High Offset Stems are Protective of Dislocation in High Risk Total Hip Arthroplasty

Background: Spinal stiffness has been shown to increase risk of dislocation due to impingement and instability. Increasing anteversion of the acetabular component has been suggested to prevent dislocation, but little has been discussed in terms of femoral or global offset restoration. The purpose of this study is to quantify dislocation rates after primary THA using standard versus high offset femoral components and to determine how differences in offset affect impingement-free range of motion in a stiff spine cohort using a novel impingement model. Methods: 12,365 patients undergoing THA from 2016-2018 were retrospectively reviewed to determine dislocation rates and utilization of standard versus high offset stems. For 50 consecutive patients with spinal stiffness, a CT-based computer software impingement modeling system assessed bony or prosthetic impingement during simulated range of motion. The model was run 5 times for each patient with varying offsets. Range of motion was simulated in each scenario to determine the degree at which impingement occurred. Results: There were 51 dislocations for a 0.41% dislocation rate. Total utilization of high offset stems in the entire cohort was 49%. Of those patients who sustained a dislocation, 49 (96%) utilized a standard offset stem. The impingement modeling demonstrated 5 degrees of added range of motion until impingement for every 1mm offset increase. Conclusion: In the impingement model, high offset stems facilitated greater ROM before bony impingement and resulted in lower dislocation rates. In the setting of high-risk THA due to spinal stiffness, surgeons should consider the use of high-offset stems and pay attention to offset restoration.

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Bony impingement affects range of motion after total hip arthroplasty: A subject-specific approach

Journal of Orthopaedic Research® ◽

10.1002/jor.20541 ◽

2007 ◽

Vol 26 (4) ◽

pp. 443-452 ◽

Cited By ~ 41

Author(s):

Oliver Kessler ◽

Shantanu Patil ◽

Wirth Stefan ◽

Eckart Mayr ◽

Clifford W. Colwell ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Range Of Motion ◽

Hip Arthroplasty ◽

Specific Approach ◽

Total Hip ◽

Bony Impingement ◽

Subject Specific

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Optimal combined anteversion pattern for obtaining a wider range of motion without prosthetic impingement after total hip arthroplasty: a three-dimensional analysis study

10.21203/rs.3.rs-871792/v1 ◽

2021 ◽

Author(s):

Ryo Hidaka ◽

Kenta Matsuda ◽

Masaki Nakamura ◽

Shigeru Nakamura ◽

Hirotaka Kawano

Keyword(s):

Total Hip Arthroplasty ◽

Range Of Motion ◽

Hip Arthroplasty ◽

Three Dimensional ◽

Target Range ◽

Total Hip ◽

Combined Anteversion ◽

Significant Difference ◽

The Absolute ◽

Prosthetic Impingement

Abstract Background Obtaining a larger theoretical range of motion (ROM) is crucial to avoid prosthetic impingement after total hip arthroplasty (THA); however, no reports have examined the permissible range values of combined anteversion (CA) satisfying targeted ROM without prosthetic impingement. This retrospective study aimed to evaluate the possible postoperative CA extent that would allow meeting target ROM criteria according to Yoshimine’s theory using computed tomography (CT)-based three-dimensional motion analysis after THA. Methods This study included 114 patients (133 hips) who underwent cementless primary THA using a CT-based navigation system and implants (oscillation angle ≥ 135°). Implant positions were determined using Yoshimine's CA formula. Postoperative evaluation was conducted using a three-dimensional templating software for CT data. The postoperative Yoshimine’s and Widmer’s CA was calculated, and the difference between the target and postoperative values was defined as the error of Yoshimine’s CA and Widmer’s CA. Prosthetic ROM was assessed by Yoshimine’s stringent criteria for activities of daily living. Based on fulfilling these criteria, all patients were divided into the ROM (+) and ROM (-) groups. Evaluation items were compared between the two groups. Results There were 111 and 22 hips in the ROM (+) and ROM (-) groups, respectively. A significant difference was noted in the absolute error of Yoshimine’s and Widmer’s CA between the two groups. Using receiver operating characteristic analysis, threshold values of 6.0 (higher values indicate greater disability; sensitivity 90.9%, specificity 72.1%) for the absolute Yoshimine’s CA difference (area under the curve [AUC] 0.87, P < 0.01) and 6.9 (higher values indicate greater disability; sensitivity 68.2%, specificity 88.3%) for the absolute Widmer’s CA difference (AUC 0.83, P < 0.01) were predictors in the ROM (-) group. Conclusions The target range of Yoshimine’s CA (90.8°±6.0°) and Widmer’s CA values (37.3°±6.9°) was crucial in implant orientation for obtaining theoretical ROM without prosthetic impingement after THA.

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Optimal Combined Anteversion Range for Obtaining a Wider Range of Motion without Prosthetic Impingement after Total Hip Arthroplasty: A Three-dimensional Analysis Study

10.21203/rs.3.rs-1050296/v1 ◽

2021 ◽

Author(s):

Ryo hidaka ◽

Kenta Matsuda ◽

Masaki Nakamura ◽

Shigeru Nakamura ◽

Hirotaka Kawano

Keyword(s):

Total Hip Arthroplasty ◽

Range Of Motion ◽

Hip Arthroplasty ◽

Three Dimensional ◽

Target Range ◽

Total Hip ◽

Combined Anteversion ◽

Significant Difference ◽

The Absolute ◽

Prosthetic Impingement

Abstract Background: Obtaining a larger theoretical range of motion (ROM) is crucial to avoid prosthetic impingement after total hip arthroplasty (THA); however, no reports have examined the permissible range values of combined anteversion (CA) satisfying targeted ROM without prosthetic impingement. This retrospective study aimed to evaluate the possible postoperative CA extent that would allow meeting target ROM criteria according to Yoshimine’s theory using computed tomography (CT)-based three-dimensional motion analysis after THA.Methods: This study included 114 patients (133 hips) who underwent cementless primary THA using a CT-based navigation system and implants (oscillation angle ≥135°). Implant positions were determined using Yoshimine's CA formula. Postoperative evaluation was conducted using a three-dimensional templating software for CT data. The postoperative Yoshimine’s and Widmer’s CA was calculated, and the difference between the target and postoperative values was defined as the error of Yoshimine’s CA and Widmer’s CA. Prosthetic ROM was assessed by Yoshimine’s stringent criteria for activities of daily living. Based on fulfilling these criteria, all patients were divided into the ROM (+) and ROM (-) groups. Evaluation items were compared between the two groups.Results: There were 111 and 22 hips in the ROM (+) and ROM (-) groups, respectively. A significant difference was noted in the absolute error of Yoshimine’s and Widmer’s CA between the two groups. Using receiver operating characteristic analysis, threshold values of 6.0 (higher values indicate greater disability; sensitivity 90.9%, specificity 72.1%) for the absolute Yoshimine’s CA difference (area under the curve [AUC] 0.87, P<0.01) and 6.9 (higher values indicate greater disability; sensitivity 68.2%, specificity 88.3%) for the absolute Widmer’s CA difference (AUC 0.83, P<0.01) were predictors in the ROM (-) group.Conclusions: The target range of Yoshimine’s CA (90.8°±6.0°) and Widmer’s CA values (37.3°±6.9°) was crucial in implant orientation for obtaining theoretical ROM without prosthetic impingement after THA.

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Patient-Specific Safe Zone Based on Daily Positions and Range of Motion

10.29007/nw28 ◽

2020 ◽

Author(s):

Wistan Marchadour ◽

Guillaume Dardenne ◽

Aziliz Guezou-Philippe ◽

Christian Lefèvre ◽

Eric Stindel

Keyword(s):

Total Hip Arthroplasty ◽

Range Of Motion ◽

Hip Arthroplasty ◽

Pelvic Tilt ◽

Safe Zone ◽

Patient Specific ◽

Total Hip ◽

Prosthetic Impingement ◽

Param Eters

Cup orientation is a challenging step in total hip arthroplasty (THA), to ensure comfort of the patient and durability of the prosthesis. The safe zone defined by Lewinnek is commonly used for cup orientation, but it is nowadays being questioned because it is not patient-specific.We propose to define a new safe zone for cup orientation, that considers patient-specific parameters such as the pelvic tilt and the range of motion (ROM) of the leg.We developed a software that easily computes a unique safe zone from these param- eters in different daily positions, ensuring a cup orientation without risks of prosthetic impingement.

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Bony impingement affects range of motion after total hip arthroplasty: A subject-specific approach

Journal of Orthopaedic Research® ◽

10.1002/jor.20737 ◽

2008 ◽

Vol 26 (10) ◽

pp. 1419-1419 ◽

Cited By ~ 2

Author(s):

Oliver Kessler ◽

Shantanu Patil ◽

Wirth Stefan ◽

Eckart Mayr ◽

Clifford W. Colwell ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Range Of Motion ◽

Hip Arthroplasty ◽

Specific Approach ◽

Total Hip ◽

Bony Impingement ◽

Subject Specific

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Efficacy of NSAIDs versus radiotherapy for heterotopic ossification prophylaxis following total hip arthroplasty in high-risk patients: a systematic review and meta-analysis

Hip International ◽

10.1177/1120700021991115 ◽

2021 ◽

pp. 112070002199111

Author(s):

Jacob Shapira ◽

Mitchell J Yelton ◽

Jeffery W Chen ◽

Philip J Rosinsky ◽

David R Maldonado ◽

...

Keyword(s):

Systematic Review ◽

High Risk ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Meta Analysis ◽

Comparable Efficacy ◽

Total Hip ◽

High Risk Patients ◽

Randomised Control Trials ◽

Risk Patients

Background: The aims of this systematic review were: (1) to investigate the prophylactic effect of radiotherapy (RT) and NSAIDs in high-risk patients following total hip arthroplasty (THA); and (2) to compare the efficacy of non-selective and COX-II selective NSAIDs in preventing post-THA HO, utilising a meta-analysis of randomised control studies. Methods: The PubMed, Embase, and Cochrane Databases were searched for articles regarding HO following THA in March 2019. Studies were included if they contained data regarding HO incidence after THA or contained data regarding HO prophylaxis comparison of NSAIDs and/or RT in terms of dosage or duration. Results: 24 studies reported on populations that were not at high-risk for HO. These studies reported between 47.3% and 90.4% of their patient populations had no HO formation; between 2.8% and 52.7% had mild formation; and between 0.0% and 10.4% had severe formation. A total of 13 studies reported on populations at high-risk for HO. Studies analysing RT in high-risk patients reported between 28.6% and 97.4% of patients developed no HO formation; between 1.9% and 66.7% developed mild HO formation; and between 0.0% and 11.9% developed severe HO formation. Studies analysing NSAID treatment among high-risk populations reported between 76.6% and 88.9% had no HO formation; between 11.1% and 23.4% had mild HO formation, and between 0.0% and 1.8% had severe HO formation. 9 studies were identified as randomised control trials and subsequently used for meta-analysis. The relative risk for COX-II in developing any HO after THA was not significantly different compared to non-selective NSAIDs (RR 1.00; CI, 0.801–1.256; p = 0.489). Conclusions: NSAIDs prophylaxis for HO may have better efficacy than RT in high-risk patients following THA. Non-selective and COX-II selective NSAIDs have comparable efficacy in preventing HO. Factors such as medical comorbidities and side-effect profile should dictate the prophylaxis recommendation.

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Predictive Value of Gross Extranodal Extension for Differentiated Thyroid Carcinoma Persistence/Recurrence

Otolaryngology ◽

10.1177/01945998211023177 ◽

2021 ◽

pp. 019459982110231

Author(s):

Ying Kou ◽

Guohua Shen ◽

Zhuzhong Cheng ◽

Anren Kuang

Keyword(s):

High Risk ◽

Thyroid Carcinoma ◽

Risk Group ◽

Differentiated Thyroid Carcinoma ◽

Individual Risk ◽

Intermediate Risk ◽

Entire Cohort ◽

Gene Group ◽

Extranodal Extension ◽

Disease Persistence

Objective We systematically investigated the predictive value of gross extranodal extension (gENE) for differentiated thyroid carcinoma persistence/recurrence. Study Design Retrospective study. Setting A tertiary care hospital. Methods This study was divided into 2 groups according to gENE status: the gENE group and non-gENE group. We compared the disease persistence/recurrence rates of these 2 groups in the entire cohort and by individual risk group (intermediate/high risk), analyzed whether gENE was an independent risk factor for disease persistence/recurrence, and explored the impact of gENE-specific features on disease persistence/recurrence. Results There were 989 patients who satisfied the inclusion criteria: 57 patients in the gENE group and 932 in the non-gENE group. The disease persistence/recurrence rate of the gENE group was higher than that of the non-gENE group in the entire cohort and by individual risk group ( P < .05 for each). Unexpectedly, the outcomes of the gENE group with intermediate risk were similar to those of the non-gENE group with high risk ( P = .72). For the entire cohort, gENE was an independent predictor for disease persistence/recurrence (odds ratio, 2.89; 95% CI, 1.39-6.00; P = .005). Specific features of gENE ( P > .05 for each) were not related to disease persistence/recurrence. Conclusion Patients with gENE and intermediate risk might be regraded as high risk. Specific features of gENE have no impact on disease persistence/recurrence.

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Abstract 12134: Risk of In-Hospital Deterioration for Children With Single Ventricle Physiology

Circulation ◽

10.1161/circ.144.suppl_2.12134 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Henry Foote ◽

Zohaib Shaikh ◽

William Ratliff ◽

Michael Gao ◽

Bradley Hintze ◽

...

Keyword(s):

High Risk ◽

Pediatric Cardiology ◽

Single Ventricle ◽

Retrospective Chart Review ◽

Clinical Deterioration ◽

Inpatient Service ◽

Lower Systolic Blood Pressure ◽

Single Ventricle Physiology ◽

Entire Cohort ◽

Increased Risk

Introduction: Children with single ventricle physiology (SV) are at high risk of in-hospital morbidity and mortality, with much of that increased risk coming in the first year of life. Understanding which children are at the highest risk for clinical deterioration may allow for increased monitoring and earlier escalation of care, with associated decreased mortality. Methods: We conducted a retrospective chart review of all admissions to the pediatric cardiology non-ICU inpatient service from 2014 - 2018 for children < 18 years old. Clinical deterioration was defined as an unplanned transfer to the ICU or inpatient mortality. Children with SV were selected by diagnosis codes. Results: From the entire cohort of 1612 pediatric cardiology admissions (56 % male, 25% SV), 288 admissions had a deterioration event including 26 deaths. Infants less than one year with SV (n = 197 admissions) were significantly more likely to have a deterioration event (107 events over 62 admissions with an event) than the overall pediatric cardiology cohort (OR 2.11, 95% CI 1.52-2.93). Among infants with SV, those with a deterioration event were significantly younger (median 1.7 v 4.3 months, p < 0.001). Further, at baseline they had significantly lower oxygen saturation (84% v 87%, p < 0.01), lower systolic blood pressure (85mmHg v 90mmHg, p< 0.02), higher respiration rate (48 v 44, p < 0.01), and higher hematocrit (44.0 v 40.2, p < 0.005) compared to those who remained stable. Mean Pediatric Early Warning Scores (PEWS) were significantly higher for infants with SV who had a deterioration event (1.4 v 0.9, p < 0.001) and PEWS scores significantly increased in the 48 hours prior to an event (p < 0.001). Of the 104 non-death events, 61 required an increase in oxygen support and 51 required a fluid bolus prior to the event (p < 0.001). Conclusions: Infants with SV are at high risk for clinical deterioration. There are baseline differences in vital signs and lab work between those that remain stable and those that have a deterioration event. PEWS scores and oxygen and fluid treatment significantly increase prior to deterioration events. Leveraging data from the Electronic Medical Record to identify the highest risk patients may allow for earlier detection and intervention to prevent clinical deterioration.

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