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1.
Young-Min Kwon Tsung-Yuan Tsai William A. Leone Ming Han Lincoln Liow 《The Journal of arthroplasty》2017,32(3):996-1000
Background
Currently, no serum metal ion threshold exists to identify adverse tissue reactions in total hip arthroplasty (THA) patients with taper corrosion. Our study aims to investigate the sensitivity and specificity of serum metal ions in detecting taper corrosion related pseudotumors in patients with dual taper modular THA.Methods
A total of 148 patients with dual taper modular THA were investigated: (1) 90 patients with pseudotumors detected with metal artifact reduction sequence-magnetic resonance imaging (MARS-MRI) and (2) 58 patients without pseudotumors on MARS-MRI. Receiver operating characteristic curves were constructed to determine the sensitivity and specificity using different metal ion thresholds. The severity of intraoperative tissue damage was correlated with preoperative metal ion levels.Results
Pseudotumor was associated with higher cobalt (5.0 μg/L vs 3.7 μg/L, P < .01) and Co/Cr ratio (6.0 vs 3.7, P < .01). The sensitivity and specificity for cobalt level of 2.8 μg/L and Co/Cr ratio of 3.8 in detecting taper corrosion–related pseudotumors on MARS-MRI was 88% and 32% and 70% and 50%, respectively. Higher intraoperative tissue damage grades demonstrated significantly higher Co/Cr ratios (8.6 vs 3.4, P = .03).Conclusion
Although metal ion levels alone should not be relied on as the sole parameter to determine revision surgery, cobalt level >2.8 μg/L and the Co/Cr ratio >3.8 are useful clinical diagnostic adjuncts in the systematic clinical evaluation for taper corrosion–related adverse tissue reactions in patients with dual modular taper THA. 相似文献2.
Rasmus T. Mikkelsen Marianne Fløjstrup Christian Lund Per Kjærsgaard-Andersen Thomas Skjødt Claus Varnum 《The Journal of arthroplasty》2017,32(9):2774-2778
Background
Modular neck femoral stem (MNFS) for total hip arthroplasty (THA) was introduced to optimize the outcome, but created concerns about pain, elevated blood metal ion levels, and adverse reaction to metal debris such as pseudotumors (PTs), related to corrosion between femoral neck and stem. We compared these outcomes in patients with MNFS or nonmodular femoral stem (NFS) THA.Methods
Thirty-three patients with unilateral MNFS THA were compared with 30 patients with unilateral NFS THA. Levels of pain, serum cobalt, serum chromium were determined. Magnetic resonance imaging was performed to describe PT and fatty atrophy of muscles.Results
The MNFS and NFS group had a mean follow-up of 2.3 and 3.1 years, respectively. Four and 13 patients in the MNFS and NFS group had pain, respectively (P = .005). The MNFS group had higher levels of serum cobalt (P < .0001) and chromium (P = .006). PTs were present in both the MNFS (n = 15) and NFS (n = 7) groups (P = .066). PTs were related to serum cobalt (P = .04) but not to pain or serum chromium. Fatty atrophy prevalence in the piriformis and gluteal muscles were higher in patients with MNFS (P = .009 and P = .032, respectively).Conclusion
More patients in the NFS group had pain. Serum cobalt and chromium levels were higher in the MNFS group. Prevalence of PTs was twice as high in the MNFS group, but the difference was insignificant. 相似文献3.
Brian J. McGrory Abigail M. Payson Johanna A. MacKenzie 《The Journal of arthroplasty》2017,32(5):1654-1658
Background
Failed total hip arthroplasty (THA) caused by mechanically assisted crevice corrosion (MACC) has serious consequences such as adverse local tissue reaction (ALTR). Serum cobalt (Co) and chromium (Cr) ion levels have been used to diagnose taper corrosion, but have not been shown to be an accurate measure of the severity of MACC or associated ALTRs. Additionally, elevated serum ions are not specific in patients with multiple artificial joints.Methods
We examined the relationship between serum and intra-articular (IA) Co and Cr levels in a cohort of 20 patients undergoing revision THA, 16 who had symptomatic MACC. IA Co and Cr levels in MACC patients were compared with demographic, pre-operative, and operative findings.Results
Serum and IA metal levels were found to be relatively low in THA patients undergoing revision surgery for isolated instability, aseptic loosening, or infection (average serum Co 0.03 ppb [parts per billion], IA Co 1.4 ppb, serum Cr 0.32 ppb, IA Cr 3.3 ppb). In patients with MACC, average IA Co (940 ppb) was significantly higher than serum Co (5.1 ppb) (P = .0003) and IA Cr (491 ppb) was significantly higher than serum Cr (1.3 ppb) (P = .0003). IA Co level was associated with shorter time of hip symptoms to revision surgery (P = .0043).Conclusion
Serum levels of Co and Cr correlated with joint levels in the entire cohort, but IA levels of MACC patients were 100 times greater than serum levels. IA Co and Cr levels may be useful in confirming MACC in a specific joint and the striking elevation may explain symptoms and ALTR with relatively low serum values. 相似文献4.
Mette Holm Hjorth Inger Mechlenburg Kjeld Soballe Lone Roemer Stig Storgaard Jakobsen Maiken Stilling 《The Journal of arthroplasty》2018,33(7):2279-2286
Background
Pseudotumors are a common finding in metal-on-metal (MoM) total hip arthroplasty (THA) and resurfacing hip arthroplasty (RHA). However, information on pseudotumors in metal-on-polyethylene (MoP) THA is limited.Methods
One hundred eleven patients with 148 hip articulations—30 MoM THA, 47 MoM RHA, and 71 MoP THA—participated in a cross-sectional study at mean 7.1 (range: 0.2-21.5) years postoperatively. Patients were evaluated with metal artifact reducing sequence magnetic resonance imaging, measurements of metal ions, clinical scores of Harris Hip Score, Oxford Hip Score, the Copenhagen Hip and Groin Outcome Score, and conventional radiographs.Results
Pseudotumors were present in 13 of 30 (43%) MoM THA, 13 of 47 (28%) MoM RHA, and 29 of 71 (41%) MoP THA patients, which was a similar prevalence (P = .10). The prevalence of mixed or solid pseudotumors was significantly higher in patients with MoP THA (n = 10) compared to MoM THA (n = 3) and MoM THA (n = 0), (P = .01). Hips with a mixed or solid pseudotumor had significantly poorer scores of Harris Hip Score (P = .01) and OHS (P = .002) and higher metal ion levels of cobalt (P = .0009) compared to hips without a pseudotumor or with a cystic pseudotumor.Conclusion
Pseudotumors have primarily been associated with MoM hip articulations, but we found a similar pseudotumor prevalence in MoP THA, which is the most common bearing worldwide. Mixed or solid pseudotumors were more often seen in MoP THA compared with MoM hip articulations, and patients with a mixed or solid pseudotumor had poorer clinical scores and higher metal ion levels than patients without a pseudotumor or with a cystic pseudotumor. 相似文献5.
James W. Connelly Vincent P. Galea Sean J. Matuszak Rami Madanat Orhun Muratoglu Henrik Malchau 《The Journal of arthroplasty》2018,33(6):1919-1925
Background
Currently, there are no universally accepted guidelines on when to obtain metal artifact reduction sequence magnetic resonance imaging (MARS-MRI) in metal-on-metal (MoM) hip resurfacing arthroplasty (HRA) patients. Our primary aims were to identify which patient and clinical factors are predictive of adverse local tissue reaction (ALTR) and create an algorithm for indicating MARS-MRI in patients with Articular Surface Replacement (ASR) HRA. The secondary aim was to compare our algorithm to existing guidelines on when to perform MARS-MRI in MoM HRA patients.Methods
The study cohort consisted of 182 patients with unilateral ASR HRA from a prospective, multicenter study. Subjects received MARS-MRI at a mean of 7.8 years from surgery, regardless of symptoms. We determined which variables were predictive of ALTR and generated cutoffs for each variable. Finally, we created an algorithm to predict ALTR and indicate MARS-MRI in ASR HRA patients using these cutoffs and compared it to existing guidelines.Results
We found high blood cobalt (Co) (odds ratio = 1.070; P = .011) and high blood chromium (Cr) (odds ratio = 1.162; P = .002) to be significant predictors of ALTR presence. Our algorithm using a blood Co cutoff of 1.15 ppb and a Cr cutoff of 1.09 ppb achieved 96.6% sensitivity and 35.3% specificity in predicting ALTR, which outperformed the existing guidelines.Conclusion
Blood Co and Cr levels are predictive of ALTR in ASR HRA patients. Our algorithm considering blood Co and Cr levels predicts ALTR in ASR HRA patients with higher sensitivity than previously established guidelines. 相似文献6.
Daisuke Hara Satoshi Hamai Keisuke Komiyama Goro Motomura Kyohei Shiomoto Yasuharu Nakashima 《The Journal of arthroplasty》2018,33(2):423-430
Background
No studies have compared sports participation between total hip arthroplasty (THA) and periacetabular osteotomy (PAO) in matched Asian cohorts. We investigated sports participation and activity levels in Asian THA cohort, and compared them between THA and PAO cohorts.Methods
Multivariate analyses were applied to determine which factors were associated with postoperative sports participation and University of California-Los Angeles (UCLA) activity score in (1) 524 THA patients and (2) 487 acetabular dysplasia patients (295 THA patients and 192 PAO patients). In addition, postoperative sports participation and UCLA score were compared between 62 THA and 62 PAO patients after adjusting for baseline characteristics with propensity score matching.Results
Sports participation and UCLA score significantly increased after THA (P < .001 in both analyses). Preoperative sports participation was the factor most associated with both postoperative sports participation and UCLA score in both 524 THA patients and 487 acetabular dysplasia patients (P < .001 in all analyses). Multivariate analysis in 487 acetabular dysplasia patients demonstrated that THA, compared with PAO, was negatively associated with postoperative sports participation (P < .001), but not postoperative UCLA score (P = .22). THA patients showed significantly lower rate of postoperative sports participation (32.3% and 51.6%, respectively, P = .046), but not postoperative UCLA score (5.0 ± 1.6 and 5.2 ± 1.9, respectively, P = .47) compared with matched PAO patients.Conclusion
THA significantly increased both sports participation and activity levels. Both multivariate and propensity score-matched analyses showed that postoperative activity levels were comparable between THA and PAO cohorts. 相似文献7.
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8.
Kentaro Iwakiri Akio Kobayashi Yoichi Ohta Yukihide Minoda Kunio Takaoka Hiroaki Nakamura 《The Journal of arthroplasty》2017,32(12):3659-3664
Background
The acetabular component orientation in total hip arthroplasty (THA) is of critical importance to the good clinical results. However, traditional widely used cup alignment guides for cup placement are reported to be relatively unreliable. The present study aims at comparing a novel cup alignment guide, which can be attached to our anatomical pelvic plane (APP) pelvic lateral positioner for reducing discrepancies in sagittal pelvic tilt and indicate a targeted cup angle based on the APP, with a conventional cup alignment guide.Methods
The subjects were 136 hips of 136 patients who underwent unilateral THA using the APP positioner. The procedure was performed with the conventional cup alignment guide (conventional group; 60 hips) and with the novel cup navigator (mechanical navigator group; 76 hips). Postoperative cup angles and discrepancies of postoperative cup angles (inclination and anteversion angles) from the targeted angles were compared between the 2 groups to evaluate the usefulness of these navigators.Results
The mean cup angles in the conventional group were 39.0° ± 5.3° for the inclination angle and 21.7° ± 6.4° for the anteversion angle, whereas those in the mechanical navigator group were 40.6° ± 3.2° and 18.3° ± 4.6°, respectively (P = .018, P < .0001). The discrepancies from the targeted angles were 3.5° ± 3.1° for the inclination angle and 4.6° ± 3.4° for the anteversion angle in the conventional group and 2.3° ± 2.3° and 3.2° ± 2.7°, respectively, in the mechanical navigator group (P = .020, P = .012).Conclusion
The mechanical cup navigator easily attachable to the APP positioner is a tool that can improve the accuracy of cup placement in a simple, economical, and noninvasive manner in THA via the lateral position. 相似文献9.
In-Sung Kim Nachiket Pansey Rajeev K. Kansay Je-Hyun Yoo Hwang-Yong Lee Jun-Dong Chang 《The Journal of arthroplasty》2017,32(6):1965-1969
Background
The purpose of the study is to evaluate the radiologic and functional results of greater trochanteric reattachment using the third-generation cable plate system in revision total hip arthroplasty (THA).Methods
A total of 47 trochanteric fixations (27 men and 18 women; mean age of 60.2 years) using the third-generation cable plate system in revision THA were retrospectively evaluated. The mean follow-up was 80.4 months (range 27-148 months). The osteotomized greater trochanter was reattached using the Cable-Ready system (Zimmer, Warsaw, IN) and the Dall-Miles cable system (Stryker, Mahwah, NJ). The clinical results with Harris hip score, visual analog scale, and radiologic outcomes were evaluated.Results
The mean Harris hip score was improved from 55.7 (range 17-72) preoperatively to 90.8 (range 68-100; P = .001) postoperatively, and the mean pain score was improved from 6.6 (range 3-10) to 2.5 (range 0-6; P = .001), respectively. Nonunion was observed in 6 hips (12.7%). Migration of the osteotomized greater trochanteric fragment (>1 cm) was seen in 8 hips (17.0%). Cable breakage occurred in 13 cases (27.6%). Although 5 cable plate systems were removed, there was no need for reattachment of the greater trochanter in this study.Conclusion
This study showed a relatively high incidence of radiologic failure after greater trochanteric reattachment using the cable plate system in revision THA, although reattachments were not required and clinical outcome was relatively satisfactory. Periodic and close observation for the early detection of failure is necessary. 相似文献10.
Jaiben George Evan M. Miller Carlos A. Higuera Thomas E. Kuivila Michael A. Mont Ryan C. Goodwin 《The Journal of arthroplasty》2018,33(4):1108-1112
Background
As the indications for total hip arthroplasty (THA) have expanded, this procedure is being increasingly performed in young patients. Oftentimes, this population has undergone one or more salvage procedures in an attempt to delay or forestall a THA. However, it is unclear whether patients with prior salvage procedure have higher risk of adverse events.Methods
From 2004 to 2014, 215 THAs performed in patients less than 30 years at a single institution were identified. These patients were screened to identify 37 THAs in which one or more salvage procedures were performed prior to the THA (salvage group). The prior salvage procedures were open in 30 (pelvic osteotomy = 5, femoral osteotomy = 15, combined osteotomy = 2, core decompression = 7, bone graft = 1) and arthroscopic in 7. Medical and surgical complications within 90 days and overall survivorship at a minimum follow-up of 2 years were recorded. Nonparametric tests and Kaplan-Meier survival curves were used to compare the groups.Results
Salvage group had a higher rate of wound complications (P = .037), superficial infections (P = .005), and reoperations (P = .015). The 5-year survivorships in the salvage and nonsalvage groups were 97.1% and 96.7%, respectively (P = .787).Conclusion
Patients less than 30 years who undergo THA after a previous salvage procedure have a higher risk of wound complications, superficial infections, and reoperations, but similar survivorship, compared to those who did not have any prior salvage procedures. This information is helpful in counseling young patients while offering various surgical options for the management of various hip pathologies. 相似文献11.
Matthew P. Siljander Erin A. Baker Kevin C. Baker Meagan R. Salisbury Clayton C. Thor James J. Verner 《The Journal of arthroplasty》2018,33(3):931-938
Background
Fretting and corrosion at the modular femoral head-femoral neck (taper) interface have been reported in retrieved total hip arthroplasty (THA) prostheses. This study investigated associations among implant design, radiographic factors, and patient factors with corrosion and fretting at the taper interface in retrieved metal-on-polyethylene modular THA prostheses.Methods
Ninety-two retrieved primary metal-on-polyethylene THA implants were evaluated and graded for fretting, corrosion, and damage at the taper interface, including the femoral stem trunnion and femoral head. Preoperative radiographs were assessed for osteolysis and femoral stem alignment; and medical records were reviewed for demographic data.Results
Male patients had greater head corrosion (P = .037), patient age at revision had a weak, negative correlation with trunnion corrosion (ρ = ?0.20, P = .04), and both body mass index and duration of implantation had weak, positive correlations with head fretting (ρ = 0.26, P = .01 and ρ = 0.33, P = .001, respectively). A weak, negative correlation was found between femoral head size and both head fretting and head corrosion (ρ = ?0.26, P = .007 and ρ = ?0.21, P = .028, respectively), and a weak, positive correlation was found between head offset and trunnion fretting (ρ = 0.23, P = .030). Varus femoral stem alignment was associated with greater head fretting (P = .038).Conclusion
Larger femoral head sizes were correlated with less severe head corrosion and head fretting, with 28-mm heads exhibiting more moderate-to-severe damage. Other factors, such as head-taper engagement and geometry, rather than head size, may affect rates of corrosion and fretting damage at the taper interface. 相似文献12.
Sean M. Kearns Hannah N. Kuhar Daniel D. Bohl Brett R. Levine 《The Journal of arthroplasty》2017,32(11):3445-3448
Background
Fibrin sealants are topical agents used to reduce perioperative blood loss; however, their efficacy in total hip arthroplasty (THA) remains uncertain. The purpose of this study was to determine if a fibrin sealant containing aprotinin as an antifibrinolytic agent, TISSEEL (Baxter, Deerfield, IL), reduces postoperative blood loss and transfusion during THA when compared with intravenous (IV) tranexamic acid (TXA) and control groups.Methods
Three retrospective uniform cohorts of primary THA procedures were identified, from a prospectively maintained database: 1 group who received TISSEEL, 1 group who received 1 g IV TXA, and 1 group who received neither (control). There were 80 patients in each group. Outcome measures included the lowest measured hemoglobin during postoperative hospitalization, greatest decrease in hemoglobin from preoperative to postoperative values, and blood transfusion rates.Results
The minimum postoperative hemoglobin level was significantly lower for TISSEEL patients compared with that of IV TXA patients (P = .021) and no different when compared with that of control patients (P = .134). Patients receiving fibrin sealant had a greater hemoglobin level decrease compared with that of IV TXA (P = .029) and control (P = .036). Postoperative transfusion rates were no different for the group receiving TISSEEL compared with those of control (P = .375) and were statistically greater when compared with those of IV TXA (P = .002).Conclusion
TISSEEL fibrin sealant does not reduce postoperative blood loss or transfusions; however, IV TXA reduced postoperative transfusions compared with TISSEEL and control. Therefore, TXA is recommended to reduce perioperative blood loss, while, utilization of a fibrin sealant requires further refinements before being adopted for routine use in THA. 相似文献13.
Christopher Del Balso Matthew G. Teeter Sok C. Tan Brent A. Lanting James L. Howard 《The Journal of arthroplasty》2018,33(1):268-272
Background
Trunnionosis at the modular head-neck taper interface in metal-on-polyethylene total hip arthroplasty (MoP THA) has been shown to occur, and represents a potential mode of MoP THA failure. The purpose of the present investigation is to elucidate differences in fretting and corrosion at the head-neck taper interface of prostheses retrieved from bipolar hemiarthroplasty (BH) and MoP THA.Methods
A retrieval analysis of BH and MoP THA prostheses featuring a single taper design from a single manufacturer and in vivo for a minimum 2 years was performed. Fifteen femoral heads of 28-mm diameter and corresponding femoral stems retrieved from BH were compared with MoP THA implants matched based on time in vivo and head length (28 mm, ?3 mm to 28 mm, +8 mm). Fretting and corrosion damage scoring was completed under stereomicroscopic visualization.Results
Femoral head bore tapers retrieved from BH exhibited decreased overall fretting (P = .02), when compared to those retrieved from MoP THA. Total corrosion scores for all retrieved implants were positively correlated with implantation time (ρ = 0.54, P < .02).Conclusion
Femoral heads retrieved from BH exhibit decreased fretting damage compared to those retrieved from MoP THA. The added articulation in BH implants may decrease torque produced at the head-neck taper junction, thereby decreasing fretting. Increased fretting damage in implants from MoP THA is not associated with increased corrosion in 28-mm heads of this taper design. The longer a BH or MoP THA prosthesis is implanted, the greater the risk of damage due to corrosion. 相似文献14.
Michael A. Gaudiani Peter B. White Narges Ghazi Amar S. Ranawat Chitranjan S. Ranawat 《The Journal of arthroplasty》2018,33(2):590-594
Background
Bearing surface wear and osteolysis are major factors limiting the durability of total hip arthroplasty (THA). Second generation annealed highly cross-linked polyethylene (HXLPE) and ceramics were introduced to THA for their excellent wear rates. However, there is little data comparing the wear rates of metal and ceramic heads on second generation HXLPE.Methods
Sixty patients who received a noncemented THA with a 32- or 36-mm delta ceramic head were matched with 60 THAs with a 32- or 36-mm metal head based on gender, head size, follow-up, and University of California, Los Angeles activity score. Linear and volumetric wear rates were measured.Results
At mean 6-year follow-up, the mean linear wear rates were 0.012 mm/y (standard deviation [SD] 0.045; 95% confidence interval [CI] 0.001-0.024) and 0.018 mm/y (SD 0.025; 95% CI 0.012-0.025) for the ceramic and metal groups, respectively (P = .724). The mean volumetric wear rates for the ceramic and metal head groups were 11.9 (SD 43.0; 95% CI 0.7-23.0) and 17.3 (SD 23.9; 95% CI 11.1-23.4), respectively. No significant differences were detectable in either the mean linear or volumetric wear rates (P = .380 and P = .398, respectively).Conclusion
Second generation HXLPE had low wear rates and we were unable to detect a significant difference in wear rates with 32- or 36-mm metal and ceramic heads. We believe that this is due to the excellent tribological properties of second generation HXLPE. We continue to use ceramic as standard of care because of issues of trunnionosis with metal heads. 相似文献15.
Jean Y. Lazennec Dominique Folinais Caroline Florequin Aidin E. Pour 《The Journal of arthroplasty》2018,33(5):1562-1566
Background
This study assessed the correlation among the patients' perception of the leg length discrepancy (LLD) after total hip arthroplasty (THA) and the anatomical and functional leg length, pelvic and knee alignments, and foot height.Methods
Patients without significant spinal pathology or previous spine or lower extremity surgery who underwent primary THA (101 patients) were evaluated using EOS images obtained in standing position. All 3-dimensional measures were evaluated and compared for the repeatability and reproducibility and correlation with patients' perception of leg length.Results
In our study, the anatomical femoral length (odds ratio [OR] 0.9, P = .732) did not correlate with patients' perception of the LLD, but other variables like the distance from the middle of the tibial plafond to ground (OR 14.3, P = .003), sagittal knee alignment (OR 1.07, P = .021), and pelvic obliquity (OR 1.05, P = .021) were correlated with the patients’ perception of LLD.Conclusion
The LLD is a multifactorial complication. We found that the anatomical femoral length as the factor that can be modified with THA technique or choice of prosthesis is not the only important factor. We recommend comprehensive physical examination to investigate spinal deformities, pelvic obliquity, abductor muscle weakness, sagittal and coronal knee alignment, and foot deformity in patients who complain of LLD after THA. 相似文献16.
Fanny L. Loth Johannes M. Giesinger Karlmeinrad Giesinger Deborah J. MacDonald A. Hamish R.W. Simpson Colin R. Howie David F. Hamilton 《The Journal of arthroplasty》2017,32(9):2755-2761
Background
Patient-reported outcome scores gain increasing importance in quantifying clinical success and procedure remuneration. Our aim was to evaluate the impact of comorbidity on joint-specific outcome and general health in patients undergoing elective total hip arthroplasty (THA).Methods
Longitudinal data on THA procedures were used to evaluate the association between comorbidity and surgical outcome in terms of joint-specific measures and general health (Forgotten Joint Score-12 [FJS-12], Oxford Hip Score [OHS], and Short Form-12) at 1-year follow-up. Comorbidities comprised the Charlson comorbidity index (CCI), low back pain (LBP), pain from other joints (POJ), and body mass index.Results
We analyzed data from 251 THA patients (age: 67.7 ± 11.8 years; 58.2% female). Most common conditions were POJ (75.9%), LBP (55.1%), connective tissue disease (12.1%), and diabetes (5.6%). With regard to postoperative improvement, we did not find statistically significant differences between patients with or without CCI comorbidities (FJS-12, +38.7 vs +43.2, P = .370; OHS, +15.6 vs +17.9, P = .100) or POJ (FJS-12, +39.9 vs +45.1, P = .325; OHS, +17.3 vs +16.6, P = .645). Patients with LBP showed less improvement on the FJS-12 than those without LBP (+35.6 vs +49.1; P = .002), whereas no difference was found for the OHS (+17.9 vs +16.5; P = .266).Conclusion
Patients with comorbid conditions report lower preoperative and postoperative outcome scores compared with patients with no such conditions; however, there was no statistically significant association of CCI comorbidities and POJ with postoperative improvement in joint-specific outcomes. LBP was found to have a negative impact on postoperative improvement in terms of joint awareness. 相似文献17.
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18.
19.
William H. Trousdale Matthew P. Abdel Anthony Viste Robert T. Trousdale John J. Callaghan Daniel J. Berry 《The Journal of arthroplasty》2017,32(6):2000-2004
Background
Periprosthetic femur fractures after primary and revision total hip arthroplasty (THA) are one of the most common long-term reasons for reoperation after THA. Previous investigations have analyzed the incidence and risk factors of these fractures. No previous study, however, has analyzed a variation in periprosthetic femur fractures between meteorologic seasons. The aim of this study was to compare the incidence of periprosthetic femur fractures after primary and revision THAs depending on the meteorologic season.Methods
We identified 8920 patients (10,672 hips) who underwent primary THAs and 1830 patients (1998 hips) who underwent revision THAs at our institution between 1995 and 2011. All patients resided in the Upper Midwest at the time of surgery. Patients who experienced periprosthetic femur fractures were identified and categorized based on the meteorologic season. A Cox model was used to assess the association of seasonality with the risk of fracture.Results
During the study period, 165 primary THAs and 80 revision THAs sustained a periprosthetic femur fracture. Using winter as a reference, the risk of a periprosthetic femur fracture after primary THA was not statistically higher in the spring (hazard ratio [HR] = 1.3; P = .2), autumn (HR = 1.4; P = .2), and summer (HR = 1.415; P = .1). Similarly, the risk of periprosthetic femur fracture after revision THA was not statistically higher in the spring (HR = 0.9; P = .6), autumn (HR = 0.6; P = .1), and summer (HR = 0.9; P = 1.0).Conclusion
The risk of periprosthetic femur fracture after primary and revision THA does not significantly differ between meteorologic seasons. 相似文献20.
Moritz M. Innmann Michael W. Maier Marcus R. Streit George Grammatopoulos Thomas Bruckner Tobias Gotterbarm Christian Merle 《The Journal of arthroplasty》2018,33(1):156-161