Clinical immunology Impact on red blood cell immunity patterns in postoperative phase following total hip arthroplasty

Purpose. Contradicting definitions of periprosthetic joint infection (PJI) are in use. Joint aspiration is performed before total hip arthroplasty (THA) revision. This study investigated the influence of PJI definition on PJI prevalence at THA revision. Test quality of prerevision aspiration was evaluated for the different PJI definitions. Methods. 256 THA revisions were retrospectively classified to be infected or not infected. Classification was performed according to the 4 different definitions proposed by the Musculoskeletal Infection Society (MSIS), the Infectious Diseases Society of America (IDSA), the International Consensus Meeting (ICM), and the European Bone and Joint Infection Society (EBJIS). Only chronic PJIs were included. Results. PJI prevalence at revision significantly correlated with the applied PJI definition ( p = 0.01 , Cramer’s V = 0.093 ). PJI prevalence was 20.7% for the MSIS, 25.4% for the ICM, 28.1% for the IDSA, and 32.0% for the EBJIS definition. For synovial fluid white blood cell count, the best ROC-AUC for predicting PJI was 0.953 in combination with the MSIS definition. Conclusion. PJI definition significantly influences the rate of diagnosed PJIs at THA revision. Synovial fluid white blood cell count is a reliable means to rule out PJI. In cases with a borderline high synovial white blood cell count before THA revision as the only sign of chronic PJI, an extended diagnostic work-up should be considered.

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Effects of early home-based strength and sensory-motor training after total hip arthroplasty: study protocol for a randomized controlled trial

10.21203/rs.3.rs-572172/v1 ◽

2021 ◽

Author(s):

Pika Krištof Mirt ◽

Vojko Strojnik ◽

Gregor Kavčič ◽

Rihard Trebše

Keyword(s):

Total Hip Arthroplasty ◽

Strength Training ◽

Hip Arthroplasty ◽

Harris Hip Score ◽

Control Group ◽

Motor Training ◽

Postoperative Phase ◽

Total Hip ◽

Home Based ◽

Sensory Motor

Abstract BackgroundTotal hip arthroplasty (THA) is very effective in alleviating pain, but functional deficits persist up to a year following surgery. Regardless of standard physiotherapy programs, significant additional muscular atrophy and weakness occurs. Deficits in strength have serious adverse consequences for these patients with respect to physical function, the maintenance of independence and the requirement for revision surgery. Progressive resistance training in rehabilitation following THA has been shown to significantly enhance muscle strength and function. The fundamental principle is to progressively overload the exercised muscle as it becomes stronger. Different strength training protocols have been used at different times in the postoperative phase, in group or individual practices, with major differences being in center-based and home-based programs with or without supervision. The primary objectives of our study are to evaluate whether an early postoperative home-based strength training protocol is feasible for all elective THA patients, does not cause major adverse effects and can improve patient functional outcomes at 3 months and 1 year following surgery.Methods/DesignThis study is a prospective multicenter randomized clinical trial to be conducted in the orthopedic departments of two Slovenian hospitals. In each hospital, 124 patients aged 60 or older with unilateral osteoarthritis, an ASA score between 1 and 3, signed informed consent form, and no terminal illness disabling rehabilitation participation will be randomly assigned to the intervention or control group. THA with an anterior approach will be performed. All patients will receive current standard physiotherapy during hospitalization. Patients in the intervention group will also learn strength and sensory-motor training exercises. Upon discharge all will receive USB drives with exercise videos, written exercise instructions and a training diary. Physiotherapists will perform the assessments (physical tests and the maximal voluntary isometric contraction assessment), and patients will fill out outcome assessment questionnaires (the Harris Hip Score and 36-Item Short Form Health Survey) at baseline and 1, 3 and 12 months after surgery.DiscussionThe main purpose of our study is to design a new standardized rehabilitation protocol with videos that will be effective, safe and accessible to all Slovenian THA patients.Trial registrationClinicalTrials.gov ID: NCT04061993. Protocol ID: PRT_PhD. Record Verification April 2021. https://clinicaltrials.gov/ct2/show/NCT04061993

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The Use of Cryotherapy in the Early Postoperative Period after Total Hip Arthroplasty

Ortopedia Traumatologia Rehabilitacja ◽

10.5604/01.3001.0013.5782 ◽

2019 ◽

Vol 21 (5) ◽

pp. 339-348 ◽

Cited By ~ 1

Author(s):

Tosan Okoro ◽

Yousef Ibrahim ◽

Nadia Mansour ◽

Phillip Alderman ◽

Aled Evans

Keyword(s):

Total Hip Arthroplasty ◽

Length Of Stay ◽

Blood Loss ◽

Outcome Measures ◽

Hip Arthroplasty ◽

Early Period ◽

Postoperative Blood Loss ◽

Secondary Outcome ◽

Postoperative Phase ◽

Total Hip

Background. Recent evidence suggests that cryotherapy may be beneficial in reducing postoperative pain and blood loss in joint arthroplasty. The objective of this study was to review the use of cryotherapy in the early postoperative phase after total hip arthroplasty to assess the benefits in terms of pain relief and reduction in postoperative blood loss. Material and methods. A prospective cohort study of the use of a cryotherapy device (Hilotherm) was performed in patients following total hip arthroplasty. The primary outcome measures were visual analogue score (VAS) for pain (at 24 and 48 hours postoperatively), and amount of postoperative blood loss, measured by change in haemoglobin (g/L). The secondary outcome measures were length of stay (days), duration of patient controlled analgesia (PCA) administered postoperatively (hours) and amount of analgesia used (mg) in the first 48 hours. Results. 28 patients were recruited (n=13 Hilotherm; n= 15 non-Hilotherm). Hilotherm application reduced pain in the first 24 hours, non-significantly, (3.50±2.41 vs 4.90±2.95; p=0.185). This effect was not carried through at 48 hours postoperatively (5.68±1.94 vs 3.72±2.46; p=0.029). Hilotherm application significantly reduced postoperative blood loss (22.38±5.71 g/L vs 29.13±10.22 g/L; p=0.045). Hilotherm reduced length of stay by almost 1 day; however, this was not statistically significant (4.46±2.33 vs 5.20±3.55; p=0.528). There was no difference in the length of time PCA was administered (22.30±0.75 vs 22.02±3.26; p=0.763). Patients in the non-Hilotherm group required more paracetamol on average (p=0.001). Conclusions. 1. Hilotherm application does not appear to significantly reduce pain postoperatively but results in less postoperative blood loss. 2. There may be a role for the continued use of cryotherapy in the early period of rehabilitation following total hip arthroplasty, as it appears to result in more rapid ambulatory rehabilitation in patients, resulting in reduced length of stay.

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Bilateral Greater Trochanteric Avulsion Fractures after Bilateral Simultaneous Total Hip Arthroplasty

Case Reports in Orthopedics ◽

10.1155/2018/6596135 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7

Author(s):

Hiroaki Tagomori ◽

Nobuhiro Kaku ◽

Tomonori Tabata ◽

Hiroshi Tsumura

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Intraoperative Complications ◽

Weight Bearing ◽

Trochanteric Fracture ◽

Posterolateral Approach ◽

Full Weight Bearing ◽

Postoperative Phase ◽

Avulsion Fractures ◽

Total Hip

We report a case of bilateral spontaneous greater trochanteric fracture after bilateral simultaneous total hip arthroplasty (THA) performed via the posterolateral approach during the early postoperative phase. A 75-year-old woman underwent bilateral simultaneous THA (BS-THA) for severe osteoarthritis with developmental dysplasia of the hip; she also presented a limited range of adduction. BS-THA was successful without any intraoperative complications. Rehabilitation with full weight-bearing exercises was initiated the day after the surgery. On the 14th postoperative day, she experienced a spontaneous left greater trochanteric fracture during a walking exercise without any trauma. Osteosynthesis was performed for the fracture on the 18th postoperative day. On the 20th postoperative day, a right spontaneous greater trochanteric avulsion fracture occurred during a transfer exercise without any trauma; this was treated on the 27th postoperative day. In the 18th postoperative month, although the right fragment showed slight upper migration, the patient had no complaints of coxalgia and both hip joints showed an excellent range of motion.

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