Primary cemented total hip arthroplasty—an Indian experience

We report outcome of 9-year follow-up of 50 Charnley cemented primary arthroplasties in 47 patients performed between 1996 and 1999. The minimum follow-up period was 5 years with a mean of 7 years. All hip joints were thoroughly assessed preoperatively to document patients’ functional level and Harris hip score was calculated. All the patients were disabled because of pain in hip and 45 (90%) had used walking aids. At follow-up all patients were living. The radiographs of all patients were available for the entire follow-up period. Of the 50 operated hips, only 2 patients (4%) complained of pain while all the rest were free of pain. Postoperatively only 10 (20%) patients used support for walking. At follow-up none of the hips were revised. Two patients (4%) had dislocation in postoperative period in which reduction was done under anesthesia. In one patient (2%) prosthesis and cement was removed because of deep infection. In two patients (4%) radiolucent clear zone was seen at bone cement interface on acetabular side and three (6%) patients had it on femoral component. None of the patients developed deep vein thrombosis or heterotopic bone. In postoperative period the Harris hip score was calculated in each case and compared with the preoperative score to evaluate the outcome. Significant improvement was found in Harris hip score after surgery.     

The Patient Acceptable Symptom State for the Harris Hip Score Following Total Hip Arthroplasty: Validated Thresholds at 3-Month, 1-, 3-, 5-, and 7-Year Follow-Up

BackgroundThe Patient Acceptable Symptom State (PASS) represents the value on a patient-reported outcome measure scale beyond which patients consider themselves well or in a satisfactory state. The aim of this study is to define and validate the PASS threshold for the HHS at 3 months, 1, 3, 5, and 7 years after THA.MethodsA total of 976 patients from 14 centers in 7 countries were enrolled into a prospective study. Patients completed the HHS and a numerical rating scale for satisfaction at each follow-up. PASS thresholds for the HHS were calculated at each follow-up interval using the anchor-based, 80% specificity method. A bootstrapping method was used to internally validate the primary PASS thresholds. A patient sample sourced from an institutional registry was used for external validation.ResultsThe HHS was an excellent predictor of satisfaction at each time point (area under the curve > 0.8; P < .001). PASS thresholds for the HHS were 76 points at 3 months, 89 points at 1 year, 93 points at 3 years, 94 points at 5 years, and 93 points at 7 years. When applied to the internal and external validation cohorts, all PASS thresholds showed acceptable or excellent ability to predict satisfaction (area under the curve = 0.73-80; P < .001).ConclusionThe present study is the first to present validated PASS thresholds for the HHS following THA. These findings will serve as a useful reference for future THA outcome studies and as benchmarks for surgeons in their assessment of their patients’ clinical success.     

Anterolateral ST segment depression in acute inferior myocardial infarction: angiographic and clinical implications

We examined the relationship between coronary anatomy and anterolateral ST segment depression during inferior acute myocardial infarction (AMI) in 84 consecutive survivors of inferior AMI, who underwent prospective coronary angiography a median time of 2 weeks after AMI. Multivessel disease was defined as two or more significantly (greater than 70%) stenosed vessels. A QRS scoring system was used to estimate myocardial infarct size. Patients with ST depression had more multivessel disease compared to patients with no ST depression (53% vs 6%, p less than 0.01), more left anterior descending stenoses (36% vs 10% p less than 0.05), and higher QRS scores (5.8 +/- 3.2 vs 2.6 +/- 1.8, p less than 0.01) indicating larger infarcts. Patients with ST depression and one-vessel disease (47%) still had higher QRS scores compared to patients with no ST depression (4.8 +/- 2.9 vs 2.6 +/- 1.8, p less than 0.001) and had an increased prevalence of infarct-related vessels with a terminal branch supplying the left ventricular lateral wall or apex. We conclude that anterolateral ST depression during inferior AMI may indicate the presence of additionally stenosed vessels or that the infarct-related vessel has a large vascular territory. The absence of ST depression virtually precludes multivessel disease.     

The role of femoral offset and abductor lever arm in total hip arthroplasty

Background

In order to create a well-functioning total hip arthroplasty (THA), it is important to restore femoral off-set and thus the abductor lever arm. The aim of this study was to investigate the clinical effect of increasing the abductor lever arm to and beyond the anatomical native lever arm in minimally invasive total hip arthroplasty performed through a direct anterior approach.

Materials and methods

We compared the lever arm of the operated hip to the lever arm of the contralateral native hip on radiographs in 148 patients following THA. The patients were divided in two groups based on whether they kept their anatomical lever arm or had an increased lever arm. The clinical outcome was assessed using hip osteoarthritis outcome score (HOOS), Harris hip score and UCLA activity score.

Results

Patients who kept their anatomical lever arm did not experience a significantly better clinical outcome than the patients with an increased abductor lever arm. We found no significant difference in clinical scores at any of the follow-ups during the first year after THA.

Conclusion

The results of this study suggest that an increase in the abductor lever arm does not have major effects on the clinical outcome after THA. To avoid the potential negative effects of decreasing the lever arm, the surgeon should aim for an equal or slightly increased lever arm.Level of evidence Level 3, prospective cohort study.     

股骨近端锁定加压钢板治疗股骨转子间骨折

目的 探讨股骨近端锁定加压钢板（LCP）内固定治疗股骨转子间骨折的临床疗效.方法 采用股骨近端LCP治疗23例股骨转子间骨折的患者.随访观察骨折愈合时间,按Harris评分标准评价疗效.结果 23例均获随访,时间6~12（9±1.4）个月.骨折愈合时间14~20（17±1.7）周.髋关节Harris评分：优13例,良9例,一般1例.结论 股骨近端LCP内固定治疗股骨转子间骨折创伤小、出血少、对骨膜影响小,符合解剖形态,临床疗效满意.     

Excellent Results and Minimal Complications of Total Hip Arthroplasty in Sickle Cell Hemoglobinopathy at Mid-Term Follow-Up Using Cementless Prosthetic Components

The purpose of this study was to compare the outcomes of cementless primary total hip arthroplasty (THA) in sickle cell patients compared to the remaining cohort of osteonecrosis patients who did not have this disease. Thirty-two sickle cell patients (42 hips) who had a mean age of 37 years and mean follow-up of 7.5 years (range, 5–11 years) were compared to 87 non-sickle cell osteonecrosis patients (102 hips) who had mean age of 43 years and mean follow-up of 7 years (range, 3–10.5 years). Outcomes evaluated included implant survivorship, Harris hip scores, complication rates, radiographic outcomes, and Short Form-(SF-36) health questionnaire. There were no significant differences in aseptic implant survivorship (95 vs. 97%), Harris hip scores (87 vs. 88 points), SF-36 score, or radiographic findings between the two patient cohorts. In light of these findings, we believe that the outcomes of THA improved in sickle cell patients with optimized medical management and the use of cementless prosthetic devices.     

髓心减压人工骨植入治疗早期股骨头坏死的护理

目的探讨个性化护理对早期股骨头坏死行髓芯减压患者的应用。方法选择在我院治疗的50例股骨头坏死患者,均行髓心减压人工骨植入术,所有患者随机分为实验组和对照组,实验组给予常规护理结合个性化护理,而对照组给予常规护理,术后3个月观察两组患者的Harris髋关节评分。结果实验组经个性,化护理后Harris髋关节评分总体分布较对照组好（χ^2=4．20,P〈0．05）。结论经个性化护理后髓芯减压患者的Harris髋关节评分较高,利于患者术后康复。     

Influence of the femoral head size on early postoperative gait restoration after total hip arthroplasty

Background We investigated the effects of using large-diameter femoral heads in total hip prostheses on early postoperative gait restoration in patients undergoing total hip arthroplasty （THA）. Methods We collected data for 19 primary THAs using 28-mm metal-on-polyethylene heads （conventional group） and for 12 THAs （BHR group） using metal-on-metal femoral heads with an average size of 45 mm （range, 40-49mm）. All patients had unilateral femoral head avascular necrosis. All patients underwent Harris Hip Scores evaluation and gait analysis with the IDEEA device at the same 3 time points which were before surgery and then at 1 month and again at 3 months after surgery, and the parameters measured were walking speed, stride length （SL）, single limb support （SLS）, cycle duration （CD）, and swing power （SP）. Harris Hip Scores and gait analysis parameters for both groups were compared. Results Intraclass comparison indicated that Harris Hip Scores, speed scores, and gait parameter measures in both groups improved significantly with the passage of time; Interclass comparison showed no significance between Harristm postop - HarriSpreop and Harris3m postop- HarriSpreop in both groups. The speed in the BHR group at 1 month and at 3 months after surgery was significantly higher than that of conventional group. At 1 month after surgery, each mean for SLnormal - SLaffected, （SLSnormal - SLSaffected）/CD, and SPnormal - SPaffected in the BHR group was significantly lower than that for the conventional group. At 3 months after surgery, the differences between means for both groups for SLnormal - SLaffected, （SLSnormal- SLSaffected）/CD, and SPnormal - SPaffected were not significant, but the mean of SPnorrnal - SPaffected in the BHR group was significantly lower than that in the conventional group. Conclusions Our data suggest that large-diameter femoral heads in THA provide better early gait restoration than conventional-size femoral heads.     

Total hip arthroplasty in young patients using the thrust plate prosthesis: clinical and radiological results

Introduction The standard treatment for patients who require total hip replacement is the implantation of an intramedullary diaphyseal anchored hip prosthesis. A bone-sparing thrust plate hip prosthesis (TPP) can be used as an alternative device for young patients. The TPP relies on proximal femoral metaphyseal fixation. The theoretical advantage of leaving diaphyseal bone intact is easier conversion to a stemmed prosthesis. This retrospective study evaluated the medium- and short-term results after total joint replacement using the third generation TPP.Materials and methods Between 1997 and 2001, 58 TPPs were used for 52 patients. Clinical and demographic data were obtained from the patients charts and our electronic database. Their average age at time of surgery was 40.9±11.4 years. At follow-up, the Harris hip score, residual pain, required pain medication, and the ability to lie on the operated side were documented. Radiographic evaluation included standardized radiographs of the hip joint and the pelvis.Results Four patients required revision surgery (6.9%). For 51 of the remaining 54 TPPs, a postoperative functional and radiological status was obtained. The average follow-up was 26±11.0 months. 88% of the patients experienced some or complete relief of pain. The median Harris hip score at follow-up was 73±20.5 points. A postoperative hip dislocation occurred in 5 patients (8.6%).Conclusion Since many patients experienced some or complete relief of pain, the TPP can be recommended as a feasible implant for the treatment of hip disorders requiring total hip arthroplasty in young patients. Revision surgeries are facilitated by the good bone stock remaining in the proximal femur.