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1.
Hisashi Ikutomo Koutatsu Nagai Keiichi Tagomori Namika Miura Norikazu Nakagawa Kensaku Masuhara 《The Journal of arthroplasty》2018,33(10):3215-3219
Background
Patients who undergo total hip arthroplasty (THA) have an increased risk of falls during the first year postoperatively. However, risk factors for falls after THA remain unclear. We investigated the relationship between gait abnormality and falls during the first year after THA.Methods
We conducted a prospective cohort study of 286 patients with severe hip osteoarthritis who underwent THA and examined fall history during the first year postoperatively. Baseline characteristics including age, body mass index, number of prescribed medications, comorbidities, and history of falling in the past year were evaluated as covariates and determined using a self-administered questionnaire and interview preoperatively. We assessed functional outcomes, including passive range of motion of the hip joint (flexion, extension, abduction, and adduction), muscle strength (hip abduction and knee extension), gait velocity, and gait abnormality, at 3 weeks postoperatively. Cox proportional hazard regression models were used to analyze the relationship between the presence of gait abnormality and falls.Results
One hundred sixty-two women were included. The incidence of at least 1 fall during the first year after THA was 31.5%. Cox proportional hazard regression models showed that the presence of gait abnormality (hazard ratio, 2.91; 95% confidence interval, 1.55-5.48; P < .001) was significantly associated with falls during the first year postoperatively.Conclusion
The presence of gait abnormality is a useful screening tool to predict future falls in women after THA. Clinicians should assess gait abnormality to identify patients who may require fall prevention measures and continuous rehabilitation to improve gait abnormality. 相似文献2.
Itay Perets Yosif Mansor Brian H. Mu John P. Walsh Victor Ortiz-Declet Benjamin G. Domb 《The Journal of arthroplasty》2017,32(12):3665-3668
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.Methods
Patients who underwent a THA following an ipsilateral hip arthroscopy were matched to a control group of THA patients with no history of ipsilateral hip surgery. Matching criteria were age within 5 years, sex, body mass index within 5, surgical approach, and robotic assistance. Harris Hip Score, Forgotten Joint Score-12, visual analog scale score, satisfaction, and postoperative complication and reoperation rates were compared at minimum 2-year follow-up.Results
Thirty-five THA after arthroscopy patients were successfully matched to control patients. There were no significant differences in demographics between study groups. The THA after arthroscopy group had significantly lower Harris Hip Score, Forgotten Joint Score-12, and satisfaction at latest follow-up. They had higher visual analog scale score and complication rate in differences that closely approached significance. There was no significant difference in reoperation rate.Conclusion
A prior hip arthroscopy may adversely affect the clinical outcomes of THA. This potential risk should be considered when assessing the candidacy of a patient for hip arthroscopy. 相似文献3.
Fiachra E. Rowan Biju Benjamin Jurek R. Pietrak Fares S. Haddad 《The Journal of arthroplasty》2018,33(5):1316-1324
Background
Prevention of dislocation after primary total hip arthroplasty (THA) begins with patient preoperative assessment and planning.Methods
We performed a literature search to assess historical perspectives and current strategies to prevent dislocation after primary THA. The search yielded 3458 articles, and 154 articles are presented.Results
Extremes of age, body mass index >30 kg/m2, lumbosacral pathology, surgeon experience, and femoral head size influence dislocation rates after THA. There is mixed evidence regarding the effect of neuromuscular disease, sequelae of pediatric hip conditions, and surgical approach on THA instability. Sex, simultaneous bilateral THA, and restrictive postoperative precautions do not influence the dislocation rates of THA. Navigation, robotics, lipped liners, and dual-mobility acetabular components may improve dislocation rates.Conclusions
Risks for dislocation should be identified, and measures should be taken to mitigate the risk. Reliance on safe zones of acetabular component positioning is historical. We are in an era of bespoke THA surgery. 相似文献4.
Huiwu Li Jiawei Xu Xinhua Qu Yuanqing Mao Kerong Dai Zhenan Zhu 《The Journal of arthroplasty》2017,32(3):849-856
Background
This study compares the outcome between THA with and without femoral shortening osteotomy for unilateral mild to moderate high hip dislocation in developmental dysplasia of the hip patients.Methods
The data on 42 hips in 42 patients who had undergone THA for unilateral mild to moderate high hip dislocation were retrospectively reviewed after being prospectively collected. In 22 patients, hips were reduced by soft tissue release and direct leverage using an elevator, without the osteotomy. The remaining 20 patients were treated with a subtrochanteric transverse shortening osteotomy. The mean follow-up of patients was 5 years (standard deviation = 1.0) for the nonosteotomy group and 6.2 years (standard deviation = 1.6) for the osteotomy group.Results
The Harris Hip Score significantly improved in both groups. In the nonosteotomy group, we observed a lower leg length discrepancy compared with the osteotomy group (0.4 cm and 2.2 cm, respectively). Four patients (18.2%) in the nonosteotomy group and 15 patients (75%) in the osteotomy group developed a limp (P < .0001). Three patients (13%) developed femoral nerve palsy in the nonosteotomy group, but they all recovered completely within 6 months after the surgery. Nineteen patients in the nonosteotomy group showed knee valgus deformity immediately after the surgery but only 4 cases in the osteotomy group.Conclusion
Compared with THA with femoral shortening osteotomy, THA without the osteotomy was associated with a lower number of patients who developed a limp at the end of follow-up; however, the rehabilitation was slower and more difficult, and a larger number of patients showed reversible nerve palsy and knee valgus deformity. 相似文献5.
Emily B. Gaillard Melissa D. Gaillard Thomas P. Gross 《The Journal of arthroplasty》2017,32(11):3404-3411
Background
Women seeking surgical intervention for their hip disorders will often find total hip arthroplasty (THA) presented as their only option. THA, when compared with hip resurfacing arthroplasty, removes substantially more bone-stock, limits range-of-motion, exhibits increased dislocation risk, and presents greater overall 10-year mortality rate. Despite these risks, most surgeons continue to select against women for hip resurfacing because registries notoriously report inferior survivorship when compared with men and THA.Methods
We investigated the reasons for why resurfacing arthroplasty devices survive poorly in women to develop interventions which might improve hip resurfacing outcomes in women. Using these findings, we developed a series of surgical interventions to treat the underlying issues. Herein, we compare 2 study groups: women who received hip resurfacings before (group 1) and after (group 2) these interventions.Results
Eight-year implant survivorship substantially improved from 89.6% for group 1 to 97.7% for group 2. Adverse wear-related failure, femoral component loosening, and acetabular component loosening were all significantly reduced in group 2, which we attribute to the implementation of our relative acetabular inclination limit guidelines, use of uncemented femoral fixation, and selection of the Tri-Spike acetabular component for supplemental fixation, respectively. Kaplan-Meier implant survivorship curves, grouped into 2-year time intervals, show that the disparity in failure rates between men and women is diminishing.Conclusion
When experienced surgeons use refined and proper surgical technique, women show promise as excellent candidates for hip resurfacing as an alternative treatment for their debilitating hip conditions. 相似文献6.
Charles D. Qin Mia M. Helfrich David W. Fitz Mark A. Oyer Kevin D. Hardt David W. Manning 《The Journal of arthroplasty》2018,33(5):1477-1480
Background
The demand for conversion of prior hip surgery to total hip arthroplasty (conversion THA) is likely to increase as a function of increasing US hip fracture burden in addition to its application in managing other conditions. Thus, outcome analysis is warranted to better inform value-based reimbursement schemes in the era of bundled payments.Methods
Via Current Procedural Terminology codes, the National Surgical Quality Improvement Project data files were queried for all patients who underwent primary THA and conversion of previous hip surgery to THA from 2005 to 2014. To better understand the isolated effect of procedure type on adverse outcomes, primary and conversion cohorts were then propensity-score matched via logistic regression modeling. Comparisons of the study's primary outcomes were drawn between matched cohorts. Statistical significance was defined by a P-value less than or equal to .05.Results
Relative to the primary THA group, the conversion THA group had statistically greater rates of Center Medicare and Medicaid Services (CMS) complications (7.5% vs 4.5%), non-home bound discharge (19.6% vs 14.7%), and longer length of hospital stay. Conversion THA was associated with increased likelihood of CMS complications (odds ratio 1.68, confidence interval 1.39-2.02) and non-home bound discharge (odds ratio 1.41, confidence interval 1.25-1.58). No statistically significant differences in mortality and readmission were detected.Conclusion
The elevated risk for CMS-reported complications, increased length of hospital stay, and non-home bound discharge seen in our study of conversion THA indicates that it is dissimilar to elective primary THA and likely warrants consideration for modified treatment within the Comprehensive Care for Joint Replacement structure in a manner similar to THA for fracture. 相似文献7.
Andrew N. Fleischman Richard H. Rothman Javad Parvizi 《The Journal of arthroplasty》2018,33(4):1194-1199
Background
Femoral nerve palsy (FNP) is a relatively uncommon complication following total hip arthroplasty (THA). There is little recent literature regarding the incidence of FNP and the natural course of recovery.Methods
Using our institutional database, we identified postoperative FNPs from 17,350 consecutive primary THAs performed from 2011 to 2016. Hip exposures were performed using a direct lateral (modified Hardinge), direct anterior (Smith-Peterson), anterolateral (Watson-Jones), or posterolateral (Southern or Moore) approach. Patients with FNP were contacted to provide a subjective assessment of convalescence and underwent objective muscle testing to determine the extent of motor recovery.Results
The overall incidence of FNP was 0.21% after THA, with the incidence 14.8-fold higher in patients undergoing anterior hip surgery using either a direct anterior (0.40%) or anterolateral (0.64%) approach. Significant recovery from FNP did not commence for a majority of patients until greater than 6 months postoperatively. Motor weakness had resolved in 75% of patients at 33.3 months, with remaining patients suffering from mild residual weakness that typically did not necessitate an assistive walking device or a knee brace. Nearly all patients had improved sensory manifestations, but such symptoms had completely resolved in less than 20% of patients.Conclusion
FNP after hip surgery remains relatively uncommon, but may increase with a growing interest in anterior THA exposures. A near complete recovery with only mild motor deficits can be expected for a majority of patients in less than 2 years, although sensory symptoms may persist. 相似文献8.
Harry A. Demos Zilan X. Lin William R. Barfield Sylvia H. Wilson Dawn C. Robertson Vincent D. Pellegrini 《The Journal of arthroplasty》2017,32(8):2375-2380
Background
Tranexamic acid (TXA) has been associated with decreased blood loss and transfusion after total hip arthroplasty (THA) and total knee arthroplasty (TKA). The purpose of this study was to examine both transfusion utilization and the economic impact of a Process Improvement Project implementing TXA for THA and TKA.Methods
After standardization of TXA administration in THA and TKA patients, retrospective data were compared from 12 consecutive months before (group A, n = 336 procedures) and after (group B, n = 436 procedures) project initiation.Results
TXA administration increased with project implementation (group A = 3.57%, group B = 86.01%) and was associated with reductions in perioperative hemoglobin decrement (20.2%), patients transfused (45%), and number of units transfused per patient (61.9%). Cost savings were notable per patient ($128) and annually program wide ($55,884) with the primary THA subgroup contributing the most to the savings. No increase in adverse effects was observed.Conclusion
Standardized administration of TXA is an effective and economically favorable blood-reduction strategy for patients undergoing elective THA or TKA. Although reduction in transfusions with TXA may be greater after TKA, the economic and clinical impact of transfusion reduction is more substantial in THA patients. 相似文献9.
Diana C. Patterson Ronald P. Grelsamer Michael J. Bronson Calin S. Moucha 《The Journal of arthroplasty》2017,32(10):2958-2962
Background
As the prevalence of total hip arthroplasty (THA) expands, so too will complications and patient dissatisfaction. The goal of this study was to identify the common etiologies of malpractice suits and costs of claims after primary and revision THAs.Methods
Analysis of 115 malpractice claims filed for alleged neglectful primary and revision THA surgeries by orthopedic surgeons insured by a large New York state malpractice carrier between 1983 and 2011.Results
The incidence of malpractice claims filed for negligent THA procedures is only 0.15% per year in our population. In primary cases, nerve injury (“foot drop”) was the most frequent allegation with 27 claims. Negligent surgery causing dislocation was alleged in 18 and leg length discrepancy in 14. Medical complications were also reported, including 3 thromboembolic events and 6 deaths. In revision cases, dislocation and infection were the most common source of suits. The average indemnity payment was $386,153 and the largest single settlement was $4.1 million for an arterial injury resulting in amputation after a primary hip replacement. The average litigation cost to the insurer was $61,833.Conclusion
Nerve injury, dislocation, and leg length discrepancy are the most common reason for malpractice after primary THA. Orthopedic surgeons should continue to focus on minimizing the occurrence of these complications while adequately incorporating details about the risks and limitations of surgery into their preoperative education. 相似文献10.
Background
The aim of this prospective cohort study is to evaluate the outcome of octogenarian patients undergoing uncemented total hip arthroplasty (THA) with a control group of similarly aged patients undergoing hybrid THA with a minimum 5-year follow-up.Methods
Clinical outcomes including intraoperative and postoperative complications, blood transfusion, revision rate, and mortality were recorded. Radiological analysis of preoperative and postoperative radiographs assessed bone quality, implant fixation, and any subsequent loosening.Results
One hundred forty-three patients (mean age 86.2 years) were enrolled in the study. Seventy-six patients underwent uncemented THA and 67 underwent hybrid THA. The uncemented cohort had a significantly lower intraoperative complication rate (P = .017) and also a lower transfusion rate (P = .002). Mean hospital stay (P = .27) was comparable between the 2 groups. Two patients underwent revision surgery in each cohort.Conclusion
Our study demonstrates that uncemented THA is safe for the octogenarian patient and we recommend that age should not be a barrier to the choice of implant. However, intraoperative assessment of bone quality should guide surgeons to the optimum decision regarding uncemented and hybrid implants.Level of evidence
3. 相似文献11.
Kurt G. Seagrave Anders Troelsen Bjørn G. Madsen Henrik Husted Thomas Kallemose Kirill Gromov 《The Journal of arthroplasty》2017,32(10):3141-3146
Background
Hip dislocation is one of the most common postoperative complications after total hip arthroplasty (THA). Potential contributors include patient- and surgical-related factors. We performed a retrospective cohort study to identify risk factors for postoperative dislocation in patients receiving THA via the posterolateral approach.Methods
We assessed 1326 consecutive primary THAs performed between 2010 and 2015. Patient information was documented, and plain radiographic films were used to evaluate cup positioning, hip offset, and hip length change. A multiple logistic regression was used to identify risk factors for dislocation. Follow-up was coordinated by the Danish National Patient Registry.Results
Age and American Society of Anesthesiologists scores were higher in dislocating THA compared with those in the nondislocating THA. Cup anteversion was less in dislocating THA compared with that in nondislocating THA. Independent risk factors for cup dislocation were increased age, body mass index <25 and >30 kg/m2, and leg shortening of >5 mm.Conclusion
Surgeons should aim for a shortening of leg length <5 mm to reduce the risk of postoperative dislocation in primary THA. Although anteversion was reduced for dislocating THA, there is likely no universal safe zone for cup positioning. Hip stability is multifactorial, and optimal cup positioning may vary from patient to patient. 相似文献12.
Yoshitoshi Higuchi Yukiharu Hasegawa Daigo Komatsu Taisuke Seki Naoki Ishiguro 《The Journal of arthroplasty》2017,32(5):1641-1646
Background
The aim of our study was to evaluate the clinical and radiographic outcomes of malseating of the acetabular liner in ceramic-on-ceramic total hip arthroplasty (THA).Methods
Outcomes for 160 ceramic-on-ceramic THAs, contributed by 116 women and 39 men, were evaluated. Clinical and radiographic measurements were obtained over a 5- to 15-year follow-up for analysis.Results
Liner malseating was identified in 20% of cases. Outcomes for 32 cases with liner malseating (group A) were compared to outcomes for 128 joints with correct liner seating (group B). The Harris hip score at the last follow-up was 90.1 for group A and 89.6 for group B. Osteolysis was identified in 5 cases in group A (15.6%), compared to 3 cases in group B (P < .001). No significant between-group differences were identified with regard to ceramic fracture, audible squeaking, loosening of components, and revision THA. The mean annual liner wear rate was comparable between groups, 0.0045 mm/y for group A and 0.0039 mm/y for group B. The 10-year Kaplan-Meier survivorship, based on an end point of revision THA, was 100% for group A and 99.0% for group B.Conclusion
Over a moderate-length follow-up of 5-15 years, malseating of the acetabular liner was not associated with negative clinical outcomes or THA survivorship. Malseating did increase the incidence of osteolysis, a risk factor for adverse effects. Long-term follow-up studies are needed to fully quantify the effects of malseating of the acetabular liner. 相似文献13.
Takeshi Utsunomiya Goro Motomura Satoshi Ikemura Satoshi Hamai Jun-ichi Fukushi Yasuharu Nakashima 《The Journal of arthroplasty》2017,32(9):2768-2773
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.Methods
Twenty-four hips in 20 patients who underwent cementless THA after ARO (postosteotomy group) were retrospectively reviewed and compared with patients who underwent cementless THA without any antecedent surgery for ONFH during the same period (primary group). In the postosteotomy group, the mean duration from ARO to THA was 19.7 years. All patients were followed for at least 5 years (mean, 8.3 years; follow-up rate, 78.5%). A clinical assessment was performed preoperatively and at the latest follow-up using the Harris Hip Score. A radiographic examination was performed at 3 months after THA and at the latest follow-up.Results
The Harris Hip Score at the latest follow-up in the postosteotomy group was equivalent to that in the primary group, but longer operation time and greater intraoperative blood loss were observed in the postosteotomy group. There were no significant differences in postoperative complications, including dislocation (2 hips in each group). The leg lengthening in the postosteotomy group tended to be longer. No hips showed implant malpositioning, loosening, or required any revision surgery.Conclusion
The clinicoradiologic outcomes of THA after ARO are considered to be comparable with those of THA without any antecedent surgery for ONFH. 相似文献14.
Stephen M. Petis Kevin I. Perry Mark W. Pagnano Daniel J. Berry Arlen D. Hanssen Matthew P. Abdel 《The Journal of arthroplasty》2017,32(11):3510-3518
Background
Prolonged retention of an antibiotic spacer is occasionally chosen during treatment of periprosthetic joint infections after total hip arthroplasty (THA) and total knee arthroplasty (TKA). The purpose of our study was to evaluate the outcome of extended spacer retention.Methods
We reviewed 1106 cases of periprosthetic joint infection after THA (n = 308) and TKA (n = 798) and identified 17 (5.5%) retained hip and 34 (4.3%) retained knee spacers. Most patients (35 of 51, 69%) underwent spacer retention because they were medically unfit for further surgery. The remaining patients (16 of 51, 31%) had acceptable function and forewent further surgery. Competing risk analyses, with death as the competing risk, determined the cumulative incidence of reinfection and spacer revision. Radiographic analysis and clinical outcomes were analyzed.Results
The 2-year cumulative incidence for reinfection was 7% for retained hip and 13% for retained knee spacers. The cumulative incidence for all-cause spacer revision was 28% at 4 years for hips and 21% at 2 years for knees. The most common complications were implant migration and femoral spacer subsidence in the hip cohort, and supracondylar femur fractures and spacer dislocations in the knee cohort. The cumulative incidence for radiographic signs of mechanical failure was 72% and 87% at late follow-up for the hip and knee groups, respectively. The latest Harris Hip Score and Knee Society Score were 62 and 63, respectively.Conclusion
Antibiotic spacer retention is a rare event in the course of planned 2-stage treatment of infected THA or TKA. Failure secondary to recurrent infection is uncommon; however, failure for mechanical reasons is frequent and clinical outcomes are relatively poor. 相似文献15.
Inari Laaksonen Vincent P. Galea James W. Connelly Sean J. Matuszak Orhun K. Muratoglu Henrik Malchau 《The Journal of arthroplasty》2018,33(2):464-469
Background
Data on the association between stem type and metal-on-metal (MoM) total hip arthroplasty (THA) performance are limited. The aim of this study is to investigate the effect of stem type on the prevalence of osteolysis and radiolucency, blood metal ion levels, and functional outcomes in patients with Articular Surface Replacement THA (ASR XL), a type of MoM THA.Methods
We analyzed 539 unilateral MoM THAs coupled with Summit (48%), Corail (35%), or S-ROM (17%) hip stems at a mean follow-up of 6.4 years. Fifty-four percent of the patients were male, and the mean age was 60 years. We studied radiographs, patient-reported outcome measures, and ion levels.Results
Patients with S-ROM hip stems were 3.8 times more likely to have osteolysis (P = .003) and 7.6 times more likely to have radiolucency (P < .001) than those treated with Summit hip stems. In addition, patients treated with S-ROM hip stems scored worse than those with Summit hip stems in 4 of the 5 patient-reported outcome measures: Harris Hip Score, Visual Analog Scale pain, University of California at Los Angeles activity, and EQ-5D index. All these differences were statistically significant and ranged from 5% to 10%, which is clinically significant.Conclusion
Patients with S-ROM hip stems had inferior functional and radiographic results compared to patients with Summit hip stems. Retrieval studies on large diameter head MoM THA and close follow-up of these patients with hip stems are needed to understand the mechanism causing the differences in outcomes between these stem types. 相似文献16.
Steven M. Kurtz Edmund C. Lau Min-Sun Son Ellen T. Chang Werner Zimmerli Javad Parvizi 《The Journal of arthroplasty》2018,33(10):3238-3245
Background
Periprosthetic joint infection (PJI) is a potentially deadly complication of total joint arthroplasty. This study was designed to address how the incidence of PJI and outcome of treatment, including mortality, are changing in the population over time.Methods
Primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients with PJI from the 100% Medicare inpatient data set (2005-2015) were identified. Cox proportional hazards regression models for risk of PJI after THA/TKA (accounting for competing risks) or risk of all-cause mortality after PJI were adjusted for patient and clinical factors, with year included as a covariate to test for time trends.Results
The unadjusted 1-year and 5-year risk of PJI was 0.69% and 1.09% for THA and 0.74% and 1.38% for TKA, respectively. After adjustment, PJI risk did not change significantly by year for THA (P = .63) or TKA (P = .96). The unadjusted 1-year and 5-year overall survival after PJI diagnosis was 88.7% and 67.2% for THA and 91.7% and 71.7% for TKA, respectively. After adjustment, the risk of mortality after PJI decreased significantly by year for THA (hazard ratio = 0.97; P < .001) and TKA (hazard ratio = 0.97; P < .001).Conclusion
Despite recent clinical focus on preventing PJI, we are unable to detect substantial decline in the risk of PJI over time, although mortality after PJI has declined. Because PJI risk appears not to be changing over time, the incidence of PJI is anticipated to scale up proportionately with the demand for THA and TKA, which is projected to increase substantially in the coming decade. 相似文献17.
Sameer Badarudeen Albert C. Shu Kevin L. Ong Doruk Baykal Edmund Lau Arthur L. Malkani 《The Journal of arthroplasty》2017,32(6):1954-1958
Background
The purpose of this study was to identify the incidence and types of complications after revision total hip arthroplasty (THA) within the first year, and determine the relative risk factors for these complications and of re-revision.Methods
The sample size of 5% Medicare claims data from 1998-2011 was studied. Primary THA patients who underwent subsequent revision were identified using ICD-9-CM codes. Outcomes and complications after revision THA were assessed. Multivariate Cox regression was used to evaluate the effect of patient demographic characteristics on the adjusted complication risk for revision THA patients.Results
Of the 64,260 primary THA patients identified between 1998 and 2011, 3555 patients (5.71%) underwent revision THA. Etiology of primary hip failure included mechanical complications such as loosening and wear (40.7%), dislocation (14.0%), and infection (11.3%). Complications after revision THA included infection and redo revision, 17.3% and 15.8% followed by venous thromboembolic disease (VTE) at 11.1%, dislocation at 5.43%, PE at 3.24%, and death at 2.11%. The rate of “new” infections after an aseptic revision was 8.13%. Patients in the 85+-year-old age group had a 100% greater adjusted risk of VTE (P < .001) and 406% higher adjusted risk of death (P < .001) than those in the 65-69 years-old age group. Patients with higher Charlson scores had higher adjusted risks of VTE (P < .001), infection (P < .001), death (P = .002), and re-revision THA (P = .011).Conclusion
Advanced age is a clear risk factor for VTE and mortality, but not for dislocation, infection, or re-revision. Higher Charlson index was found to be a risk factor for every complication after revision except dislocation. Greater attention is required to address the high rate of infection and re-do revision after revision THA (17.3% and 15.8%). 相似文献18.
Yasushi Wako Junichi Nakamura Michiaki Miura Yuya Kawarai Masahiko Sugano Kento Nawata 《The Journal of arthroplasty》2018,33(2):601-607
Background
The purpose of this study is to clarify interobserver and intraobserver reliabilities of the three-dimensional (3D) templating of total hip arthroplasty (THA).Methods
We selected preoperative computed tomography from 60 hips in 46 patients (14 men and 32 women) who underwent primary THA. To evaluate interobserver and intraobserver reliability, 6 orthopedic surgeons performed 3D templating twice over a 4-week interval. We investigated intraclass correlation coefficients (ICCs) and percent agreement of component size and alignment, comparing morphological differences in the hip. Reproducibility was also compared between groups with osteoarthritis (OA) and those with osteonecrosis (ON).Results
The interobserver reliabilities for mean cup size and stem size were excellent, with ICC = 0.907 and 0.944, respectively. The value was significantly higher in the ON group than in the OA group. In the OA group, the reliability of cup size and alignment decreased in hips with severe subluxation. Percent agreement of stem size was significantly different between the shapes of femoral canal. For intraobserver reliability, the mean ICC of cup size was 0.965 overall, while the value in the ON group was significantly higher than in the OA group. The mean ICC of stem size was 0.972 overall.Conclusion
Computed tomography–based 3D templating showed excellent reliability for component size and alignment in THA. Deformity of the affected joint influenced the reliability of preoperative planning. 相似文献19.
Georgios K. Triantafyllopoulos Vasileios G. Soranoglou Stavros G. Memtsoudis Thomas P. Sculco Lazaros A. Poultsides 《The Journal of arthroplasty》2018,33(4):1166-1170
Background
As periprosthetic joint infections (PJIs) can have tremendous health and socioeconomic implications, recognizing patients at risk before surgery is of great importance. Therefore, we sought to determine the rate of and risk factors for deep PJI in patients undergoing primary total hip arthroplasty (THA).Methods
Clinical characteristics of patients treated with primary THA between January 1999 and December 2013 were retrospectively reviewed. These included patient demographics, comorbidities (including the Charlson/Deyo comorbidity index), length of stay, primary diagnosis, total/allogeneic transfusion rate, and in-hospital complications, which were grouped into local and systemic (minor and major). We determined the overall deep PJI rate, as well as the rates for early-onset (occurring within 2 years after index surgery) and late-onset PJI (occurring more than 2 years after surgery). A Cox proportional hazards regression model was constructed to identify risk factors for developing deep PJI. Significance level was set at 0.05.Results
A deep PJI developed in 154 of 36,494 primary THAs (0.4%) during the study period. Early onset PJI was found in 122 patients (0.3%), whereas late PJI occurred in 32 patients (0.1%). Obesity, coronary artery disease, and pulmonary hypertension were identified as independent risk factors for deep PJI after primary THA.Conclusion
The rate of deep PJIs of the hip is relatively low, with the majority occurring within 2 years after THA. If the optimization of modifiable risk factors before THA can reduce the rate of this complication remains unknown, but should be attempted as part of good practice. 相似文献20.
Yusuke Osawa Taisuke Seki Daigo Morita Yasuhiko Takegami Toshiaki Okura Naoki Ishiguro 《The Journal of arthroplasty》2017,32(10):3088-3092