Twenty Years Experience in Large Joints Arthroplasty at specialized department of CITO named after N.N. Priorov

Experience in hip and knee arthroplasty (primary and revision) accumulated at CITO department for large joints arthroplasty during the period from 1990 to 2010 is presented. Dynamic of the development of that direction in traumatology and orthopaedics, i.e. perfection of implants and surgical technique, is shown. Typical difficulties and complications in primary and revision operations are noted. Elaborated at the department technique for acetabulum reconstruction at revision hip arthroplasty in patients with significant deficit of bone mass and disturbance of mechanical bone strength is described.

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Health-Related Quality of Life After Hip and Knee Arthroplasty Operations

Scandinavian Journal of Surgery ◽

10.1177/1457496920952232 ◽

2020 ◽

pp. 145749692095223

Author(s):

H. J. A. Miettinen ◽

N. Mäkirinne-Kallio ◽

H. Kröger ◽

S. S. A. Miettinen

Keyword(s):

Quality Of Life ◽

Knee Arthroplasty ◽

Hip Arthroplasty ◽

Control Population ◽

Health Related Quality ◽

Related Quality ◽

Hip And Knee Arthroplasty ◽

Health Related

Background and Aims: The aim of this study was to investigate the health-related quality of life before and after a hip and a knee arthroplasty operation using a 15D instrument and to compare these scores to the Finnish control population 15D scores. Materials and Methods: The pre- and post-operative data of 15D were prospective collected from the patients undergoing total hip arthroplasty or total knee arthroplasty at the Kuopio University Hospital. Post-operative data were collected at 6 and 12 months after the operation. Results: The mean change of the 15D score after hip arthroplasty was +0.062 and after knee arthroplasty, it was +0.033 at the 12-month follow-up ( p < 0.001). Total hip arthroplasty patients of all ages reached the control population 15D scores at the 12-month follow-up. Of the total knee arthroplasty patients, only patients aged >75 years and males aged 55–64 years did reach control population 15D scores at the 12-month follow-up. Patients experienced a statistically significant improvement in mobility, vision, sleeping, usual activities, discomfort and symptoms, distress, and vitality ( p < 0.05). Conclusion: Successful hip and knee arthroplasty operations improve patients’ health-related quality of life. According to this study, hip arthroplasty improves the health-related quality of life more than knee arthroplasty.

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Predicting Perioperative Transfusion in Elective Hip and Knee Arthroplasty

Anesthesiology ◽

10.1097/aln.0000000000001709 ◽

2017 ◽

Vol 127 (2) ◽

pp. 317-325 ◽

Cited By ~ 11

Author(s):

Josephine To ◽

Romi Sinha ◽

Susan W. Kim ◽

Kathryn Robinson ◽

Brendon Kearney ◽

...

Keyword(s):

Logistic Regression ◽

Total Hip Arthroplasty ◽

Knee Arthroplasty ◽

Hip Arthroplasty ◽

Odds Ratio ◽

Patient Specific ◽

Data Set ◽

Total Hip ◽

Preoperative Hemoglobin ◽

Hip And Knee Arthroplasty

Abstract Background Preoperative anemia is a significant predictor of perioperative erythrocyte transfusion in elective arthroplasty patients. However, interactions with other patient and procedure characteristics predicting transfusion requirements have not been well studied. Methods Patients undergoing elective primary total hip arthroplasty or total knee arthroplasty at a tertiary hospital in Adelaide, South Australia, Australia, from January 2010 to June 2014 were used to identify preoperative predictors of perioperative transfusion. A logistic regression model was developed and externally validated with an independent data set from three other hospitals in Adelaide. Results Altogether, 737 adult patients in the derivation group and 653 patients in the validation group were included. Binary logistic regression modeling identified preoperative hemoglobin (odds ratio, 0.51; 95% CI, 0.43 to 0.59; P < 0.001 for each 1 g/dl increase), total hip arthroplasty (odds ratio, 3.56; 95% CI, 2.39 to 5.30; P < 0.001), and females 65 yr of age and older (odds ratio, 3.37; 95% CI, 1.88 to 6.04; P = 0.01) as predictors of transfusion in the derivation cohort. Conclusions Using a combination of patient-specific preoperative variables, this validated model can predict transfusion in patients undergoing elective hip and knee arthroplasty. The model may also help to identify patients whose need for transfusion may be decreased through preoperative hemoglobin optimization.

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What Characteristics of the Acetabular Defect Influence the Choice of the Acetabular Component During Revision Hip Arthroplasty?

Traumatology and Orthopedics of Russia ◽

10.21823/2311-2905-2020-26-2-31-49 ◽

2020 ◽

Vol 26 (2) ◽

pp. 31-49

Author(s):

R. M. Tikhilov ◽

A. A. Dzhavadov ◽

A. N. Kovalenko ◽

A. O. Denisov ◽

A. S. Demin ◽

...

Keyword(s):

Hip Arthroplasty ◽

Retrospective Cohort ◽

Defect Formation ◽

Bone Defects ◽

Revision Hip Arthroplasty ◽

Acetabular Defects ◽

Type 3 ◽

Revision Operations

The purposes of the retrospective cohort study were: 1) to determine the severity of defects in the acetabulum and the probable causes of their formation in patients who underwent revision hip arthroplasty (RHA), as well as an assessment of factors that exacerbate the severity of the defects; 2) identifying the proportion of severe defects in the overall structure of acetabular revisions and determining the effectiveness of using serial implants in comparison with individual constructions made by 3D printing; 3) the rationale for rational indications for the use of individual constructions.Materials and Methods. The structure and reasons for the formation of bone defects in the acetabulum were evaluated in 726 cases of revisions performed from 2004 to 2018. In addition, the results of revision operations in a group of patients with severe defects (type 3 according to Paprosky and pelvic discontinuity) were evaluated.Results. The most frequent cause of defect formation was iatrogenic (53.2%), and the share of severe defects was 39.5% (287 observations). A factor aggravating the severity of the defect is the lack of its limitation by the support bone. The results of RHA in patients with severe defects were assessed in 186 cases out of 287 (64.8%). In 73 (39.2%) cases, individual constructions were used, the average follow-up was 26 months. (from 12 to 50), and in 113 (60.8%) cases, serial implants were used, the average follow-up period was 62 months. (12 to 186). Individual constructions were more often implanted in patients with 3B acetabular defects (p<0.05) and its uncontained defects (p<0.001). The number of cases of aseptic loosening in the group of patients undergoing endoprosthetics using serial implants was greater than in the group of patients with individual constructions for the entire period (p<0.05) and in the early stages of observation (p<0.05).Conclusion. In case of RHA in patients with severe acetabular defects, individual implants, in comparison with serials, demonstrate better survival with an average follow-up of 26 months and due to design features, they can count on great long-term effectiveness. This study needs to be continued to increase follow-up.

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Readmissions after Diagnosis of Surgical Site Infection Following Knee and Hip Arthroplasty

Infection Control and Hospital Epidemiology ◽

10.1086/674854 ◽

2014 ◽

Vol 35 (2) ◽

pp. 152-157 ◽

Cited By ~ 17

Author(s):

Kyle G. Miletic ◽

Thomas N. Taylor ◽

Emily T. Martin ◽

Rahul Vaidya ◽

Keith S. Kaye

Keyword(s):

Surgical Site Infection ◽

Hospital Stay ◽

Knee Arthroplasty ◽

Hip Arthroplasty ◽

Hospital Admissions ◽

Site Infection ◽

Median Cost ◽

Readmission Rates ◽

Total Hip ◽

Hip And Knee Arthroplasty

Context.Surgical site infection (SSI) after total hip and knee arthroplasty is a common postoperative complication. We sought to determine readmission rates and costs for total hip and knee arthroplasty complicated by SSI.Design.The Thomson Reuters MarketScan database was searched for patients who underwent knee or hip arthroplasty in 2007. From these data, patients who received a diagnosis of SSI and were readmitted after diagnosis were identified.Setting.A population of 31 to 45 million individuals receiving insurance coverage. Patients who underwent knee or hip arthroplasty who experienced a hospitalization for SSI in the year after surgery were analyzed.Outcome Measures.Total readmission rates and costs per readmission at 30, 60, and 90 days and 1 year after diagnosis of SSI.Results.Of the 76,289 case patients with hip or knee replacement in 2007, 1,026 (1.3%) had a hospitalization for SSI within the year after surgery. Among these patients, 310 (30.2%) were subsequently rehospitalized in the year after initial hospitalization specifically due to SSI-related issues. These rehospitalizations were associated with a mean hospital stay of 7.4 ± 11.4 days and a median cost of $20,001 (interquartile range [IQR], $14,057-$30,551). A total of 517 subjects had a subsequent “all-cause” hospitalization during the year after SSI. These rehospitalizations were associated with a mean hospital stay of 6.4 ± 10.4 days and a median cost of $19,870 (IQR, $13,913-$29,728).Conclusions.Readmissions during the year after SSI diagnosis accounted for 1,072 hospital admissions and cost over $25.5 million. These readmissions are costly and might be a future target for decreased reimbursement.

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Perfil clínico-epidemiológico dos pacientes em pós-operatório de artroplastia em um hospital do sul de Minas Gerais / Epidemiological clinical profile of patients in arthroplasty postoperative period in a hospital south of Minas Gerais

REVISTA CIÊNCIAS EM SAÚDE ◽

10.21876/rcsfmit.v7i3.678 ◽

2017 ◽

Vol 7 (3) ◽

pp. 14-20 ◽

Cited By ~ 1

Author(s):

Verônica dos Santos Rezende ◽

Paulo José Oliveira Cortez

Keyword(s):

Knee Arthroplasty ◽

Hip Arthroplasty ◽

Postoperative Period ◽

Female Gender ◽

Cross Sectional Study ◽

Minas Gerais ◽

Cross Sectional ◽

Minas Gerais State ◽

Hip And Knee Arthroplasty ◽

Epidemiological Profile

Introdução: Conhecer a epidemiologia das artroplastias contribui para uma melhor assistência ao paciente, proporcionando medidas corretivas e preventivas das possíveis complicações. Objetivos: Traçar o perfil clínico-epidemiológico dos pacientes em pós-operatório (PO) de artroplastia em um Hospital do Sul de Minas Gerais. Métodos: Foi realizado um estudo observacional, retrospectivo e transversal a partir da análise de prontuários e exames complementares de pacientes submetidos à artroplastia de quadril e joelho no Hospital Escola da Faculdade de Medicina de Itajubá (HE/FMIt). Resultados: Houve prevalência do gênero feminino; a idade média foi de 69,1 anos; 93,6% eram brancos; 49,4% eram casados; 92,0% eram católicos. Em relação à artroplastia de quadril e joelho, respectivamente, 48,4% tiveram fratura de fêmur e 73,3% artrose; 83,4% foram submetidos à artroplastia total de quadril e 100,0% à artroplastia total de joelho; 82,2% e 100,0% utilizaram prótese cimentada; 91,1% internados de 5 a 10 dias e 86,7% internados de 1 a 5 dias; 42,7% negaram comorbidades e 66,7% tinham hipertensão arterial; 46,5% e 60,0% relataram dor, 5,1% apresentaram luxação e 80,0% sem complicações. Destaca-se que 100,0% dos pacientes não foram encaminhados à fisioterapia. Conclusão: Conclui-se que a organização e sistematização de dados são fundamentais para a promoção da segurança do paciente, prevenindo suas complicações e aumentando a sua qualidade de vida.Palavras-Chave: Perfil epidemiológico; Ortopedia; Artroplastia de quadril; Artroplastia de joelhoIntroduction: To know the epidemiology of arthroplasties is a way to contribute to better patient care, by providing corrective and preventive measures of possible complications. Aims: To describe the clinical-epidemiological profile of patients in the postoperative period (PO) of arthroplasty in a Hospital in the South of Minas Gerais State. Methods: An observational, retrospective and cross-sectional study was carried out and it was based on the analysis of charts and complementary exams of patients who underwent hip and knee arthroplasty at the School Hospital of the Medical School of Itajubá (HE/FMIt). Results: There was a prevalence of female gender; mean age was 69.1 years of age; 93.6% of the patients were Caucasian; 49.4% were married; 92.0% were catholic. Concerning hip and knee arthroplasty, 48.4% had a femur fracture and 73.3% had arthrosis; 83.4% underwent total hip arthroplasty and 100.0% underwent total knee arthroplasty; 82.2% and 100.0% used cemented prosthesis; 91.1% were hospitalized for 5 to 10 days and 86.7% hospitalized for 1 to 5 days; 42.7% denied comorbidities and 66.7% had arterial hypertension; 46.5% and 60.0% reported pain; 59.0% presented pain dislocation and 80.0% had no complications. It is highlighted that 100.0% of patients were not referred to physical therapy. Conclusion: It is concluded that the organization and systematization of data are fundamental for the promotion of patient safety, preventing complications and increasing their quality of life.Keywords: Epidemiological profile; Orthopedics; Hip arthroplasty; Knee arthroplasty

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Impact of comorbidities on the safety and effectiveness of hip and knee arthroplasty surgery

The Bone & Joint Journal ◽

10.1302/0301-620x.103b1.bjj-2020-0859.r1 ◽

2021 ◽

Vol 103-B (1) ◽

pp. 56-64

Author(s):

Bélène Podmore ◽

Andrew Hutchings ◽

John A. Skinner ◽

Alexander J. MacGregor ◽

Jan van der Meulen

Keyword(s):

Heart Disease ◽

Knee Arthroplasty ◽

Hip Arthroplasty ◽

Length Of Hospital Stay ◽

Safety Risks ◽

Related Quality ◽

Hip And Knee Arthroplasty ◽

Health Related ◽

Mean Differences ◽

The Impact

Aims Access to joint replacement is being restricted for patients with comorbidities in a number of high-income countries. However, there is little evidence on the impact of comorbidities on outcomes. The purpose of this study was to determine the safety and effectiveness of hip and knee arthroplasty in patients with and without comorbidities. Methods In total, 312,079 hip arthroplasty and 328,753 knee arthroplasty patients were included. A total of 11 common comorbidities were identified in administrative hospital records. Safety risks were measured by assessing length of hospital stay (LOS) and 30-day emergency readmissions and mortality. Effectiveness outcomes were changes in Oxford Hip or Knee Scores (OHS/OKS) (scale from 0 (worst) to 48 (best)) and in health-related quality of life (EQ-5D) (scale from 0 (death) to 1 (full health)) from immediately before, to six months after, surgery. Regression analysis was used to estimate adjusted mean differences (LOS, change in OHS/OKS/EQ-5D) and risk differences (readmissions and mortality). Results Patients with comorbidities had a longer LOS and higher readmission and mortality rates than patients without. In hip arthroplasty patients with heart disease, for example, LOS was 1.20 days (95% confidence interval (CI) 1.15 to 1.25) longer and readmission rate was 1.52% (95% CI 1.34% to 1.71%) and mortality 0.19% (95% CI 0.15% to 0.23%) higher. Similar patterns were observed for knee arthroplasty patients. Patients without comorbidities reported large improvements in function (mean improvement OHS 21.3 (SD 9.91) and OKS 15.9 (SD 10.0)). Patients with comorbidities reported only slightly smaller improvements. In patients with heart disease, mean improvement in OHS was 0.39 (95% CI 0.27 to 0.51) and in OKS 0.56 (95% CI 0.45 to 0.67) less than in patients without comorbidities. There were no significant differences in EQ-5D improvement. Conclusion Comorbidities were associated with small increases in adverse safety risks but they have little impact on pain or function in patients undergoing hip or knee arthroplasty. These results do not support restricting access to hip and knee arthroplasty for patients with common comorbidities. Cite this article: Bone Joint J 2021;103-B(1):56–64.

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The use of patient-reported outcome measures to guide referral for hip and knee arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.102b7.bjj-2019-0102.r2 ◽

2020 ◽

Vol 102-B (7) ◽

pp. 941-949 ◽

Cited By ~ 1

Author(s):

Andrew J. Price ◽

Sujin Kang ◽

Jonathan A. Cook ◽

Helen Dakin ◽

Ashley Blom ◽

...

Keyword(s):

Knee Arthroplasty ◽

Hip Arthroplasty ◽

Secondary Care ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Meaningful Improvement ◽

Score Threshold ◽

Patient Reported ◽

Hip And Knee Arthroplasty ◽

Definition Of

Aims To calculate how the likelihood of obtaining measurable benefit from hip or knee arthroplasty varies with preoperative patient-reported scores. Methods Existing UK data from 222,933 knee and 209,760 hip arthroplasty patients were used to model an individual’s probability of gaining meaningful improvement after surgery based on their preoperative Oxford Knee or Hip Score (OKS/OHS). A clinically meaningful improvement after arthroplasty was defined as ≥ 8 point improvement in OHS, and ≥ 7 in OKS. Results The upper preoperative score threshold, above which patients are unlikely to achieve any meaningful improvement from surgery, is 41 for knees and 40 for hips. At lower scores, the probability of improvement increased towards a maximum of 88% (knee) and 95% for (hips). Conclusion By our definition of meaningful improvement, patients with preoperative scores above 41 (OKS) and 40 (OHS) should not be routinely referred to secondary care for possible arthroplasty. Using lower thresholds would incrementally increase the probability of meaningful benefit for those referred but will exclude some patients with potential to benefit. The findings are useful to support the complex shared decision-making process in primary care for referral to secondary care; and in secondary care for experienced clinicians counselling patients considering knee or hip arthroplasty, but should not be used in isolation. Cite this article: Bone Joint J 2020;102-B(7):941–949.

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Safety of intraarticular corticosteroid injection preceding hip and knee arthroplasty: a systematic review and meta-analysis amid resolving COVID-19 arthroplasty restrictions

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnab064 ◽

2021 ◽

Author(s):

Tim Cheok ◽

Matthew Jennings ◽

Alessandro Aprato ◽

Narlaka Jayasekera ◽

Ruurd L Jaarsma

Keyword(s):

Systematic Review ◽

Knee Arthroplasty ◽

Hip Arthroplasty ◽

Subgroup Analysis ◽

Corticosteroid Injection ◽

Meta Analysis ◽

Joint Infection ◽

Cochrane Library ◽

Level Of Evidence ◽

Hip And Knee Arthroplasty

ABSTRACT Intraarticular corticosteroid injection (ICSI) is a widely practiced management for hip and knee osteoarthritis. Imposed delays to arthroplasty during coronavirus disease 2019 pandemic have led us to postulate that many patients have opted for recent ICSI. We compared the odds of prosthetic joint infection (PJI) in patients who were or were not administered ICSI within 12 months prior to hip or knee arthroplasty. A systematic search of PubMed, Embase, The Cochrane Library and Web of Science was performed in February 2021, with studies assessing the effect of ICS on PJI rates identified. All studies, which included patients that received ICSI in the 12 months prior to primary hip and knee arthroplasty, were included. In total 12 studies were included: four studies with 209 353 hips and eight studies with 438 440 knees. ICSI administered in the 12 months prior to hip arthroplasty increased the odds of PJI [odds ratio (OR) = 1.17, P = 0.04]. This was not the case for knees. Subgroup analysis showed significantly higher odds of PJI in both hip [OR = 1.45, P = 0.002] and knee arthroplasty [OR = 2.04; P = 0.04] when ICSI was within the preceding 3 months of surgery. A significantly higher odds of PJI were seen in patients receiving ICSI within the 12 months prior to hip arthroplasty. Subgroup analysis showed increased odds of PJI in both hip and knee arthroplasty, in patients receiving ICSI within 3 months prior to their arthroplasty. We recommend delaying knee arthroplasty for at least 3 months after ICSI and possibly longer for hip arthroplasty. Level of Evidence Level III - Systematic Review of Level II and III Studies.

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Custom Triflange Acetabular Components for Revision Hip Arthroplasty in the Patients with Severe Acetabular Defects: Planning, Surgical Technique, Outcomes

Traumatology and Orthopedics of Russia ◽

10.21823/2311-2905-2020-26-2-20-30 ◽

2020 ◽

Vol 26 (2) ◽

pp. 20-30

Author(s):

A. A. Korytkin ◽

Ya. S. Novikova ◽

E. A. Morozova ◽

S. A. Gerasimov ◽

K. A. Kovaldov ◽

...

Keyword(s):

Surgical Technique ◽

Hip Arthroplasty ◽

Pelvic Ring ◽

Term Treatment ◽

Revision Hip Arthroplasty ◽

Short Term Treatment ◽

Pelvic Ring Disruption ◽

Acetabular Defects ◽

Acetabular Components

Employment of custom triflange acetabular components (CTAC) is one of the few options for pelvic reconstruction in the patients requiring complex acetabulum revisions with Paprosky 2 C, 3 A and 3 B defects and pelvic ring disruption.The purpose of the study was to describe the features of planning, surgical technique, and short-term treatment outcomes of the patients with significant acetabular defects, in which the revision hip arthroplasty was performed using the CTAC.Materials and Methods. A single-center analysis of a series of consecutive patients was performed: 50 complex acetabulum revisions in 47 patients (16 men and 31 women). The average age of the patients was 60±12 years (from 31 to 82; Me 62 years), the average body mass index was 29.7±6.3 kg/m2 (18.4 to 46.3; Me 29.0 kg/m).Results. The mean follow-up was 22±13 months (from 3 to 3.6 years; Me 20 months). The average Harris score increased from 27±7 (from 15 to 39; Me 27) before surgery to 64±16 (from 22 to 90; Me 67) a year after (p<0.001). The level of pain according to VAS before surgery was 7±1 points (from 5 to 9; Me 7), after treatment it decreased to 2±1 points (from 0 to 7; Me 1, p<0.001). In 17 cases out of 50 (34%), there was at least one complication: dislocations — 7 (14%) cases; infection — 3 (6%); loosening — 2 (4%); complications associated with the femoral component — 4 (8%), including 3 intraoperative fractures and 1 postoperative, associated with loosening of the implant; pronounced disturbances of static and locomotor functions — 2 (4%). 12 cases out of 50 (24%) required another surgery, all of which were performed in a year. The Kaplan-Meyer survival rate for the hip implants was 0.71, for the CTAC — 0.87.Conclusion. Employment of the CTAC for revision hip arthroplasty in the patients with significant acetabulum defects and pelvic ring disruption allows reliable fixation of the endoprosthesis components. The STAC placement technique is more anatomical than use of structural allografts, several augments or sup-cage systems. It allows reconstruction of extensive bone defects, theoretically avoiding the long-term problems with allografts, modular trabecular components, antiprotrusion systems and cup-cage. Although, to prove this, the longer follow-up is needed.

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