Perioperative protocol to reduce blood transfusions in ankylosing spondylitis patients undergoing total hip arthroplasty

Abstract Introduction: Although tranexamic acid (TXA) can reduce bleeding during total hip arthroplasty (THA), the amount of perioperative bleeding is greater in patients with ankylosing spondylitis (AS); So blood management is more challenging. Patient Blood Management (PBM) program can improve AS patients care and reduce health costs in THA. The purpose of this study is to assess the effects of PMB program on allogeneic transfusion rate, length of hospital stay(LOS), hospitalization expenses and adverse events. Methods : We conducted a retrospective observational study of patients with AS who underwent THA. All patients were treated with tranexamic acid before and after operation. Our PBM program included preoperative evaluation, preoperative acute normovolemic hemodilution and intraoperative recovery autotransfusion. We compared results between the group of patients before and the one after the PBM program implementation. Result: We included 68 as patients who underwent total hip arthroplasty before PBM program from January 2013 to December 2015 (group A) and 84 as patients who underwent total hip arthroplasty after PBM program from January 2016 to December 2019 (group B). In the comparison of intraoperative blood transfusion volume, intraoperative blood transfusion rate and total blood transfusion rate between the two groups, the group B was significantly lower than the group A (P ≤ 0.05); The length of stay and hospitalization expenses of the group B were lower than the group A (P ≤ 0.05). No adverse events were recorded. Conclunsions: Our PMB program can reduce allogeneic blood transfusion, hospital stay and hospitalization expenses, without risking patients to higher number of com- plications in AS patients undergoing THA.

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Synchronous or sequential cementless bilateral total hip arthroplasty for osseous ankylosed hips with ankylosing spondylitis: a retrospective cohort study

10.21203/rs.3.rs-46810/v1 ◽

2020 ◽

Author(s):

Ping Mou ◽

Nan Wei Zeng ◽

Yu Chen ◽

Zongke Zhou

Keyword(s):

Ankylosing Spondylitis ◽

Total Hip Arthroplasty ◽

Clinical Outcomes ◽

Hip Arthroplasty ◽

Hip Dislocation ◽

Radiographic Evaluation ◽

Leg Length ◽

Total Hip ◽

Group A ◽

Group B

Abstract Purpose cementless total hip arthroplasty (THA) for bilateral osseous ankylosed hips with ankylosing spondylitis (AS) is a challenging procedure. No literature compares the clinical outcomes of synchronous and sequential bilateral THA of these special patients. Methods 23 patients (46 hips) were retrospectively analyzed and classified into receiving bilateral THA synchronously (group A) and receiving bilateral THA sequentially (group B). The clinical measurement, radiological assessments and complications were compared. Independent sample T test were used for data analysis. Results Harris Hip Scores (HHS) improved greatly for both groups (P = 0.58) as well as the range of motion (P = 0.64). But group B can realize shorter time (3.6 ± 1.2 days) to walk for the first time postoperatively (P = 0.02). The group A need more blood transfusions (P = 0.028). For group A, no statistic difference was found in bilateral inclination of cup (IC) (P = 0.48) and femoral offset (FO) (P = 0.07). For group B, no statistic difference was observed in bilateral IC (P = 0.37) but in bilateral FO (P = 0.04). The group A showed fewer difference of bilateral IC (P = 0.02), while comparative measurements for two groups in the difference of bilateral FO (P = 0.78) and leg length discrepancy (P = 0.83). For group A, one patient encountered femoral fracture intraoperatively and one patient encountered hip dislocation and delay union of wound as well as three hips encountering heterotopic ossification (HO). For group B, only three hips encountered HO. Conclusion Cementless bilateral THA was a safe and effective technique to improve hip function for patients diagnosed with osseous ankylosed hip due to AS. Synchronous bilateral THA can realize good clinical outcomes and more superior radiographic evaluation compared to sequential bilateral THA.

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A Randomised, Controlled Clinical Study on Total Hip Arthroplasty Using 4 Different Bearings: Results after 10 Years

Hip International ◽

10.5301/hipint.5000428 ◽

2016 ◽

Vol 27 (1) ◽

pp. 96-103

Author(s):

Arne Borgwardt ◽

Bo Zerahn ◽

Sandra D. Fabricius ◽

Tine H. Bertelsen ◽

Henrik Daugaard ◽

...

Keyword(s):

Clinical Study ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Total Hip ◽

Metal On Metal ◽

Group A ◽

Group B ◽

Randomised Controlled ◽

Group D ◽

Controlled Clinical Study

Purpose To compare 4 different bearings in total hip arthroplasty (THA) in a randomised controlled clinical study on clinical performance. Methods 393 patients with osteoarthritis of the hip or avascular necrosis were included and allocated to 1 of the head-and-cup couples zirconia-on-polyethylene (group A), metal-on-metal (group B), zirconia-on-polyethylene with the liner moulded into the shell (group C), or alumina-on-alumina (group D). In the individual case the surgeon could choose other implants if indicated. Results 299 patients were operated with the allocated prosthesis. The estimated cumulated prosthesis survival percentages and 95% confidence interval after 10 years were: group A 84.6 (75.8-93.4); group B 95.0 (89.5-100); group C 93.2 (86.7-99.7); group D 66.1 (54.5-77.7). The patients' physical function was significantly improved and remained equally good in all 4 groups, however slightly declining with ageing. The luxation rate was initially high, and equal between the groups, but was reduced by improving the surgical procedure introducing capsule repair by reinsertion of the short external hip rotators. Conclusions The metal-on-metal or zirconia-on-polyethylene prostheses had high 10-year survival percentages. The longevity of these bearing couples by themselves was not related to the combination of materials. The zirconia-on-polyethylene prosthesis with the liner mounted peroperatively possibly exhibited cases of backside wear which the corresponding bearing couple with moulded polyethylene (Asian) did not. The alumina-on-alumina bearing performed poorly - it was redesigned after our study initiation and later withdrawn from the market.

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Active Ankylosing Spondylitis Increases Blood Loss during Total Hip Arthroplasty for a Stiff Hip Joint

10.21203/rs.2.16401/v1 ◽

2019 ◽

Author(s):

Yong Hu ◽

Wei-Zhou Jiang

Keyword(s):

Ankylosing Spondylitis ◽

Total Hip Arthroplasty ◽

Blood Loss ◽

Disease Activity ◽

Hip Arthroplasty ◽

Active Group ◽

Nutrition Status ◽

Transfusion Rate ◽

Stable Group ◽

Total Hip

Abstract Background: Total hip arthroplasty (THA) has been highlighted as the best treatment option for ankylosing spondylitis (AS) patients with advanced hip involvement. The huge blood loss associated with THA is a common concern of postoperative complications. Disease activity is a specific reflection of systematic inflammation of AS. The purpose of this study was to determine the eﬀect of disease activity on blood loss during THA in patients with AS. Methods: Forty-nine patients with AS who underwent unilateral THAs were retrospectively studied. Ankylosing Spondylitis Disease Activity Score (ASDAS) was employed to evaluate the disease activity. Orthopedic Surgery Transfusion Hemoglobin European Overview (OSTHEO) formula was used to assess the surgical blood loss. The patients were divided into active group (ASDAS≥1.3; n=32) and stable groups (ASDAS<1.3; n=17) based on the ASDAS. Peri-operative laboratory values, plain radiographs, intra-operative data, transfusion volume, and use of hemostatic agents were recorded and statistically analyzed. Results: The ASDAS, pre-operative C-reactive protein level, erythrocyte sedimentation rate, and fibrinogen concentration in the active group were higher than the stable group (all P <0.05); however, the pre-operative hemoglobin concentration and albumin level were higher in the stable group (both P <0.05). The total blood loss during THA in stable patients was 1415.31 mL and 2035.04 mL in active patients ( P =0.006). The difference between the two groups was shown to be consistent after excluding the gender difference ( P =0.030). A high transfusion rate existed in both groups (stable group, 76.47% with an average of 1.53 units; active group, 84.37% with an average of 2.31 units), but there was no significant difference between the two groups (both P >0.05). Compensated blood loss, corresponding to transfusion, was noted significantly more often in the active group compared to the stable group ( P =0.027). Conclusion: Active AS patients are at high risk for increased blood loss during THA compared to stable patients. The underlying mechanism includes disorders of the coagulation and fibrinolytic systems, poor nutrition status, osteoporosis, imbalance of oxidative–antioxidative status and local inflammatory reaction. It is strongly recommended to perform THA in AS patients with stable disease.

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Octyl-2-cyanoacrylate tissue adhesive without subcuticular suture for wound closure after total hip arthroplasty: a prospective observational study on thirty-two cases with controls for 3 months follow-up

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01997-9 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Li-Shen Wang ◽

Xin-Yu Wang ◽

Hao-tian Tu ◽

Yi-Fan Huang ◽

Xin Qi ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Tissue Adhesive ◽

Wound Complications ◽

Subcuticular Suture ◽

Total Hip ◽

Skin Staples ◽

Significant Difference ◽

Group A ◽

Group B

Abstract Background Whether using tissue adhesive alone after subcutaneous suture can close the skin incision with safety as well as cosmetic appearance after total hip arthroplasty was not clear. Methods A prospective study was conducted. The same surgical methods were consistent throughout the entire study. After implanting prosthesis, the joint capsule was reconstructed. Fascial and subcutaneous layer were respectively closed by continuous running barbed suture. Patients were randomized allocated to group A with octyl-2-cyanoacrylate tissue adhesive alone, to group B with tissue adhesive after continuous subcuticular suture, or to group C with skin staples. Time of closure, drainage, pain, wound complications, and cosmesis were compared. All data were analyzed statistically. Results There was no significant difference in drainage, Visual Analog Scale score or early wound complications between the three groups. However, there was significant difference in time of closure (P = 0.013). In pairwise comparison, time of closure in groups A and B was significantly longer than those in group C (P = 0.001 and P = 0.023, respectively); time of closure in group A was significantly shorter than those in group B (P = 0.003). Patient and Observer Scar Assessment Scale total scores were not significantly different at 6 weeks and 3 months postoperatively (P = 0.078 and P = 0.284, respectively). Conclusion Tissue adhesive without subcuticular suture was similar with a combination of subcuticular suture and tissue adhesive as well skin staples in terms of safety and cosmetic appearance after total hip arthroplasty.

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Preoperative Optimisation of Anaemia for Primary Total Hip Arthroplasty: A Systematic Review

Hip International ◽

10.5301/hipint.5000530 ◽

2017 ◽

Vol 27 (6) ◽

pp. 515-522 ◽

Cited By ~ 6

Author(s):

Dinesh P. Alexander ◽

Nicholas Frew

Keyword(s):

Systematic Review ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Autologous Blood ◽

Transfusion Rate ◽

National Audit ◽

Blood Management ◽

Total Hip ◽

Preoperative Anaemia ◽

Primary Total Hip Arthroplasty

Background The 2009 NHS Blood and Transplant national comparative audit on blood use following primary total hip arthroplasty (THR) highlighted that preoperative anaemia was common and undertreated. They recommended that hospitals have a written policy for treating anaemia preoperatively. In our centre, we found that preoperative optimisation of anaemia, significantly reduced blood transfusion rate to <5%. The 2015 national audit showed that even though 48% of patients received tranexamic acid, 85% of patients required transfusion. By conducting a systematic review of literature on blood management for preoperative anaemia in primary THR; we aimed to validate the recommendations of the national audit and increase its awareness in the orthopaedic community. Methods A PubMed Search was performed to identify suitable literature limited to randomised controlled trials, cohort studies, meta-analyses and systematic reviews involving primary THR. We excluded any THRs performed for trauma and revision arthroplasty. Our exclusion criteria for the intervention was the use of autologous methods such as cell salvage techniques and preoperative autologous blood donation. Results Analysis of 13 publications showed widespread study heterogeneity, which precluded meta-analysis. Preoperative blood management (PBM) interventions included the use of recombinant human erythropoietin and oral iron supplementation in 12/13 and 11/13 studies respectively. There were significant differences in transfusion rates between PBM and control groups in 12/13 studies. Conclusions The findings overwhelmingly support preoperative optimisation of anaemia. The main barrier to wider implementation remains the cost effectiveness. We recommend using our validated protocol, which has shown to significantly reduce transfusion rates, length of stay and remain cost effective.

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Using the anterior capsule of the hip joint to protect the tensor fascia lata muscle during direct anterior total hip arthroplasty: a randomized prospective trial

10.21203/rs.2.14815/v2 ◽

2019 ◽

Author(s):

Gongyin Zhao ◽

Ruixia Zhu ◽

Shijie Jiang ◽

Nanwei Xu ◽

Hongwei Bao ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Joint ◽

Hip Arthroplasty ◽

Anterior Approach ◽

Prospective Trial ◽

Direct Anterior Approach ◽

Anterior Capsule ◽

Total Hip ◽

Group A ◽

Group B

Abstract Background The direct anterior approach for total hip arthroplasty (THA) has specific advantages, but injury to the tensor fasciae lata muscle (TFLM) remains a concern. This injury in part negates some of the advantages of the intermuscular approach, because injury of the muscle fibers of the TFLM can lead to less satisfactory clinical results. Thus, in this study, we propose an intraoperative method to protect the TFLM and demonstrate its feasibility.Methods Fifty-six patients undergoing THA by the direct anterior approach were divided randomly into two groups. In group A, the TFLM was protected by an autogenous tissue “pad” created from the anterior capsule of the joint that was rotated to protect the TFLM from direct contact with the retractors needed to expose the joint space. In group B, the operation was carried out in the typical fashion with no other protection of the TFLM except the attempt by the surgeons to consciously avoid compressive injury of the TFLM. We evaluated the magnitude of changes in the muscle cross-sectional area (MSCA) and fatty atrophy (FA) early and postoperatively between groups by magnetic resonance imaging. The differences in blood hemoglobin and serum levels of myoglobin, lactate dehydrogenase (LDH), and creatine phosphokinase (CPK) were compared at 8, 24, and 48 h, postoperatively. Postoperative drainage volume and pain evaluated by visual analogue scores (VAS) were compared between the two groups.Results LDH, CPK and myoglobin in group B were significantly higher than those in group A at 8, 24, and 48 hours after the surgery. (p<0.05) Compared to the group A, the decrease of hemoglobin in group B displayed significantly at 24 and 48 hours after surgery. (P<0.05) The significantly increased MSCA and FA of TFLM were demonstrated in group B. The PDV and VAS in group B were significantly higher compared with those in group A. (P<0.05)Conclusions Using the anterior capsule of the hip joint as an autogenous, protective capsular tissue pad to limit the trauma to the TFLM during a direct anterior approach to THA is an effective method to protect the TFLM and improve the clinical effect.

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Methods of the physical medicine therapy in prevention of heterotopic ossification after total hip arthroplasty

Vojnosanitetski pregled ◽

10.2298/vsp0609807k ◽

2006 ◽

Vol 63 (9) ◽

pp. 807-811 ◽

Cited By ~ 5

Author(s):

Mirjana Kocic ◽

Milica Lazovic ◽

Zoran Kojovic ◽

Milorad Mitkovic ◽

Sasa Milenkovic ◽

...

Keyword(s):

Soft Tissue ◽

Total Hip Arthroplasty ◽

Heterotopic Ossification ◽

Hip Arthroplasty ◽

Nonsteroidal Antiinflammatory Drugs ◽

Antiinflammatory Drugs ◽

Postoperative Rehabilitation ◽

Total Hip ◽

Group A ◽

Group B

Background/aim: In the prevention of periarticular heterotopic ossification (HO), a common complication after total hip arthroplasty (THA), nonsteroidal antiinflammatory drugs (NSAID) and irradiation are used. Some theories presume that local hypoxia of the soft tissue causes HO. The aim of this study was to investigate if the early use of pulsed electromagnetic fields (PEMF) could prevent this ossification since it accelerates the circulation and oxigenation of soft tissue. Methods. The study included three groups of the patients with primary THA. The group C consisted of 66 patients/79 hips who had only kinesitherapy in postoperative rehabilitation. The group B consisted of 117 patients/ 131 hips who had PEMF and interferential current (IC) which, on average, started on the 14th day after the surgery combined with the standard kinesitherapy. The group A consisted of 117 patients/131 hips who had PEMF from the third postoperative day and IC from, on average, the 14th postoperative day with the standard kinesitherapy. The classification of HO was done on a standard AP roentgenograms of the hips, taken at least one year after the surgery. Results. The overall HO was seen in 50.63% of the group C patients, in 43.51% of the B group and in 16.67% of the group A. Severe HO (III and IV class according to Brooker) was seen in 26.58% of the group C patients and in 6.10% of the group B, but none in the group A. Conclusion. According to the obtained results an early treatment with PEMF could prevent severe HO and reduce the overall HO.

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Cementless total hip arthroplasty for three different degrees of hip involved secondary to ankylosing spondylitis: an analysis of 195 hips

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02742-6 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Ping Mou ◽

Hua Li ◽

An-Jing Chen ◽

Zheng Ji ◽

Xin-Yi Dai ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Short Form ◽

Total Hip ◽

Cementless Total Hip Arthroplasty ◽

Hip Function ◽

Group A ◽

Group B ◽

And Function

Abstract Background Hip involved secondary to ankylosis spondylitis (AS) had a huge influence on hip function. Cementless total hip arthroplasty (THA) can improve hip function. However, no previous study compared the outcomes of THA for AS patients with three different degrees of hip involvement. Methods The 195 hips were retrospectively analyzed and divided into non-ankylosed group (group A, 94 hips), fibrous ankylosed group (group B, 49 hips), and bony ankylosed group (group C, 52 hips). postoperative range of motion (ROM), harris hip scores (HHS), the short-form 12 health survey (SF-12), length of stay (LOS), cost, radiological assessments, and complications were compared. Results The follow-up time was (79.4 ± 29.5) months for group A, (80.6 ± 28.9) months for group B, and (79.1 ± 28.9) months for group C (P = 0.966). Group A had the best postoperative hip ROM (P < 0.001), while group A and B can realize better HHS than group C (P < 0.001). The three groups had similar SF-12 postoperatively. For group A, LOS and cost for unilateral procedure were the least than that for group B and C (P = 0.003 and P = 0.001). Similar radiological assessments were achieved for three groups. 1 hip in group A encountered delay union of wound. 1 hip in group C encountered delay union of wound and dislocation and another patient encountered femoral fracture intraoperatively. 12 hips (12.8%) in group A, 6 hips (12.2%) in group B, and 6 hips (11.5%) in group C encountered asymptomatic heterotopic ossification (P = 0.977). Conclusion For AS patients with hip involvement, THA can improve hip ROM and function. THA for the non-ankylosed hip can realize the better hip function and postoperative ROM than ankylosed hip.

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High Hip Center Technique in Total Hip Arthroplasty for Crowe Type II-III Developmental Dysplasia: Results of Midterm Follow-up

10.21203/rs.3.rs-16950/v2 ◽

2020 ◽

Author(s):

Junmin Shen ◽

Yonggang Zhou ◽

Jingyang Sun ◽

Haiyang Ma ◽

Yinqiao Du ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Confidence Interval ◽

Hip Arthroplasty ◽

Developmental Dysplasia ◽

Harris Hip Score ◽

Total Hip ◽

Group A ◽

Group B ◽

Dysplasia Of The Hip

Abstract Background: High hip center technique is still controversial about the survivorship of prothesis and postoperative complications. We aimed to show the utility of high hip center technique used in patients with Crowe II-III developmental dysplasia of the hip at the midterm follow-up and evaluated the clinical and radiographic results between different heights of hip center.Methods: We retrospectively evaluated 69 patients (85 hips) with Crowe II-III dysplasia who underwent a high hip center cementless total hip arthroplasty at a mean follow up of 8.9 years (range, 6.0-14.1years). The patients were divided into two groups according to the height of hip center, respectively group A (≥22mm and <28mm) and group B (≥28mm). Radiographic, functional and survivorship outcomes were evaluated.Results: There were no statistically significant differences between two groups in horizontal distance, offset, abductor lever arm, leg length discrepancy and cup inclination. At the final follow up, the mean WOMAC and Harris hip score were significantly improved in both groups. Of the 85 hips, 7 hips (8.2%) showed a positive Trendelenburg sign. Besides, 6 patients (8.7%) presented with a limp. No significant differences were shown regarding the Harris hip score, WOMAC score, Trendelenburg sign and limp between two groups. The Kaplan-Meier implants survivorship rates at the final follow-up for all-causes revisions in group A and group B were similar (96.7% [95% confidence interval, 90.5%-100%] and 96.2% [95% confidence interval, 89.0%-100%], respectively).Conclusions: The high hip center technique is a valuable alternative to achieve excellent midterm results for Crowe II-III developmental dysplasia of the hip.

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Selection of spinal surgery and hip replacement sequence in patients with both degenerative scoliosis and hip disease

Journal of International Medical Research ◽

10.1177/0300060520959224 ◽

2020 ◽

Vol 48 (12) ◽

pp. 030006052095922

Author(s):

Haocong Zhang ◽

Hailong Yu ◽

Meng Zhang ◽

Zijun Huang ◽

Liangbi Xiang ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Spinal Surgery ◽

Hip Replacement ◽

Lumbar Surgery ◽

Degenerative Scoliosis ◽

Total Hip ◽

Hip Disease ◽

Group A ◽

Group B

Objective To discuss how the sequence of spinal surgery and hip replacement is determined for patients with both degenerative scoliosis and hip disease. Methods Twenty-six patients treated for both degenerative scoliosis and hip disease from June 2012 to June 2015 were retrospectively studied. Eleven patients underwent hip replacement followed by lumbar surgery (Group A), and 15 patients underwent lumbar surgery followed by hip replacement (Group B). The average follow-up duration was 1.5 years. Related indicators were assessed preoperatively and postoperatively. Results The parameters showing significant differences between Groups A and B after surgery were acetabular anteversion, the Oswestry functional disability score, and the Harris hip score. Postoperatively, five patients in Group A had unequal shoulder heights and inclination of the trunk to one side. After lumbar surgery and before total hip arthroplasty in Group B, eight patients could not walk, and the limitation was more severe than that preoperatively. Conclusion Spinal surgery may be performed first to resolve lumbar nerve symptoms and restore sagittal balance of the spine; hip replacement may then be performed to simplify hip replacement difficulties and resolve the imbalance after spinal surgery. Severely limited range of motion exists after lumbar surgery and before total hip arthroplasty.

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