The role of hip arthroplasty in management of the hip fracture patient

Hip fractures are becoming increasingly common in a growing elderly population, and are associated with significant morbidity and mortality. Displaced intracapsular femoral neck fractures are usually treated with either total hip arthroplasty (THA) or hemiarthroplasty, although the indication for each operation remains an area for debate. THA has been associated with longer operative time, increased risk of dislocation and a slight increase in general complications compared with hemiarthroplasty. However, it has also been associated with a modest improvement in functional outcomes and quality of life. Guidelines have been created within the UK to aid the decision-making process based upon current available literature. The principal focus of these has been to identify patients suitable for THA, and include patients who are cognitively intact, mobile outside their home with the use of no more than one stick, and who are medically fit enough for the procedure. However, implant selection must also be taken into consideration in order to achieve the best outcomes for patients. Options for implants include use of dual mobility cups and choice of femoral head size in THA, bipolar versus unipolar hemiarthroplasty, and cemented versus uncemented implants. Further research is required into this area to make additional recommendations.     

Impact of modified-release opioid use on clinical outcomes following total hip and knee arthroplasty: a propensity score-matched cohort study

Modified-release opioids are often prescribed for the management of moderate to severe acute pain following total hip and knee arthroplasty, despite recommendations against their use due to increasing concerns regarding harm. The primary objective of this multicentre study was to examine the impact of modified-release opioid use on the incidence of opioid-related adverse events compared with immediate-release opioid use, among adult inpatients following total hip or knee arthroplasty. Data for total hip and knee arthroplasty inpatients receiving an opioid analgesic for postoperative analgesia during hospitalisation were collected from electronic medical records of three tertiary metropolitan hospitals in Australia. The primary outcome was the incidence of opioid-related adverse events during hospital admission. Patients who received modified with or without immediate-release opioids were matched to those receiving immediate-release opioids only (1:1) using nearest neighbour propensity score matching with patient and clinical characteristics as covariates. This included total opioid dose received. In the matched cohorts, patients given modified-release opioids (n = 347) experienced a higher incidence of opioid-related adverse events overall, compared with those given immediate-release opioids only (20.5%, 71/347 vs. 12.7%, 44/347; difference in proportions 7.8% [95%CI 2.3–13.3%]). Modified-release opioid use was associated with an increased risk of harm when used for acute pain during hospitalisation after total hip or knee arthroplasty.     

Optimisation of imaging parameters during CT guided interventional procedures in patients with total hip arthroplasty

ObjectiveTo determine the optimal KV and mAs settings during CT guided injections in the presence of a total hip arthroplasty so that image quality is maintained whist keeping the dose as low as reasonably achievable.MethodsA total hip arthroplasty phantom with needles with differing gauges was scanned using different CT parameters (from low dose to high dose) and evaluating if this had any effect on needle conspicuity. Conspicuity was graded from 1 to 3 by 2 independent blinded reviewers.ResultsIrrespective of the CT settings used (high dose or low dose parameters) needle conspicuity was not adversely affected by the THA for either scorer, therefore a kVp of 100 mA and a. In addition the needle gauge did not affect the conspicuity of the needle.ConclusionCT guided injections in this total hip arthroplasty phantom model can be performed without any adverse effect on the conspicuity of the needle tip on low dose CT settings.Advancement in knowledgeThis paper enables one to optimise the kV and mA while performing interventional procedures.     

One Week of Hospitalization Following Elective Hip Surgery Induces Substantial Muscle Atrophy in Older Patients

Objectives

Short successive periods of skeletal muscle disuse have been suggested to substantially contribute to the observed loss of skeletal muscle mass over the life span. Hospitalization of older individuals due to acute illness, injury, or major surgery generally results in a mean hospital stay of 5 to 7 days, during which the level of physical activity is strongly reduced. We hypothesized that hospitalization following elective total hip arthroplasty is accompanied by substantial leg muscle atrophy in older men and women.

抗阻训练联合家居康复护理在发育性髋关节不良中的应用

目的探究与分析Thera-Band渐进抗阻训练联合家居康复护理对发育性髋关节不良术后患儿髋关节功能的促进效果。方法选取医院自2016年12月—2018年12月收治的发育性髋关节不良手术患儿68例作为研究对象,采用随机数字表法分为对照组与观察组,每组各34例,两组均给予常规护理,对照组给予Thera-Band渐进抗阻训练,观察组在对照组基础上给予家居康复护理,对比两组患儿术后不同时间点Harris评分以及患儿家属发育性髋关节不良的健康教育知晓情况。结果两组患儿出院后1个月、出院后3个月的Harris评分明显高于出院时,观察组较对照组相比Harris评分改善更加显著,组间差异具有统计学意义(P<0.05)。观察组与对照组相比家属发育性髋关节不良情况健康教育知晓评分较高,组间差异具有统计学意义(P<0.05)。结论Thera-Band渐进抗阻训练联合家居康复护理进一步的提高了患儿髋关节功能功能,也在护理工作中促进提高了患儿家属对发育性髋关节不良的健康教育知晓情况,更好的发挥了辅助效果。     

Normative Data of the Hip Disability and Osteoarthritis Outcome Score,JR in a Healthy United States Population

BackgroundPatient-reported outcome measures (PROMs) play a vital role in the care we provide our patients. To help understand the application of PROMs in arthroplasty, normative and benchmark data to serve as a comparison to patients presurgery and postsurgery would be extremely valuable. We collected normative data of the Hip Disability and Osteoarthritis Outcome Score (HOOS), JR on a healthy population, greater than 17 years of age, in the United States devoid of hip injury and/or surgery.MethodsThis is a cross-sectional study, where hard copy surveys were administered to 1140 patients, being seen for an orthopedic issue unrelated to their hip, and nonpatient visitors in July 2018 at an outpatient orthopedic clinic in a suburban metropolitan city. Participants were eligible if they self-reported a medical history negative for hip arthroplasty, current hip pain/disability, or hip procedure (surgery or injection) within the past year. Mean, standard deviation, 95% confidence intervals, and ranges on the HOOS, JR interval scores were calculated by sex, age decade, body mass index (BMI), reason for visit, history of orthopedic procedure, and medical history.ResultsWe included 425 men and 575 women in the final study cohort. Women aged between 70+ years reported the lowest mean interval score (mean = 89.8). Overall women scored lower as well (93.3 vs 95.7, P = .001). There was not a statistical difference between the interval scores by tobacco consumption (93.5 vs 94.4, P = .49) and between patients versus nonpatient visitors (94.2 vs 94.5, P = .672). Lower scores were observed in participants with a past nonhip orthopedic procedure (92.6 vs 94.9, P = .016), with a medical history of a chronic illness (92.5 vs 95.9, P = <.001), and classified as obese (BMI > 30) (91.7 vs 95.2, P < .001). On regression analysis, there was a decrease of 0.3 and 0.1 in the interval score for each unit of BMI and age by year, respectively (P < .001).ConclusionThis study provides normative reference values for the HOOS, JR in a US population from a suburban metropolitan city for individuals greater than 17 years of age. These scores can facilitate physician-patient shared decision-making to help patients understand expectations after hip arthroplasty in respect to PROMs.     

Etiologic Classification Criteria of ARCO on Femoral Head Osteonecrosis Part 2: Alcohol-Associated Osteonecrosis

Background

Although alcohol is a leading risk factor for osteonecrosis of the femoral head (ONFH) and its prevalence reportedly ranges from 20% to 45%, there are no unified classification criteria for this subpopulation. In 2015, Association Research Circulation Osseous decided to develop classification criteria for alcohol-associated ONFH.