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1.
Hisashi Ikutomo Koutatsu Nagai Keiichi Tagomori Namika Miura Norikazu Nakagawa Kensaku Masuhara 《The Journal of arthroplasty》2018,33(7):2268-2272
Background
We investigated the incidence and circumstances related to falls in patients before and after total hip arthroplasty (THA), and compared them with those in an age-matched control group.Methods
This is a prospective cohort study. A total of 140 women with severe hip osteoarthritis (OA) who underwent THA (OA group) and a control cohort of 319 age-matched healthy women were analyzed. We investigated the incidence and circumstances of falls before THA and during the first year after surgery. We assessed the Harris Hip Score and investigated hip pain and ambulatory ability using a self-administered questionnaire.Results
The incidence of at least one fall during the first year after THA in the OA group (30.0%) was significantly higher than that in the control group (13.5%) (P < .001), as were the rates of indoor falls (50.0%) and falls during daytime (66.2%). Although the incidence of fall-induced injuries after THA (37.8%) was significantly lower than that in the control group (62.5%), 5.9% of patients who experienced a fall developed a fracture. No significant differences were found in the number and circumstances of falls before and after THA, with 31.4% and 30.0% of the OA group reporting at least one fall in the 12 months before and after surgery, respectively. Self-reported pain, ambulation, and Harris Hip Score significantly improved after THA.Conclusion
Women undergoing THA have an increased risk of falls during the first year after surgery. Clinicians should suggest preventive measures during rehabilitation to prevent falling in post-THA women. 相似文献2.
Connor A. King David C. Landy John M. Martell Hue H. Luu Lewis L. Shi Michael J. Lee 《The Journal of arthroplasty》2018,33(12):3768-3772
Background
Although a history of lumbar spine fusion (LSF) is associated with increased dislocation risk following total hip arthroplasty (THA), the effect of LSF following THA is not well described. This study sought to describe the dislocation-free survival experience of patients with THA undergoing LSF, compare this to similar patients not undergoing LSF, and assess factors associated with dislocation risk following LSF.Methods
Center for Medicare Service billing data from 2005 to 2014 was analyzed utilizing the PearlDiver platform. Patients without evidence of hip instability, defined as no dislocation event within at least 6 months following THA, were identified and stratified by having subsequent LSF. Kaplan-Meier curves were used to describe dislocation-free survival of these groups and assess factors associated with dislocation.Results
Among 17,223 patients without history of hip instability following THA, there was no spike in dislocations following LSF with patients having a persistent and stable rate of dislocation of 0.7% per year. This experience was of similar shape but increased hazard when compared to that of 863,182 patients not undergoing LSF who had a dislocation rate of 0.4% per year (P < .001). Dislocations were not strongly associated with gender, age, comorbidities, or fusion length.Conclusion
Patients without evidence of hip instability following THA subsequently undergoing LSF do not have a spike in dislocations in the perioperative period but do assume a persistently elevated risk of dislocation. Future research should identify factors responsible for this increased risk to determine whether they may be modifiable. 相似文献3.
Guo Chen Yong Nie Jinwei Xie Guorui Cao Qiang Huang Fuxing Pei 《The Journal of arthroplasty》2018,33(5):1437-1441
Background
Few studies investigate gait characteristics and symmetry of developmental dysplasia of the hip patients (Crowe II and III) after total hip arthroplasty (THA) whose leg length discrepancy (LLD) is within 20 mm. Our study aimed to explore whether gait analysis parameters in these patients can return to the level of unaffected people and how bodies compensate for the discrepancy.Method
A total of 45 patients who underwent cementless THA and 20 healthy controls were involved in this study prospectively. Group 1 includes patients whose LLD is <10 mm and group 2 includes patients whose LLD is 10-20 mm. Gait analysis was performed during 5-year midterm postoperative follow-up.Result
The parameters, particularly the range of motion (ROM) in the hip, in both experimental groups (1 and 2) were significantly lower than healthy control group. For the nonoperated side, group 1 displayed significantly reduced ROM in the hip and knee compared with the age-matched controls. This was not observed in group 2. Greater bilateral symmetry can be seen in group 1 compared with group 2.Conclusion
Despite LLD being limited to within 20 mm, THA patients in both groups showed a less efficient gait than that of healthy controls on 5-year midterm follow-up. The increased ROM in the nonoperated hip may act as a compensatory mechanism. LLD of 10 mm may be a cutoff value to assess whether compensation occurs in the contralateral limb. Reconstruction of equal limb length is recommended when surgeons perform THA for dysplastic hips. 相似文献4.
Huiwu Li Yao Yuan Jiawei Xu Yongyun Chang Kerong Dai Zhenan Zhu 《The Journal of arthroplasty》2018,33(3):794-799
Background
A number of methods for reduction in high hip dislocation in total hip arthroplasty (THA) are time-consuming and laborious, and require great surgical skills. This study aimed to introduce a new reduction technique to achieve rapid, safe, and easy reduction in high hip dislocation.Methods
We retrospectively reviewed 74 THA patients (82 hips; 44 women, 30 men) with severe hip dysplasia who underwent direct leverage using a Hohmann retractor into the anatomical acetabulum without femoral shortening osteotomy between September 2007 and January 2014. Forty-nine hips were classified as Crowe III and 33 hips were classified as Crowe IV. The mean follow-up period was 5.1 years (range 2-8).Results
Mean Harris Hip Score increased from 42.1 (range 24-71) before surgery to 89.9 (range 76-100) at final follow-up examination. The legs were lengthened by a mean of 3.0 cm (range 1.1-5.5) and 2.5 cm (range 1.1-3.5) in Crowe III hips and 3.6 cm (range 1.9-5.5) in Crowe IV hips postoperatively. The average leg-length discrepancy at the final follow-up examination was 0.4 cm (standard deviation 0.5 cm). One greater trochanteric fracture occurred during the hip reduction process. One patient developed femoral nerve palsies and recovered completely at 3 weeks postoperatively.Conclusion
Direct leverage using the Hohmann retractor for the reduction in high hip dislocation in THA without femoral shortening osteotomy is simple, safe, and effective. 相似文献5.
Jourdan M. Cancienne Brian C. Werner Surajudeen A. Bolarinwa James A. Browne 《The Journal of arthroplasty》2017,32(8):2519-2522
Background
Two-stage exchange arthroplasty remains the preferred approach to treatment of chronic periprosthetic joint infection (PJI) following total hip arthroplasty (THA). The objective of the present study is to investigate the fate of antibiotic spacers placed for periprosthetic joint infection after THA and evaluate risk factors for outcomes other than reimplantation.Methods
A national database was queried for Medicare patients who underwent removal of an infected hip prosthesis and placement of an antibiotic spacer. Patients with a study end point within 1 year postoperatively were included: (1) in-hospital mortality, (2) repeat debridement without reimplantation within 1 year, (3) resection arthroplasty, and (4) reimplantation of a hip arthroplasty. Independent patient-related risk factors for these end points were evaluated with a multivariate logistic regression analysis.Results
A total of 7146 patients met all inclusion and exclusion criteria. Within 1 year postoperatively, 464 patients (6.5%) died in a hospital setting, 775 patients (10.8%) had a repeat debridement procedure, 404 patients (5.7%) had a resection arthroplasty, 1202 patients (16.8%) retained their spacers, and the remaining 4301 patients (60.2%) were reimplanted at an average of 124.4 ± 39.3 days. Numerous independent patient-related risk factors for these were identified.Conclusion
At 1 year only 60% of patients undergo reimplantation. One-sixth of patients retain their spacer and approximately 10% require repeat debridement. Death occurred in at least 6% of the population. Several independent patient-related risk factors exist for repeat debridement, no reimplantation or death within 1 year following index THA removal. 相似文献6.
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7.
Background
Considerable blood loss which requires transfusion is frequently reported after total hip and knee arthroplasties (THA and TKA). The purpose of this study is to review the transfusion rates in contemporary THA and TKA with optimized perioperative protocols including minimized surgical trauma and optimal perioperative patient care.Methods
This retrospective study included 1442 consecutive patients receiving either a primary THA or a TKA from the same high-volume surgeon between January 2008 and December 2015. Demographics and surgical data were collected from patients' journals. Estimated blood loss, decline in hemoglobin, and use of transfusion were registered.Results
One (0.0013%) THA and 3 (0.0044%) TKAs required blood transfusion postoperatively. Average measured bleeding was 253 mL ± 142 and 207 mL ± 169 in THA and TKA, respectively. Average decline in hemoglobin was 23.5 g/L ± 11.4 and 22.9 g/L ± 11.6 for THA and TKA, respectively.Conclusion
In contemporary THA and TKA, perioperative protocols and patient optimization can decrease the rate of blood transfusion to near zero. 相似文献8.
Ana Mata-Fink Daniel J. Philipson Benjamin J. Keeney Dipak B. Ramkumar Wayne E. Moschetti Ivan M. Tomek 《The Journal of arthroplasty》2017,32(4):1241-1244
Background
Failure of metal-on-metal (MOM) total hip arthroplasty (THA) bearings is often accompanied by an aggressive local reaction associated with destruction of bone, muscle, and other soft tissues around the hip. Little is known about whether patient-reported physical and mental function following revision THA in MOM patients is compromised by this soft tissue damage, and whether revision of MOM THA is comparable with revision of hard-on-soft bearings such as metal-on-polyethylene (MOP).Methods
We identified 75 first-time MOM THA revisions and compared them with 104 first-time MOP revisions. Using prospective patient-reported measures via the Veterans RAND-12, we compared Physical Component Score and Mental Component Score function at preoperative baseline and postoperative follow-up between revision MOM THA and revision MOP THA.Results
Physical Component Score did not vary between the groups preoperatively and at 1 month, 3 months, and 1 year postoperatively. Mental Component Score preoperatively and 1 and 3 months postoperatively were lower in patients in the MOM cohort compared with patients with MOP revisions (baseline: 43.7 vs 51.3, P < .001; 1 month: 44.9 vs 53.3, P < .001; 3 months: 46.0 vs 52.3, P = .016). However, by 1 year, MCS scores were not significantly different between the revision cohorts.Conclusion
Postrevision physical function in revised MOM THA patients does not differ significantly from the outcomes of revised MOP THA. Mental function is markedly lower in MOM patients at baseline and early in the postoperative period, but does not differ from MOP patients at 1 year after revision. This information should be useful to surgeons and physicians facing MOM THA revision. 相似文献9.
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10.
Background
Parkinson disease (PD) results in severe limitation in ambulation caused by abnormality of gait and posture. The rate of complications, including fractures and dislocation after total hip arthroplasty (THA), can be higher among these patients. The goal of this study was to investigate the long-term outcomes of primary and revision THAs with cementless dual mobility implants.Methods
This retrospective study examines 59 PD patients who had surgery between 2002 and 2012. All the primary cases were performed for osteoarthritis and all patients received cementless acetabular implants with dual mobility bearing surface. The femoral stem was cemented in 4 patients who underwent revision surgery. The mean follow-up time was 8.3 years (4-14 years).Results
Good to excellent pain relief was achieved in 53 of 57 patients at the 2-year follow-up and in 40 of 47 patients at their latest follow-up. The most common medical complication was cognitive impairment (12 of 57 patients). One patient sustained an intraprosthetic hip dislocation 9 years after surgery, which required revision. Four patients sustained periprosthetic femoral fractures with well-fixed stem, requiring open reduction and internal fixation. The disability had increased in 68% of the patients in the latest follow-up visit.Discussion
Our study shows that elective primary or revision THA using cementless implants with dual mobility bearing surface in patients with PD provides satisfactory long-term outcomes, although many of these patients may see a general worsening of their activities over time due to PD. 相似文献11.
Ran Schwarzkopf Garwin Chin Kelvin Kim Dermot Murphy Antonia F. Chen 《The Journal of arthroplasty》2017,32(3):862-871
Background
The incidence of hip fractures is growing with the increasing elderly population. Typically, hip fractures are treated with open reduction internal fixation, hemiarthroplasty, or total hip arthroplasty (THA). Failed hip fracture fixation is often salvaged by conversion THA. The total number of conversion THA procedures is also supplemented by its use in treating different failed surgical hip treatments such as acetabular fracture fixation, Perthes disease, slipped capital femoral epiphysis, and developmental dysplasia of the hip. As the incidence of conversion THA rises, it is important to understand the perioperative characteristics of conversion THA. Some studies have demonstrated higher complication rates in conversion THAs than primary THAs, but research distinguishing the 2 groups is still limited.Methods
Perioperative data for 119 conversion THAs and 251 primary THAs were collected at 2 centers. Multivariable linear regression was performed for continuous variables, multivariable logistic regression for dichotomous variables, and chi-square test for categorical variables.Results
Outcomes for conversion THAs were significantly different (P < .05) compared to primary THA and had longer hospital length of stay (average 3.8 days for conversion THA, average 2.8 days for primary THA), longer operative time (168 minutes conversion THA, 129 minutes primary THA), greater likelihood of requiring metaphysis/diaphysis fixation, and greater likelihood of requiring revision type implant components.Conclusion
Our findings suggest that conversion THAs require more resources than primary THAs, as well as advanced revision type components. Based on these findings, conversion THAs should be reclassified to reflect the greater burden borne by treatment centers. 相似文献12.
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13.
Massimo Mariconda Giovangiuseppe Costa Mario Misasi Pasquale Recano Giovanni Balato Maria Rizzo 《The Journal of arthroplasty》2017,32(2):447-452
Background
Total hip arthroplasty (THA) has not only been associated with best functional outcomes but also with higher dislocation risk when compared with bipolar hemiarthroplasty (HA). The functionality and activities of daily living (ADL) of patients treated with THA or HA for intracapsular hip fracture (IHF) have been scarcely investigated in comparison with the preoperative status.Methods
Two comparable groups of 60 patients with an IHF who had undergone either THA or bipolar HA were created matching several preoperative characteristics. Matched variables included age, gender, body mass index, surgical delay, American Society of Anesthesiologists class, comorbidity, cognitive status, educational status, prefracture functional status, and radiographic fracture classification. Patients were prospectively followed up for 1 year using telephone interviews.Results
The ambulatory ability (5-item scale) and ADL Index significantly decreased in both the groups in comparison with the prefracture status at the 4-month and 1-year follow-up. The need for walking aids (5-item scale) at 4 months was significantly higher among patients who had undergone HA. Lower scores on the ADL Index were recorded among patients with HA in comparison with those with THA at 4 months and 1 year. No significant differences in ambulatory ability, complication rate, and mortality were detected between the 2 groups although HA and THA were associated with a tendency to a higher prevalence of general and local complications, respectively.Conclusion
THA provides better short-term results in terms of ADLs and allows early discontinuation in the use of walking aids as compared with bipolar HA in elderly cognitively intact patients with IHF. 相似文献14.
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15.
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16.
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17.
Hilal Maradit Kremers Stephanie R. Schilz Holly K. Van Houten Jeph Herrin Karl M. Koenig Kevin J. Bozic Daniel J. Berry 《The Journal of arthroplasty》2017,32(3):750-755
Background
The utilization of hip arthroscopy continues to increase in the United States. The purpose of this study was to examine trends in hip arthroscopy procedures and outcomes.Methods
We performed a retrospective cohort study using Optum Labs Data Warehouse administrative claims data. The cohort comprised 10,042 privately insured enrollees aged 18-64 years who underwent a hip arthroscopy procedure between 2005 and 2013. Utilization trends were examined using age-specific, sex-specific, and calendar-year-specific hip arthroscopy rates. Outcomes were examined using the survival analysis methods and included subsequent hip arthroscopy and total hip arthroplasty (THA).Results
Hip arthroscopy rates increased significantly over time from 3.6 per 100,000 in 2005 to 16.7 per 100,000 in 2013. The overall 2-year cumulative incidence of subsequent hip arthroscopy and THA was 11% and 10%, respectively. In the subset of patients in whom laterality of the subsequent procedure could be determined, about half of the subsequent hip arthroscopy procedures (46%) and almost all of the THA procedures (94%) were on the same side. Decreasing age was significantly associated with the risk of subsequent arthroscopy (P < .01), whereas increasing age was significantly associated with the subsequent risk of THA (P < .01). The 5-year cumulative incidence of THA reached as high as 35% among individuals aged 55-64 years.Conclusion
The utilization of hip arthroscopy procedures increased dramatically over the last decade in the 18-64-year-old privately insured population, with the largest increase in younger age-groups. Future studies are warranted to understand the determinants of the large increase in utilization of hip arthroscopy and outcomes. 相似文献18.
Megan Richards Hussein Alyousif Jung-Kyong Kim Stéphane Poitras John Penning Paul E. Beaulé 《The Journal of arthroplasty》2018,33(10):3206-3210
Background
Outpatient hip arthroplasty is being performed more routinely; however, safety remains a concern. The purpose of this study was to compare the rate of adverse events of outpatient total hip arthroplasty (THA) and assess barriers to discharge.Methods
We examined 136 patients who underwent unilateral THA by one surgeon and were discharged on the same day of surgery. Using propensity matching, 136 inpatients who received the same procedure, and were discharged on postoperative day one or later, were identified. For each cohort, 90-day occurrence of adverse events, readmissions, and emergency visits were recorded and compared. Adverse events were graded using the OrthoSAVES tool. A secondary objective was to assess potential barriers to same-day discharge.Results
Within 90 days postoperatively, 12 outpatients (8.82%) and 14 inpatients (10.29%) developed an adverse event. There were no significant differences between the rate or severity of adverse events between the 2 groups and no serious adverse events in either group. In the outpatient group, there was a correlation between the dosage of spinal anesthetic (bupivacaine) given and time required to stay in postanesthetic care unit postoperatively.Conclusion
When comparing the 2 groups, there were no differences in adverse events at 90 days. At our center, in the appropriate patient population, outpatient THA is a safe and cost-effective option. A potential barrier to mobility postoperatively and successful same-day discharge is the time required to stay in postanesthetic care unit postoperatively, which was significantly correlated with an increased dose of spinal anesthetic given in our outpatient cohort. 相似文献19.
Christina I. Esposito Kaitlin M. Carroll Peter K. Sculco Douglas E. Padgett Seth A. Jerabek David J. Mayman 《The Journal of arthroplasty》2018,33(5):1449-1454
Background
Sitting radiographs have been used as a pre-operative tool to plan patient-specific total hip arthroplasty (THA) component position that would improve hip stability. Previous work has demonstrated that spinal mobility may impact functional acetabular position when seated. We sought to determine whether patients who dislocate following THA have different sitting spinopelvic alignment or acetabular component orientation compared to patients who did not dislocate.Methods
A consecutive series of 1000 patients underwent post-operative low-dose biplanar spine-to-ankle lateral radiographs in standing and sitting positions 1 year following THA. Twelve patients (1% of all patients) experienced hip dislocation. Patients were categorized as having normal lumbar spines (without radiographic arthrosis) or as having lumbar multi-level degenerative disc disease. Measurements of spinopelvic alignment parameters (including sacral slope, lumbar lordosis, and proximal femur angles) and acetabular component orientation in sitting position (functional inclination and functional anteversion) were performed.Results
Patients who dislocated had significantly less spine flexion, less change in pelvic tilt, and more hip flexion from standing to sitting positions compared to patients with normal spines. In sitting position, dislocators had acetabular components with less functional inclination and less functional anteversion.Conclusion
This study demonstrates that patients with fixed spinopelvic alignment from standing to sitting position are at higher risk of hip dislocation. Imaging patients from standing to sitting position using this technique can provide valuable information on whether a patient has fixed spinopelvic alignment with postural changes and is therefore at higher risk of dislocation. 相似文献20.
Jie J. Yao Hilal Maradit Kremers Cathy D. Schleck Dirk R. Larson Jasvinder A. Singh Daniel J. Berry David G. Lewallen 《The Journal of arthroplasty》2017,32(11):3319-3321