scholarly journals Predictors of total hip replacement in community based older adults: a cohort study

2019 ◽  
Author(s):  
Veronica Mezhov ◽  
Laura L Laslett ◽  
Harbeer Ahedi ◽  
C Leigh Blizzard ◽  
Richard M Aspden ◽  
...  
Keyword(s):  
Older Adults ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Community Dwelling ◽  
Hip Pain ◽  
Mineral Density ◽  
Mixed Effect ◽  
Total Hip ◽  
Cam Impingement ◽  
End Stage

Abstract Background Hip osteoarthritis (OA) commonly affects older adults and leads to high morbidity. There is no preventative treatment available and total hip replacement (THR) is offered for end stage disease. Known predictors of THR include pain and radiographic OA. Hip structure has also been shown to worsen hip OA and predict THR. A better understanding of predictors of THR can aid in triaging patients and researching preventative strategies. The purpose of this study is to describe predictors of THR in community dwelling older adults.Methods At baseline, participants had assessment of radiographicOA and cam impingement (from pelvic radiographs), shape mode scores (from dual energy X-ray absorptiometry (DXA)) and hip bone mineral density (BMD) (from DXA). After 2.6 and 5 years, participants reported hip pain using WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), and had hip structural changes assessed using magnetic resonance imaging (MRI). Risk of THR was analysed using mixed-effect Poisson regression.Results Incidence of THR for OA over 14 years was 5.0% (40 / 802). As expected, WOMAC hip pain and hip radiographic OA both predicted risk of THR. Additionally, shape mode 2 score (decreasing acetabular coverage) (RR 1.57 per SD; 95% CI 1.01-2.46), shape mode 4 score (non-spherical femoral head) (RR 0.65/SD; 95% CI 0.44-0.97), cam impingement (α >60°) (RR 2.66/SD; 95% CI 1.38-5.13), neck of femur BMD (RR 1.85/SD, 95% CI 1.4-2.44) and bone marrow lesions (BMLs) increased risk of THR (RR 5.62/unit; 95% CI 1.1 – 28.81). There was a trend for hip effusions to increase the risk of THR (RR 1.88/SD; 95% CI 0.24 to 14.78).Conclusion In addition to hip pain and radiographic hip OA, measures of hip shape, cam impingement, BMD and BMLs independently predict risk of THR. This supports the role of hip bone geometry and structure in the pathogenesis of end stage hip OA and has identified factors that can be used to improve prediction models for THR.

scholarly journals Predictors of total hip replacement in community based older adults: a cohort study

2020 ◽  
Author(s):  
Veronica Mezhov ◽  
Laura L Laslett ◽  
Harbeer Ahedi ◽  
C Leigh Blizzard ◽  
Richard M Aspden ◽  
...  
Keyword(s):  
Older Adults ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Community Dwelling ◽  
Hip Pain ◽  
Mineral Density ◽  
Mixed Effect ◽  
Total Hip ◽  
End Stage ◽  
Cam Morphology

Abstract Background: Hip osteoarthritis (OA) commonly affects older adults and leads to high morbidity. There is no preventative treatment available and total hip replacement (THR) is offered for end stage disease. Known predictors of THR include pain and radiographic OA. Hip structure has also been shown to worsen hip OA and predict THR. A better understanding of predictors of THR can aid in triaging patients and researching preventative strategies. The purpose of this study is to describe predictors of THR in community dwelling older adults. Methods: At baseline, participants had assessment of radiographic OA and cam morphology (from pelvic radiographs), shape mode scores (from dual energy X-ray absorptiometry (DXA)) and hip bone mineral density (BMD) (from DXA). After 2.6 and 5 years, participants reported hip pain using WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), and had hip structural changes assessed using magnetic resonance imaging (MRI). Risk of THR was analysed using mixed-effect Poisson regression.Results: Incidence of THR for OA over 14 years was 5.0% (40 / 802). As expected, WOMAC hip pain and hip radiographic OA both predicted risk of THR. Additionally, shape mode 2 score (decreasing acetabular coverage) (RR 1.57 per SD; 95% CI 1.01-2.46), shape mode 4 score (non-spherical femoral head) (RR 0.65/SD; 95% CI 0.44-0.97), cam morphology (α >60°) (RR 2.66/SD; 95% CI 1.38-5.13), neck of femur BMD (RR 1.85/SD, 95% CI 1.4-2.44) and bone marrow lesions (BMLs) increased risk of THR (RR 5.62/unit; 95% CI 1.1 – 28.81). Conclusion: In addition to hip pain and radiographic hip OA, measures of hip shape, cam morphology, BMD and BMLs independently predict risk of THR. This supports the role of hip bone geometry and structure in the pathogenesis of end stage hip OA and has identified factors that can be used to improve prediction models for THR.

Rivaroxaban for Thromboprophylaxis in Patients Undergoing Total Hip Replacement: Comparison of Pharmacokinetics and Pharmacodynamics with Once- and Twice-Daily Dosing.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 903-903 ◽  
Author(s):  
Wolfgang Mueck ◽  
Bengt I. Eriksson ◽  
Lars C. Borris ◽  
Ola E. Dahl ◽  
Sylvia Haas ◽  
...  
Keyword(s):  
Confidence Intervals ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Plasma Concentrations ◽  
Dose Finding ◽  
Total Daily Dose ◽  
Time Curve ◽  
Mixed Effect ◽  
Total Hip ◽  
Daily Dose

Abstract Rivaroxaban (BAY 59-7939) is an oral, direct Factor Xa inhibitor in clinical development for the prevention and treatment of thromboembolic disorders. Two phase IIb, dose-finding studies with rivaroxaban for the prevention of venous thromboembolism (VTE) after total hip replacement (THR) were conducted: one with twice-daily (bid), and one with once-daily (od) rivaroxaban dosing. In the bid study, rivaroxaban total daily doses of 5–20 mg had similar efficacy and safety to enoxaparin (40 mg od), and the od study identified a dose within this range (10 mg od) as the appropriate dose for further investigation. This analysis compared the pharmacokinetics (PK) and pharmacodynamics (PD) of rivaroxaban when given od or bid, using non-linear, mixed-effect population modeling. The analysis was restricted to the rivaroxaban 5, 10, and 20 mg total daily dose groups from each study, and used samples from 758 patients. In both studies, rivaroxaban PK were well described by an oral, one-compartment model, and were affected by anticipated factors: age and renal function influenced clearance, and body weight influenced volume of distribution. These effects were moderate, within the variability of the patient population, and suggested that no dose adjustment would be necessary, in this population. In both studies, the maximum and minimum plasma concentrations (Cmax and Ctrough, respectively) of rivaroxaban increased dose dependently (Table). Cmax values were higher, and Ctrough values were lower, in the od study than in the bid study; however, the 90% confidence intervals for Cmax and Ctrough in the two studies overlapped. These findings are as expected, and suggest that od dosing with rivaroxaban should not expose patients to a greater risk of bleeding (at Cmax) or VTE (at Ctrough) than bid dosing. Estimates for area under the rivaroxaban plasma-concentration time curve (AUC) were 20–28% higher in the od study than the bid study. In the PD analysis, prolongation of prothrombin time correlated with rivaroxaban plasma concentrations in a linear fashion in both studies. In conclusion, this analysis of rivaroxaban in patients undergoing THR suggested that the PK and PD of rivaroxaban are predictable after od or bid dosing, allowing selection of a convenient od dosing regimen. Median predicted rivaroxaban PK parameters in THR patients at steady state (with 90% confidence intervals) Rivaroxaban total daily dose Parameter 5 mg 10 mg 20 mg n (bid/od) 122/124 122/140 118/132 bid Cmax (μg/L) 39.7 (29.2–73.4) 65.2 (46.2–105) 141 (101–218) od Cmax (μg/L) 69.0 (49–112) 124 (88.1–194) 222 (160–360) bid Ctrough (μg/L) 8.61 (1.71–26.5) 15.4 (4.65–46.2) 34.9 (7.85–99.7) od Ctrough (μg/L) 4.50 (0.7–37.7) 9.12 (1.34–37.8) 22.4 (4.3–95.7) bid AUC (μg·h/L) 531 (304–1188) 915 (583–1637) 1982 (1139–3757) od AUC (μg·h/L) 670 (377–1283) 1170 (767–2077) 2374 (1366–4858)

The effects of the empowerment education program in older adults with total hip replacement surgery

2017 ◽  
Vol 73 (8) ◽  
pp. 1848-1861 ◽  
Author(s):  
Tzu-Ting Huang ◽  
Chia-Chun Sung ◽  
Woan-Shyuan Wang ◽  
Bi-Hwa Wang
Keyword(s):  
Older Adults ◽  
Total Hip Replacement ◽  
Education Program ◽  
Hip Replacement ◽  
Total Hip ◽  
Replacement Surgery ◽  
Hip Replacement Surgery
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