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1.
Impingement of the iliopsoas muscle after total hip arthroplasty is a potential cause of postoperative groin pain. In addition, hematoma within the iliopsoas sheath has been documented as a cause of groin pain in patients on long-term anticoagulation. We present the case of a patient on long-term anticoagulation presenting after total hip arthroplasty with recurrent, symptomatic iliopsoas sheath hematomas. We believe this was due to iliopsoas impingement caused by a malpositioned acetabular component. His pain was relieved after revision of the acetabular component and debridement of the inflamed psoas tendon. 相似文献
2.
Leonard T. Buller Luke G. Menken Evan J. Hawkins Marcel A. Bas Gilbert C. Roc H. John Cooper Jose A. Rodriguez 《The Journal of arthroplasty》2021,36(5):1772-1778
BackgroundThe objective of this study is to evaluate the incidence, natural history, response to treatment, and risk factors for anterior iliopsoas impingement (AIPI) after direct anterior approach (DAA) total hip arthroplasty (THA).MethodsBetween January 1, 2009 and January 4, 2014, 600 patients (655 hips) who underwent primary DAA THA were retrospectively reviewed. AIPI incidence was calculated. Natural history and response to a stepwise treatment approach was assessed. Radiographic anterior acetabular component overhang was measured. Asymptomatic controls were used to identify risk factors for the development of AIPI.ResultsIn total, 518 patients (559 hips) met the inclusion criteria. The incidence of AIPI was 32/559 (5.7%). Symptom resolution occurred in 22/32 (68.8%) patients at final follow-up. Nonoperative management was successful in 15/32 (46.9%) patients. Operative intervention resulted in symptom resolution in 5/8 (62.5%) patients. On univariate analysis, female gender (odds ratio [OR] 2.79), acetabular component to native femoral head diameter ratio above 1.1 (OR 3.85), and any measurable overhang (OR 7.07) significantly raised the risk of AIPI, while increasing native femoral head diameter was protective for AIPI (OR 0.83).ConclusionAIPI is a cause of groin pain after DAA THA, which often improves with conservative measures. Significant predisposing factors for AIPI include female gender, small native femoral head diameter, increased acetabular component to femoral head diameter ratio, and most notably, any measurable acetabular component overhang.Level of EvidenceLevel III, retrospective cohort study. 相似文献
3.
Courtney D. Bell Mark B. Wagner Lian Wang Kenneth R. Gundle Lloyd E. Heller Hanne A. Gehling Paul J. Duwelius 《The Journal of arthroplasty》2019,34(7):1498-1501
BackgroundIliopsoas impingement after total hip arthroplasty (THA) occurs in up to 4.3% of patients resulting in functional groin pain. Operative treatment historically has included open iliopsoas tenotomy or acetabulum revision. We present a large single surgeon series of patients treated with endoscopic iliopsoas tenotomy for iliopsoas impingement after THA to evaluate the effectiveness and risks.MethodsA consecutive series of 60 patients with iliopsoas impingement after THA treated with endoscopic iliopsoas tenotomy was retrospectively evaluated. Outcomes assessed were resolution of pain, change in Hip Outcome Score (HOS), and complications. Radiographs were reviewed by a musculoskeletal radiologist to evaluate component positioning and to compare with a control cohort.ResultsAt last follow-up (mean 5.5 months), 93.3% of patients had resolution of pain. The HOS activities of daily living (ADL) subscale mean was 57.5 (range 10.9-89.3, standard deviation [SD] 18.8) preoperatively and 71.6 (range 14.1-100, SD 26.1) postoperatively (P = .005). The HOS sports subscale mean was 37.3 (range 0-83.3, SD 24.0) preoperatively and 58.1 (range 0-100, SD 33.2) postoperatively (P = .002). One complication was reported, a postoperative hematoma managed conservatively. Body mass index and increased offset were associated with iliopsoas symptoms after THA in this series.ConclusionEndoscopic iliopsoas tenotomy after THA had a 93.3% resolution of pain, clinically important improvements in HOS, and low rate of complications. Endoscopic tenotomy should be considered as a treatment option in patients with iliopsoas impingement after THA. 相似文献
4.
Takuro Ueno Tamon Kabata Yoshitomo Kajino Daisuke Inoue Takaaki Ohmori Hiroyuki Tsuchiya 《The Journal of arthroplasty》2018,33(10):3288-3296.e1
Background
Groin pain and functional limitations may occur after total hip arthroplasty (THA) due to iliopsoas impingement (IPI). We aimed to determine the risk factors and thresholds of cup protrusion for symptomatic IPI.Methods
This retrospective case-control study evaluated 569 primary THAs performed by a single surgeon in a single center. In all THAs, the cup was inserted with the assistance of the computed tomography–based navigation system. Twenty-two THAs (3.9%) were identified to have symptoms of IPI and included in the IPI group. Control group 1 comprised 547 THAs. Control group 2 (66 THAs) was formed by recruiting 3 data-matched controls per patient in control group 1. Risk factors for IPI were assessed in the IPI group and control group 1. Further analysis was performed in the IPI group and control group 2 to evaluate cup protrusion parameters measured on computed tomography images and radiographs.Results
Multivariate logistic regression analysis confirmed that the anterolateral approach was associated with a higher risk of IPI (odds ratio [OR], 4.20); however, its goodness of fit was low. Axial protrusion length ≥12 mm (OR, 23.29; sensitivity = 72.7; specificity = 91.0) and sagittal protrusion length ≥4 mm (OR, 61.60; sensitivity = 86.4; specificity = 78.8) were determined as independent predictors of symptomatic IPI. In the linear regression analyses, higher native acetabular version and lower cup anteversion and inclination were related to cup protrusion.Conclusions
This study determined the thresholds of cup protrusion length for IPI and identified associated factors increasing cup protrusion, which are useful for surgeons in determining cup position and alignment. 相似文献5.
Postoperative pain after total hip arthroplasty can have a wide range of underlying causes. Iliopsoas tendonitis secondary to the impingement of this tendon is a relatively rare cause of pain after arthroplasty. This condition is characterized by pain on active flexion and an absence of signs or symptoms of loosening or infection. In this report, we describe the case of a patient who had signs and symptoms of iliopsoas tendonitis secondary to the protrusion of an acetabular fixation screw through the ilium after primary total hip arthroplasty. Nonoperative treatment was ineffective, and the patient ultimately underwent surgical removal of the screw. The severity of the patient's symptoms decreased significantly after the operation. 相似文献
6.
《The Journal of arthroplasty》2020,35(11):3410-3416
BackgroundAlthough extended trochanteric osteotomy (ETO) is an effective technique for femoral stem removal and for the concomitant management of proximal femoral deformities, complications including persistent pain, trochanteric nonunion, and painful hardware can occur.MethodsThe US National Library of Medicine (PubMed/MEDLINE) and the Cochrane Database of Systematic Reviews were queried for publications utilizing the following keywords: “extended” AND “trochanteric” AND “osteotomy.”ResultsNineteen articles were included in the present study with 1478 ETOs. The mean overall union rate of the ETO was 93.1% (1377 of 1478 cases), while the overall rate of radiographic femoral stem subsidence >5 mm was 7.1% (25 of 350 cases). ETO union rates and femoral stem subsidence rates were similar between patients with periprosthetic fractures treated with total hip arthroplasty (THA) revision and ETO and patients treated with THA revision and ETO for reasons other than fractures. There was limited evidence that prior femoral cementation and older age might negatively influence ETO union rates.ConclusionThere was moderate quality evidence to show that the use of ETO in aseptic patients undergoing single-stage revision THA is safe and effective, with a 7% rate of ETO nonunion and subsidence >5 mm in 7%. ETO can be safely used in cases with periprosthetic fractures in which stem fixation is jeopardized and a reimplantation is required. A well-conducted ETO should be preferred in selective THA revision cases to prevent intraoperative femoral fractures which are associated with deteriorated clinical outcomes. The use of trochanteric plate with cables should be considered as the first choice for ETO fixation. 相似文献
7.
《The Journal of arthroplasty》2023,38(8):1571-1577
BackgroundRevision total hip arthroplasty (THA) presents a greater risk to patients than primary THA, and surgical approach may impact outcomes. This study aimed to summarize acetabular revisions at our institution and to compare outcomes between direct anterior and posterior revision THA.MethodsA series of 379 acetabular revision THAs performed from January 2010 through August 2022 was retrospectively reviewed. Preoperative, perioperative, and postoperative factors were summarized for all revisions and compared between direct anterior and posterior revision THA.ResultsThe average time to acetabular revision THA was 10 years (range, 0.04 to 44.1), with mechanical failure (36.7%) and metallosis (25.6%) being the most prevalent reasons for revision. No differences in age, body mass index, or sex were noted between groups. Anterior revision patients had a significantly shorter length of stay (2.2 versus 3.2 days, P = .003) and rate of discharge to a skilled nursing facility (7.5 versus 25.2%, P = .008). In the 90-day postoperative period, 9.2% of patients returned to the emergency department (n = 35) and twelve patients (3.2%) experienced a dislocation. There were 13.2% (n = 50) of patients having a rerevision during the follow-up period with a significant difference between anterior and posterior approaches (3.8 versus 14.7%, respectively, P = .049).ConclusionThis study provides some evidence that the anterior approach may be protective against skilled nursing facility discharge and rerevision and contributes to decreased lengths of stay. We recommend surgeons select the surgical approach for revision THA based on clinical preferences and patient factors. 相似文献
8.
Steven F. Harwin Assem A. Sultan Anton Khlopas Morad Chughtai Nipun Sodhi Nicolas S. Piuzzi Michael A. Mont 《The Journal of arthroplasty》2018,33(5):1494-1500
Background
This study evaluated (1) survivorship, (2) clinical outcomes, (3) complications, and (4) radiographic outcomes of dual mobility (DM) systems when compared to fixed-bearing prostheses in revision total hip arthroplasty (THA).Methods
A cohort of 85 patients who underwent revision THA using DM implants were compared to a prior matching cohort of 170 patients who received fixed-bearing implants. Mean follow-up time was 4 years in the DM cohort and 10 years in the fixed-bearing cohort. Kaplan-Meier analysis was performed to assess survivorships. Clinical outcomes were evaluated using the Harris Hip Score (HHS). Complications and radiographs were evaluated and reported at the final follow-up.Results
Overall aseptic and all-cause survivorships of the DM cohort were 96.5% and 95.3% compared to 94.7% and 93.5% in fixed-bearing cohort (P = .01 for aseptic and all-cause survivorships). The DM cohort had statistically significant higher survivorship when compared at equivalent follow-up interval in the fixed-bearing cohort. There were 3 aseptic (one due to dislocation) and 1 septic revision in the DM cohort compared to 9 aseptic (6 due to dislocation) and 2 septic revisions in the fixed-bearing cohort. Postoperative HHS scores were 88 and 86 points in the DM and fixed-bearing cohorts. However, the difference in mean improvement in HHS scores from preoperative to postoperative (ΔHHS) was not statistically significant (35 vs 34, P = .533). Except for the aforementioned revisions, there were no progressive radiolucencies or osteolysis on radiographic evaluation in both cohorts.Conclusion
DM articulations demonstrated superior survivorship at equal follow-up intervals when compared to fixed-bearing implants and showed a trend toward lower dislocation rates. 相似文献9.
《The Journal of arthroplasty》2023,38(9):1808-1811
BackgroundCannabis use in patients undergoing arthroplasty has increased with ongoing legalization throughout the United States. The purpose of this study was to report total hip arthroplasty (THA) outcomes in patients self-reporting cannabis use.MethodsThere were 74 patients who underwent primary THA from January 2014 to December 2019 at a single institution with minimum 1-year follow-up who had their self-reported cannabis use retrospectively reviewed. Patients who had a history of alcohol or illicit drug abuse were excluded. A match control was conducted based on age; body mass index; sex; Charlson Comorbidity Index; insurance status; and use of nicotine, narcotics, antidepressants, or benzodiazepines to patients undergoing THA who did not self-report cannabis use. Outcomes included Harris Hip Score (HHS), Hip Disability and Osteoarthritis Outcome Score for Joint Reconstruction (HOOS JR), in hospital morphine milligram equivalents (MMEs) consumed, outpatient MMEs prescribed, in hospital lengths of stay (LOS), postoperative complications, and readmissions.ResultsThere was no difference in the preoperative, postoperative, or change in Harris Hip Score or HOOS JR between cohorts. There was also no difference in hospital MMEs consumed (102.4 versus 101, P = .92), outpatient MMEs prescribed (119 versus 156, P = .11) or lengths of stay (1.4 versus 1.5 days, P = .32). Also, readmissions (4 versus 4, P = 1.0) and reoperations (2 versus 1, P = .56) were not different between groups.ConclusionSelf-reported cannabis use does not influence 1-year outcomes after THA. Further studies are warranted to determine the efficacy and safety of perioperative cannabis use after THA to help guide orthopaedic surgeons in counseling patients. 相似文献
10.
《The Journal of arthroplasty》2019,34(7):1435-1440
BackgroundThe purpose of this study was to identify reasons for revision of total hip arthroplasty (THA) in patients who underwent primary THA at or before the age of 35 years. We hypothesized that the reasons for revision in younger patients would be different from the general older population of patients undergoing THA because of the differences in diagnoses, complexity of deformities, and differences in activity level.MethodsData for 108 hips in 82 patients who underwent primary THA at our institution before the age of 35 years from 1982-2007 and subsequently underwent revision THA were reviewed. Operative reports and clinic notes were reviewed to determine baseline characteristics, reason for revision, timing of revision, and components revised.ResultsThe mean age at index surgery was 25.4 years, and mean time from index to revision surgery was 10.1 years. The most common preoperative diagnoses included avascular necrosis, juvenile idiopathic arthritis, developmental dysplasia of the hip, and posttraumatic arthritis. The most common reasons for revision were acetabular loosening (30.1%), femoral loosening (23.7%), and polyethylene wear (24.7%). 8.3% of patients underwent primary THA with highly cross-linked polyethylene, while the remainder of the patients underwent THA when conventional polyethylene was used. There was no statistically significant association between which component(s) were revised and initial fixation (ie cemented or uncemented prosthesis) (P = .26).ConclusionCauses of revision in this population appear to differ from the general THA population. In young patients, acetabular loosening, femur loosening, and polyethylene wear were the most common causes of revision. Instability and infection were less common compared with literature reports of causes of revision in older patients. Findings in this study may be useful in counseling young patients undergoing THA, though results were likely influenced by the use of conventional rather than highly cross-linked polyethylene in this cohort. 相似文献
11.
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12.
《The Journal of arthroplasty》2019,34(10):2511-2518
BackgroundSeveral studies have evaluated the survivorship and clinical outcomes of custom triflange acetabular component (CTAC) usage in complex acetabular revision; however, there remains no consensus on the overall performance of this custom implant design. We therefore performed a systematic review of the literature in order to examine survivorship and complication rate of CTAC usage.MethodsA systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. A comprehensive search of PubMed, MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews was conducted for English articles using various combinations of the keywords “custom triflange,” “custom-made triflange,” “acetabular triflange,” “THA,” “THR,” “revision,” “bone loss,” “bone defect,” and “pelvic discontinuity.”ResultsIn all, 17 articles met our inclusion criteria. A total of 579 CTACs were implanted. The all-cause revision-free survivorship was 82.7%. The overall complication rate was 29%. Dislocation and infection were the most common complications observed with an incidence of 11% and 6.2%, respectively. Nerve injuries following CTAC placement had an incidence of 3.8%. The incidence of CTAC aseptic loosening was 1.7%. Overall, patients had improved outcomes as documented by postoperative hip scores.ConclusionBased on the current data, CTACs have a high complication rate but remain an efficacious treatment option in complex acetabular reconstructions. When dealing with patients with significant acetabular bone loss for revision total hip arthroplasty, surgeons should continue to consider CTACs as a viable option but educate patients as to the increased risk of postoperative complications and reoperations. 相似文献
13.
Nicolas Reina Ayoosh Pareek Aaron J. Krych Mark W. Pagnano Daniel J. Berry Matthew P. Abdel 《The Journal of arthroplasty》2019,34(3):594-603
Background
Utilization of dual-mobility constructs in total hip arthroplasties (THA) has increased in the recent years. Benefits and risks of these implants in terms of reducing dislocations, long-term survivorship, and associated complications are uncertain when compared to non-dual-mobility articulations.Methods
A systematic review of prospective and retrospective studies that compared dual-mobility constructs with controls for primary or revision THAs between 1986 and 2018 was performed. All articles in both English and French were reviewed.Results
Five studies with primary THAs and 6 with revision THAs were analyzed. For primary THAs, the overall rate of dislocation was 0.9% in the dual-mobility group compared to 6.8% in the control group (P < .001) at a mean follow-up of 7.6 years. The odds ratios for the control group to the dual-mobility group were 4.06 (P < .001) for dislocation, 1.18 (P = .87) for revision, 2.97 (P = .04) for revision due to dislocation, 1.67 (P = .57) for infection, 0.6 (P = .53) for fracture, and 1.21 (P = .81) for aseptic loosening. Similarly, for revision THAs, the overall dislocation rates were 2.2% compared to 7.1% (P < .001) at a mean follow-up of 4.1 years. The odds ratios for the control group to the dual-mobility group were 3.59 (P < .001) for dislocation, 2.46 (P < .001) for re-revision, 4.88 (P = .007) for re-revision due to dislocation, 1.51 (P = .32) for infection, 1.18 (P = .81) for fracture, and 2.71 (P = .003) for aseptic loosening.Conclusion
This systematic review of comparative studies supports the efficacy of dual-mobility constructs to minimize dislocation after both primary and revision THAs in addition to excellent mid-term survivorship compared to control constructs. However, further evidence is needed to evaluate the long-term risks and benefits of dual-mobility constructs in the primary and revision THA setting when compared to contemporary conventional implants.Level of Evidence
III, therapeutic. 相似文献14.
Jean-Christophe Chatelet Tarik Ait-Si-Selmi Alain Machenaud Sonia Ramos-Pascual Michel-Henri Fessy 《The Journal of arthroplasty》2021,36(1):261-267
BackgroundFor the past 2 decades, the authors have been using a long tapered cementless stem made of titanium and fully coated with hydroxyapatite for revision total hip arthroplasty. The purpose of this multicentric study is to assess clinical outcomes, radiographic outcomes, re-revision rates, and survival rates of this revision stem at a minimum 5-year follow-up.MethodsThe records of a multicentric continuous series of 335 adults undergoing revision total hip arthroplasty using the Corail revision stem (DePuy, Leeds, UK) between 2000 and 2012 were retrospectively reviewed. The Harris Hip Score, Oxford Hip Score, and Engh score were recorded. Survival was assessed using the Kaplan-Meier method and cumulative incidence function.ResultsSeventy-seven patients died with their revision stem in place, 47 could not be contacted, and 22 had stem re-revisions. This left a final cohort of 201 patients, aged 70 ± 12 years at revision surgery, with a body mass index of 26 ± 4. The Kaplan-Meier survival was 93.9% for re-revision of any component for any reason, 96.7% for re-revision of the stem for any reason, and 99.3% for re-revision of the stem for aseptic reasons. At last follow-up, the Harris Hip Score was 84.8 ± 13.1, the Oxford Hip Score was 21.0 ± 7.8, and the Engh score was 16.4 ± 6.7.ConclusionThe long tapered cementless revision stem had excellent clinical and radiographic outcomes at a minimum follow-up of 5 years. The revision stem enabled restoration of bone stock in femurs with pre-revision bone defects, confirming that the hydroxyapatite coating promotes osseointegration, even in femurs with extensive bone loss.Level of EvidenceLevel IV, retrospective cohort study. 相似文献
15.
Ronald E. Delanois Chukwuweike U. Gwam Nequesha Mohamed Anton Khlopas Morad Chughtai Arthur L. Malkani Michael A. Mont 《The Journal of arthroplasty》2017,32(9):2806-2809
Background
We are reporting on the minimum 5-year outcomes of patients who underwent revision total hip arthroplasty (THA) using a specific highly-porous titanium shell. We assessed (1) aseptic and all-cause survivorship; (2) functional outcomes; (3) complications; and (4) radiographic outcomes.Methods
Two hospital databases were evaluated for patients who underwent revision THA due to component instability or aseptic loosening using a cementless highly-porous titanium shell between September 2006 and December 2011. This yielded 35 patients who had a mean age of 61 years (range 14-88 years). Patients had a mean follow-up of 6 years (minimum 5 years). All-cause and aseptic survivorship of the shell was calculated. Functional outcomes were assessed using the Harris Hip Score. We determined the incidence of postoperative complications and performed radiographic evaluation of pelvic radiographs from regular office visits.Result
The aseptic survivorship of the acetabular component was 97% (95% confidence interval; 8.1-9.5). The all-cause survivorship of the acetabular component was 91% (95% confidence interval; 7.3-8.1). One patient had an aseptic failure and 2 patients had septic failures. The mean postoperative Harris Hip Score was 76 points (range, 61-91 points). Excluding the aseptic and septic failures, there was no osteolysis or progressive radiolucencies present on radiographic evaluation at final follow-up.Conclusion
At a minimum of 5-year follow-up, the highly-porous titanium acetabular revision shell has excellent survivorship and functional outcomes. Although long-term follow-up is needed to further monitor these implants, the results are promising and demonstrate that this prosthesis may be an excellent option for patients undergoing revision THA. 相似文献16.
《The Journal of arthroplasty》2021,36(12):3922-3927.e2
BackgroundThere has been an increase in hip arthroscopy (HA) over the last decade. After HA, some patients may ultimately require a total hip arthroplasty (THA). However, there is a scarcity of research investigating the outcomes in patients undergoing THA with a history of ipsilateral HA.MethodsThe PearlDiver research program (www.pearldiverinc.com) was queried to capture all patients undergoing THA between 2015 and 2020. Propensity matching was performed to match patients undergoing THA with and without a history of ipsilateral THA. Rates of 30-day medical complications, 1-year surgical complications, and THA revision were compared using multivariate logistic regression. Kaplan-Meier analysis was conducted to estimate survival probabilities of each of the groups with patients undergoing THA .ResultsAfter propensity matching, cohorts of 1940 patients undergoing THA without prior HA and 1940 patients undergoing a THA with prior HA were isolated for analysis. The mean time from HA to THA was 1127 days (standard deviation 858). Patients with a history of ipsilateral HA had an increased risk for dislocation (odds ratio [OR] 1.56, P = .03) and overall decreased implant survival within 4 years of undergoing THA (OR 1.53; P = .05). Furthermore, our data demonstrate the timing of previous HA to be associated with the risk of complications, as illustrated by the increased risk for dislocation (OR 1.75, P = .03), aseptic loosening (OR 2.18, P = .03), and revision surgery at 2 (OR 1.92, P = .02) and 4 years (OR 2.05, P = .01) in patients undergoing THA within 1 year of HA compared twitho patients undergoing THA more than 1 year after HA or with no previous history of HA.ConclusionPatients undergoing THA after HA are at an increased risk for surgical complications, as well as the need for revision surgery. 相似文献
17.
BackgroundPrimary and revision total hip arthroplasty (THA) is increasingly performed in patients with high comorbidity burden. Its predominantly negative effects on outcomes are well understood in primary THA; however, the effects of morbidity on revision THA are unknown. Since revision procedures account for about 10% of the total surgical volume, we set out to investigate the effects of physical health status on perioperative outcomes in this setting.MethodsWe queried our prospectively collected institutional database for patients who underwent revision THA at our institution (Orthopedic University Hospital Friedrichsheim, Frankfurt) between 2007 and 2011. Patients were classified according to American Society of Anesthesiologists (ASA) category and number of comorbidities. Subsequently, their impact on perioperative parameters was analyzed.ResultsOur database revealed 294 cases of revision THA during the study period. Patients preoperatively classified as ASA 3 and 4 showed significantly higher rates of intraoperative and postoperative complications, transfusions, prolonged intensive care unit (ICU) stay, and total length of stay (LOS) compared to patients classified as ASA 1 and 2. Similarly, patients with >3 comorbidities presented with significantly elevated postoperative complications, ICU stay, and LOS. Particularly, preoperative cardiac diseases were associated with increased blood loss, transfusions, duration of surgery, postoperative complications, ICU stay, LOS, and re-revisions.ConclusionPoor physical health condition is associated with negative perioperative outcomes in revision THA. Especially cardiac comorbidities are linked to unfavorable outcomes, which have important implications for assessment of perioperative risk. 相似文献
18.
Rohit Rambani David M. Kepecs Tatu J. Mäkinen Oleg A. Safir Allan E. Gross Paul R. Kuzyk 《The Journal of arthroplasty》2017,32(6):1959-1964
Background
Total hip arthroplasty revision for a fractured ceramic bearing is rare but offers unique challenges. The purpose of this review was to provide a summary of existing literature on fractured ceramic bearings.Methods
Two authors performed a literature search of the MEDLINE OVID and PubMed databases with the following search terms: ceramic, fracture, total hip arthroplasty, and revision.Results
The search identified 228 articles of which 199 were selected for review.Conclusions
It is mandatory to perform a complete synovectomy and thorough debridement of the fractured ceramic fragments. A well-fixed acetabular component should be removed if either the locking mechanism is damaged or the component is malpositioned. If the femoral stem taper is damaged, the femoral stem should be removed. However, if minimal damage is present, the femoral stem may be retained and revised using a fourth generation ceramic head with a titanium sleeve. Metal bearings should be avoided and revision with ceramic bearings should be performed whenever possible. 相似文献19.
《The Journal of arthroplasty》2023,38(3):541-547
BackgroundPerioperative advancements have made outpatient primary total hip arthroplasty (THA) a viable option for patients. This study evaluated the feasibility of expedited discharge after revision THA and compared 30-day outcomes to patients who had prolonged inpatient hospitalizations. The authors hypothesized that expedited discharge would not result in inferior 30-day outcomes.MethodsAseptic revision THAs in a national database were reviewed from 2013 to 2020. THAs were stratified by hospital length of stay (LOS) more or less than 24 hours. Demographics, comorbidities, preoperative laboratory values, American Society of Anesthesiology (ASA) scores, operative times, components revised, 30-day readmissions, and reoperations were compared. Multivariable analyses evaluated predictors of discharge prior to 24 hours, 30-day readmissions, and reoperations. Of 17,044 aseptic revision THAs, 211 were discharged within 24 hours.ResultsAccelerated discharge patients were younger, mean age 63 years (range, 20-92) versus 66 years (range, 18-94) (P < .01) had lower body mass index, mean 28.7 (range, 18.3-46.4) versus 29.9 (range, 17.3-52.5) (P = .01), and ASA scores (ASA, 1-2; 40.4-57.8%) (P < .01). Components revised had no association with LOS (P = .39); however, operative times were shorter and mean 100 minutes (range, 35-369) versus 139 minutes (range, 24-962) (P < .01) in accelerated discharge patients. Accelerated discharge patients had lower readmission rates (P < .01) but no difference in reoperation rates (P = .06).ConclusionDischarge less than 24 hours after revision THA is a feasible option for the correct patient and further efforts to decrease LOS should be evaluated. 相似文献
20.
《The Journal of arthroplasty》2020,35(6):1737-1749
BackgroundA number of papers have been published reporting on the clinical performance of highly porous coated titanium acetabular cups in primary and revision total hip arthroplasty (THA). However, no systematic review of the literature has been published to date.MethodsThe US National Library of Medicine (PubMed/MEDLINE), Embase, and the Cochrane Database of Systematic Reviews were queried for publications utilizing the following keywords: “tritanium” OR “highly-porous” AND “titanium” OR “acetabular” AND “trabecular” AND “titanium”.ResultsOverall, 16 studies were included in this review (11,366 cases; 60% females, 2-7 years mean follow-up). The overall survival rate of highly porous titanium acetabular components in primary cases was 99.3% (10,811 of 10,886 cases), whereas the rate of aseptic loosening was 0.1%. The overall survival rate of the highly porous titanium acetabular components in revision THA cases was 93.5% (449 of 480 cases), whereas the rate of aseptic loosening was 2.1%.ConclusionThere was moderate quality evidence to show that the use of highly porous titanium acetabular components in primary and revision THA cases is associated with satisfactory clinical outcomes in the short- and medium-term, without showing any evidence of cup migration or radiolucency. Taking into consideration that there is no evidence yet regarding the long-term survivorship of these components, we feel that further research of higher quality is required to generate more evidence-based conclusions regarding the longevity of highly porous titanium acetabular implants compared with conventional titanium counterparts. 相似文献