scholarly journals Antibiotic-Loaded Hydrogel Coating to Reduce Early Postsurgical Infections in Aseptic Hip Revision Surgery: A Retrospective, Matched Case-Control Study

2020 ◽  
Vol 8 (4) ◽  
pp. 571 ◽  
Author(s):  
Daniele De Meo ◽  
Valeria Calogero ◽  
Lorenzo Are ◽  
Armando U. Cavallo ◽  
Pietro Persiani ◽  
...  
Keyword(s):  
Bone Ingrowth ◽  
Group Versus ◽  
Functional Results ◽  
Hip Surgery ◽  
Control Group ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
Joint Infections ◽  
Secondary Objective ◽  
Revision Hip Replacement

Periprosthetic joint infections (PJIs) are a cause of frequent implant failure in revision hip replacement surgery. The purpose of this study is to evaluate the onset of early postoperative infections in patients who underwent hip surgery with cementless prostheses treated with an antibiotic loaded hydrogel on their surface, in addition to systemic prophylaxis, and compare them to a control group. The secondary objective was to evaluate the onset of any local and systemic adverse effects and interference with bone ingrowth processes and functional recovery. A retrospective observational study was conducted on patients who underwent revision hip surgery by performing a 1:1 match between patients treated with an antibiotic hydrogel (ALH) and the control patients. The incidence of PJIs was assessed with a minimum of six months follow-up. Seventeen patients treated with the ALH were compared with 17 patients from the control group. No PJIs were reported in the ALH group versus the six cases encountered in the control group (p < 0.0001). No significant differences were reported with regard to prosthetic osseointegration and functional results, nor were there side effects in the ALH group. Despite the low sample size, the use of on-site prophylaxis with ALH has proven effective and safe in reducing the risk of PJIs in patients with a high risk for infections. Further studies are needed to validate these results in other implant-related surgeries.

scholarly journals Bone and Joint Tissue Penetration of the Staphylococcus-Selective Antibiotic Afabicin in Patients Undergoing Elective Hip Replacement Surgery

2018 ◽  
Vol 63 (3) ◽  
Author(s):  
Annick Menetrey ◽  
Annick Janin ◽  
John Pullman ◽  
J. Scott Overcash ◽  
Amina Haouala ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Soft Tissue ◽  
Synovial Fluid ◽  
Hip Replacement ◽  
Clinical Development ◽  
Efficacy Data ◽  
Content Type ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
Joint Infections

ABSTRACT Afabicin (formerly Debio 1450, AFN-1720) is a prodrug of afabicin desphosphono (Debio 1452, AFN-1252), a novel antibiotic in development which targets the staphylococcal enoyl-acyl carrier protein reductase (FabI) and exhibits selective potent antibacterial activity against staphylococcal species, including methicillin-resistant Staphylococcus aureus. As part of clinical development in bone and joint infections, a distribution study in bone was performed in 17 patients who underwent elective hip replacement surgery. Patients received 3 doses of 240 mg afabicin orally (every 12 h) at various time points before surgery. Afabicin desphosphono concentrations were measured by liquid chromatography-tandem mass spectrometry in plasma, cortical bone, cancellous bone, bone marrow, soft tissue, and synovial fluid collected during surgery at 2, 4, 6, or 12 h after the third afabicin dose. The study showed good penetration of afabicin desphosphono into bone tissues, with mean area under the curve ratios for cortical bone-, cancellous bone-, bone marrow-, soft tissue-, and synovial fluid-to-total plasma concentrations of 0.21, 0.40, 0.32, 0.35, and 0.61, respectively. When accounting for the free fraction in plasma (2%) and synovial fluid (9.4%), the mean ratio was 2.88, which is indicative of excellent penetration and which showed that the afabicin desphosphono concentration was beyond the MIC90 of S. aureus over the complete dosing interval. These findings, along with preclinical efficacy data, clinical efficacy data for skin and soft tissue staphylococcal infection, the availability of both intravenous and oral formulations, and potential advantages over broad-spectrum antibiotics for the treatment of staphylococcal bone or joint infections, support the clinical development of afabicin for bone and joint infections. (This study has been registered at ClinicalTrials.gov under identifier NCT02726438.)

scholarly journals Acetabular defects reconstruction with tantalum constructions.

2020 ◽  
Author(s):  
Artak Galstyan ◽  
Yulin Wu ◽  
Peiliang Fu
Keyword(s):  
Hip Replacement ◽  
Hip Prosthesis ◽  
Functional Results ◽  
Hip Surgery ◽  
Pelvic Bone ◽  
Porous Tantalum ◽  
Common Procedure ◽  
Replacement Surgery ◽  
Acetabular Defects ◽  
Research Period

Abstract Background Total hip replacement (THR) is a common procedure that is performed increasingly often. Al­though most patients have satisfactory long-term stability, approximately 17% of prosthetic hips fail, thus requiring revision. Frequently, when hip prosthesis revision is undertaken, there is significant ace­tabular bone deficiency present; this clinical setting presents one of the most challenging circu­m­stances in hip surgery. There is a variety of surgical hardware and strategies available to address this problem. Preoperative planning is a critical aspect of any reconstructive hip surgery but is particularly im­por­tant in revision surgery. The surgeon must anticipate instrument, bone graft, and implant requi­re­ments for the surgery, as well as which reconstructive options may be needed, based on what may be found intraoperatively. The purpose of this study was to evaluate early functional results of hip arthroplasty with acetabular defects, pelvic bone loss revised with porous tantalum acetabular components.Methods 56 patients were operated during research period with different kind of acetabular defects. W.G. Paprosky classification was used to classify existing acetabular defect. From 56 patients 26 was primary hip replacement and 30 – revision.Results Different kind of tantalum constructions were used to reconstruct acetabular defects during replacement surgery. During research period three patient had complications: two cases of dislocation after revision replacement (3,6%) and one – after primary replacement (1,8%), one suppuration case (1,8%).Conclusions According research results possible to make conclusion: using tantalum augments during acetabular region reconstruction allow to avoid non-biological fixators – support rings and structural grafts; tantalum augments are successfully applicable during all kinds of acetabular defects reconstruction, in primary and revision replacement; using tantalum augments during acetabular region reconstruction allow to achieve components stable primary fixation.

scholarly journals Complex revision hip arthroplasty for aseptic implant instability with 3D-modeling

2021 ◽  
pp. 58-62
Author(s):  
Diomyd Chabanenko ◽  
Oleksandr Polіvoda ◽  
Grigory Puhkan ◽  
Oleh Vytychak
Keyword(s):  
3D Modeling ◽  
Hip Replacement ◽  
Revision Arthroplasty ◽  
Functional Results ◽  
Progressive Increase ◽  
High Tech ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
Exact Size ◽  
The Individual

The increasing number of hip replacement surgeries in the worldwide practice causes the progressive increase in revision cases. The treatment of patients with instability of the hip implants requires the individual approach, taking into account the size of the defect, the loss of bone mass and the structural state of the bone in each case. Objective. To show the technical opportunities of the revision cementless implants in combination with 3D-modeling for the treatment of acetabulum massive defects. Methods. It was shown the cli­nical case of hip replacement surgery of the patient with the aseptic instability of endoprosthesis components. A 3D-model of the pelvis and femur was created on the basis of the СT scan in order to make an analysis of bone tissue defects and to select the exact size of implant components for revision surgery. Results. It was suggested a standardized methodology of the preoperative examination to make the high-tech operation easier and maximally effective. It is necessary not only to take into account the results of the X- ray analysis, but also to pay attention to all changes in the damaged segments. It was shown that the real plastic model make the work of the surgeon easier during all steps of the treatment. The opportunity to use the standard revision components for the restoration of the complex geometrically shaped bone was demonstrated with the good nearest clinical and radiological and functional results. Conclusions. The success of the revision arthroplasty depends on the carefully preoperative planning, the maximum approximation of the parameters of the artificial joint to the anatomical parameters of the patient and biomechanics of the hip join. No less important is the individual recovery program during the postoperative period.

scholarly journals Compressive cryotherapy is superior to cryotherapy alone in reducing pain after hip arthroscopy

2019 ◽  
Author(s):  
Ianiv Klaber ◽  
Eugene Greeff ◽  
John O’Donnell
Keyword(s):  
Hip Arthroscopy ◽  
Early Mobilization ◽  
Early Discharge ◽  
Control Group ◽  
Analgesic Requirement ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
Lower Pain ◽  
Analgesia Requirement ◽  
Vas Scores

Abstract The early post-operative period after hip arthroscopy for femoroacetabular impingement is characterized by pain and swelling. Minimization of pain is of critical importance to the patient, but pain might also reduce patients’ compliance to early physiotherapy, delay rehabilitation and hospital discharge. Avoiding early mobilization represents a risk factor for developing capsulolabral adhesions. Compressive cryotherapy (CC) has been shown to reduce pain after knee and hip replacement surgery. The aim of this study was to assess the effect of the inclusion of CC in the pain management and early discharge after hip arthroscopy. A prospective cohort of 20 patients who received CC and 20 retrospectively matched controls who received standard cryotherapy (SC) were compared. The CC was added to the standard post-operative analgesia and rehabilitation protocol. Using non-parametric tests, the percentage of patients discharged in post-operative day one, pain VAS scores and analgesia requirement were compared. The CC group reported significantly lower pain scores compared to SC; VAS 1 (0–3) and 2 (0–5) (P = 0.0028), respectively. A non-significant reduction in analgesic requirement 1.75 versus 2.8 doses per patient was found and 20/20 patients were discharged on post-operative day one versus 17/20 in the SC group (P = 0.23). Patients treated with CC after hip arthroscopy reported lower levels of pain during the early post-operative phase and were able to be discharged home sooner when compared with a matched control group receiving ice therapy alone. A trend towards lower opioid analgesia requirement was observed.

Prolonged Thromboprophylaxis Following Hip Replacement Surgery – Results of a Double-blind, Prospective, Randomised, Placebo-controlled Study with Dalteparin (Fragmin®)

1997 ◽  
Vol 77 (01) ◽  
pp. 026-031 ◽  
Author(s):  
O E Dahl ◽  
G Andreassen ◽  
T Aspelin ◽  
C Müller ◽  
P Mathiesen ◽  
...  
Keyword(s):  
Hip Replacement ◽  
Group Versus ◽  
Treated Group ◽  
Controlled Study ◽  
Double Blind ◽  
Once Daily ◽  
Randomised Study ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
To Receive

SummaryDiscontinuation of thromboprophylaxis a few days after surgery may unmask delayed hypercoagulability and contribute to late formation of deep venous thrombosis (DVT). To investigate whether thromboprophylaxis should be prolonged beyond the hospital stay, a prospective, double-blind randomised study was conducted in 308 patients. All patients received initial thromboprophylaxis with dalteparin, dextran and graded elastic stockings. On day 7, patients were randomised to receive dalteparin (Fragmin®) 5000IU once daily, or placebo, for 4 weeks. All patients were subjected to bilateral venography, perfusion ventilation scintigraphy and chest X-ray on days 7 and 35. Patients with venographically verified proximal DVT on day 7 were withdrawn from the randomised study to receive anticoagulant treatment. The overall prevalence of DVT on day 7 was 15.9%. On day 35, the prevalence of DVT was 31.7% in placebo-treated patients compared with 19.3% in dalteparin-treated patients (p = 0.034). The incidence of DVT from day 7 to day 35 was 25.8% in the placebo-treated group versus 11.8% in the dalteparin-treated group (p = 0.017). The incidence of symptomatic pulmonary embolism (PE) from day 7 to day 35 was 2.8% in the placebo-treated group compared with zero in the dalteparin-treated group. This included one patient who died from PE. No patients experienced serious complications related to the injections of dalteparin or placebo. This study shows that prolonged thromboprophylaxis with dalteparin, 5000 IU, once daily for 35 days significantly reduces the frequency of DVT and should be recommended for 5 weeks after hip replacement surgery.

scholarly journals Postoperative Cognitive Dysfunction after Sevoflurane Or Propofol General Anaesthesia in Combination with Spinal Anaesthesia for Hip Arthroplasty

2018 ◽  
Vol 46 (6) ◽  
pp. 596-600 ◽  
Author(s):  
Y. Konishi ◽  
L. A. Evered ◽  
D. A. Scott ◽  
B. S. Silbert
Keyword(s):  
General Anaesthesia ◽  
Cognitive Dysfunction ◽  
Postoperative Cognitive Dysfunction ◽  
Group Versus ◽  
General Anaesthetic ◽  
Sevoflurane Group ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
Significant Difference ◽  
Neurocognitive Test

It is unknown if the type of general anaesthetic used for maintenance of anaesthesia affects the incidence of postoperative cognitive dysfunction (POCD). The aim of this study was to compare the incidence of POCD in patients administered either sevoflurane or propofol for maintenance of anaesthesia during total hip replacement surgery. Following administration of a spinal anaesthetic, patients received either sevoflurane (n=121) or propofol (n=171) at the discretion of the anaesthetist for maintenance of general anaesthesia to maintain the processed electroencephalogram (bispectral index, BIS) under 60. POCD was assessed postoperatively at day 7, three months, and 12 months using a neurocognitive test battery. There was no statistically significant difference between the incidence of POCD at any timepoint with sevoflurane compared to propofol. The mean BIS was significantly lower in the sevoflurane group than in the propofol group (mean BIS 44.3 [standard deviation, SD, 7.5] in the sevoflurane group versus 53.7 [SD 8.1] in the propofol group, P=0.0001). However, there was no statistically significant association between intraoperative BIS level and the incidence of POCD at any timepoint. Our results suggest that the incidence of POCD is not strongly influenced by the type of anaesthesia used in elderly patients.

scholarly journals Histomorphometric case-control study of subarticular osteophytes in patients with osteoarthritis of the hip

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Rasmus Klose-Jensen ◽  
Andreas Wiggers Nielsen ◽  
Louise Brøndt Hartlev ◽  
Jesper Skovhus Thomsen ◽  
Lene Warner Thorup Boel ◽  
...  
Keyword(s):  
Femoral Head ◽  
Case Control Study ◽  
Case Control ◽  
Control Group ◽  
Cross Sectional ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
Boundary Length ◽  
Femoral Heads ◽  
Control Study

Abstract Objective The objective of this cross-sectional case-control study was to determine the prevalence and size of marginal and subarticular osteophytes in patients with osteoarthritis (OA), and to compare these to that of a control group. Design We investigated femoral heads from 25 patients with OA following hip replacement surgery, and 25 femoral heads from a control group obtained post-mortem. The area and boundary length of the femoral head, marginal osteophytes, and subarticular osteophytes were determined with histomorphometry. Marginal osteophytes were defined histologically as bony projections at the peripheral margin of the femoral head, while subarticular osteophytes were defined as areas of bone that expanded from the normal curvature of the femoral head into the articular cartilage. Results The prevalence of OA patients with marginal- and subarticular osteophytes were 100 and 84%, respectively. Whereas the prevalence of the participants in the control group with marginal- and subarticular osteophytes were 56 and 28%, respectively. The area and boundary length of marginal osteophytes was (median (Interquartile range)) 165.3mm2 (121.4–254.0) mm2 and 75.1 mm (50.8–99.3) mm for patients with OA compared to 0 mm2 (0–0.5) mm2 and 0 mm (0–0.5) mm for the control group (P <  0.001). For the subarticular osteophytes, the area and boundary length was 1.0 mm2 (0–4.4) mm2 and 1.4 mm (0–6.5) mm for patients with OA compared to 0 mm2 (0–0.5) mm2 and 0 mm (0–0.5) mm for the control group (P <  0.001). Conclusion As expected, both marginal- and subarticular osteophytes at the femoral head, were more frequent and larger in patients with OA than in the control group. However, in the control group, subarticular osteophytes were more prevalent than expected from the minor osteophytic changes at the femoral head margin, which may suggest that subarticular osteophytes are an early degenerative phenomenon that ultimately might develop into clinical osteoarthritis.

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