Discrepancy on Patient Satisfaction and Functional Outcome Following Total Hip Arthroplasty

2013 ◽  
Vol 28 (8) ◽  
pp. 1408-1414 ◽  
Author(s):  
Michael R. Whitehouse ◽  
Natalija S. Stefanovich-Lawbuary ◽  
Luke R. Brunton ◽  
Ashley W. Blom
Keyword(s):  
Patient Satisfaction ◽  
Total Hip Arthroplasty ◽  
Functional Outcome ◽  
Hip Arthroplasty ◽  
Leg Length Discrepancy ◽  
Leg Length ◽  
Total Hip ◽  
Length Discrepancy ◽  
The Impact

Direct anterior approach has short-term functional benefit and higher resource requirements compared with the posterior approach in primary total hip arthroplasty

2021 ◽  
Vol 103-B (6) ◽  
pp. 1078-1087 ◽  
Author(s):  
Mohamed E. Awad ◽  
Brendan J. Farley ◽  
Gamal Mostafa ◽  
Khaled J. Saleh
Keyword(s):  
Total Hip Arthroplasty ◽  
Functional Outcome ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Posterior Approach ◽  
Direct Anterior Approach ◽  
Short Term ◽  
The Mean ◽  
One Year ◽  
Meta Analyses

Aims It has been suggested that the direct anterior approach (DAA) should be used for total hip arthroplasty (THA) instead of the posterior approach (PA) for better early functional outcomes. We conducted a value-based analysis of the functional outcome and associated perioperative costs, to determine which surgical approach gives the better short-term outcomes and lower costs. Methods This meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol and the Cochrane Handbook. Several online databases were searched. Non-stratified and stratified meta-analyses were conducted to test the confounding biases in the studies which were included. The mean cost and probability were used to determine the added costs of perioperative services. Results The DAA group had significantly longer operating times (p < 0.001), reduced length of hospital stay by a mean of 13.4 hours (95% confidence interval (CI) 9.12 to 18; p < 0.001), and greater blood loss (p = 0.030). The DAA group had significantly better functional outcome at three (p < 0.001) and six weeks (p = 0.006) postoperatively according to the Harris Hip Score (HHS). However, there was no significant difference between the groups for the HHS at six to eight weeks (p = 0.230), 12 weeks (p = 0.470), six months (p = 0.740), and one year (p = 0.610), the 12-Item Short Form Survey (SF-12) physical score at six weeks (p = 0.580) and one year (p = 0.360), SF-12 mental score at six weeks (p = 0.170) and one year (p = 0.960), and University of California and Los Angeles (UCLA) activity scale at 12 weeks (p = 0.250). The mean non-stratified and stratified difference in costs for the operating theatre time and blood transfusion were $587.57 (95% CI 263.83 to 1,010.29) to $887.04 (95% CI 574.20 to 1,298.88) and $248.38 (95% CI 1,003.40 to 1,539.90) to $1,162.41 (95% CI 645.78 to 7,441.30), respectively, more for the DAA group. However, the mean differences in costs for the time in hospital were $218.23 and $192.05, respectively, less for the DAA group. Conclusion The use of the DAA, rather than the PA, in THA has earlier benefits for function and pain. However, these are short-lasting, with no significant differences seen at later intervals. In addition the limited benefits were obtained with higher cumulative costs for DAA. Cite this article: Bone Joint J 2021;103-B(6):1078–1087.

scholarly journals Cemented Exeter total hip arthroplasty with a 32 mm head on highly crosslinked polyethylene

2019 ◽  
Vol 8 (6) ◽  
pp. 275-287 ◽  
Author(s):  
N. D. Clement ◽  
M. Bardgett ◽  
K. Merrie ◽  
S. Furtado ◽  
R. Bowman ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Patient Satisfaction ◽  
Total Hip Arthroplasty ◽  
Functional Outcome ◽  
Hip Arthroplasty ◽  
Age Groups ◽  
Age Group ◽  
Mineral Density ◽  
Sf 36 ◽  
Stem Migration

Objectives Our primary aim was to describe migration of the Exeter stem with a 32 mm head on highly crosslinked polyethylene and whether this is influenced by age. Our secondary aims were to assess functional outcome, satisfaction, activity, and bone mineral density (BMD) according to age. Patients and Methods A prospective cohort study was conducted. Patients were recruited into three age groups: less than 65 years (n = 65), 65 to 74 years (n = 68), and 75 years and older (n = 67). There were 200 patients enrolled in the study, of whom 115 were female and 85 were male, with a mean age of 69.9 years (sd 9.5, 42 to 92). They were assessed preoperatively, and at three, 12 and, 24 months postoperatively. Stem migration was assessed using Einzel-Bild-Röntgen-Analyse (EBRA). Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Harris Hip Score (HHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), EuroQol-5 domains questionnaire (EQ-5D), short form-36 questionnaire (SF-36,) and patient satisfaction were used to assess outcome. The Lower Extremity Activity Scale (LEAS), Timed Up and Go (TUG) test, and activPAL monitor (energy expelled, time lying/standing/walking and step count) were used to assess activity. The BMD was assessed in Gruen and Charnley zones. Results Mean varus/valgus tilt was -0.77⁰ and axial subsidence was -1.20 mm. No significant difference was observed between age groups (p ⩾ 0.07). There was no difference according to age group for postoperative WOMAC (p ⩾ 0.11), HHS (p ⩾ 0.06), HOOS (p ⩾ 0.46), EQ-5D (p ⩾ 0.38), patient satisfaction (p ⩾ 0.05), or activPAL (p ⩾ 0.06). Patients 75 years and older had a worse SF-36 physical function (p = 0.01) and physical role (p = 0.03), LEAS score (p < 0.001), a shorter TUG (p = 0.01), and a lower BMD in Charnley zone 1 (p = 0.02). Conclusion Exeter stem migration is within normal limits and is not influenced by age group. Functional outcome, patient satisfaction, activity level, and periprosthetic BMD are similar across all age groups. Cite this article: N. D. Clement, M. Bardgett, K. Merrie, S. Furtado, R. Bowman, D. J. Langton, D. J. Deehan, J. Holland. Cemented Exeter total hip arthroplasty with a 32 mm head on highly crosslinked polyethylene: Does age influence functional outcome, satisfaction, activity, stem migration, and periprosthetic bone mineral density? Bone Joint Res 2019;8:275–287. DOI: 10.1302/2046-3758.86.BJR-2018-0300.R1.

A Comparative Analysis of Patient Satisfaction following Total Knee Arthroplasty and Total Hip Arthroplasty Using the Forgotten Joint Score

2020 ◽  
Vol 04 (02) ◽  
pp. 084-089
Author(s):  
Vivek Singh ◽  
Stephen Zak ◽  
Ran Schwarzkopf ◽  
Roy Davidovitch
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Total Hip Arthroplasty ◽  
Knee Arthroplasty ◽  
Hip Arthroplasty ◽  
Demographic Data ◽  
Demographic Differences ◽  
Total Hip ◽  
Forgotten Joint Score ◽  
Total Knee

AbstractMeasuring patient satisfaction and surgical outcomes following total joint arthroplasty remains controversial with most tools failing to account for both surgeon and patient satisfaction in regard to outcomes. The purpose of this study was to use “The Forgotten Joint Score” questionnaire to assess clinical outcomes comparing patients who underwent a total hip arthroplasty (THA) with those who underwent a total knee arthroplasty (TKA). We conducted a retrospective review of patients who underwent primary THA or TKA between September 2016 and September 2019 and responded to the Forgotten Joint Score-12 (FJS-12) questionnaire at least at one of three time periods (3, 12, and 21 months), postoperatively. An electronic patient rehabilitation application was used to administer the questionnaire. Collected variables included demographic data (age, gender, race, body mass index [BMI], and smoking status), length of stay (LOS), and FJS-12 scores. t-test and chi-square were used to determine significance. Linear regression was used to account for demographic differences. A p-value of less than 0.05 was considered statistically significant. Of the 2,359 patients included in this study, 1,469 underwent a THA and 890 underwent a TKA. Demographic differences were observed between the two groups with the TKA group being older, with higher BMI, higher American Society of Anesthesiologists scores, and longer LOS. Accounting for the differences in demographic data, THA patients consistently had higher scores at 3 months (53.72 vs. 24.96; p < 0.001), 12 months (66.00 vs. 43.57; p < 0.001), and 21 months (73.45 vs. 47.22; p < 0.001). FJS-12 scores for patients that underwent THA were significantly higher in comparison to TKA patients at 3, 12, and 21 months postoperatively. Increasing patient age led to a marginal increase in FJS-12 score in both cohorts. With higher FJS-12 scores, patients who underwent THA may experience a more positive evolution with their surgery postoperatively than those who had TKA.

Biomechanical analysis of transverse acetabular fracture fixation in the elderly via the posterior versus the anterior approach with and without a total hip arthroplasty

2020 ◽  
Vol 234 (9) ◽  
pp. 966-974
Author(s):  
Joel Moktar ◽  
Alan Machin ◽  
Habiba Bougherara ◽  
Emil H Schemitsch ◽  
Radovan Zdero
Keyword(s):  
Total Hip Arthroplasty ◽  
Acetabular Component ◽  
Hip Arthroplasty ◽  
Acetabular Fracture ◽  
Anterior Approach ◽  
Posterior Approach ◽  
Failure Load ◽  
The Elderly ◽  
Clinical Failure ◽  
Total Hip

This study provides the first biomechanical comparison of the fixation constructs that can be created to treat transverse acetabular fractures when using the “gold-standard” posterior versus the anterior approach with and without a total hip arthroplasty in the elderly. Synthetic hemipelvises partially simulating osteoporosis (n = 24) were osteotomized to create a transverse acetabular fracture and then repaired using plates/screws, lag screws, and total hip arthroplasty acetabular components in one of four ways: posterior approach (n = 6), posterior approach plus a total hip arthroplasty acetabular component (n = 6), anterior approach (n = 6), and anterior approach plus a total hip arthroplasty acetabular component (n = 6). All specimens were biomechanically tested. No differences existed between groups for stiffness (range, 324.6–387.3 N/mm, p = 0.629), clinical failure load at 5 mm of femoral head displacement (range, 1630.1–2203.9 N, p = 0.072), or interfragmentary gapping (range, 0.67–1.33 mm, p = 0.359). Adding a total hip arthroplasty acetabular component increased ultimate mechanical failure load for posterior (2904.4 vs. 3652.3 N, p = 0.005) and anterior (3204.9 vs. 4396.0 N, p = 0.000) approaches. Adding a total hip arthroplasty acetabular component also substantially reduced interfragmentary sliding for posterior (3.08 vs. 0.50 mm, p = 0.002) and anterior (2.17 vs. 0.29 mm, p = 0.024) approaches. Consequently, the anterior approach with a total hip arthroplasty may provide the best biomechanical stability for elderly patients, since this fixation group had the highest mechanical failure load and least interfragmentary sliding, while providing equivalent stiffness, clinical failure load, and gapping compared to other surgical options.

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