Lonkan tekonivelleikkauksen jälkeinen fysioterapeuttinen ohjaus fysioterapeuttien kuvaamana

Lonkan tekonivelleikkausten sekä leikkauksen jälkeistä fysioterapiaa tarvitsevien määrä kasvaa väestön ikääntyessä. Kuntoutumisen kannalta fysioterapeuttinen ohjaus on tärkeää. Tämän tutkimuksen tarkoituksena oli tarkastella fysioterapeuttien käsityksiä lonkan tekonivelleikkauksen jälkeisestä fysioterapeuttisesta ohjauksesta. Laadullisen tutkimuksen aineistona oli fysioterapeuttisten ohjaustilanteiden (n=7) kuvanauhojen pohjalta tehdyt recall-haastattelut. Aineiston fenomenografisessa analyysissä muodostettiin kolme hierarkkista kuvauskategoriaa, jotka olivat suppeammasta laajempaan: asiantuntijalähtöinen fysioterapeuttinen ohjaus, potilaan yksilöllisyyttä arvostava fysioterapeuttinen ohjaus sekä fysioterapeuttinen ohjaus osana potilaan kuntoutumista. Nämä kategoriat sisälsivät kuusi ohjaustilanteita kuvaavaa teemaa ja niiden variaatiot: potilaan osallistuminen, kehollinen ohjaus, eettisyys ohjaussuhteessa, fysioterapeutin asiantuntijuus, yhteistyö ja terveydenhuoltojärjestelmän eettisyys. Fysioterapeuttisen ohjauksen onnistumisen kannalta kriittiset tekijät fysioterapeuttien ohjauskäsityksissä olivat potilaskeskeisyys, moniammatillinen yhteistyö ja kuntoutumisprosessin jatkuvuus. Abstract Physiotherapists’ perceptions of patient counseling after total hip arthroplasty (THA) The number of total hip arthroplasties is growing due to the fact that THA is a cost-effective procedure moving people quickly from poor to good functional capacity. The aim of the qualitative study was to explore physiotherapists’ perceptions of post-operative patient counseling. The data of this study consisted of seven physiotherapy situations with inpatients in hospital setting. Data were collected by open recall-interviews based on videotapes of patient counseling situations. The data were analyzed according to phenomenographic approach, which revealed three hierarchical categories: therapist-centered patient counseling, patient counseling which values patient’ individuality and patient counseling as part of individual rehabilitation process. Six themes that varied hierarchically in three categories describing different ways of understanding patient counseling were found: patients’ active participation, counseling for movement awareness, ethical counseling relationship, physiotherapy expertise, cooperation, and ethicality of national health care system. The critical variation between categories manifested as patient-centeredness, multiprofessional cooperation and the continuity of rehabilitation process.

Total hip arthroplasty in Cambodia – Our experience of two hundred and fifty six consecutive total hip arthroplasties in a low-income country & the challenge of service delivery in this setting

The Children's Surgical Centre has performed 256 THAs since 2007, We aim to assess the outcome of arthroplasty in a LMIC. Primary outcome: all cause of re-operation, Secondary outcome: any other complication. A retrospective review of all consecutive THA since 2007 was conducted. Electronic and physical case notes were reviewed. Statistical analysis was performed using MedCalc. 256 THA. Mean age: 43, gender M2:1F. Common pathologies include (1) AVN (44%), (2) OA (11%) and (3) DDH (11%). Revision rate 13%. Time to revision was 2.8 years (0–9). Common revision reasons: (1) stem fracture (5.8%), (2) aseptic loosening (4.8%) and (3) infection (2.7%). Complications were identified in 85 patients (33.2%). Common complications included (1) aseptic loosening (10.5%) (2) stem fracture (5.8%) and (3) dislocation (5.8%). Patients at CSC benefit from THA, the complication rates at CSC are declining suggesting the apex of the ‘learning curve’ has passed. Cheap poorly manufactured implants continue to cause catastrophic failure.

Similar Biomechanical Behavior in Gait Analysis between Ceramic-on-Ceramic and Ceramic-on-XLPE Total Hip Arthroplasties

In vitro measurements are widely used to implement gait kinematic and kinetic parameters to predict THA wear rate. Clinical tests of materials and designs are crucial to prove the accuracy and validate such measurements. This research aimed to examine the effect of CoC and CoXLPE kinematics and kinetics on wear during gait, the essential functional activity of humans, by comparing in vivo data to in vitro results. Our study hypothesis was that both implants would present the same hip joint kinematics and kinetics during gait. In total, 127 unilateral primary cementless total hip arthroplasties were included in the research. There were no statistically significant differences observed at mean peak abduction, flexion, and extension moments and THA kinematics between the two groups. THA gait kinematics and kinetics are crucial biomechanical inputs associated with implant wear. In vitro studies report less wear in CoC than CoXLPE when tested in a matched gait kinematic protocol. Our findings confirm that both implants behave identically in terms of kinematics in a clinical environment, thus strengthening CoC advantage in in vitro results. Correlated to all other significant factors that affect THA wear, it could address in a complete prism the wear on CoC and CoXLPE.

The effect of uncemented acetabular liner geometry and lip size on the risk of revision for instability or loosening

Aims The aim of this study was to determine if uncemented acetabular polyethylene (PE) liner geometry, and lip size, influenced the risk of revision for instability or loosening. Methods A total of 202,511 primary total hip arthroplasties (THAs) with uncemented acetabular components were identified from the National Joint Registry (NJR) dataset between 2003 and 2017. The effect of liner geometry on the risk of revision for instability or loosening was investigated using competing risk regression analyses adjusting for age, sex, American Society of Anesthesiologists grade, indication, side, institution type, surgeon grade, surgical approach, head size, and polyethylene crosslinking. Stratified analyses by surgical approach were performed, including pairwise comparisons of liner geometries. Results The distribution of liner geometries were neutral (39.4%; 79,822), 10° (34.5%; 69,894), 15° (21.6%; 43,722), offset reorientating (2.8%; 5705), offset neutral (0.9%; 1,767), and 20° (0.8%; 1,601). There were 690 (0.34%) revisions for instability. Compared to neutral liners, the adjusted subhazard ratios of revision for instability were: 10°, 0.64 (p < 0.001); 15°, 0.48 (p < 0.001); and offset reorientating, 1.6 (p = 0.010). No association was found with other geometries. 10° and 15° liners had a time-dependent lower risk of revision for instability within the first 1.2 years. In posterior approaches, 10° and 15° liners had a lower risk of revision for instability, with no significant difference between them. The protective effect of lipped over neutral liners was not observed in laterally approached THAs. There were 604 (0.3%) revisions for loosening, but no association between liner geometry and revision for loosening was found. Conclusion This registry-based study confirms a lower risk of revision for instability in posterior approach THAs with 10° or 15° lipped liners compared to neutral liners, but no significant difference between these lip sizes. A higher revision risk is seen with offset reorientating liners. The benefit of lipped geometries against revision for instability was not seen in laterally approached THAs. Liner geometry does not seem to influence the risk of revision for loosening. Cite this article: Bone Joint J 2021;103-B(12):1774–1782.

Combination of musculoskeletal and wear models to investigate the effect of daily living activities on wear of hip prostheses

Numerical wear predictions are gaining increasing interest in many engineering applications, as they allow to simulate complex operative conditions not easily replicable in the laboratory. As far as hip prostheses are concerned, most of the wear models in the literature are based on the simulation of gait (recommended also in experimental wear tests), since gait is considered the most frequent and important motor task to recover after arthroplasty. However, since joint prostheses have been increasingly implanted in younger people, high loads and potentially severe conditions, e.g. due to sporting activities, should also be considered for a more reliable wear assessment of these implants. In this study, we propose a profitable combination of musculoskeletal and analytical wear modelling for the prediction of wear caused by common daily activities in metal-on-plastic hip arthroplasties. Several motion analysis data available in the literature (walking, fast walking, lunge, squat, stair negotiation) were selected and the effects of such motor tasks on prosthesis wear were investigated, both separately and in combination. Additionally, for comparative purposes, wear prediction for simplified gait conditions prescribed by the ISO 14242 standard, were also considered. Results suggest that this latter case produces lower wear depth and volume with respect to a relatively demanding combination of the selected daily activities. The preliminary results of the present study represent a first step towards the auspicious goal of validating the proposed procedure for in silico trials of hip arthroplasties.

Comparable mortality but higher revision rate after uncemented compared with cemented total hip arthroplasties in patients 80 years and older: report of 43,053 cases of the Dutch Arthroplasty Register

Background and purpose — Mortality and revision risks are important issues during shared decision-making for total hip arthroplasty (THA) especially in elderly patients. We examined mortality and revision rates as well as associated patient and prosthesis factors in primary THA for osteoarthritis (OA) in patients ≥ 80 years in the Netherlands. Patients and methods — We included all primary THAs for OA in patients ≥ 80 years in the period 2007–2019. Patient mortality and prosthesis revision rates were calculated using Kaplan-Meier survival analyses. Risk factors for patient mortality and prosthesis revision were analyzed using multivariable Cox regression analysis adjusted for age, sex, ASA class, fixation method, head size, and approach.Results — Mortality was 0.2% at 7 days, 0.4% at 30 days, 2.7% at 1 year, and 20% at 5 years. Mortality was higher in males and higher ASA class, but did not differ between fixation methods. The 1-year revision rate was 1.6% (95% CI 1.5–1.7) and 2.6% (CI 2.5–2.7) after 5 years. Multivariable Cox regression analysis showed a higher risk of revision for uncemented (hazard ratio [HR] 1.6; CI 1.4–1.8) and reverse hybrid THAs (HR 2.9; CI 2.1–3.8) compared with cemented THAs. Periprosthetic fracture was the most frequently registeredreason for revision in uncemented THAs. Interpretation — Mortality is comparable but revision rate is higher after uncemented compared with cemented THA in patients 80 years and older, indicating that cemented THA might be a safer option in this patient group.

The Reconstruction Accuracy of the Hip Center of Rotation After Cementless Total Hip Arthroplasty for Failed Treatment of Acetabular Fractures. Does It Matter?

Background To assess the impaction of reconstruction accuracy of hip center of rotation (COR) on midterm clinical and radiographic results of cementless reconstruction of total hip arthroplasties (THAs) for patients after failed treatment of acetabular fractures. Methods One hundred and four patients (107 hips) who underwent THAs after failed treatment of acetabular fractures were retrospectively evaluated and cementless cups and stems were implanted in all hips. Clinical outcomes were assessed using the Harris hip score (HHS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scoring system. Radiographic results were analyzed by serial perioperative x-rays. Results At the latest follow-up examination, the median HHS increased from 52 (42-65) before surgery to 93 (90-97) (p < 0.001) and the median WOMAC decreased from 52 (36-65) before surgery to 5.8 (1.5-8) (p < 0.001). Compared with normal contralateral hip, 79 cups migrated superiorly (0.2-33.6mm) and 22 cups migrated inferiorly (0.2-16.1mm). The distance of superior migration of reconstructed COR was correlated with positive Trendelenburg sign at the latest follow-up examination (r=0.504; p < 0.001). The percentage of postoperative Trendelenburg sign was significantly higher in superior migration subgroup than that in subgroup with anatomical restoration of COR (P=0.015). Conclusions Cementless THAs in patients after failed treatment for acetabular fractures achieved predictable clinical and radiographic outcomes. A superiorly migrated hip COR appeared to exert a negative effect on abductor muscle function.

Value of ultrasound-guided aspiration of hip arthroplasties performed in an orthopedic clinic by orthopedic surgeons

Background: Total joint arthroplasties continue to increase as do periprosthetic joint infections (PJIs). Ultrasound-guided aspiration can yield useful synovial fluid for analysis while avoiding radiation exposure. This study presents a high-yield, ultrasound-guided technique with analysis of aspiration results. Methods: All consecutive ultrasound-guided aspirations of hip arthroplasties performed from May 2016 through to April 2019 were retrospectively reviewed. Patient demographic information, component specifics, presence of draining sinus, and inflammatory markers were recorded. Results of aspiration including volume, appearance, lavage use, synovial fluid differential leukocyte count, synovial neutrophil percent, and culture results were recorded. Surgical results, specimen cultures, and surgeon description of purulence were recorded. Aspiration results were compared to the surgical specimen results in all patients who underwent reoperations. Results: Review of 349 hip aspirations demonstrated accuracy of 87 %, sensitivity of 83 %, specificity of 89 %, positive predictive value of 79 %, and negative predictive value 91 %. Surgical and aspiration cultures matched in 81 % of cases. Bloody aspirates and aspirates obtained after lavage had less accuracy at 69 % and 60 %, respectively. Specificity was 100 % for cultures obtained with lavage and 91 % for bloody aspirates. Synovial leukocyte count and neutrophil percentage was obtained in 85 % of aspirations, and cultures were obtained in 98 % of aspirates. Contamination rate was 2 %. Conclusion: Ultrasound-guided aspirations aid in the diagnosis of PJI. The use of lavage to obtain fluid is helpful when aspiration cultures are positive. Bloody aspirates are less accurate but have high specificity. A low contamination rate and 88 % accuracy results with this meticulous technique.

Design of an affordable, modular implant device for soft tissue tension assessment and range of motion tracking during total hip arthroplasty

<p>Inexperienced surgeons undertaking hip arthroplasties are twice as likely to experience errors than their experienced colleagues, leading to dislocations, pain and discomfort for the patients. To address this issue, a new 3DOF force measurement system was developed and integrated in multiple new prototypes able to measure forces and movements intraoperatively in 3D. The prototypes were evaluated in three cadaver trials, with the goal of providing surgeons objective data to help determine the optimal implant fit and configuration. The devices comprise deformable polymer material that provide strain-based displacements measured with electromagnetic-based sensors and inertial measurement unit (IMU) for motion data. Device results show an accuracy of approx. 2 N and a sensitivity of approx. 1 N. Cadaver results indicated that soft tissue forces on the hip joint peak in the order of ~100 N and trend with positions of the leg during range of motion (ROM) tests, although force patterns differ between each cadaver. We propose that by monitoring forces and force patterns, in combination with standardised ROM tests, anomalies could be detected and corrected during surgery.</p>