Prior Arthroscopy Leads to Inferior Outcomes in Total Hip Arthroplasty: A Match-Controlled Study

Background

Total hip arthroplasty (THA) is one of the most common reoperations after hip arthroscopy. Although arthroscopy causes changes in the hip joint and the surrounding soft tissues that can make THA more challenging, previous reports on arthroscopy before THA have not demonstrated any significant effect on clinical outcomes.

Effect of Spinal Fusion Surgery on Total Hip Arthroplasty Outcomes: A Matched Comparison Study

Background

Studies regarding postoperative outcomes after primary total hip arthroplasty (THA) in patients who have comorbid factors tend to focus on medical diseases. However, there is a paucity of literature examining the effect of a patient's orthopedic surgical history on outcomes after THA. Significantly, there are currently no studies on the effect of spinal fusion surgery on THA outcomes.

Does Hepatitis C Affect the Clinical and Patient-Reported Outcomes of Primary Total Hip Arthroplasty at Midterm Follow-Up?

Background

It is estimated that 3%-6% of orthopedic patients, many of whom may undergo lower extremity total joint arthroplasty, are infected with hepatitis C. The purpose of this study was to assess the outcomes of patients with hepatitis C who undergo total hip arthroplasty (THA) in comparison with a matched control cohort in terms of (1) patient-reported outcomes, (2) implant survivorship, and (3) complications.

Total hip arthroplasty for posttraumatic osteoarthritis following acetabularfracture: A systematic review of characteristics, outcomes, and complications

Purpose: Posttraumatic arthritis (PTA) may develop years after acetabular fracture, hindering joint function and causing significant chronic musculoskeletal pain. Given the delayed onset of PTA, few studies have assessed outcomes of delayed total hip arthroplasty (THA) in acetabular fracture patients. This study systematically reviewed the literature for outcomes of THA in patients with PTA and prior acetabular fracture. Methods: Pubmed, EMBASE, SCOPUS, and Cochrane library were searched for articles containing the keywords “acetabular”, “fracture”, “arthroplasty”, and “post traumatic arthritis” published between 1995 and August 2017. Studies with less than 10 patients, less than 2 years of follow-up, conference abstracts, and non-English language articles were excluded. Data on patient demographics, surgical characteristics, and outcomes of delayed THA, including implant survival, complications, need for revision, and functional scores, was collected from eligible studies. Results: With 1830 studies were screened and data from 10 studies with 448 patients were included in this review. The median patient age on date of THA was 51.5 years, ranging from 19 to 90 years. The median time from fracture to THA was 37 months, with a range of 27-74 months. Mean follow-up times ranged from 4 to 20 years. The mean Harris hip scores (HHS) improved from 41.5 pre-operatively, to 87.6 post-operatively. The most prevalent postoperative complications were heterotopic ossification (28%-63%), implant loosening (1%-24%), and infection (0%-16%). The minimum 5-year survival of implants ranged from 70% to 100%. Revision rates ranged from 2% to 32%. Conclusion: Despite the difficulties associated with performing THA in patients with PTA from previous acetabular fracture (including soft tissue scarring, existing hardware, and acetabular bone loss) and the relatively high complication rates, THA in patients with PTA following prior acetabular fracture leads to significant improvement in pain and function at 10-year follow-up. Further high quality randomized controlled studies are needed to confirm the outcomes after delayed THA in these patients.     

Total Hip Arthroplasty in Hemophilia Patients: A Mid‐term to Long‐term Follow‐up

Objective

To report the results of mid‐term to long‐term follow‐up after primary total hip arthroplasty (THA) in hemophiliacs and to hypothesize that THA can provide satisfactory outcomes in these patients.

Methods

Twenty‐four primary THA performed in 21 hemophilia patients between 2002 and 2012 were reviewed retrospectively, including 20 cases of hemophilia A and 1 case of hemophilia B. The standard lateral approach was used for all implantations. Substitution therapy for factor VIII and activated prothrombin complex concentrates were administered to patients with hemophilia A and B, respectively. Total and hidden blood loss were calculated. Outcomes were assessed using the Harris hip score before surgery and at the final follow‐up visit. Complications were recorded by clinical and radiographic assessment and then compared to those in previous reports.

Results

The mean follow‐up period was 113 months (range, 5–15 years). The average total blood loss was 3559 mL (range, 1494–7506 mL). The mean amount of red blood cell (RBC) transfusion was 4.4 U (range, 0–14 U). The mean amount of clotting factor used in the perioperative period for management of hemophilia was 14 031.3 U (range, 8100–25 200 U). Harris hip scores improved from 37 points (range, 15–81) before surgery to 90 points (range, 70–96) at the last follow‐up. No signs of loosening, infection or other complications of the implant components occurred after discharge. The overall survivorship of the implants was 100% for all patients, and no revision surgery was performed.

Conclusions

With modern techniques and hematological management, THA in patients with hemophilia leads to significant improvement in joint function with a relatively low incidence of complications. Increased blood loss and substitution therapy have no obvious negative influences on the mid‐term to long‐term results of THA.

     

Cementless Total Hip Arthroplasty for Patients with Crowe Type III or IV Developmental Dysplasia of the Hip: Two-Stage Total Hip Arthroplasty Following Skeletal Traction after Soft Tissue Release for Irreducible Hips

Background

Total hip arthroplasty (THA) for severe developmental dysplasia of the hip (DDH) is a technically demanding procedure for arthroplasty surgeons, and it is often difficult to reduce the hip joint without soft tissue release due to severe flexion contracture. We performed two-stage THAs in irreducible hips with expected lengthening of the affected limb after THA of over 2.5 cm or with flexion contractures of greater than 30 degrees in order to place the acetabular cup in the true acetabulum and to prevent neurologic deficits associated with acute elongation of the limb. The purpose of this study is to evaluate the outcomes of cementless THA in patients with severe DDH with a special focus on the results of two-stage THA.

Methods

Retrospective clinical and radiological evaluations were done on 17 patients with Crowe type III or IV developmental DDH treated by THA. There were 14 women and 3 men with a mean age of 52.3 years. Follow-ups averaged 52 months. Six cases were treated with two-stage THA followed by surgical hip liberalization and skeletal traction for 2 weeks.

Results

The mean Harris hip score improved from 40.9 to 89.1, and mean leg length discrepancy (LLD) in 13 unilateral cases was reduced from 2.95 to 0.8 cm. In the patients who underwent two-stage surgery, no nerve palsy was observed, and the single one-stage patient with incomplete peroneal nerve palsy recovered fully 4 weeks postoperatively.

Conclusions

The short-term clinical and radiographic outcomes of primary cementless THA for patients with Crowe type III or IV DDH were encouraging. Two-stage THA followed by skeletal traction after soft tissue release could provide alternative solutions to the minimization of limb shortenings or LLD without neurologic deficits in highly selected patients.     

Medial placement of the acetabular component in an alumina-on-alumina total hip arthroplasty: a comparative study with propensity score matching

Purpose

In an alumina-on-alumina total hip arthroplasty (THA), recommended with a small inclination angle <45°, the acetabular component (cup) may be positioned more medially to be covered almost completely by host bone. The purpose of this study was to identify the correlating factors and to evaluate the outcomes of medial placement of the cup in patients with alumina-on-alumina THAs.

Methods

Using the propensity score matching with age, gender, body mass index, initial diagnosis, and the length of follow-up as variables, 38 hips with a medialized cup and 38 hips with a non-medialized one were identified from 389 hips in 347 who patients underwent primary alumina-on-alumina THA and followed up for more than 7 years. Clinical and radiological outcomes were compared between the two groups.

Results

Preoperative acetabular medial wall thickness and the cup inclination angle were significantly smaller in the medialization group compared to the non-medialization group. Center edge angle, cup size, and coverage by host bone were not significantly different between the two groups. The hip center of rotation was significantly medialized in the medialization group. The Harris hip scores were not significantly different between the two groups. No component loosening or osteolysis was observed and no revision was required in either groups.

Conclusions

Thin acetabular medial wall and a small inclination angle of the cup were the correlating factors of medial placement of the cup in patients who underwent an alumina-on-alumina THA. Medial placement did not lead to differences in the clinical or radiological outcomes.     

Midterm Outcomes of Revision Total Hip Arthroplasty With the Use of a Multihole Highly-Porous Titanium Shell

Background

We are reporting on the minimum 5-year outcomes of patients who underwent revision total hip arthroplasty (THA) using a specific highly-porous titanium shell. We assessed (1) aseptic and all-cause survivorship; (2) functional outcomes; (3) complications; and (4) radiographic outcomes.

The incidence of implant fractures after total hip arthroplasty

Purpose

Implant fractures after total hip arthroplasty (THA) are considered as rare in clinical practice. Nevertheless they are relevant complications for patients, physicians, and the public health system leading to high socioeconomic burdens. The aim of this study was to assess the incidence of fractures after THAs in a comparative analysis of clinical studies and worldwide arthroplasty register datasets.

Methods

We calculated the pooled incidence of revision operations after fractures of THAs in a comparison of clinical studies published in Medline-listed journals and annual reports of worldwide arthroplasty registers in a structured literature analysis based on a standardised methodology.

Results

Included clinical studies (sample-based datasets) were mono-centre trials comprising a cumulative number of approximately 70,000 primary implantations whereas worldwide national arthroplasty register datasets referred to 733,000 primary implantations, i.e. approximately ten times as many as sample-based datasets. In general, sample-based datasets presented higher revision rates than register datasets with a maximum deviation of a 14.5 ratio for ceramic heads, respectively. The incidence of implant fractures in total hip arthroplasty in pooled worldwide arthroplasty register datasets is 304 fractures per 100,000 implants. In other words, one out of 323 patients has to undergo revision surgery due to an implant fracture after THA in their lifetime.

Conclusions

Implant fractures in total hip arthroplasty occur in a relevant number of patients. The authors believe that comprehensive arthroplasty register datasets allow more general evaluations and conclusions on that topic in contrast to clinical studies.     

Total Hip Arthroplasty After Periacetabular and Intertrochanteric Valgus Osteotomy

Background

We performed periacetabular osteotomy (PAO) combined with intertrochanteric valgus osteotomy (TVO) to obtain better congruity for patients with acetabular dysplasia and nonspherical femoral head. These patients with PAO-combined TVO demonstrate long-term progression of osteoarthritis, thereby, needing conversion to total hip arthroplasty (THA) and is difficult due to morphological changes. The objective of the present study was to investigate outcomes of patients who underwent THA after PAO-combined TVO.

Long-Term Outcomes After Metal-on-Metal Total Hip Arthroplasty With a 28-mm Head: A 17- to 23-Year Follow-Up Study of a Previous Report

Background

Second-generation, metal-on-metal total hip arthroplasty (MoM THA) using a 28-mm head has shown favorable results compared with large head MoM THA. The purpose of this study is to evaluate the long-term outcomes of cementless primary MoM THA with a 28-mm head and the incidence of osteolysis using computed tomography.

The Results of Total Hip Arthroplasty After Sugioka Transtrochanteric Anterior Rotational Osteotomy for Osteonecrosis

Background

Since Sugioka transtrochanteric anterior rotational osteotomy (ARO) for osteonecrosis of the femoral head (ONFH) changes the morphology of the proximal femur, total hip arthroplasty (THA) after previous ARO is considered a technically demanding procedure. The purpose of this study was to compare the clinicoradiologic outcomes of THA after ARO with those of THA without any antecedent surgery for ONFH.

Porous tantalum shells and augments for acetabular cup revisions

Purpose

The purpose of this study was to evaluate early functional results of revision hip arthroplasty with pelvic bone loss revised with porous tantalum (PT) acetabular components.

Methods

Twenty-five consecutive patients (25 hips) with loose acetabular components after total hip arthroplasty with a minimum of Paprosky IIa pelvic bone loss treated with PT cups with and without modular augments were retrospectively reviewed. Clinical outcomes were assessed using Harris hip score, and Western Ontario and McMaster Universities scores. Mean follow-up was 20.5 months and no patient was lost during follow-up.

Results

The average Harris hip score, and Western Ontario and McMaster Universities scores improved from 40 and 36 preoperatively to 79 and 73 postoperatively, respectively. No statistically significant differences in functional outcome scores were found between the group with moderate (Paprosky IIa, b) and severe (Paprosky IIc or more) acetabular bone loss. At the most recent radiographic evaluation, 24 cups demonstrated no lucent lines and 1 cup had lucent lines but remained well fixed. One cup was revised for traumatic dislocation but was found well fixed at open reduction. There were no septic or aseptic failures in this series.

Conclusion

While awaiting longer-term follow-up studies, trabecular metal components show sufficient primary stability and appear suitable for revision hip arthroplasty with acetabular bone loss.     

Total hip arthroplasty for vascular necrosis of the femoral head in patients with systemic lupus erythematosus: a midterm follow-up study of 28 hips in 24 patients

Objective

Avascular necrosis of the femoral head is one of the most frequently reported complications in patients with systemic lupus erythematosus (SLE) and often requires total hip arthroplasty (THA). Our objective was to analyze the perioperative management, technical problems, clinical outcomes, and complications associated with THA in patients with SLE.

Methods

A total of 28 total hip arthroplasties performed for 24 patients with SLE, including 19 women and 5 men with a mean age of 38.8 years performed from 1998 to 2011 were retrospectively reviewed. SLE disease activity index and ASA class were evaluated preoperatively. WOMAC, HHS, and SF-36 scores were also evaluated in all cases pre- and post-operatively for functional recovery of the hip and health-related quality of life (HRQOL).

Results

The average SLE disease activity index was 3.5 points. Three patients were in ASA class I, 12 class II, and 9 were class III (37.5%). The average duration of follow-up was 67.5 months. None of the patients required a revision, and 3 patients died during the follow-up period. A statistically significant improvement in all scores was found comparing pre- and post-operative conditions (P < 0.001). The complication rate was 11.1% with 2 wound infections and 1 urinary tract infection.

Conclusion

THA is an acceptable method for achieving functional recovery and increasing HRQOL in patients with SLE and ANFH who receive proper perioperative management.     

Hip Osteonecrosis: Does Prior Hip Surgery Alter Outcomes Compared to an Initial Primary Total Hip Arthroplasty?

The purpose of this study was to assess the clinical and radiographic outcomes of total hip arthroplasty (THA) in patients who had osteonecrosis to see if prior hip preserving surgery affected outcomes. Implant survivorship, Harris hip scores, and radiographic outcomes were compared between 87 patients (92 hips) who had undergone prior hip preserving procedures and 105 patients (121 hips) who had only undergone THA. Patients were also sub-stratified into low- and high-risk groups for osteonecrosis. At a mean follow-up of 75 months, there were no significant differences in survivorship, clinical, and radiographic outcomes among the cohorts. Higher revision rates were associated with patients who were in the high-risk group. The authors believe that hip joint preserving procedures may not adversely affect the outcomes of later THA in patients with osteonecrosis.     

Patient-reported outcomes in patients who undergo total hip arthroplasty after periacetabular osteotomy

Background

There has been constant discussion about whether the clinical outcome of THA after periacetabular osteotomy (PAO) is equivalent to that after primary total hip arthroplasty (THA). However, there have been few reports about patient-reported outcomes (PRO) for those who undergo THA after PAO. We compared the pre- and postoperative PRO of patients who underwent THA after PAO and those who underwent primary THA alone.

Cementless bilateral synchronous total hip arthroplasty in ankylosing spondylitis with hip ankylosis

Purpose

This study was a retrospective analysis of early and mid-term clinical effects and perioperative management of cementless bilateral synchronous total hip arthroplasty (THA) in patients with ankylosing spondylitis (AS) with bilateral hip ankylosis.

Methods

Fifteen AS patients (30 hips) with bilateral hip ankylosis were managed with cementless bilateral synchronous THA. Surgical outcome was evaluated using the visual analogue scale (VAS), the range of motion and the Harris score.

Results

The mean follow-up period was 29.3 months. At the last follow-up visit, the VAS score decreased from 7.53?±?0.99 before the operation to 2.40?±?0.91. The Harris score increased from 24.8?±?7.42 before the operation to 83.8?±?4.61. The total range of motion increased from 78.73?±?14.53 before the operation to 209.73?±?16.19 after the operation. After the operation, there was one case of early hip dislocation, one case of femoral nerve stretch injury and one case of superficial incision infection. There were no cases of deep venous thrombosis. X-ray examinations did not show prosthetic loosening or displacement.

Conclusion

AS patients with bilateral hip ankylosis can be treated with cementless bilateral synchronous THA, which could greatly improve hip joint function without significant complications. The clinical effects proved to be satisfactory.     

Mid-Term Outcomes of Dual Mobility Acetabular Cups for Revision Total Hip Arthroplasty

Background

This study evaluated (1) survivorship, (2) clinical outcomes, (3) complications, and (4) radiographic outcomes of dual mobility (DM) systems when compared to fixed-bearing prostheses in revision total hip arthroplasty (THA).

Klinische Ergebnisse nach minimal-invasiver Hüftendoprothetik

Aim

This article presents an analysis and review of recent literature with a focus on clinical results after minimally invasive (MIS) total hip arthroplasty (THA) and with special attention to the different approaches currently used.

Methods

An online database (Medline) search for clinical trials after THA between 2007 and 2011 was performed with a special focus on prospective controlled randomized trials focusing on THA with a MIS approach. The data were analyzed for pain, blood loss, complications, gait analysis, Harris hip and other scores.

Results

A total of 24 studies (19 comparative studies) were included in this study with a total of 801 MIS THA cases and 695 conventionally operated hips. Almost every study showed superior results for the MIS group with respect to postoperative pain, blood loss and rehabilitation but these advantages almost totally disappeared after 3–6?months. The complication rate was comparable in both groups. After 3–6?months the clinical scores, such as the Harris hip score did not show any differences between conventional and MIS groups.

Conclusions

In this present study all MIS approaches showed advantages over the conventional surgical approach but these benefits disappeared after 3–6?months. With comparable risks for complications, MIS surgical approaches are superior in the early postoperative phase and rehabilitation.