Preoperative Chronic Pain as a Risk Factor for Early Postoperative Cognitive Dysfunction in Elderly Patients Undergoing Hip Joint Replacement Surgery: A Prospective Observational Cohort Study

Background: Although major joint replacement surgery has a high overall success rate, postoperative cognitive dysfunction (POCD) is a common complication after anesthesia and surgery, increasing morbidity and mortality. Identifying POCD risk factors would be helpful to prevent and decrease the occurrence of POCD. We hypothesized that preoperative chronic pain increases the risk of POCD.Methods: A single-center, observational, prospective cohort study was conducted from January 2018 to March 2020. All consecutive elderly patients (>65 years) who underwent elective total hip arthroplasty or hemiarthroplasty with general anesthesia by the same surgeon were enrolled. The patients underwent neuropsychological testing preoperatively and at 7 days and 2 months after surgery. To determine POCD, a nonsurgical control group was recruited from the general community.Results: Of the 141 patients who finished the neuropsychological testing 7 days after surgery, 61 (43.2%) had preoperative chronic pain. Of the 61 patients, 17 (27.9%) developed POCD; of the 79 patients with no chronic pain, 10 (12.7%) had developed POCD by 7 days after surgery. Multivariate logistic regression analysis identified preoperative chronic pain as a risk factor of POCD assessed 7 days after surgery (odds ratio 6.527; P = 0.009). There was no significant difference in the POCD incidence 2 months after surgery between patients with and without preoperative chronic pain.Conclusion: Preoperative chronic pain was a risk factor of developing POCD within 7 days after surgery in elderly patients following hip joint replacement surgery.Clinical Trial Registration: [www.ClinicalTrials.gov], identifier [NCT03393676].

Orthopaedic surgery

This chapter discusses the anaesthetic management of orthopaedic surgery. It begins with general principles of the anaesthetic management of orthopaedic surgical patients, including the management of fat embolism syndrome (FES), bone cement implantation syndrome (BCIS), and the use of tourniquets. Surgical procedures covered include total hip joint replacement (THJR) (including revision THJR); femoral neck fracture surgery; total knee joint replacement (TKJR); arthroscopy; cruciate ligament repair; ankle surgery; foot surgery; spinal surgery (including the cervical spine); shoulder surgery (including total shoulder joint replacement (TSJR)); elbow replacement surgery and hand surgery.

The first experience of arthroscopy in the case of aseptic necrosis of the femoral head

Observation of patients with avascular necrosis of the femoral head formed a hypothesis about inability to eliminate the hip contracture by tunneling the femoral head on the background of drug therapy and therapeutic exercises, which causes an unsatisfactory outcomes. Therefore, the was idea to use arthroscopy for performing capsulotomy, synovectomy and removal of free cartilage and bone fragments. Objective. To evaluate efficiency of arthroscopy in patients with avascular necrosis of the femoral head. Methods. In the period from 2010 to 2018, 60 patients were observed. With the I–II stages, absence of inflammatory processes in the joint, body mass index less than 35. In the comparison group (28 patients) we made only tunneling of the femoral head, in the study group (32) at first we performed arthroscopy of the hip joint, capsulotomy, synovectomy, removal of cartilage fragments, and only then — tunneling. We analyzed the proportion of hip joint replacement that was performed in the long term follow up and the intensity of pain by visual analog scale. Results. During arthroscopy we often revealed the joint cartilage lesions — 30 %, articular labrum lesions — 5 %, synovitis — 100 %, CAM impingement — 90 %. In the study group in the first 2 weeks after surgery, the pain was severe more than in the comparison group. Then the pain rate became the same in both groups. In the control group in the period from 3 to 5 years after tunneling of the femoral head, arthroplasty was performed in 11 patients (39.3 %), in the study group for 2 to 3 years after surgery — 8 (25.0 %). Conclusions. Analysis of long-term results of tunneling of the femoral head with arthroscopy of the hip joint in patients with avascular necrosis of the femoral head showed improvement in hip function, no disease progression in 60–75 % patients in 2–3 years after surgery.

An assessment of biomaterials for hip joint replacement

Hip replacement is a surgical process where natural hip joints are replaced by artificial hip joint that helps the human being for getting better lifestyle by reduction in the unavoidable pain and better leg movement. The selection of material and durability of the hip joint replacement are serious significance for the implantation, because it determines how load is transferred through the stem. In the selection of materials, various problems related to hip joint replacement are found like adverse tissue reaction, allergic reaction, wear and corrosion resistance etc. To overcome this problem one has to create different new biomaterial. This review gives brief description about the different biomaterial used for hip joint replacement.

Unusual Combination of Hip Dislocation with Ipsilateral Femoral Neck and Acetabulum Fracture: A Rare Case Report

Introduction: Traumatic dislocation of hip associated with ipsilateral femur neck and acetabulum fracture is a rare and devastating injury as a result of high-energy trauma, with potential complications of femur head aseptic necrosis and hip joint degenerative arthritis. Patients, postoperatively, may encounter decreased functional outcomes and serious challenge, during activities of daily living. Management guidelines lack clarity, with possible options including fracture fragments fixation or hip joint replacement. Case Report: A 45-year-old patient was diagnosed with posterior dislocation of hip with ipsilateral femur neck and acetabulum fracture. Plan for emergent hip reduction and primary surgical fixation of fracture fragments was made. Intraoperatively, posterior wall acetabulum fracture was found to be excessively comminuted and non-amenable for fixation and femoral head was found to be avascularized. Subsequently, plan was changed to total hip replacement with acetabular defect reconstruction. At 1-year follow-up, no aseptic loosening was observed on radiographic views of pelvis, with total Harris Hip Score of 91. Conclusion: Early operative management for such complex injuries is a necessity. Definitive management in the form of primary fracture fixation/arthroplasty should be decided intraoperatively. Keywords: Femur neck, hip dislocation, acetabulum fracture, ipsilateral, case report.

THE CERAMIC MODULAR HEAD IMPROVEMENT IN THE DESIGN OF A TOTAL HIP REPLACEMENT

For the first time, a design of a modular ceramic ball head of a total hip joint replacement (THR) friction pair has been developed, which has the properties of a metal in conjunction with the stem neck and the properties of a ceramics on bearing surface of the pair. This is achieved by creating a low-cost, low-toxic, durable fixed connection of the head made of alumina or zirconia ceramics and the titanium-based alloy sleeve to obtain a brazed joint that is efficient in human synovial fluid. With the help of finite element analysis, a quantitative assessment of the strength and rigidity of the proposed head design was performed and its use in modern hip arthroplasty was indicated. The approbation of the proposed design solutions for creating a THR ceramic head with a titanium-based alloy sleeve brazed was carried out.