共查询到20条相似文献，搜索用时 31 毫秒
1.
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
Background
Patient-reported outcomes are increasingly used to capture the patients' perspective in total hip arthroplasty (THA). They can potentially be used to streamline post-THA follow-up to high-risk patients. We aimed to determine whether the long-term revision risk in THA relates to patient-reported measures at 2 and 5 years.Methods
In a single-institution cohort of primary THA procedures, we examined the association between 2-year and 5-year pain and Mayo Hip Scores and the risk of revision.Results
The absolute scores at 2 and 5 years were both significantly associated with the risk of revisions. Every 10-unit decline in the 2-year Mayo Hip Score <60 was associated with a significant 50% increase in the risk of revision (hazard ratio, 1.5 per 10 units; 95% confidence interval, 1.3-1.8). Similarly, every 10-unit decline in the 5-year Mayo Hip Score <60 was associated with almost doubling of the risk of revision (hazard ratio, 1.9 per 10 units; 95% confidence interval, 1.7-2.1).Conclusion
We conclude that patient-reported outcomes in THA have prognostic importance and can be taken into account when planning frequency of aftercare. This will improve the efficiency of follow-up in large registry-based follow-up efforts. 相似文献2.
Birmingham Hip Resurfacing vs Total Hip Arthroplasty: A Matched-Pair Comparison of Clinical Outcomes
Victor R. Ortiz-Declet David A. Iacobelli Leslie C. Yuen Itay Perets Austin W. Chen Benjamin G. Domb 《The Journal of arthroplasty》2017,32(12):3647-3651
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.Methods
Patients who underwent BHR were matched to patients who underwent posterior THA by computing a propensity score using 5 covariates: age, body mass index, gender, worker's compensation claims, and previous hip surgery. Surgical outcomes were assessed using 6 patient-reported outcome measures, including the FJS, the visual analog scale for pain, and patient satisfaction.Results
There were 42 patients in the BHR group and 18 patients in the THA group. The FJS was 78.0 for the BHR group and 76.0 for the THA group. The Veterans RAND 12-Item Health Survey Mental Component Summary and Short Form 12 Mental Component Summary were significantly higher in the BHR group. No differences were seen between all other patient-reported outcomes.Conclusion
BHR offers excellent results in young patients that are comparable to THA. As no clinical difference could be shown between BHR and THA, even with the use of the FJS, the choice between BHR and THA should not be based solely on any expectation that either yields superior clinical outcomes compared to the other at short-term follow-up. 相似文献3.
Hilal Maradit Kremers Walter K. Kremers Daniel J. Berry David G. Lewallen 《The Journal of arthroplasty》2017,32(11):3304-3307
Background
Patient-reported outcomes are increasingly used as complementary measures to clinical outcomes in total knee arthroplasty (TKA). However, their prognostic importance has yet to be established. We aimed to determine whether the long-term revision risk in TKA relates to pain and Knee Society Score (KSS) measures at baseline, 1, and 2 years.Methods
This was a registry-based study of primary TKA procedures at a large tertiary care institution between 1995 and 2010. Patients completed pain and KSS questionnaires both preoperatively and at 1 and 2 years of follow-up. Clinical information including revision outcomes and mortality was collected and recorded by trained registry personnel. Age and gender-adjusted Cox regression models were used to assess the association between pain and KSS measures and revisions and mortality as outcomes.Results
Both the 1-year and 2-year pain and KSSs were significantly associated with the risk for revisions (P < .0001 for trend). The risk for revision was 50%-100% higher among individuals reporting poor or fair KSS at 1 year. Similarly, ≥10 points worsening on the KSS was associated with about 2-fold higher risk for revision (hazard ratio, 2.50; 95% confidence interval, 1.25-5.47). The predictive power of the 1- and 2-year KSS diminished but persisted for revisions that occurred furthest from the reporting time points. The results with pain scores were similar but stronger than the KSS.Conclusion
Patient-reported outcomes in TKA have long-term prognostic importance and should be taken into account when planning frequency of aftercare of TKA patients. 相似文献4.
Graham Seow-Hng Goh Ming Han Lincoln Liow Hamid Rahmatullah Bin Abd Razak Darren Keng-Jin Tay Ngai-Nung Lo Seng-Jin Yeo 《The Journal of arthroplasty》2017,32(2):419-425
Background
Recent studies have shown a discrepancy between traditional functional outcomes and patient satisfaction, with some reporting less than 85% satisfaction in older patients undergoing total knee arthroplasty (TKA). As native knee biomechanics are not completely replicated, the resulting functional limitations may cause dissatisfaction in higher-demand individuals. Few studies have recorded patient-reported outcomes, health-related quality of life scores, and patient satisfaction in a young population undergoing TKA.Methods
One hundred thirty-six primary TKAs were performed in 114 patients aged 50 years or younger (mean age, 47.0 years; range, 30-50 years) at a single institution. The main diagnoses were osteoarthritis (85%) and rheumatoid arthritis (10%).Results
The range of motion, Knee Society Score, Oxford Knee Score, and Physical and Mental Component Scores of Short Form-36 increased significantly (P < .001). At 2 years, 85.3% of patients had good/excellent knee scores, 71.3% had good/excellent function scores, 94.9% met the minimal clinically important difference for the Oxford Knee Score, and 84.6% met the minimal clinically important difference for the Physical Component Score. We found that 88.8% of patients were satisfied with their surgeries, whereas 86.8% had their expectations fulfilled. Survivorship using revision as an end point was 97.8% at a mean of 7 years (range, 3-16 years).Conclusion
Patients aged 50 years or younger undergoing TKA can experience significant improvements in their quality of life, have their expectations met, and be satisfied with their surgeries, at rates similar to those of non–age-restricted populations. Surgeons should inform them of these benefits and the potential risk of revision surgery in the future, albeit increasingly shown to be low. 相似文献5.
Matthew P. Abdel Brian P. Chalmers Robert T. Trousdale Arlen D. Hanssen Mark W. Pagnano 《The Journal of arthroplasty》2017,32(9):2744-2747
Background
A previous randomized clinical trial at our institution demonstrated slower recovery of 35 2-incision total hip arthroplasties (THAs) when compared with 36 mini-posterior THAs at 2 years. The primary aim of the present study was to report concise 10-year follow-up results.Methods
We retrospectively reviewed the 71 patients in the previous randomized clinical trial, comparing clinical outcomes, revisions, reoperations, and implant survivorship between the 2-incision and the mini-posterior THAs.Results
At the most recent follow-up, the mean Harris hip score was 85 in the 2-incision group and 87 in the mini-posterior group (P = .4). There were 4 revisions and 2 reoperations (16%) in the 2-incision group vs 1 revision and 3 reoperations (11%) in the mini-posterior group (P = .5). Ten-year survivorship free of aseptic revision or reoperation was 77% in the 2-incision group vs 90% in the mini-posterior group (P = .15).Conclusion
There were no improvements in early or midterm clinical outcomes with the 2-incision technique. However, there was a clinical trend toward a higher rate of aseptic revisions in the 2-incision THA group. 相似文献6.
Cameron K. Ledford Joseph M. Statz Brian P. Chalmers Kevin I. Perry Arlen D. Hanssen Matthew P. Abdel 《The Journal of arthroplasty》2017,32(5):1560-1564
Background
As solid organ transplant (SOT) patients' survival improves, the number undergoing total hip (THA) and total knee arthroplasty (TKA) is increasing. Accordingly, the number of revision procedures in this higher-risk group is also increasing. The goals of this study were to identify the most common failure mechanisms, associated complications, clinical outcomes, and patient survivorship of SOT patients after revision THA or TKA.Methods
A retrospective review identified 39 revision procedures (30 revision THAs and 9 revision TKAs) completed in 37 SOT patients between 2000 and 2013. The mean age at revision surgery was 62 years with a mean follow-up of 6 years.Results
The most common failure mode for revision THA was aseptic loosening (10/30, 33%), followed by periprosthetic joint infection (PJI; 7/30, 23%). The most common failure mode for revision TKA was PJI (5/9, 56%). There were 6 re-revision THAs for PJI (3/30; 10%) and instability (3/30; 10%). There were 2 reoperations after revision TKA, both for acute PJI (2/9; 22%). Final Harris Hip Scores significantly (P = .03) improved as did Knee Society Scores (P = .01). Estimated survivorship free from mortality at 5 and 10 years was 71% and 60% after revision THA and 65% and 21% after revision TKA, respectively.Conclusion
Revision THA and TKA after solid organ transplantation carry considerable risk for re-revision, particularly for PJI. Although SOT recipients demonstrate improved clinical function after revision procedures, patient survivorship at mid- to long-term follow-up is low. 相似文献7.
Robert A. Burnett Nicholas A. Bedard David E. DeMik Yubo Gao Steve S. Liu John J. Callaghan 《The Journal of arthroplasty》2017,32(12):3693-3697
Background
Blood transfusion guidelines in elective surgery have been implemented over the last decade to minimize risk and cost related to transfusion without sacrificing patient outcomes. Blood utilization in primary total hip (THA) and total knee arthroplasty (TKA) has been extensively studied but there is a paucity of studies evaluating utilization in revision THA and TKA. The purpose of this study is to evaluate current trends in transfusion following revision THA and TKA.Methods
The Humana dataset was reviewed for transfusion trends from 2007 to 2015 for patients undergoing revision THA and TKA. Subgroup analysis was performed to evaluate the impact of age, gender, geographic location, and obesity.Results
In total, 9176 and 12,493 revision THA and TKA patients were analyzed with transfusion rates of 19.2% and 11.9%, respectively. Allogeneic packed red blood cells were most commonly transfused (90% and 92%, respectively). Transfusion rates decreased significantly from 24.7% to 10.3% and 15.9% to 4.5%, respectively, over the years 2007-2015. Women had higher transfusion rates (odds ratio [OR] THA:TKA 1.24:1.23), while obesity was associated with lower transfusion rates after revision THA (OR 0.88). Transfusion rates were higher in 2-component revisions compared to primary (OR THA:TKA 1.24:1.24), while 1-component revisions had lower transfusion rates than primary procedures (OR THA:TKA 0.79:0.25).Conclusion
Transfusion rates after revision THA and TKA have fallen substantially since 2007. In 2016, only 10% and 4% of revision THA and TKA, respectively, required transfusion. The study should provide benchmark data for surgeons to use as comparison to the blood utilization following revision joint replacement at their institutions. 相似文献8.
Kyung-Soon Park Jong-Keun Seon Keun-Bae Lee Sung-Kyu Kim Chee-Ken Chan Taek-Rim Yoon 《The Journal of arthroplasty》2017,32(2):503-509
Background
This study aims at determining the average long-term result of revision total hip arthroplasty (THA) using the acetabular reinforcement ring with a hook (ARRH) and bone grafting in severe acetabular bony defect. Expected 15-year survival of ARRH in revision THA is included in the study.Methods
Retrospective review of 48 patients (48 hips) with follow-up duration of average 11.4 years (range, 6.1-21.4 years) was conducted. At each follow-up, Harris hip score was used to assess functional outcome, and radiographic acetabular component osteolysis was measured by DeLee and Charnley classification. Bone defects were assessed preoperatively and intraoperatively using American academy of orthopedic surgeons and Paprosky classification. The common modes of ARRH failures were evaluated. Bone consolidation, presence of heterotopic ossification, and complications such as infection and dislocation were recorded.Results
The bone defects were varied and included cavitary, segmental, and combined defects without any pelvic discontinuity. Mean Harris hip score improved from 52.6 points preoperatively to 82.0 points postoperatively. Nine acetabular revisions and 3 stem revisions (2 concurrent with acetabular revisions and 1 isolated stem revision) were performed. There were 5 infected cases and 1 patient with recurrent dislocation. The 11.4-year survival of revision THA with ARRH was 71% as the end point for acetabular revision surgery for any reason. The expected 15-year survival of revision THA with ARRH was 60%. The most common failure mode of ARRH was superomedial migration followed by lateral migration.Conclusion
ARRH combined with bone grafting produces relatively good average long-term clinical results. 相似文献9.
Michael D. Hellman Sean M. Kearns Daniel D. Bohl Bryan D. Haughom Brett R. Levine 《The Journal of arthroplasty》2017,32(12):3698-3703
Background
In revision total hip arthroplasty (THA), proximal femoral bone loss creates a challenge of achieving adequate stem fixation. The purpose of this study was to examine the outcomes of a monoblock, splined, tapered femoral stem in revision THA.Methods
Outcomes of revision THA using a nonmodular, splined, tapered femoral stem from a single surgeon were reviewed. With a minimum of 2-year follow-up, there were 68 cases (67 patients). Paprosky classification was 3A or greater in 85% of the cases. Preoperative and postoperative Harris Hip Scores (HHS), radiographic subsidence and osseointegration, limb length discrepancy, complications, and reoperations were analyzed.Results
The Harris Hip Score improved from 37.4 ± SD 19.4 preoperatively to 64.6 ± SD 21.8 at final follow-up (P < .001). There were 16 revision procedures—8 for septic indications and 8 for aseptic indications. Subsidence occurred at a rate of 3.0% and dislocation at 7.4%. Limb length discrepancy of more than 1 cm after revision was noted in 13.6% of patients. Bone ingrowth was observed in all but 4 patients (94.1%). At 4-year follow-up, Kaplan-Meier estimated survival was 72.9% (95% confidence interval [CI] 57.0-83.8) for all causes of revision, 86.6% (95% CI 72.0-93.9) for all aseptic revision, and 95.5% (95% CI 86.8-98.5) for aseptic femoral revision.Conclusion
Although complications were significant, revision for femoral aseptic loosening occurred in only 3 patients. Given the ability of this monoblock splined tapered stem to adequately provide fixation during complex revision THA, it remains a viable option in the setting of substantial femoral bone defects. 相似文献10.
Brian C. Werner Matthew D. Higgins Hakan C. Pehlivan Joshua T. Carothers James A. Browne 《The Journal of arthroplasty》2017,32(2):402-406
Background
Recent studies have reported higher postoperative complication rates in obese and morbidly obese patients undergoing total hip arthroplasty (THA). Less data are available regarding super-obese (body mass index [BMI] >50 kg/m2) patients. This study aims to quantify the risk of complications after THA in super-obese patients on a national scale and to put these risks in context by comparing them to patients of other BMI classes as well as those undergoing revision THA.Methods
Utilizing a national insurance database, complication rates after THA in super-obese patients (n = 3244) were compared to nonobese, obese, and morbidly obese patients undergoing primary THA and all patients undergoing revision THA. A logistic regression analysis controlling for demographic and comorbidity variables was utilized to determine the independent effect of super obesity on complication rates after THA.Results
Super-obese patients had significantly higher rates of most complications than nonobese, obese, morbidly obese, and revision THA patients, including venous thromboembolism, infection, blood transfusion, medical complications, dislocation, readmission, and revision THA.Conclusion
Super-obese patients (BMI >50 kg/m2) have higher rates of postoperative complications after THA than nonobese, obese, morbidly obese, and revision THA patients. Super obesity is an independent risk factor for increased rates of most postoperative complications including the need for early revision THA. 相似文献11.
Takeshi Utsunomiya Goro Motomura Satoshi Ikemura Satoshi Hamai Jun-ichi Fukushi Yasuharu Nakashima 《The Journal of arthroplasty》2017,32(9):2768-2773
Background
Since Sugioka transtrochanteric anterior rotational osteotomy (ARO) for osteonecrosis of the femoral head (ONFH) changes the morphology of the proximal femur, total hip arthroplasty (THA) after previous ARO is considered a technically demanding procedure. The purpose of this study was to compare the clinicoradiologic outcomes of THA after ARO with those of THA without any antecedent surgery for ONFH.Methods
Twenty-four hips in 20 patients who underwent cementless THA after ARO (postosteotomy group) were retrospectively reviewed and compared with patients who underwent cementless THA without any antecedent surgery for ONFH during the same period (primary group). In the postosteotomy group, the mean duration from ARO to THA was 19.7 years. All patients were followed for at least 5 years (mean, 8.3 years; follow-up rate, 78.5%). A clinical assessment was performed preoperatively and at the latest follow-up using the Harris Hip Score. A radiographic examination was performed at 3 months after THA and at the latest follow-up.Results
The Harris Hip Score at the latest follow-up in the postosteotomy group was equivalent to that in the primary group, but longer operation time and greater intraoperative blood loss were observed in the postosteotomy group. There were no significant differences in postoperative complications, including dislocation (2 hips in each group). The leg lengthening in the postosteotomy group tended to be longer. No hips showed implant malpositioning, loosening, or required any revision surgery.Conclusion
The clinicoradiologic outcomes of THA after ARO are considered to be comparable with those of THA without any antecedent surgery for ONFH. 相似文献12.
Chukwuweike U. Gwam Jaydev B. Mistry Nequesha S. Mohamed Melbin Thomas Kevin C. Bigart Michael A. Mont Ronald E. Delanois 《The Journal of arthroplasty》2017,32(7):2088-2092
Background
Despite the excellent outcomes associated with primary total hip arthroplasty (THA), implant failure and revision continues to burden the healthcare system. THA failure has evolved and displays variability throughout the literature. In order to understand how THAs are failing and how to reduce this burden, it is essential to assess modes of implant failure on a large scale. Thus, we report: (1) etiologies for revision THA; (2) frequencies of revision THA procedures; (3) patient demographics, payor type, and US Census region of revision THA patients; and (4) the length of stay and total costs based on the type of revision THA procedure.Methods
We queried the National Inpatient Sample database for all revision THA procedures performed between January 1, 2009 and December 31, 2013. This yielded 258,461 revision THAs. Patients specific demographics were identified in order to determine the prevalence of revision procedure performed.Results
Dislocation was the main indication for revision THA (17.3%), followed by mechanical loosening (16.8%). All-component revision was the most common procedure performed (41.8%). Patients were most commonly white (77.4%), aged 75 years and older (31.6%), and resided in the South US Census region (37.0%). The average length of stay for all procedures was 5.29 days. The mean total charge for revision THA procedures was $77,851.24.Conclusion
Dislocation and mechanical loosening is the predominant indication for revision THA in the United States. With the frequency of revision THAs projected to double in the next decade, orthopedists must take steps to mitigate this potentially devastating complication. 相似文献13.
Sameer Badarudeen Albert C. Shu Kevin L. Ong Doruk Baykal Edmund Lau Arthur L. Malkani 《The Journal of arthroplasty》2017,32(6):1954-1958
Background
The purpose of this study was to identify the incidence and types of complications after revision total hip arthroplasty (THA) within the first year, and determine the relative risk factors for these complications and of re-revision.Methods
The sample size of 5% Medicare claims data from 1998-2011 was studied. Primary THA patients who underwent subsequent revision were identified using ICD-9-CM codes. Outcomes and complications after revision THA were assessed. Multivariate Cox regression was used to evaluate the effect of patient demographic characteristics on the adjusted complication risk for revision THA patients.Results
Of the 64,260 primary THA patients identified between 1998 and 2011, 3555 patients (5.71%) underwent revision THA. Etiology of primary hip failure included mechanical complications such as loosening and wear (40.7%), dislocation (14.0%), and infection (11.3%). Complications after revision THA included infection and redo revision, 17.3% and 15.8% followed by venous thromboembolic disease (VTE) at 11.1%, dislocation at 5.43%, PE at 3.24%, and death at 2.11%. The rate of “new” infections after an aseptic revision was 8.13%. Patients in the 85+-year-old age group had a 100% greater adjusted risk of VTE (P < .001) and 406% higher adjusted risk of death (P < .001) than those in the 65-69 years-old age group. Patients with higher Charlson scores had higher adjusted risks of VTE (P < .001), infection (P < .001), death (P = .002), and re-revision THA (P = .011).Conclusion
Advanced age is a clear risk factor for VTE and mortality, but not for dislocation, infection, or re-revision. Higher Charlson index was found to be a risk factor for every complication after revision except dislocation. Greater attention is required to address the high rate of infection and re-do revision after revision THA (17.3% and 15.8%). 相似文献14.
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15.
Dean C. Perfetti Ran Schwarzkopf Aaron J. Buckland Carl B. Paulino Jonathan M. Vigdorchik 《The Journal of arthroplasty》2017,32(5):1635-1640.e1
Background
Lumbar-pelvic fusion reduces the variation in pelvic tilt in functional situations by reducing lumbar spine flexibility, which is thought to be important in maintaining stability of a total hip arthroplasty (THA). We compared dislocation and revision rates for patients with lumbar fusion and subsequent THA to a matched comparison cohort with hip and spine degenerative changes undergoing only THA.Methods
We identified patients in New York State who underwent primary elective lumbar fusion for degenerative disc disease pathology and subsequent THA between January 2005 and December 2012. A propensity score match was performed to compare 934 patients with prior lumbar fusion to 934 patients with only THA according to age, gender, race, Deyo comorbidity score, year of surgery, and surgeon volume. Revision and dislocation rates were assessed at 3, 6, and 12 months post-THA.Results
At 12 months, patients with prior lumbar fusion had significantly increased rates of THA dislocation (control: 0.4%; fusion: 3.0%; P < .001) and revision (control: 0.9%; fusion: 3.9%; P < .001). At 12 months, fusion patients were 7.19 times more likely to dislocate their THA (P < .001) and 4.64 times more likely to undergo revision (P < .001).Conclusion
Patients undergoing lumbar fusion and subsequent THA have significantly higher risks of dislocation and revision of their hip arthroplasty than a matched cohort of patients with similar hip and spine pathology but only undergoing THA. During preoperative consultation for patients with prior lumbar fusion, orthopedic surgeons must educate the patient and family about the increased risk of dislocation and revision. 相似文献16.
Anita Sadhu Denis Nam Benjamin R. Coobs Toby N. Barrack Ryan M. Nunley Robert L. Barrack 《The Journal of arthroplasty》2017,32(3):987-991
Background
Recently, the importance of acetabular component positioning in the Lewinnek “safe zone” in preventing prosthetic dislocation following total hip arthroplasty (THA) has been questioned. The purpose of this study was to determine the proportion of acetabular components within the Lewinnek safe zone between primary and revision THAs that have sustained a dislocation vs matched controls without a dislocation event.Methods
This was a retrospective, institutional review board–approved investigation of THAs performed at our institution or referred to our institution between 1997 and 2013. Ninety-six primary THAs and 60 revision THAs that sustained a dislocation were included and matched 1:1 based on age, gender, and body mass index with nondislocated controls. Acetabular component inclination and anteversion were performed using Martell Hip Analysis Suite and compared between the 2 cohorts for both primary and revision THAs.Results
The proportion of acetabular components within the safe zone for both inclination and anteversion was 23 of 96 (24%) in primary THA dislocators vs 48 of 96 (50%, P < .001) in controls. The proportion of acetabular components within the safe zone for both inclination and anteversion was 28 of 60 (47%) in revision THA dislocators vs 40 of 60 (66%, P = .03) in controls.Conclusion
Patients sustaining a dislocation following a primary or revision THA had acetabular components less frequently positioned within the safe zone compared to control patients. This study suggests acetabular component positioning remains an important variable in decreasing the risk of dislocation following primary and revision THA. 相似文献17.
Stephen M. Petis Kevin I. Perry Mark W. Pagnano Daniel J. Berry Arlen D. Hanssen Matthew P. Abdel 《The Journal of arthroplasty》2017,32(11):3510-3518
Background
Prolonged retention of an antibiotic spacer is occasionally chosen during treatment of periprosthetic joint infections after total hip arthroplasty (THA) and total knee arthroplasty (TKA). The purpose of our study was to evaluate the outcome of extended spacer retention.Methods
We reviewed 1106 cases of periprosthetic joint infection after THA (n = 308) and TKA (n = 798) and identified 17 (5.5%) retained hip and 34 (4.3%) retained knee spacers. Most patients (35 of 51, 69%) underwent spacer retention because they were medically unfit for further surgery. The remaining patients (16 of 51, 31%) had acceptable function and forewent further surgery. Competing risk analyses, with death as the competing risk, determined the cumulative incidence of reinfection and spacer revision. Radiographic analysis and clinical outcomes were analyzed.Results
The 2-year cumulative incidence for reinfection was 7% for retained hip and 13% for retained knee spacers. The cumulative incidence for all-cause spacer revision was 28% at 4 years for hips and 21% at 2 years for knees. The most common complications were implant migration and femoral spacer subsidence in the hip cohort, and supracondylar femur fractures and spacer dislocations in the knee cohort. The cumulative incidence for radiographic signs of mechanical failure was 72% and 87% at late follow-up for the hip and knee groups, respectively. The latest Harris Hip Score and Knee Society Score were 62 and 63, respectively.Conclusion
Antibiotic spacer retention is a rare event in the course of planned 2-stage treatment of infected THA or TKA. Failure secondary to recurrent infection is uncommon; however, failure for mechanical reasons is frequent and clinical outcomes are relatively poor. 相似文献18.
Yong Huang Yixin Zhou Hongyi Shao Jianming Gu Hao Tang Qiheng Tang 《The Journal of arthroplasty》2017,32(10):3108-3113
Background
Both modular and nonmodular tapered fluted titanium stems are used in revision total hip arthroplasty (THA), with follow-up showing good results for both stems. We aimed to determine whether there were any differences in clinical outcomes, survivorship, or frequency of complications.Methods
A retrospective review of 160 consecutive THAs (153 patients) revised with a tapered fluted modular titanium stem from 2002 to 2014 and 129 consecutive THAs (128 patients) revised with a tapered fluted nonmodular titanium stem between 2008 and 2014 was conducted. The patient's level of satisfaction, clinical assessment, and complications were examined. A Kaplan-Meier survivorship analysis was performed with the endpoint defined as any reoperation due to septic/aseptic complications.Results
Mean duration of follow-up was longer in the modular group (6.3 years) than the nonmodular group (5.0 years; P = .003). No significant group differences were found in the postoperative Harris Hip Score, the level of overall satisfaction, the 8-year cumulative survival, the rate of infection, dislocation, or postoperative periprosthetic fractures. However, intraoperative fractures occurred significantly more frequently in the modular group (16.9%) than in the nonmodular group (7.0%; P = .011), and stem subsidence was significantly less in the modular group (0.95 mm) than in the nonmodular group (1.93 mm; P = .001). Two mechanical failures associated with the modular design occurred in the modular group.Conclusion
Both modular and nonmodular tapered fluted titanium stems provide satisfactory midterm results in revision THA. Although tapered fluted modular stems are gaining in popularity in revision THA, tapered fluted nonmodular stems should not be disregarded as a viable alternative, especially for relatively straightforward cases. 相似文献19.
Yusuke Osawa Yukiharu Hasegawa Toshiaki Okura Daigo Morita Naoki Ishiguro 《The Journal of arthroplasty》2017,32(3):857-861
Background
We performed periacetabular osteotomy (PAO) combined with intertrochanteric valgus osteotomy (TVO) to obtain better congruity for patients with acetabular dysplasia and nonspherical femoral head. These patients with PAO-combined TVO demonstrate long-term progression of osteoarthritis, thereby, needing conversion to total hip arthroplasty (THA) and is difficult due to morphological changes. The objective of the present study was to investigate outcomes of patients who underwent THA after PAO-combined TVO.Methods
We performed 3 groups' case-control study. The participants were 20 patients (20 hips) who underwent THA after PAO-combined TVO (PAO-TVO group); these patients had a mean age at surgery of 56.3 years and underwent postoperative follow-up for a mean period of 6.8 years. For the control group, we included 53 patients (57 joints) who underwent THA after PAO and 76 patients (80 joints) who underwent primary THA for hip dysplasia matching age, sex, and time of surgery.Results
Harris hip score at the last follow-up was significantly poorer in PAO-TVO group compare with PAO group and primary group. Short Form-36 of Physical Component Summary was significantly poorer in PAO-TVO group compared with primary group. The socket position in the PAO-TVO group was significantly superior and lateral compared with that in the primary THA group. Considering socket placement in Lewinnek's safe zone and stem malalignment, there were no significant differences in the 3 groups.Conclusion
Harris hip score and Short Form-36–Physical Component Summary for THA after PAO-combined TVO were significantly poorer compared to those of primary THA. 相似文献20.
Diana C. Patterson Ronald P. Grelsamer Michael J. Bronson Calin S. Moucha 《The Journal of arthroplasty》2017,32(10):2958-2962