Hip Dysplasia Compromises the Outcome of Femoroacetabular Impingement Surgery

Background

The optimal treatment for patients with symptomatic hip dysplasia presenting with labral tear is unknown. Although femoroacetabular osteoplasty (FAO) has excellent outcome for most femoroacetabular impingement patients, the presence of concomitant hip dysplasia has been implicated as an adverse prognostic factor. This study evaluated the outcome of FAO in a group of dysplastic hips and compared the outcome to a cohort of patients without dysplasia.

Prior Pelvic Osteotomy Affects the Outcome of Subsequent Total Hip Arthroplasty

BackgroundAlthough pelvic osteotomy (PO) is an important surgical procedure that can alleviate symptoms and potentially slow progression of osteoarthritis in patients with development dysplasia of the hip, some patients eventually require conversion to total hip arthroplasty (THA). This study aimed to determine the outcome of conversion THA in patients with prior PO.MethodsForty nine patients with a history of prior PO who underwent conversion THA at a single institution were matched at a 1:3 ratio based on the date of surgery, age, gender, and body mass index with 147 developmental dysplasia of the hip patients who underwent primary THA without prior PO. A retrospective chart review was performed to compare outcomes at a minimum follow-up of 2 years.ResultsPatients with prior PO required more supplemental screw fixation for the acetabular component (59.2% vs 38.1%, P = .016), more autologous bone grafting (24.5% vs 11.6%, P = .048), had a longer mean operative time (106.0 vs 79.8 minutes, P < .001), and greater estimated blood loss (350.0 vs 206.8 mL, P = .015). Patients with prior PO had smaller cup version angle (26.0° vs 29.0°, P = .012) and greater discrepancy in the limb length (10.3 vs 7.26 mm, P = .041). Eight hips (16.3%) with prior PO and 6 (4.1%) without osteotomy required reoperation (P = .008). There was no difference in outcome scores at the latest follow-up.Conclusion: THA after prior PO is technically demanding, leading to longer operative times, greater blood loss, and variation in implant placement. Although functional outcomes are similar, THA after a prior PO is more likely to require reoperation.ConclusionTHA after prior PO is technically demanding, leading to longer operative times, greater blood loss, and variation in implant placement. Although functional outcomes are similar, THA after a prior PO is more likely to require reoperation.     

Cannabis Use Does Not Affect Outcomes After Total Hip Arthroplasty

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.     

Low Vitamin D Status Does Not Adversely Affect Short-Term Functional Outcome After Total Hip Arthroplasty

We prospectively measured functional performances (Western Ontario and McMaster Universities Osteoarthritis Index, Short Form-36, 2-minute walk test, and timed get-up-and-go test) of patients who underwent total hip arthroplasty (THA) and had serum vitamin D levels tested during the preoperative evaluation. Of 219 patients, 102 (46.6%) had low vitamin D levels (25-hydroxyvitamin D < 30 ng/mL). Low vitamin D status did not adversely affect short-term function at 6 weeks after THA. In addition, there was no association between serum vitamin D levels and the within-patient changes of scores of each outcome measurement. Because this 6-week period is generally adequate to correct vitamin D deficiency, orthopedic surgeons can safely perform THA without delay. Nevertheless, because vitamin D deficiency impairs bone quality, patients with low vitamin D levels should be treated once identified.     

同期双侧全髋关节置换术的临床观察

目的探讨同期双侧人工全髋关节置换术的疗效。方法2000年8月至2005年3月,对10例(20髋)患者行双侧全髋关节置换术。其中男8例16髋,女2例4髋;年龄25~65岁,病程1~30年(平均4.8年)。术前髋关节Harris评分12~45分,平均27分。其中7例采用Smith-Peterson切口,3例采用后路M oore切口。手术时间为3.4~5.5 h,平均4.5 h,术中输血600~1600 mL,平均1000 mL。结果10例均获6个月~5年3个月,平均18个月随访,髋关节术后Harris评分70~100分,平均86分,较术前平均提高59分(27~86分),差异有统计学意义(P<0.05)。除1例患者于术后1个月因心脏病死亡外,其余患者术后均无感染、肺栓塞、深静脉栓塞、假体松动、假体下沉及脱位等并发症发生。患者均能独立行走,自理生活。结论同期双侧人工全髋关节置换术是一种安全有效的手术,充分的术前准备,慎重选择病例,严格的假体安装标准,有效地风险防范是手术成功的关键。     

Conversion of Hip Arthrodesis to Total Hip Arthroplasty: Survivorship and Clinical Outcome

This study evaluated survivorship and clinical outcomes of patients undergoing conversion of a hip arthrodesis to a total hip arthroplasty (THA) and compared them to 2 patient cohorts: primary THA and first-time revision THA. Patients completed 5 standardized outcome questionnaires. The study cohort was compared to matched groups of primary THA and first-time revision THA patients. Twenty-six patients were identified, 2 deceased and 7 revised, leaving 17 patients available for review. A 10-year survivorship of 74.2% and complication rate of 54% were noted. All outcome scores were lower for the study cohort: clinically significant difference vs revision THA group and statistically significant difference vs primary THA group. Takedown arthrodesis patients experience poor clinical outcomes and high complication rates compared to primary and even revision THA.     

股骨髋臼撞击综合征

骨关节炎是一个多病因引起的疾病,常累及髋关节。老年性髋关节骨关节炎患者的发病机制是在长期轴向负荷作用下关节软骨发生退行性的改变。临床上也可见到部分成年人及经常运动的年轻人表现出髋关节炎症状,用传统的发病机制不能得到满意的解释。Ganzetal提出股骨髋臼撞击综合征（femoro—acetabularimpingement,FAI）可能是导致原发性髋关节炎的重要原因。     

Are Functional Outcomes of a Total Hip Arthroplasty Predictive of a Contralateral Total Hip Arthroplasty: A Retrospective Cohort Study

BackgroundCurrent literature suggests that 8%-35% of patients undergoing total hip arthroplasty (THA) undergo a subsequent contralateral THA. This study aims to determine if functional outcomes after primary THA predict outcomes in the subsequent primary THA of the contralateral side.MethodsA retrospective cohort of patients undergoing staged bilateral primary THA was reviewed. The Oxford Hip Score (OHS) was utilized as the functional outcome measurement tool and was assessed preoperatively and at one year postoperatively. The minimal clinically important difference (MCID) was assessed. Based on the first-side THA one-year outcomes, the odds of maintaining an MCID, or not, for the second-side THA were determined.ResultsThe study cohort consisted of 551 patients and 1102 primary THAs. The average postoperative OHSs were similar after the first and second THA. Patients achieving the MCID with the first-side surgery were 2.6 times (95% confidence interval 1.0 to 6.64, P = .04) more likely to achieve the MCID for the second-side surgery than patients failing to reach the MCID for their first-side surgery. After the first THA, 29 (5.3%) patients failed to reach the predefined MCID for the OHS compared with 54 (9.8%) patients undergoing their second THA (odds ratio: 1.96 [95% confidence interval: 1.23 to 3.1], χ² = 8.14, P = .005).ConclusionsFunctional outcomes after the first THA are predictive of functional outcomes of the second THA. Patients are more likely to achieve a clinically significant improvement after their first THA related to higher preoperative OHSs before the second THA.     

Accelerated Discharge After Aseptic Revision Total Hip Arthroplasty Does Not Predict Inferior 30-Day Outcomes

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.     

Early Outcomes of Primary Total Hip Arthroplasty After Prior Lumbar Spinal Fusion

Background

The coexistence of degenerative hip disease and spinal pathology is not uncommon with the number of surgical treatments performed for each condition increasing annually. The limited research available suggests spinal pathology portends less pain relief and worse outcomes after total hip arthroplasty (THA). We hypothesize that primary THA patients with preexisting lumbar spinal fusions (LSF) experience worse early postoperative outcomes.

Femoroacetabular impingement: Avoiding arthroplasty

Femoroacetabular impingement (FAI) is caused by structural alterations of the hip joint and can lead to abnormal stresses to the cartilage and labrum. FAI can cause pain and early osteoarthritis. Diagnosis of FAI is based on specific clinical and radiographic features. While the efficacy of nonoperative treatment of FAI is unknown, various operative treatments, including surgical hip dislocation, anteversion periacetabular osteotomy, and hip arthroscopy, have shown successful outcomes.     

Birmingham Hip Resurfacing vs Total Hip Arthroplasty: A Matched-Pair Comparison of Clinical Outcomes

Background

Birmingham hip resurfacing (BHR) has proven to be a good alternative for younger patients with osteoarthritis. Some have asserted that BHR may yield outcomes which are superior to total hip arthroplasty (THA), and that some studies which failed to show a difference were plagued by ceiling effects and lack of sensitivity of outcome measures. The purpose of this study is to compare outcomes of BHR and THA using the “Forgotten Joint” Score-12 (FJS), a more sensitive score with lesser vulnerability to the ceiling effect.

Recurrent Hematomas Within the Iliopsoas Muscle Caused by Impingement After Total Hip Arthroplasty

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.     

Radiographic Predictors of Hip Pain in Femoroacetabular Impingement

The primary diagnosis of femoroacetabular impingement is based on clinical symptoms, physical exam findings, and radiographic abnormalities. The study objective was to determine the radiographic findings that correlate with and are predictive of hip pain in femoroacetabular impingement (FAI). One hundred prospective patients with unilateral FAI symptoms based on clinical and radiographic findings were included in this study. All patients filled out a WOMAC pain questionnaire. Two independent-blinded surgeons assessed antero-posterior and lateral radiographs for 33 radiographic parameters of FAI. Correlations between pain scores and radiographic findings were calculated. A matched radiographic analysis was performed comparing symptomatic versus asymptomatic hips. Radiograph findings were also compared between males and females. Weak positive correlations were identified between increasing pain scores with radiographic findings of posterior wall dysplasia, presence of a shallow socket, and a more lateral acetabular fossa relative to the Ilioischial line. A symptomatic hip had a lower neck shaft angle, greater distance from Ilioischial line to acetabular fossa and larger distance from cross-over sign to superolateral point of the acetabulum when compared to the asymptomatic hip in the same patient. Symptomatic hips in males had more joint space narrowing, femoral osteophytes, higher alpha angles and larger, more incongruent femoral heads compared to females. Females had more medial acetabular fossa relative to the Ilioischial line and smaller femoral head extrusion index. Similar to other musculoskeletal conditions, radiographic findings of FAI are poor predictors of hip pain.     

Clinical Outcomes in Patients with Pulmonary Hypertension Undergoing Total Hip Arthroplasty

Background

Pulmonary hypertension (PH) is regarded as a risk factor for perioperative complications in patients undergoing noncardiac surgery.

Questions/Purposes

The objective of this retrospective case–control study was to evaluate the adverse outcomes of pulmonary hypertension patients undergoing elective unilateral hip replacements.

Methods

We performed a retrospective case–control study of total hip replacement patients with pulmonary hypertension (cases) and without pulmonary hypertension (control). From the years 2003 to 2008, we identified a total of 132 patients undergoing primary total hip replacements with a diagnosis of pulmonary hypertension (right ventricular systolic pressure >35). The primary outcome assessed was the incidence of adverse events that occurred during the postoperative hospital stay. Secondary outcomes studied included length of hospital stay, mortality, and ability to reach certain physical therapy milestones.

Results

The PH group had significantly more adverse events than the control group. Nonlethal cardiac dysrhythmias comprised the most common adverse outcome among the PH group. Overall, the PH group had a morbidity rate of 34.7% while the control had a rate of 21%. The PH group had longer hospital stay (6.7 days vs. 5.9). Both groups had zero mortality during the hospital stay. The PH group had comparable rehabilitation recovery times than the control group.

Conclusion

This retrospective case–control study demonstrates that pulmonary hypertension patients undergoing total hip arthroplasty are more prone to adverse outcomes, especially cardiac dysrhythmias, and longer hospital stays.     

Differences in Post-Operative Outcome Between Conversion and Primary Total Hip Arthroplasty

Background

The demand for conversion of prior hip surgery to total hip arthroplasty (conversion THA) is likely to increase as a function of increasing US hip fracture burden in addition to its application in managing other conditions. Thus, outcome analysis is warranted to better inform value-based reimbursement schemes in the era of bundled payments.

Diagnosing Infection in Patients Undergoing Conversion of Prior Internal Fixation to Total Hip Arthroplasty

Background

Criteria for diagnosis of infected internal fixation implants at the time of conversion to total hip arthroplasty (THA) are not clear. The purpose of this study is to identify risk factors for infection in patients undergoing conversion to THA.

Outcomes of Nonoperative Management,Iliopsoas Tenotomy,and Revision Arthroplasty for Iliopsoas Impingement after Total Hip Arthroplasty: A Systematic Review

BackgroundNonoperative and operative management of iliopsoas impingement (IPI) is commonly performed following total hip arthroplasty (THA). The purpose of this systematic review is to compare patient-reported outcomes (PROs) following conservative treatment, iliopsoas (IP) tenotomy, and revision arthroplasty in patients presenting with IPI after THA.MethodsThe PubMed and Embase databases were searched for articles regarding IPI following THA. Studies were included if (1) IPI after THA was treated with conservative management, an IP tenotomy, or acetabular component revision and (2) included PROs.ResultsEleven articles were selected for review and there were 280 hips treated for IPI following THA. Harris Hip Scores reported for the conservative group, the IP tenotomy group, and the cup revision group were 59.0 preoperatively to 77.8, 58.0 preoperatively to 85.4, and 58.1 preoperatively to 82.4 at latest follow-up, respectively. The IP tenotomy cohort also demonstrated superior postoperative functional outcomes using the Western Ontario and McMaster Universities Index, Medical Research Council score, Oxford Hip Score, and Merle d'Aubigné-Postel Pain Score. Patients who had a revision exhibited higher Oxford Hip Scores, higher Medical Research Council scores, and lower Visual Analog Scale Pain scores postoperatively.ConclusionManagement of IPI following THA includes nonoperative measures, IP tenotomy, or acetabular component revision. Patients have been shown to experience favorable PROs at latest follow-up, with an apparent advantage for surgical treatment. Compared to revision arthroplasty, IP tenotomy resulted in a lower overall rate of complications with less severe complication types. Therefore, IP tenotomy should be considered as a second line of treatment for patients who failed conservative measures. Revision arthroplasty should be reserved for recalcitrant cases.Level of EvidenceIV.