The Reliability and Validity of the Self-Reported Patient-Specific Index for Total Hip Arthroplasty*

2000 ◽  
Vol 82 (6) ◽  
pp. 829-837 ◽  
Author(s):  
JAMES G. WRIGHT ◽  
NANCY L. YOUNG ◽  
JAMES P. WADDELL
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Reliability And Validity ◽  
The Self ◽  
Patient Specific ◽  
Total Hip ◽  
Specific Index

Redesign of the Femoral Stem for a Total Hip Arthroplasty for Additive Manufacturing

2018 ◽  
Author(s):  
Bradley Hanks ◽  
Shantanab Dinda ◽  
Sanjay Joshi
Keyword(s):  
Additive Manufacturing ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Lattice Structure ◽  
Stress Shielding ◽  
Patient Specific ◽  
Hip Implants ◽  
Hip Implant ◽  
Total Hip ◽  
Multiple Materials

Total hip arthroplasty (THA) is an increasingly common procedure that replaces all or part of the hip joint. The average age of patients is decreasing, which in turn increases the need for more durable implants. Revisions in hip implants are frequently caused by three primary issues: femoral loading, poor fixation, and stress shielding. First, as the age of hip implant patients decreases, the hip implants are seeing increased loading, beyond what they were traditionally designed for. Second, traditional implants may have roughened surfaces but are not fully porous which would allow bone to grow in and through the implant. Third, traditional implants are too stiff, causing more load to be carried by the implant and shielding the bone from stress. Ultimately this stress shielding leads to bone resorption and implant loosening. Additive manufacturing (AM) presents a unique opportunity for enhanced performance by allowing for personalized medicine and increased functionality through geometrically complex parts. Much research has been devoted to how AM can be used to improve surgical implants through lattice structures. To date, the authors have found no studies that have performed a complete 3D lattice structure optimization in patient specific anatomy. This paper discusses the general design of an AM hip implant that is personalized for patient specific anatomy and proposes a workflow for optimizing a lattice structure within the implant. Using this design workflow, several lattice structured AM hip implants of various unit cell types are optimized. A solid hip implant is compared against the optimized hip implants. It appears the AM hip implant with a tetra lattice outperforms the other implant by reducing stiffness and allowing for greater bone ingrowth. Ultimately it was found that AM software still has many limitations associated with attempting complex optimizations with multiple materials in patient specific anatomy. Though software limitations prevented a full 3D optimization in patient specific anatomy, the challenges associated such an approach and limitations of the current software are discussed.

Risk Factors for Periprosthetic Femoral Fracture in Non-cemented Total Hip Arthroplasty Through the Direct Anterior Approach

2021 ◽  
pp. 155633162110508
Author(s):  
Zachary Berliner ◽  
Cameron Yau ◽  
Kenneth Jahng ◽  
Marcel A. Bas ◽  
H. John Cooper ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Hip Arthroplasty ◽  
Parkinson Disease ◽  
Hip Arthroplasty ◽  
Femoral Fracture ◽  
Categorical Variables ◽  
Patient Specific ◽  
Periprosthetic Femoral Fracture ◽  
Total Hip ◽  
Increased Risk

Background: Although total hip arthroplasty (THA) performed through the direct anterior (DA) approach is frequently marketed as superior to other approaches, there are concerns about increased risks of intraoperative and early postoperative femoral fracture. Purpose: We sought to assess patient-specific and radiographic risk factors for intraoperative and early postoperative (90-day) periprosthetic femoral fracture (PPFx) following DA approach THA. Methods: We retrospectively reviewed 1107 consecutive, primary, non-cemented DA THAs, performed between April 2009 and January 2015, for intraoperative and early postoperative PPFx. Patients lost to follow-up before 90 days (63), cemented or hybrid THA (52), or early femoral failure for another indication (3) were excluded, yielding 989 hips for analysis. Demographic variables and patient comorbidities were analyzed as risk factors for PPFx. Continuous variables were initially compared with 1-way analysis of variance (ANOVA) and categorical variables with chi-square test. A demographic matched-paired radiographic analysis was performed for femoral stem canal fill and compared using univariate logistic regression. Results: The incidence of perioperative PPFx was 2.02%, including 10 intraoperative and 10 early postoperative fractures. Sustaining a postoperative PPFx was associated with being 70 years old or older with a body mass index (BMI) of less than 25, or with having either osteoporosis or Parkinson disease. Radiographs demonstrated that intraoperative PPFx was associated with stems that filled greater proximally rather than distally. Conclusion: Our cohort study found older age, age over 70 with BMI of less than 25, osteoporosis, and Parkinson disease were associated with increased risk for early postoperative PPFx following DA approach THA. Intraoperative fractures may occur with disproportionate proximal femoral canal fill. Further study can evaluate whether cemented femoral components may mitigate risk in these patient populations.

scholarly journals A Multidisciplinary Patient-Specific Opioid Prescribing and Tapering Protocol Is Associated with a Decrease in Total Opioid Dose Prescribed for Six Weeks After Total Hip Arthroplasty

Pain Medicine ◽  
2019 ◽  
Vol 21 (7) ◽  
pp. 1474-1481 ◽  
Author(s):  
Mallika Tamboli ◽  
Edward R Mariano ◽  
Kerianne E Gustafson ◽  
Beverly L Briones ◽  
Oluwatobi O Hunter ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Opioid Consumption ◽  
Mean Difference ◽  
Patient Specific ◽  
Prescription Data ◽  
Opioid Dose ◽  
Total Hip ◽  
Institutional Review ◽  
Discharge Protocol

Abstract Objective This retrospective cohort study tested the hypothesis that implementing a multidisciplinary patient-specific discharge protocol for prescribing and tapering opioids after total hip arthroplasty (THA) will decrease the morphine milligram equivalent (MME) dose of opioids prescribed. Methods With institutional review board approval, we analyzed a Perioperative Surgical Home database and prescription data for all primary THA patients three months before (PRE) and three months after (POST) implementation of this new discharge opioid protocol based on patients’ prior 24-hour inpatient opioid consumption. The primary outcome was total opioid dosage in MME prescribed and opioid refills for six weeks after surgery. Secondary outcomes included the number of tablets and MME prescribed at discharge, in-hospital opioid consumption, length of stay, and postoperative complications. Results Forty-nine cases (25 PRE and 24 POST) were included. Total median (10th–90th percentiles) MME for six weeks postoperatively was 900 (57–2082) MME PRE vs 295 (69–741) MME POST (mean difference = 721, 95% confidence interval [CI] = 127–1316, P = 0.007, Mann-Whitney U test). Refill rates did not differ. The median (10th–90th percentiles) initial discharge prescription in MME was 675 (57–1035) PRE vs 180 (18–534) POST (mean difference = 387, 95% CI = 156–618, P = 0.003, Mann-Whitney U test) MME. There were no differences in other outcomes. Conclusions Implementation of a patient-specific prescribing and tapering protocol decreases the mean six-week dosage of opioid prescribed by 63% after THA without increasing the refill rate.

Non-steroidal anti-inflammatory drugs for heterotopic ossification prophylaxis after total hip arthroplasty

2018 ◽  
Vol 100-B (7) ◽  
pp. 915-922 ◽  
Author(s):  
M. Joice ◽  
G. I. Vasileiadis ◽  
D. F. Amanatullah
Keyword(s):  
Total Hip Arthroplasty ◽  
Heterotopic Ossification ◽  
Hip Arthroplasty ◽  
Patient Specific ◽  
Inclusion Criteria ◽  
Total Hip ◽  
Inflammatory Drugs ◽  
Specific Factors ◽  
Anti Inflammatory ◽  
Meta Analyses

Aims The aim of this study was to assess the efficacy of non-selective and selective non-steroidal anti-inflammatory drugs (NSAIDs) in preventing heterotopic ossification (HO) after total hip arthroplasty (THA). Methods A thorough and systematic literature search was conducted and 29 studies were found that met inclusion criteria. Data were extracted and statistical analysis was carried out generating forest plots. Results Non-selective NSAIDs showed a significant decrease in the odds for forming HO after THA (odds ratio (OR) -1.35, confidence interval (CI) -1.83 to -0.86) when compared with placebo. Selective NSAIDs also showed a significant decrease in the odds for forming HO after THA when compared with placebo (OR -1.58, CI -2.41 to -0.75). When comparing non-selective NSAIDs with selective NSAIDs, there was no significant change in the odds for forming HO after THA (OR 0.22, CI -0.36 to 0.79). Conclusion Our meta-analyses of all available data suggest that both non-selective and selective NSAIDs are effective HO prophylaxis and can be used routinely after THA for pain control as well as prevention of HO. Indomethacin may serve as the benchmark among non-selective NSAIDs and celecoxib among selective NSAIDs. There was no difference in the incidence of HO between non-selective and selective NSAIDs, allowing physicians to choose either based on the clinical scenario and patient-specific factors. Cite this article: Bone Joint J 2018;100-B:915–22.

scholarly journals Reliability and Validity of Acetabular and Femoral Bone Loss Classification Systems in Total Hip Arthroplasty: A Systematic Review

2020 ◽  
Vol 16 (3) ◽  
pp. 288-295
Author(s):  
Alex Gu ◽  
Marco Adriani ◽  
Michael-Alexander Malahias ◽  
Safa C. Fassihi ◽  
Allina A. Nocon ◽  
...  
Keyword(s):  
Systematic Review ◽  
Total Hip Arthroplasty ◽  
Bone Loss ◽  
Hip Arthroplasty ◽  
Reliability And Validity ◽  
Classification Systems ◽  
Femoral Bone ◽  
Total Hip

scholarly journals Improving Prosthetic Selection and Predicting BMD from Biometric Measurements in Patients Receiving Total Hip Arthroplasty

Diagnostics ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. 815
Author(s):  
Carlo Ricciardi ◽  
Halldór Jónsson ◽  
Deborah Jacob ◽  
Giovanni Improta ◽  
Marco Recenti ◽  
...  
Keyword(s):  
Decision Making ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Quality Data ◽  
National Database ◽  
Patient Specific ◽  
Surgical Approaches ◽  
Decision Making Process ◽  
Mineral Density ◽  
Total Hip

There are two surgical approaches to performing total hip arthroplasty (THA): a cemented or uncemented type of prosthesis. The choice is usually based on the experience of the orthopaedic surgeon and on parameters such as the age and gender of the patient. Using machine learning (ML) techniques on quantitative biomechanical and bone quality data extracted from computed tomography, electromyography and gait analysis, the aim of this paper was, firstly, to help clinicians use patient-specific biomarkers from diagnostic exams in the prosthetic decision-making process. The second aim was to evaluate patient long-term outcomes by predicting the bone mineral density (BMD) of the proximal and distal parts of the femur using advanced image processing analysis techniques and ML. The ML analyses were performed on diagnostic patient data extracted from a national database of 51 THA patients using the Knime analytics platform. The classification analysis achieved 93% accuracy in choosing the type of prosthesis; the regression analysis on the BMD data showed a coefficient of determination of about 0.6. The start and stop of the electromyographic signals were identified as the best predictors. This study shows a patient-specific approach could be helpful in the decision-making process and provide clinicians with information regarding the follow up of patients.

Predicting Perioperative Transfusion in Elective Hip and Knee Arthroplasty

2017 ◽  
Vol 127 (2) ◽  
pp. 317-325 ◽  
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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