Analysis of the Risk of Wear on Cemented and Uncemented Polyethylene Liners According to Different Variables in Hip Arthroplasty

Wear debris in total hip arthroplasty is one of the main causes of loosening and failure, and the optimal acetabular fixation for primary total hip arthroplasty is still controversial because there is no significant difference between cemented and uncemented types for long-term clinical and functional outcome. To assess and predict, from a theoretical viewpoint, the risk of wear with two types of polyethylene liners, cemented and uncemented, a simulation using the finite element (FE) method was carried out. The risk of wear was analyzed according to different variables: the polyethylene acetabular component’s position with respect to the center of rotation of the hip; the thickness of the polyethylene insert; the material of the femoral head; and the relationship of the cervical–diaphyseal morphology of the proximal end of the femur to the restoration of the femoral offset. In all 72 simulations studied, a difference was observed in favour of a cemented solution with respect to the risk of wear. With regard to the other variables, the acetabular fixation, the thickness of the polyethylene, and the acetabular component positioning were statistically significant. The highest values for the risk of wear corresponded to a smaller thickness (5.3 mm), and super-lateral positioning at 25 mm reached the highest value of the von Mises stress. According to our results, for the reconstruction of the acetabular side, a cemented insert with a thickness of at least 5 mm should be used at the center of rotation.

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Functional and radiographical results of asymmetrically reconstructed total hip arthroplasty in patients with bilateral dysplastic arthritic hips with one hip Crowe II–III and the other Crowe IV: a retrospective cohort study

Journal of Orthopaedics and Traumatology ◽

10.1186/s10195-021-00576-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Junmin Shen ◽

Jingyang Sun ◽

Yinqiao Du ◽

Bohan Zhang ◽

Tiejian Li ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

The Other ◽

Anatomical Reconstruction ◽

Center Of Rotation ◽

Total Hip ◽

Anatomical Position ◽

Significant Difference ◽

The Mean

Abstract Background The study aimed to evaluate the functional and radiographical results of asymmetrically reconstructed total hip arthroplasty in patients with bilateral dysplastic arthritic hips with one hip Crowe II–III and the other hip Crowe IV. Materials and methods From April 2006 to April 2019, we evaluated 23 patients who had a reconstruction of one Crowe II–III hip with high hip center (HHC) and the other Crowe IV hip at the anatomical position (H group). The radiographic and clinical outcomes were compared with those of a control group of 19 patients with bilateral dysplasia who had one Crowe IV hip and the contralateral hip both reconstructed in the anatomical position (A group). Medical records and radiographs were reviewed, and a complete follow-up was conducted for all patients. Results The mean vertical center of rotation (V-COR) and horizontal center of rotation (H-COR) in the H group were 30.6 ± 5.8 mm and 30.0 ± 5.5 mm, respectively. In the A group, the corresponding values were 14.0 ± 4.3 mm and 23.0 ± 2.3 mm, respectively. A significant difference was found in terms of V-COR and H-COR between the two groups, and no significant difference was shown regarding the cup inclination, abductor lever arm (ALA), ALA ratio, and leg length discrepancy (LLD). Three patients of the H group and four patients of the A group exhibited LLD > 10 mm. All seven patients who had LLD > 10 mm underwent the shortening subtrochanteric osteotomy (SSTO) of the Crowe IV hip. Subgroup analysis based on the presence and absence of SSTO showed that the LLD of the SSTO group was greater than that of the non-SSTO group in both groups, but the difference was only statistically significant in the A group. At the last follow-up, the mean Harris Hip Scores significantly improved in the two groups, and there was no revision during the follow-up period. In the H group, four patients presented with a slight limp and three patients with a moderate limp, while it was six patients and one patient in the A group, respectively. Conclusions Asymmetrical reconstruction in patients with bilateral dysplastic arthritic hips with one hip Crowe II–III and the other Crowe IV is acceptable and comparable when compared with bilateral anatomical reconstruction. Level of evidence III, retrospective observational study. Trial registration Chinese Clinical Trail Registry. ChiCTR2000033848

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Risk analysis of patients with an osteolytic acetabular defect after total hip arthroplasty using subject-specific finite-element modelling

The Bone & Joint Journal ◽

10.1302/0301-620x.100b11.bjj-2018-0092.r2 ◽

2018 ◽

Vol 100-B (11) ◽

pp. 1455-1462 ◽

Cited By ~ 1

Author(s):

J. T. Munro ◽

J. S. Millar ◽

J. W. Fernandez ◽

C. G. Walker ◽

D. W. Howie ◽

...

Keyword(s):

Finite Element ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Von Mises Stress ◽

Mineral Density ◽

Pubic Ramus ◽

Total Hip ◽

Subject Specific ◽

Von Mises

Aims Osteolysis, secondary to local and systemic physiological effects, is a major challenge in total hip arthroplasty (THA). While osteolytic defects are commonly observed in long-term follow-up, how such lesions alter the distribution of stress is unclear. The aim of this study was to quantitatively describe the biomechanical implication of such lesions by performing subject-specific finite-element (FE) analysis on patients with osteolysis after THA. Patients and Methods A total of 22 hemipelvis FE models were constructed in order to assess the transfer of load in 11 patients with osteolysis around the acetabular component of a THA during slow walking and a fall onto the side. There were nine men and two women. Their mean age was 69 years (55 to 81) at final follow-up. Changes in peak stress values and loads to fracture in the presence of the osteolytic defects were measured. Results The von Mises stresses were increased in models of those with and those without defects for both loading scenarios. Although some regions showed increases in stress values of up to 100%, there was only a moderate 11.2% increase in von Mises stress in the series as a whole. The site of fracture changed in some models with lowering of the load to fracture by 500 N. The most common site of fracture was the pubic ramus. This was more frequent in models with larger defects. Conclusion We conclude that cancellous defects cause increases in stress within cortical structures. However, these are likely to lead to a modest decrease in the load to fracture if the defect is large (> 20cm3) or if the patient is small with thin cortical structures and low bone mineral density. Cite this article: Bone Joint J 2018;100-B:1455–62.

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Short-stem total hip arthroplasty is not associated with an earlier return to work compared to a straight-stem design

Scientific Reports ◽

10.1038/s41598-021-82805-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Georg Hauer ◽

Maria Smolle ◽

Sabrina Zaussinger ◽

Joerg Friesenbichler ◽

Andreas Leithner ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Sick Leave ◽

Return To Work ◽

Hip Arthroplasty ◽

Short Stem ◽

Multivariate Linear Regression Analysis ◽

Stem Design ◽

Total Hip ◽

Straight Stem ◽

Significant Difference

AbstractReturn to work (RTW) has been specifically identified as a high priority in patients undergoing total hip arthroplasty (THA). This investigation sought to assess the effect of the stem design on patients’ RTW. Secondly, the study aimed to identify risk factors that lead to a delayed RTW. Questionnaires inquiring about RTW, employment history, educational level, type of work, physical demands and joint awareness were administered by post. Further data were collected from patients’ hospital records. 176 patients who underwent THA using a short-stem and 97 patients using a straight-stem design were compared. The median return to work time was 10 weeks [IQR 7–14 weeks], with no significant difference between the two groups (short stems vs. straight stems; 10 [IQR 7–14] vs. 11 [7.5–13.5] weeks; p = 0.693). In the multivariate linear regression analysis, self-employment vs. employee (p = 0.001), dimension of preoperative workload (p = 0.001), preoperative sick leave (p < 0.001), and hospital length of stay (LOS) (p < 0.001) independently affected the period until work was resumed. The Forgotten-Joint-Score-12 showed no significant difference between the two groups. The data show that the majority of THA patients can expect to resume work and stem design has no impact on RTW. Employees with preoperative sick leave, prolonged hospital LOS and low workload are at higher risk for a delayed RTW.

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Revision Rates After Surgical Treatment for Femoral Neck Fractures: Results of 2-Year Follow-up

Medicina ◽

10.3390/medicina49030022 ◽

2013 ◽

Vol 49 (3) ◽

pp. 22

Author(s):

Jaunius Kurtinaitis ◽

Narūnas Porvaneckas ◽

Giedrius Kvederas ◽

Tomas Butėnas ◽

Valentinas Uvarovas

Keyword(s):

Total Hip Arthroplasty ◽

Femoral Neck ◽

Internal Fixation ◽

Hip Arthroplasty ◽

Revision Surgery ◽

Femoral Neck Fractures ◽

Total Hip ◽

Significant Difference ◽

Surgery Rates

Background and Objective. Intracapsular fractures of the femoral neck account for a major share of fractures in the elderly. Open reduction and internal fixation has been shown to have a higher rate of revision surgery than arthroplasty. The aim of this study was to assess and compare the rates of revision surgery performed after internal fixation and primary total hip arthroplasty. Material and Methods. Between 2004 and 2006, 681 intracapsular femoral neck fractures in 679 consecutive patients were treated with internal fixation or total hip arthroplasty at our institution. Revision surgery rates were evaluated at 1-, 3-, 6-, 12-, and 24-month follow-up. Results. There was no significant difference in the ratio of internal fixation to total hip arthroplasty during 2004–2006 (P=0.31). The mean rate of total hip arthroplasty was 19.1% with a lower rate being among patients younger than 60 years. Revision surgery rates at the 2-year followup were higher in the internal fixation group compared with total hip arthroplasty group (28.9% vs. 7.0%, P<0.001). Patients who underwent internal fixation were at a 4-fold greater risk of having revision surgery at the 2-year follow-up than those who underwent total hip arthroplasty (odds ratio, 4.11; 95% CI, 1.95–8.65; P<0.001). Age was a significant risk factor for revision surgery after total hip arthroplasty (hazard ratio, 0.93; 95% CI, 0.87–0.98; P=0.02), but not significant after the internal fixation (P=0.86). Conclusions. Higher revision surgery rates after internal fixation favors arthroplasty as a primary choice of treatment for the femoral neck fractures.

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Total hip arthroplasty for high-riding hips: A retrospective analysis of 79 cases and proposal of a new classification

Journal of Orthopaedic Surgery ◽

10.1177/2309499020924164 ◽

2020 ◽

Vol 28 (2) ◽

pp. 230949902092416

Author(s):

İsmail Demirkale ◽

Yüksel Uğur Yaradılmış ◽

Ahmet Ateş ◽

Murat Altay

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Classification System ◽

Operating Time ◽

Limb Length Discrepancy ◽

Harris Hip Score ◽

Level Of Evidence ◽

Total Hip ◽

Significant Difference ◽

Functional Scores

Purpose: Total hip arthroplasty (THA) for high-riding hips is a complex procedure and the requirement for subtrochanteric osteotomy (STO) is an important decision that needs to be taken preoperatively. STO renders this complex surgery even more complicated and there are no guidelines to determine the STO requirement. In this study, the outcomes of THA for patients with high-riding hips were evaluated and a practical classification system is proposed to predict any osteotomy requirement. Methods: A retrospective evaluation was made of 79 hips of 76 patients who underwent THA for high-riding hip dysplasia. The amount of shortening in patients with STO and in patients without STO was compared. All patients were evaluated in respect of Harris hip score, operating time, erythrocyte suspension need, and actual limb length discrepancy. Preoperative radiographs were classified into four types according to the ratio of the distance between the lesser trochanter and the ischial tuberosity with pelvic height (LT-IT/P) to grade the degree of dislocation. Results: The mean follow-up was 30 ± 6.54 months. STO was applied to 47 (60%) hips and not to 32 (40%). There was no statistically significant difference between the groups in respect of the functional scores. STO prolonged the operating time and increased the need for blood transfusion ( p = 0.026, p < 0.001, respectively). When the LT-IT/P index was <0.19 (type 1), no additional surgical approach was required for reduction, at 0.19–0.29 (type 2), the head can be safely reduced with additional reduction methods, and when >0.3 (type 3), a shortening osteotomy will most likely be required. The rate of complications is increased if LT-IT/P is >0.4 (type 4). Conclusion: STO adjunct to THA increases the rate of complications. This practical classification system may guide the surgeon in the decision of whether an STO should be added to the procedure or not. Level of evidence: Level III, clinical trial

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Total hip arthroplasty performed by direct anterior approach – Does experience influence the learning curve?

SICOT-J ◽

10.1051/sicotj/2020015 ◽

2020 ◽

Vol 6 ◽

pp. 15 ◽

Cited By ~ 2

Author(s):

Constant Foissey ◽

Mathieu Fauvernier ◽

Cam Fary ◽

Elvire Servien ◽

Sébastien Lustig ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Learning Curve ◽

Hip Arthroplasty ◽

Anterior Approach ◽

Operating Time ◽

Surgical Techniques ◽

Direct Anterior Approach ◽

Clinical Results ◽

Total Hip ◽

Significant Difference

Introduction: Proficiency in the direct anterior approach (DAA) as with many surgical techniques is considered to be challenging. Added to this is the controversy of the benefits of DAA compared to other total hip arthroplasty (THA) approaches. Our study aims to assess the influence of experience on learning curve and clinical results when transitioning from THA via posterior approach in a lateral position to DAA in a supine position. Methods: A consecutive retrospective series of 525 total hip arthroplasty of one senior and six junior surgeons was retrospectively analysed from May 2013 to December 2017. Clinical results were analysed and compared between the two groups and represented as a learning curve. Mean follow up was 36.2 months ± 11.8. Results: This study found a significant difference in complications between the senior and junior surgeons for operating time, infection rate, and lateral femoral cutaneous nerve (LFCN) neuropraxia. A trainee’s learning curve was an average of 10 DAA procedures before matching the senior surgeon. Of note, the early complications correlated with intraoperative fractures increased with experience in both groups. Operating time for the senior equalised after 70 cases. Dislocation rate and limb length discrepancy were excellent and did not show a learning curve between the two groups. Conclusion: DAA is a safe approach to implant a THA. There is a learning curve and initial supervision is recommended for both seniors and trainees. Level of evidence: Retrospective, consecutive case series; level IV.

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Effect of Multiple Doses of Oral Tranexamic Acid on Haemostasis and Inflammatory Reaction in Total Hip Arthroplasty: A Randomized Controlled Trial

Thrombosis and Haemostasis ◽

10.1055/s-0038-1676625 ◽

2018 ◽

Vol 119 (01) ◽

pp. 092-103 ◽

Cited By ~ 7

Author(s):

Duan Wang ◽

Yang Yang ◽

Chuan He ◽

Ze-Yu Luo ◽

Fu-Xing Pei ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Blood Loss ◽

Inflammatory Response ◽

Tranexamic Acid ◽

Hip Arthroplasty ◽

Multiple Dose ◽

Control Group ◽

Total Hip ◽

Estimated Blood Loss ◽

Significant Difference

AbstractTranexamic acid (TXA) reduces surgical blood loss and alleviates inflammatory response in total hip arthroplasty. However, studies have not identified an optimal regimen. The objective of this study was to identify the most effective regimen of multiple-dose oral TXA in achieving maximum reduction of blood loss and inflammatory response based on pharmacokinetic recommendations. We prospectively studied four multiple-dose regimens (60 patients each) with control group (group A: matching placebo). The four multiple-dose regimens included: 2-g oral TXA 2 hours pre-operatively followed by 1-g oral TXA 3 hours post-operatively (group B), 2-g oral TXA followed by 1-g oral TXA 3 and 7 hours post-operatively (group C), 2-g oral TXA followed by 1-g oral TXA 3, 7 and 11 hours post-operatively (group D) and 2-g oral TXA followed by 1-g oral TXA 3, 7, 11 and 15 hours post-operatively (group E). The primary endpoint was estimated blood loss on post-operative day (POD) 3. Secondary endpoints were thromboelastographic parameters, inflammatory components, function recovery and adverse events. Groups D and E had significantly less blood loss on POD 3, with no significant difference between the two groups. Group E had the most prolonged haemostatic effect, and all thromboelastographic parameters remained within normal ranges. Group E had the lowest levels of inflammatory cytokines and the greatest range of motion. No thromboembolic complications were observed. The post-operative four-dose regimen brings about maximum efficacy in reducing blood loss, alleviating inflammatory response and improving analgaesia and immediate recovery.

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Age matters when comparing hemiarthroplasty and total hip arthroplasty for femoral neck fractures in Medicare patients

Hip International ◽

10.1177/1120700018816924 ◽

2018 ◽

Vol 29 (6) ◽

pp. 674-679 ◽

Cited By ~ 3

Author(s):

Scott M Eskildsen ◽

Ganesh V Kamath ◽

Daniel J Del Gaizo

Keyword(s):

Total Hip Arthroplasty ◽

Femoral Neck ◽

Hip Arthroplasty ◽

Femoral Neck Fractures ◽

National Database ◽

Medicare Patient ◽

Entire Study ◽

Total Hip ◽

Significant Difference ◽

Medicare Patients

Introduction: The optimal treatment of patients with a displaced intracapsular femoral neck fracture remains controversial. We utilised a national database of Medicare patients to determine if there was any difference in complications and reoperation rate of patients undergoing total hip arthroplasty (THA) or hemiarthroplasty (HA) for femoral neck fractures. Methods: This study utilised the PearlDiver Patient Records Database, a national for-fee database of Medicare patient procedure and diagnosis records from 2005 to 2012. Outcome procedures and diagnoses including revision, dislocation, infection, and cardiovascular events that occurred during the study time period were also identified over the entire study period as well as 90 days and 2 years. Results: We identified 275,439 patients with femoral neck fractures who underwent HA and 26,017 patients who underwent THA, respectively. Patients undergoing HA had significantly lower rates ( p < 0.0001) of revision 2.48% versus 3.85% (OR = 0.633; 95% CI, 0.592–0.678), dislocation 1.76% versus 3.39% (0.512; 0.476–0.551), infection 3.44% versus 4.87% (0.694; 0.657–0.737). There was no statistical significant difference in 2-year cardiac morbidity ( p = 0.252). However, when controlling for age, patients 65–69 years showed no significant difference in infection or revision over the study period or at 2 years. Conclusions: In this study, patients who underwent THA for femoral neck fractures had a higher rate of dislocations, infections and increased rates of repeat surgery than those who underwent HA but this difference was not significant in patients 65–69 years. Hemiarthroplasty may result in fewer complications in older Medicare patients although this difference may not be present in younger Medicare patients.

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32-mm ceramic-on-ceramic total hip arthroplasty versus 28-mm ceramic bearings: 5- to 15-year follow-up study

Hip International ◽

10.1177/1120700018760971 ◽

2018 ◽

Vol 29 (1) ◽

pp. 65-71 ◽

Cited By ~ 3

Author(s):

Yoshitoshi Higuchi ◽

Taisuke Seki ◽

Yukiharu Hasegawa ◽

Yasuhiko Takegami ◽

Daigo Morita ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Harris Hip Score ◽

Total Hip ◽

Kaplan Meier ◽

Significant Difference ◽

Average Patient ◽

The Mean ◽

Ceramic On Ceramic

Introduction: This study aimed to compare the clinical and radiographic results of 28-mm ceramic-on-ceramic (CoC) total hip arthroplasty (THA) to those of 32-mm CoC during a 5- to 15-year follow-up period. Methods: 107 joints (95 women and 6 men) underwent 28-mm CoC, and 60 (49 women and 7 men) underwent 32-mm CoC. The average patient age at the time of surgery was 56.1 and 55.7 years in the 28-mm and 32-mm CoC groups, respectively. Clinical and radiologic measurements of all patients were analysed. Results: The mean preoperative Harris hip score (HHS) was similar in the 2 groups (28-mm, 58.9; and 32-mm, 58.5). However, at final follow-up, the mean HHS of the 32-mm CoC (91.8) was significantly better than that of the 28-mm CoC (88.2) ( p = 0.003), as were the ranges of motion (ROM) for flexion (98.3 ± 13.5° vs. 87.3 ± 19.3°, p < 0.001) and abduction (27.8 ± 14.9° vs. 22.1 ± 19.3°, p = 0.007). The mean wear rate was 0.0044 mm/year for the 28-mm CoC and 0.0044 mm/year for the 32-mm CoC. No ceramic fractures were found in the 2 groups. One joint in the 28-mm CoC (0.9%) required revision owing to progressive osteolysis. Kaplan-Meier survival at 10 years, with implant loosening or revision THA as the endpoint, was 98.3% for 28-mm CoC and 100% for 32-mm CoC ( p = 0.465). Conclusion: There was no significant difference in ceramic-related complications between the 2 groups. Our study demonstrated that the 32-mm and 28-mm CoC are safe and are associated with good clinical outcomes.

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Total Hip Arthroplasty Using Imageless Computer-Assisted Navigation—2-Year Follow-Up of a Prospective Randomized Study

Journal of Clinical Medicine ◽

10.3390/jcm9061620 ◽

2020 ◽

Vol 9 (6) ◽

pp. 1620

Author(s):

Richard Lass ◽

Boris Olischar ◽

Bernd Kubista ◽

Thomas Waldhoer ◽

Alexander Giurea ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Clinical Outcome ◽

Hip Arthroplasty ◽

Important Determinant ◽

Randomized Study ◽

Prospective Randomized Study ◽

Computer Assisted ◽

Total Hip ◽

Significant Difference

The purpose of this study is to compare computer-assisted to manual implantation-techniques in total hip arthroplasty (THA) and to find out if the computer-assisted surgery is able to improve the clinical and functional results and reduce the dislocation rate in short-terms after THA. We performed a concise minimum 2-year follow-up of the patient cohort of a prospective randomized study published in 2014 and evaluated if the higher implantation accuracy in the navigated group can be seen as an important determinant of success in total hip arthroplasty. Although a significant difference was found in mean postoperative acetabular component anteversion and in the outliers regarding inclination and anteversion (p < 0.05) between the computer-assisted and the manual-placed group, we could not find significant differences regarding clinical outcome or revision rates at 2-years follow-up. The implantation accuracy in the navigated group can be regarded as an important determinant of success in THA, although no significant differences in clinical outcome could be detected at short-term follow-up. Therefore, further long-term follow-up of our patient group is needed.

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