Do Conversion Total Hip Arthroplasty Yield Comparable Results to Primary Total Hip Arthroplasty?

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.

Is Total Hip Arthroplasty after Hip Arthrodesis as Good as Primary Arthroplasty?

Background  

Conversion of hip arthrodesis to a THA reportedly provides a reasonable solution, improving function, reducing back and knee pain, and slowing degeneration of neighboring joints associated with a hip fusion. Patients generally are satisfied with conversion despite the fact that range of mobility, muscle strength, leg-length discrepancy (LLD), persistence of limp, and need for assistive walking aids generally are worse than those for conventional primary THA.     

Is Outpatient Total Hip Arthroplasty Safe?

Background

Safety data for outpatient total hip arthroplasty (THA) remains scarce.

Orthopaedic Surgeons’ Cardiovascular Response During Total Hip Arthroplasty

The literature contains limited and contradictory information regarding the amount of physical effort and/or emotional stress needed to perform surgery. We therefore investigated cardiovascular response to psychophysical stress in orthopaedic surgeons while they were performing surgery. We monitored 29 male orthopaedic surgeons from four university centers while they performed total hip arthroplasties. Changes in their cardiovascular parameters were recorded by ambulatory monitoring methods. Exercise stress testing of each participant was used as a control state. We compared the cardiovascular response during surgery to energy requirements of everyday activities. Preoperative and postoperative testing showed lower values of cardiovascular parameters than during physically less difficult parts of the operation; physically more difficult phases of the operation additionally increased the values of parameters. We concluded performing total hip arthroplasty increases surgeons’ cardiovascular parameters because of psychologic stress and physical effort. Excitement of the cardiovascular system during total hip arthroplasty appears similar to the excitement during moderate-intensity daily activities, such as walking the dog, leisurely bicycling, or climbing stairs. Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent was obtained.     

Total Hip Arthroplasty: Is Small Incision Better?

Outcome data are eagerly awaited at present time to evaluate the role of minimally invasive surgery in orthopedic surgery. This matched-pair study reports the outcome of total hip arthroplasty (THA) performed through regular or small incision technique by a single surgeon. There were 120 patients in this cohort with a mean age of 66.8 years (range, 39-90 years). There was no detectable difference in outcome between the two groups with regard to blood loss, analgesia requirement, functional recovery, length of hospital stay, or disposition at discharge. One patient in the small incision group with undersized femoral component required revision of the femoral stem 8 months later. The recent extensive interest for minimally invasive THA has been attributed to market-driven and patient-driven demand for this procedure. We were not able to detect any difference in outcome parameters for THA performed through small incision compared with the conventional techniques.     

Late Dislocations After Total Hip Arthroplasty: Is the Bearing a Factor?

Background

Dislocation is a leading cause of revision after primary total hip arthroplasty (THA). Although more common in the first few years after the procedure, dislocation can occur at any time. This study investigated the difference in late dislocation in ceramic-on-ceramic (CoC) bearings compared with metal-on-polyethylene and ceramic-on-polyethylene bearings in THA.

Is Routine Mid-term Total Hip Arthroplasty Surveillance Beneficial?

Background  

Routine followup of patients after primary or revision THA is commonly practiced and driven by concerns that delays in identifying early failure will result in more complicated or more costly surgical interventions. Although mid-term followup (4–10 years) has been performed to follow cohorts of patients, the benefit of observing individual patients regardless of symptoms has not been established.     

Can Squeaking With Ceramic-On-Ceramic Hip Articulations In Total Hip Arthroplasty Be Avoided?

Squeaking is a recognized complication of total hip arthroplasty with ceramic on ceramic bearings but the etiology has not been well identified. We evaluated 183 hips in 148 patients who had undergone ceramic-on-ceramic noncemented total hip arthroplasties at one center between 1997–2007 by standardized telephone interviews and radiographic review. Audible squeaking was reported from 22 hips (12% of 183) of 19 patients. Prevalence of squeaking was associated with younger age; obesity; lateralized cup position; use of beta titanium alloy femoral components and shortened head length options; and higher reported activity level, greater pain, and decreased satisfaction at the time of the interview. Squeaking was described as having little personal significance by most patients. Squeaking might be preventable in part through medialization of the acetabular cup and avoidance of the use of shortened femoral necks.     

Outcomes of Total Hip Arthroplasty After Acetabular Open Reduction and Internal Fixation in the Elderly—Acute vs Delayed Total Hip Arthroplasty

BackgroundOptimum management for the elderly acetabular fracture remains undefined. Open reduction and internal fixation (ORIF) in this population does not allow early weight-bearing and has an increased risk of failure. This study aimed to define outcomes of total hip arthroplasty (THA) in the setting of an acetabular fracture and compared delayed THA after acetabular ORIF (ORIF delayed THA) and acute fixation and THA (ORIF acute THA).MethodsAll acetabular fractures in patients older than 60 years who underwent ORIF between 2007 and 2018 were reviewed (n = 85). Of those, 14 underwent ORIF only initially and required subsequent THA (ORIF delayed THA). Twelve underwent an acute THA at the time of the ORIF (ORIF acute THA). The ORIF acute THA group was older (81 ± 7 vs 76 ± 8; P < .01) but had no other demographic- or injury-related differences compared with the ORIF delayed THA group. Outcome measures included operative time, length of stay, complications, radiographic assessments (component orientation, leg-length discrepancy, heterotopic ossification), and functional outcomes using the Oxford Hip Score (OHS).ResultsOperative time (P = .1) and length of stay (P = .5) for the initial surgical procedure (ORIF only or ORIF THA) were not different between groups. Four patients had a complication and required further surgeries; no difference was seen between groups. Radiographic assessments were similar between groups. The ORIF acute THA group had a significantly better OHS (40.1 ± 3.9) than the ORIF delayed THA group (33.6 ± 8.5) (P = .03).ConclusionIn elderly acetabulum fractures, ORIF acute THA compared favorably (a better OHS, single operation/hospital visit, equivalent complications) with ORIF delayed THA. We would thus recommend that in patients with risk factors for failure requiring delayed THA (eg, dome or roof impaction) that ORIF acute THA be strongly considered.     

Is There a Role for Preoperative Iron Supplementation in Patients Preparing for a Total Hip or Total Knee Arthroplasty?

Background

Several treatment modalities exist for the treatment of perioperative anemia. We determined the effect of oral iron supplementation on preoperative anemia, and the use of blood-conserving interventions before total hip arthroplasty (THA) and total knee arthroplasty (TKA).

Does Prior Bariatric Surgery Affect Implant Survivorship and Complications Following Primary Total Hip Arthroplasty/Total Knee Arthroplasty?

Background

The purpose of this study is to evaluate the impact of prior bariatric surgery on survivorship, outcome, and complications following primary total hip arthroplasty (THA)/total knee arthroplasty (TKA).

Are Acetabular Component Alignment Guides for Total Hip Arthroplasty Accurate?

The acetabular component orientation of total hip arthroplasty is of critical importance to the clinical results. Although navigation systems have recently been introduced, acetabular component alignment guides are still used in most of ordinary hospitals. However, the accuracy of alignment guides themselves has not been evaluated. Fifteen types of alignment guide were examined. In all the alignment guides, the angles actually indicated and those stated by manufacturers were different. Our results showed that usage of modern alignment guides inherently misleads anteversion into decrease by a mean of 6° (maximum, 12°) and inclination into increase by a mean of 2° (maximum: 4°). Such setting of alignment guides could be one of the factors of error in acetabular component orientation.     

What do Patients Think About Minimally Invasive Total Hip Arthroplasty?

INTRODUCTION

The introduction of minimally invasive techniques for hip replacement into clinical practice has been driven by the perceived benefits of smaller incisions, shorter in-patient stays and faster rehabilitation. This may be at the cost of higher complication rates. The purpose of this study was to explore the opinions and priorities of patients in relation to these techniques.

PATIENTS AND METHODS

A cross-sectional survey was performed in an elective out-patient setting.

RESULTS

Of 44 patients approached, 36 agreed to participate. From most important to least important, patients rated the following items in order: ‘rate of complications’; ‘implant survival’; ‘length of rehabilitation’; ‘time in hospital’ and ‘length of scar’. Despite this, 21 of 35 (60%) responders stated they would accept the offer of minimally invasive techniques if made.

CONCLUSIONS

Patients appear to prioritise long-term outcomes and low complication rates over the shorter scars, reduced in-patient stay and reduced rehabilitation times potentially offered by minimally invasive hip arthroplasty. Despite this, the technique remains popular among patients.