共查询到20条相似文献，搜索用时 31 毫秒
1.
Clayton R. Perry Adam M. Fahs Michael D. Kurdziel Denise M. Koueiter Randy J. Fayne James J. Verner 《The Journal of arthroplasty》2018,33(6):1770-1774
Background
Modern joint arthroplasty protocols place an emphasis on minimizing patient-reported postoperative pain while minimizing opioid consumption. The use of multimodal pain management protocols has been reported to improve patient outcomes and satisfaction after total hip arthroplasty.Methods
In a prospective, single-surgeon trial, 50 patients undergoing primary direct anterior approach total hip arthroplasty were randomized to receive a preoperative fascia iliaca compartment block (FICB) or an intraoperative surgeon-delivered psoas compartment block (PCB). Patient-reported pain was recorded in the postanesthesia care unit, recovery floor and 3 weeks postoperatively. Opioid use was recorded during the hospital stay.Results
Average visual analog scale pain scores in the postanesthesia care unit were 38.7 ± 8.7 vs 35.6 ± 8.3 (P = .502) for the preoperative FICB and intraoperative PCB groups, respectively. No significant difference was found between groups at the 3-week visit for postoperative pain (FICB: 2.9 ± 1.4; PCB: 3.2 ± 2.0; P = .970) and patient-reported pain satisfaction (FICB: 8.8 ± 2.2; PCB: 9.7 ± 0.6; P = .110).Conclusion
During the direct anterior approach for total hip arthroplasty, PCB is an effective and efficient regional anesthesia technique. It may be used to obtain satisfactory postoperative pain control and patient satisfaction while decreasing hospital resources. 相似文献2.
Background
The aim of this prospective cohort study is to evaluate the outcome of octogenarian patients undergoing uncemented total hip arthroplasty (THA) with a control group of similarly aged patients undergoing hybrid THA with a minimum 5-year follow-up.Methods
Clinical outcomes including intraoperative and postoperative complications, blood transfusion, revision rate, and mortality were recorded. Radiological analysis of preoperative and postoperative radiographs assessed bone quality, implant fixation, and any subsequent loosening.Results
One hundred forty-three patients (mean age 86.2 years) were enrolled in the study. Seventy-six patients underwent uncemented THA and 67 underwent hybrid THA. The uncemented cohort had a significantly lower intraoperative complication rate (P = .017) and also a lower transfusion rate (P = .002). Mean hospital stay (P = .27) was comparable between the 2 groups. Two patients underwent revision surgery in each cohort.Conclusion
Our study demonstrates that uncemented THA is safe for the octogenarian patient and we recommend that age should not be a barrier to the choice of implant. However, intraoperative assessment of bone quality should guide surgeons to the optimum decision regarding uncemented and hybrid implants.Level of evidence
3. 相似文献3.
Katsuhiko Maezawa Masahiko Nozawa Takahito Yuasa Hironobu Sato Motosi Gomi Kazuo Kaneko 《Journal of orthopaedic science》2018,23(3):538-541
Background
We think that it is necessary to evaluate whether the patient after total hip arthroplasty has achieved age-appropriate locomotor ability by improvement in hip joint function. The 25-question Geriatric Locomotive Function Scale (GLFS-25) have been determined age-specific standard values for the general population. The aim of this study was to compare postoperative hip muscle strength and functional performance at 3 months after THA with preoperative levels, and to compare the outcomes at 3 months after THA with the function of age-matched adults without hip disease.Methods
The GLFS-25 scores and muscle strength were investigated before THA and 3 months after surgery in 12 men and 75 women who underwent total hip arthroplasty.Results
The mean preoperative and postoperative GLFS-25 score was 55.4 and 19.1, respectively. With regard to the influence of age, the mean scores before and after THA were respectively 52.0 versus 18.2 for patients aged 60–69 years and 61.2 versus 17.3 for those aged 70–79 years in the normal/mild OA group. When female patients from the normal/mild OA group and the implant group classified into levels 4–7 after THA were combined (n = 15), their mean preoperative and postoperative straight leg raising (SLR) strength was 0.56 Nm/kg and 0.75 Nm/kg, respectively. On the other hand, the mean preoperative and postoperative SLR strength was respectively 0.54 Nm/kg and 0.86 Nm/kg for patients classified into levels 1–3 after THA (n = 45).Conclusion
Before THA, 90% of the patients who has severe hip disturbance were in need of nursing care (levels 4–7), while the percentage decreased to 30% after surgery. There was a difference of SLR muscle strength between the patients in levels 4–7 and those in levels 1–3 after THA, suggesting that achieving levels 1–3 postoperatively might depend on whether SLR muscle strength shows improvement. 相似文献4.
Naofumi Taniguchi Tetsuya Jinno Daisuke Koga Tetsuo Hagino Atsushi Okawa Hirotaka Haro 《The Journal of arthroplasty》2017,32(5):1547-1552
Background
Appropriate stem anteversion is important for achieving stability of the prosthetic joint in total hip arthroplasty. Anteversion of a cementless femoral stem is affected by the femoral canal morphology and varies according to stem geometry. We investigated the difference and variation of the increase in anteversion between 2 types of cementless stems, and the correlation between each stem and the preoperative femoral anteversion.Methods
We retrospectively compared 2 groups of hips that underwent total hip arthroplasty using a metaphyseal filling stem (78 hips) or a tapered wedge stem (83 hips). All the patients had osteoarthritis due to hip dysplasia. Computed tomography was used to measure preoperative femoral anteversion at 5 levels and postoperative stem anteversion.Results
The increase in anteversion of the tapered wedge stem group (22.7° ± 11.6°) was more than that of the metaphyseal filling stem group (17.2° ± 8.3°; P = .0007). The variation of the increase in the tapered wedge stem group was significantly larger than that in the metaphyseal filling stem group (P = .0016). The metaphyseal filling stem group was more highly and positively correlated with femoral anteversion than the tapered wedge stem group.Conclusion
Femoral anteversion affects stem anteversion differently according to stem geometry. The tapered wedge stems had greater variation of the increase in anteversion than did the metaphyseal filling stems. Based on the results of this study, it is difficult to preoperatively estimate the increase in stem anteversion for tapered wedge stems. 相似文献5.
Keisuke Akiyama Katsuya Nakata Makoto Kitada Mitsuyoshi Yamamura Hajime Owaki Takeshi Fuji 《The Journal of arthroplasty》2018,33(2):415-422
Background
Internal rotation of the hip and lateral patellar tilt increases after total hip arthroplasty (THA). However, it remains unknown whether these parameters change with time after the index THA.Methods
A total of 91 patients undergoing 2-stage bilateral primary THAs between January 2008 and May 2014 were included to assess the association of chronological changes in internal rotation of the hip or lateral patellar tilt with anthropometric and perioperative parameter and changes in alignment after the index THA. Chronological changes were assessed as changes between postoperative computed tomography on the index surgery and the preoperative computed tomography on the contralateral THA. Internal rotation of the hip was defined as the angle between the posterior intercondylar line and a line passing through the posterior inferior iliac spines. Lateral patellar tilt was defined as the angle between the posterior intercondylar line and a line joining the medial and lateral edges of the patella.Results
Internal rotation of the hip and lateral patellar tilt changed until 2 years after the index surgery by a mean of ?2° (range ?17.3° to 17.7°) and ?2° (range ?18.2° to 5.3°), respectively. Adductor tenotomy was associated with increasing internal rotation of the hip with time (adjusted R2 0.076); leg lengthening and larger preoperative femorotibial angle were associated with decreasing lateral patellar tilt with time (adjusted R2 0.159).Conclusion
Both internal rotation of the hip at rest and lateral patellar tilt decreased by approximately 2° until 2 years after surgery and there was a large variation in chronological change. 相似文献6.
Purpose
The aim of our study was to determine predictive factors and requirement for perioperative blood transfusion in elderly patients with extra capsular hip fractures treated with cephalo-medullary device.Methods
Seventy-nine patients with extra capsular hip fractures treated with cephalo-medullary nailing were included in the study. Age, sex, ASA grade, timing of surgery, preoperative and postoperative haemoglobin, length of hospital stay, fracture type, number of units transfused and 30-day mortality were recorded.Results
The mean age was 82.3 years. Forty-seven patients underwent a short nail and 32 patients a long nail; 53.4% patients required blood transfusion postoperatively. Transfusion was required in 71.8% of the long nails (p < 0.05), 65.8% patients above the age of 80 (p < 0.05), 100% of the patients with hemoglobin below 90 g/L and 20 patients with a ASA grade of 3 (p < 0.05). 78.5% patients with A2 fracture and 75% of A3 fractures needed blood transfusion (p > 0.05). Length of hospital stay in non-transfusion group was 13 days and in transfusion group was 19 days (p < 0.05). 55.1% operated within 36 h and 47.6% operated after 36 h of admission needed transfusion (p > 0.05). Thirty-day mortality in patients needing blood transfusion was 5% and in non-transfusion group was 3.7% (p > 0.05).Conclusion
Patient age, ASA grade, preoperative haemoglobin and length of nail are reliable predictors for perioperative blood transfusion in extra capsular hip fractures in elderly patients treated with cephalo-medullary nailing and reinforce a selective transfusion policy. 相似文献7.
Ahmet Kocabiyik Abdulhamit Misir Turan B. Kizkapan Kadir I. Yildiz Mehmet A. Kaygusuz Yakup Alpay Atakan Ezici 《The Journal of arthroplasty》2017,32(11):3449-3456
Background
To investigate changes in lower extremity coronal alignment in patients with unilateral Crowe type IV developmental dysplasia of the hip who underwent total hip arthroplasty with transverse femoral shortening osteotomy.Methods
We reviewed the preoperative and 1-year postoperative full-length lower extremity radiographs of 25 patients. Femoral offset (FO), mechanical hip-knee-ankle angle, anatomical axis, mechanical axis deviation (MAD), mechanical lateral proximal femoral angle, anatomical medial proximal femoral angle, mechanical lateral distal femoral angle, anatomical lateral distal femoral angle, knee joint line congruency angle, mechanical medial proximal tibial angle, mechanical lateral distal tibial angle, ankle joint line orientation angle, tibial plafond talus angle, extremity length, and pelvic obliquity were measured on both the operative and nonoperative sides.Results
Postoperatively, there were significant changes in FO (P = .001), hip-knee-ankle angle (P = .004), MAD (P = .016), mechanical lateral proximal femoral angle (P = .001), anatomical medial proximal femoral angle (P = .012), mechanical lateral distal femoral angle (P = .043), and ankle joint line orientation angle (P = .012) on the operative side. Only MAD (P = .035) changed significantly on the nonoperative side.Conclusion
Modification of FO and reconstruction of hip joint anatomy led to neutralization of knee and ankle valgus alignment. Effects on the nonoperative side were minimal. 相似文献8.
Matthew J. Thompson Bryce N. Clinger Robert M. Simonds Camille J. Hochheimer Laura A. Lahaye Gregory J. Golladay 《The Journal of arthroplasty》2017,32(9):2676-2679
Background
Recent emphasis on bundled payments and outcomes tracking has increased the focus on preoperative optimization in patients undergoing elective lower extremity arthroplasty. Since patients with obstructive sleep apnea (OSA) have an increased risk of adverse perioperative pulmonary events, screening for undiagnosed OSA is sometimes included as part of preoperative risk assessment. However, there are limited data regarding quantification of OSA risk in lower extremity arthroplasty patients, and little is known about the utility of quantitative OSA screening and the risk of pulmonary complications in hip and knee arthroplasty patients who receive intrathecal morphine anesthetic.Methods
A retrospective review of 990 patients at a tertiary care, urban academic medical center who underwent lower extremity arthroplasty with a multimodal pain regimen including intrathecal morphine anesthesia, comparing the rate of pulmonary complications and length of stay between patients previously diagnosed with OSA and those identified as low, moderate, and high risk of undiagnosed OSA established by screening with the STOP-BANG questionnaire in the preoperative setting.Results
Using logistic regression and adjusting for age, gender, and body mass index, the results suggested the rate of complications was not different across the sleep apnea risk groups (P = .4024). In addition, linear regression suggested length of stay did not differ significantly by sleep apnea risk group (P = .2823).Conclusion
In patients receiving intrathecal morphine as part of a multimodal pain regimen undergoing hip or knee arthroplasty, neither risk of adverse pulmonary events nor length of stay appeared to correlate with preoperative risk of undiagnosed OSA. 相似文献9.
Diren Arsoy James I. Huddleston Derek F. Amanatullah Nicholas J. Giori William J. Maloney Stuart B. Goodman 《The Journal of arthroplasty》2017,32(11):3434-3437
Background
Opioids have been the mainstay of treatment in the physiologically young geriatric hip fracture patient undergoing total hip arthroplasty (THA). However opioid-related side effects increase morbidity. Regional anesthesia may provide better analgesia, while decreasing opioid-related side effects. The goal of this study was to examine the effect of perioperative continuous femoral nerve blockade with regards to pain scores, opioid-related side effects and posthospital disposition in hip fracture patients undergoing THA.Methods
Twenty-nine consecutive geriatric hip fracture patients (22 women/7 men) underwent THA. Average follow-up was 8.3 months (6 weeks-39 months). Fifteen patients were treated with standard analgesia (SA). Fourteen patients received an ultrasound-guided insertion of a femoral nerve catheter after radiographic confirmation of a hip fracture. All complications and readmissions that occurred within 6 weeks of surgery were noted.Results
Continuous femoral nerve catheter (CFNC) patients were discharged home more frequently than SA patients (43% for CFNC vs 7% for SA; P = .023). CFNC patients reported lower average pain scores preoperatively (P < .0001), on postoperative day 1 (P = .005) and postoperative day 2 (P = .037). Preoperatively, CFNC patients required 61% less morphine equivalent (P = .007). CFNC patients had a lower rate of opioid-related side effects compared with SA patients (7% vs 47%; P = .035).Conclusion
CFNC patients were discharged to home more frequently. Use of a CFNC decreased daily average patient-reported pain scores, preoperative opioid usage, and opioid-related side effects after THA for hip fracture. Based on these data, we recommend routine use of perioperative CFNC in hip fracture patients undergoing THA. 相似文献10.
Asep Santoso Pramod Shaligram Ingale Ik-Sun Choi Young-Rok Shin Kyung-Soon Park Taek-Rim Yoon 《Acta orthopaedica et traumatologica turcica》2018,52(3):216-221
Objective
Disparity in size between femoral head and acetabulum could promote premature degeneration of the hip joint. The purpose of this study was to report the results of Kawamura's dome osteotomy for acetabular dysplasia due to sequelae of Perthes' disease.Patients and Methods
Fourteen patients (14 hips) operated between 1999 and 2012 were retrospectively reviewed. There were 9 males and 5 females with a mean age of 29 years (range, 15–54 years). Functional and radiological results were reviewed at mean follow-up of 9 years (range, 4–12 years).Results
Pain relief was obtained in 13 of 14 (92.8%) patients postoperatively. Good to excellent functional outcome was obtained in 10 of 14 (71.4%) patients. Mean Harris hip score was improved from 63 to 84 (p < 0.05) at the final follow-up. Improvement of limping gait was observed in 10 of 14 (71.4%) patients. Center edge angle improved from mean 24° (11–36°) preoperatively to mean 35° (27–46°) postoperatively (p < 0.05), acetabular angle improved from mean 43° (36–49°) preoperatively to mean 37° (32–44°) postoperatively (p < 0.05), acetabular head index improved from mean 69% (50–83%) preoperatively to mean 85% (73–100%) postoperatively (p < 0.05). Progression of arthrosis stage occurred in 3 of 14 (21%) patients. None of the hip with preoperative Stulberg III, 2 of 9 hips with Stulberg IV and 2 of 2 hips with Stulberg V needed conversion to total hip arthroplasty during the follow-up.Conclusion
Dome osteotomy of the pelvis combined with trochanteric advancement could give a reasonable treatment outcome for acetabular dysplasia due to Perthes' disease at mid to long-term follow-up. Advanced stage of arthrosis, preoperative Stulberg V and no improvement of limping gait after the surgery possibly associated with poor outcome.Level of evidence
Level IV, therapeutic study. 相似文献11.
Barrett A. Kielhorn Anthony J. Senagore Theodor Asgeirsson 《American journal of surgery》2018,215(3):373-376
Background
Perioperative insulin resistance is associated with significant hyperglycemia-related morbidity in patients undergoing major surgery. We sought to assess the effect of preoperative loading with a low-dose maltodextrin/citrulline solution compared to a commercially available sports drink on glycemic levels in an established colorectal enhanced recovery program.Methods
Retrospective analysis was undertaken of elective non-diabetic colectomies and enterectomies from January 2016–March 2017. Cohorts included simple (SIM) and complex carbohydrate (COM) groups. Statistical analysis was performed with linear and logarithmic regression.Results
83 patients were included (42 SIM, 41 COM). SIM group was older (61.7 vs 52.7 p = 0.012) Glycemic variability was less in the COM group (7.6% vs 21.4% P = 0.034). The frequency of hyperglycemia, postoperative complications, and length of stay trended higher in the SIM group.Conclusions
This retrospective analysis identifies significant improvement in the perioperative glycemic variability with preoperative low dose complex carbohydrate loading compared to simple carbohydrate loading in colorectal surgery patients. 相似文献12.
Masanori Fujii Tetsuro Nakamura Toshihiko Hara Yasuharu Nakashima 《Journal of orthopaedic science》2017,22(6):1089-1095
Background
We aimed to determine correlations between the hip joint center position and pelvic dimensions and whether the three-dimensional position of the original hip joint center could be estimated from pelvic landmarks in dysplastic and normal hips.Methods
We reviewed the pelvic CT scans of 70 patients (70 hips) with hip dysplasia. Seventy-seven normal hips were used as controls. The hip joint center coordinates (Cx, Cy, and Cz) and pelvic dimensions were measured with reference to the anterior pelvic plane coordinate system. Multiple regression formulas were used to estimate the original hip joint center.Results
The hip center for both dysplastic and normal hip was highly correlated with the distance between the anterior superior iliac spine (ASIS) in the coronal plane (r = 0.76 and 0.84), the distance from the ASIS to the pubic tubercle in the sagittal plane (r = 0.81 and 0.76), and distance from the pubic tubercle to the most posterior point of the ischium on the transverse plane (r = 0.76 and 0.78). The hip joint center could be estimated within a 5-mm error for more than 80% of hips on their respective axes in both dysplastic and normal hips.Conclusions
The three-dimensional position of the original hip joint center was correlated with pelvic dimensions, and can be estimated with substantial accuracy using pelvic landmarks as references. Although these results are preliminary, this estimation method may be useful for surgeons planning total hip arthroplasties. 相似文献13.
Markus Weber Benjamin Craiovan Michael L. Woerner Timo Schwarz Joachim Grifka Tobias F. Renkawitz 《The Journal of arthroplasty》2018,33(2):431-435
Background
Total hip and knee replacements are frequently performed curative treatment options in end-stage arthritis. In this study, we analyzed clinical outcome, complications, and predictors of outcome in modern joint replacement.Methods
In a retrospective analysis of over 2000 primary total hip and knee replacements from our institutional joint registry, responder rates for positive outcome as defined by the OMERACT-OARSI criteria, postoperative complication rates, and patient-reported outcome measures (EQ-5D, WOMAC) within the first year were compared between hip and knee replacements. Furthermore, preoperative risk factors associated with nonresponder rate were evaluated.Results
Positive responder rate was higher for hip replacements with 92.8% (1145/1234) than for knee replacements with 86.1% (839/975, P < .001). Infection rates were lower (P = .04), whereas intraoperative fracture occurred more frequently (P = .001) in hip than in knee replacements. Patient-reported outcome measures 1 year after surgery were higher in hip than in knee replacements with EQ-5D (0.88 ± 0.17 to 0.81 ± 0.19, P < .001) and WOMAC (84.58 ± 16.73 to 74.31 ± 18.94, P < .001). Besides the type of joint replacement (hazard ratio [HR] 2.0, P < .001), high preoperative outcome measures (HR 7.4, P < .001) and male gender (HR 1.4, P = .05) were independent risk factors of nonresponders after joint replacement.Conclusion
Both total hip and knee replacements are safe procedures with low complication rates. Still, postoperative outcome is higher in hip than in knee arthroplasty. High preoperative clinical scores are a risk factor for poor clinical improvement following total joint replacement and can be used in counseling patients in the office. 相似文献14.
Young Wook Lim James I. Huddleston Stuart B. Goodman William J. Maloney Derek F. Amanatullah 《The Journal of arthroplasty》2018,33(12):3699-3703
Background
To evaluate how canal morphology affects the technical aspects of total hip arthroplasty, we investigated the effects of femoral cortical index (FCI) on the re-establishment of leg length at the conclusion of surgery.Methods
We retrospectively reviewed age, gender, body mass index, and radiographs of 516 patients with osteoarthritis or osteonecrosis who underwent unilateral cementless primary total hip arthroplasty between 2008 and 2015. Patients were divided into level of FCI and leg length discrepancy (LLD). Each cohort was compared in terms of demographics and LLD. One-way analysis of variance and Kruskal-Wallis test were used.Results
The mean FCI and LLD were 0.6 ± 0.1 and 3.5 ± 6.3 mm, respectively. Utilization of an extended offset stem was highest with Dorr type A and B hips (P = .001). High FCI increased the risk of lengthening (P = .017) and low FCI increased the risk of shortening (P = .005).Conclusion
A high FCI increases the probability of a leg length increase and a low FCI increases the probability of a leg length decrease. Surgeons might consider informing patients in advance of possible variation in leg length depending on the patients’ proximal femoral shape and bony quality. 相似文献15.
Hong-Man Cho Jae-Woong Seo Hyun-Ju Lee Kyu-Bok Kang Jung-Ryul Kim Ho-Wook Wee 《Acta orthopaedica et traumatologica turcica》2018,52(5):343-347
Objective
There is limited literature concerning the outcomes and role of THA as a surgical option for amputee patients. The aim of this study is to determine the mid-to long-term survival and complication rates of cementless total hip arthroplasty (THA) in patients with contralateral below knee amputations.Methods
A retrospective review of 54 patients with below knee amputation were perfomed who underwent THA for osteoarthritis of the contralateral hip over a 5-year period between 1999 and 2014. Patients were monitored for at least 5 years and assessed with the Harris Hip Score and activities of daily living scale and by evaluating migration or osteolysis around the acetabular cup and femoral stems (amputee group). The amputee group was compared with a control group (non-amputee group) with the same number of patients.Results
Differences in the Harris Hip Score (p = 0.021) and activities of daily living scale (p = 0.043) between the two groups were statistically significant lower in the amputee group at 3 months after surgery. However, no differences were found between the groups from 6 months postoperatively to the last follow-up (Harris Hip Score p = 0.812, activities of daily living scale p = 0.885). Radiologically, any cups or stems showed no signs of migration or osteolysis. In the amputee group, dislocation was found in 1 patient 2 months after arthroplasty (p = 0.315) and long stem revision surgery were performed on two patients due to periprosthetic fracture (p = 0.153).Conclusions
THA performed on the contralateral side of patients with below knee amputation is considered to be an effective treatment with good clinical and radiological results at mid-to long-term follow-up.Level of evidence
Level IV, therapeutic study. 相似文献16.
Bariq Sh. Al-Amiry John F. Gaber Bakir K. Kadum Torkel B. Brismar Arkan S. Sayed-Noor 《The Journal of arthroplasty》2018,33(2):436-440
Background
We aimed to investigate the influence of preoperative radiological severity and symptom duration of hip osteoarthritis (OA) on the postoperative functional outcome, quality of life, as well as abductor muscle strength after total hip arthroplasty (THA).Methods
In this prospective cohort study, we studied 250 patients. Preoperatively, we evaluated the function with the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index and quality of life with euroqol-5D (EQ-5D). At 1 year after THA, the same scores and also hip abductor muscle strength were measured in 222 patients. We divided the cohort twice, first according to the radiological OA severity [Kellgren-Lawrence classification (KL)] and then according to the OA symptom duration. We investigated whether the preoperative KL class and symptom duration influenced the 1-year WOMAC (primary outcome measure) or EQ-5D and abductor muscle strength (secondary outcome measures).Results
The crude results showed that KL class and symptom duration had no influence (P = .90 and P = .20, respectively) on the 1-year WOMAC. Younger age, male gender, and lower body mass index were associated with a better function. Regarding 1-year EQ-5D, the crude results showed that body mass index and KL class had no influence (P = .83 and P = .39, respectively). The adjusted results showed that only age and gender influenced the postoperative EQ-5D. No influence of the tested factors was found on the 1-year abductor muscle strength.Conclusion
Preoperative radiological OA severity and symptom duration had no influence on the outcome of THA and should probably not affect the decision about timing the operative intervention. 相似文献17.
Suleman Qurashi Jason Chinnappa Sarah J. Lord Alan Nazha Jonathan Gordon James Chow 《The Journal of arthroplasty》2017,32(5):1525-1529
Background
Patients undergoing total hip arthroplasty (THA) are often advised to avoid driving for 6 weeks postoperation. This is based on patients having to maintain postoperative hip precautions and studies investigating brake reaction time (BRT) following THA using conventional techniques. The aim of this study was to assess patients' ability to drive in the early postoperative period following microinvasive THA by assessing BRT.Methods
Hundred consecutive patients undergoing SuperPATH® THA in 2015 who drove automobiles preoperatively were included in this prospective cohort study. BRT was measured preoperatively and at day 1 or 2 postoperation using a driving simulator. A subset of 25 consecutive patients had repeat BRT testing at 2 weeks postoperation. Five BRT measures were taken at each time point. Differences in the patient's mean and best BRT at each time point were assessed using the paired t-test.Results
The study cohort included 50 men and 50 women with mean age 63 years (range 25-86). The mean preoperative BRT was 0.63 s (range 0.43-1.44), with a mean difference of ?0.1 s (range ?0.57 to 0.33, P < .0001) at day 1 or 2 postoperation. The 2-week mean and best BRTs were also better than paired preoperative readings with a mean improvement of 0.15 s (range ?0.78 to ?0.004, P < .0001).Conclusion
BRT reaches preoperative values by day 2 following microinvasive THA. Patients may be suitable to drive earlier than the previously recommended 6 weeks postoperation. 相似文献18.
Kyrill Rykov Inge H.F. Reininga Maurits S. Sietsma Bas A.S. Knobben Bas L.E.F. ten Have 《The Journal of arthroplasty》2017,32(12):3652-3658.e1
Background
The direct anterior approach (DAA) for total hip arthroplasty has claimed to be a true tissue-sparing minimally invasive approach that has less tissue damage and a faster recovery when compared to the posterolateral approach (PLA). The aim of this randomized controlled trial is to measure the differences in serum markers and functional outcomes between the DAA and PLA for total hip arthroplasty.Methods
Forty-six patients were prospectively included and randomized for either the DAA (n = 23) or PLA (n = 23). All surgical procedures were performed by 3 well-trained orthopedic surgeons. The degree of tissue damage was assessed by measuring creatine kinase (CK) and C-reactive protein levels (CRP) preoperatively and 2 hours, 1 day, 2 weeks, and 6 weeks postoperatively. Generalized linear mixed models analyses were used to assess differences between serum markers over time; correction for possible confounding factors was performed. The Hip disability and Osteoarthritis Outcome Score and the Harris Hip Score were assessed preoperatively and 6 weeks postoperatively.Results
There were no differences in patient demographics. The DAA had a longer operative time (P = .001). CK and CRP levels increased postoperatively, but no significant differences between the groups were found on any of the time points. Functional outcomes were also similar in both approaches.Conclusion
No difference in tissue damage measured with serum markers CK and CRP were found between the DAA and PLA for total hip arthroplasty. 相似文献19.
Maximilian F. Kasparek Martin Faschingbauer Wenzel Waldstein Cosima S. Boettner Friedrich Boettner 《The Journal of arthroplasty》2017,32(4):1176-1179
Background
Topical tranexamic acid (TXA) was introduced to replace the previous targeted preoperative autologous blood donation (PABD) program. This study aims to analyze the efficacy of topical TXA compared with targeted PABD in anemic patients undergoing primary total hip arthroplasty (THA).Methods
Two thousand two hundred fifty-one patients underwent primary THA between 2009 and 2013 using targeted autologous blood donation for 280 anemic patients (12%; Hb <12.5 g/dL). One thousand nine hundred seventy-one nonanemic patients (88%; ≥12.5 Hb/dL) received no blood management intervention. Starting in 2014, 505 consecutive patients were operated using 3 grams of topical TXA and abandoning PABD. Ninety-one patients (18%) were anemic and 414 (82%) nonanemic.Results
The utilization of topical TXA in anemic patients resulted in higher hemoglobin levels on the first postoperative day (P = .014), but not on the second postoperative day (P = .198) compared with PABD. There was no difference in allogeneic transfusion rates between both groups: 12% vs 13% (P = .848). In the nonanemic group, TXA significantly increased hemoglobin levels on the first postoperative day (P = .001) as well as on the second postoperative day (P < .001), and resulted in a reduction in allogeneic transfusion rates from 8% to 1%.Conclusion
The present study suggests that topical TXA is equivalent to PABD in anemic patients and reduces transfusion rates and increases Hb-levels in nonanemic patients. 相似文献20.
Mette Holm Hjorth Inger Mechlenburg Kjeld Soballe Lone Roemer Stig Storgaard Jakobsen Maiken Stilling 《The Journal of arthroplasty》2018,33(7):2279-2286