scholarly journals Comparison of Supine and Lateral Decubitus Positions for Total Hip Arthroplasty with the Direct Lateral Approach in Overweight and Obese Patients

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Olcay Güler ◽  
Sidar Öztürk ◽  
Ferit Tufan Özgezmez ◽  
Mehmet Halis Çerçi
Keyword(s):  
Total Hip Arthroplasty ◽  
Blood Loss ◽  
Hospital Stay ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
Complication Rates ◽  
Obese Patients ◽  
Total Hip ◽  
Lateral Decubitus

Background. The purpose of our study is to compare the results of supine and lateral decubitus positions for total hip arthroplasty (THA) with the direct lateral (DL) approach in overweight and obese patients. Methods. Patients who had a THA with the DL approach using the lateral decubitus position (LD group) (n=54) or supine position (S group) (n=45) were retrospectively investigated. Demographic characteristics, age, and body mass indexes were calculated. Blood loss of patients, amount of transfusion, Harris Hip Scores (HHSs) (preop, 6 weeks, 3 months, 6 months, and 12 months), incision size, surgery time, postoperative acetabular cup inclination angle, femoral stem alignment, follow-up period, hospital stay, preoperative-postoperative leg length inequality, and complication rates (infection, wound site problems, and dislocation rates) were compared. Results. Both groups did not differ from each other by means of age, gender, BMI, and affected side (p=0.814, p=0.723, p=0.582, and p=0.833, respectively). The incision length (p<0.001), blood loss (p=0.010), and amount of blood transfused (p=0.002) were significantly higher in the S group than in the LD group. The surgical time was significantly longer in the S group (p<0.001). There were no statistically significant differences between the LD and S groups in terms of pre- and postoperative height, cup inclination, stem alignment, duration of hospital stay, and follow-up period. The change between pre- and postoperative HHS in the LD and S groups was statistically significant. Post hoc binary comparison analysis was conducted to investigate the difference between the groups. The values of HHS were significantly increased from the preoperative period to the final follow-up. Conclusions. The LD and S groups had comparable functional outcomes one year postoperatively. However, the S group was associated with worse intraoperative outcomes than the LD group.

Short Femoral Stem in Total Hip Arthroplasty: Stable Fixation and Low Complication Rates in Elderly Patients

2017 ◽  
Vol 27 (4) ◽  
pp. 311-316 ◽  
Author(s):  
Jaime J. Morales de Cano ◽  
Christian Gordo ◽  
Jordi Canosa Areste
Keyword(s):  
Total Hip Arthroplasty ◽  
Elderly Patients ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
Short Stem ◽  
Control Group ◽  
Complication Rates ◽  
Total Hip ◽  
Short Femoral Stem

Background We present the result of our experience in using a short femoral stem in elderly patients (>70 years of age) compared to patients younger than 70 years. Methods Data were prospectively collected on 138 patients who underwent 148 primary total hip arthroplasty (THA), with a conservative short stem between November 2010 and June 2014. The cohort was divided into 2 groups: the study group (group 1) comprised 57 patients (60 THA) over 70 years of age at the time of surgery, with a mean age of 75.4 years (range 70-87 years) and a mean follow-up of 26.7 months (range 9-48 months). The control group (group 2) comprised 81patients (88 THA) less than 70 years of age with a mean age of 57.4 years (range 33-69 years) and a mean follow-up of 27.3 months (range 9-54 months). Hip function in the 2 groups was compared preoperatively and postoperatively using the Merle D'Aubigne hip score (MD) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) score. Results At the latest follow-up, 1 calcar fracture was reported in a 54-year-old patient in the control group, which required fixation with a screw and had a favourable outcome. No cases of clinical or radiographic loosening were reported. Clinical results showed no statistically significant differences between the 2 groups. Conclusions The use of the GTS conservative short stem in patients over 70 years old has shown very good results and low complication rates, comparable to those for patients younger than 70 years.

scholarly journals Measurement of operative femoral anteversion during cementless total hip arthroplasty and influencing factors for using neck-adjustable femoral stem

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jingyang Sun ◽  
Bohan Zhang ◽  
Lei Geng ◽  
Qingyuan Zheng ◽  
Juncheng Li ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Influencing Factors ◽  
Hip Arthroplasty ◽  
Perioperative Complications ◽  
Demographic Data ◽  
Univariate Analysis ◽  
Femoral Stem ◽  
Femoral Anteversion ◽  
Total Hip

Abstract Background Placement of femoral stem in excessive anteversion or retroversion can cause reduced range of motion, prosthetic impingement, and dislocation. The aim of this study was to assess the operative femoral anteversion in patients treated with total hip arthroplasty (THA) and analyze the need of adjusting stem anteversion. Methods We retrospectively included 101 patients (126 hips) who underwent cementless THA with a manual goniometer to determine the femoral anteversion between October 2017 and December 2018. The operative femoral anteversion we measured was recorded during THA. We further divided those hips into three subgroups based on the range of operative femoral anteversion: group 1 (<10°), group 2 (10–30°), and group 3 (>30°) and compared the differences of their demographic data. Univariate and multivariate logistic regression were used to identify the influencing factors for the need of neck-adjustable femoral stem. The clinical and radiographic outcomes were also assessed. Perioperative complications were recorded. Results After THA, the Harris hip scores improved from 52.87 ± 15.30 preoperatively to 90.04 ± 3.31 at the last follow-up (p < 0.001). No implant loosening, stem subsidence, and radiolucent lines were observed on radiographs. No severe complications occurred and no components needed revision at the latest follow-up. The mean operative femoral anteversion was 14.21° ± 11.80° (range, −9 to 60°). Patients with femoral anteversion more than 30° were about 10 years younger than others. Femoral anteversion >30° was more common in patients with developmental dysplasia of the hip (DDH). There were totally 14 hips treated with the neck-adjustable femoral stem. From the univariate analysis, we can observe that female sex, diagnosis of DDH (compared with osteonecrosis), and higher operative femoral anteversion and its value >30° (compared with <10°) are associated with higher rates of using the neck-adjustable femoral stem. However, all these factors were no longer considered as independent influencing factors when mixed with other factors. Conclusions This study highlighted the significance of operative femoral anteversion. Identification of abnormal femoral anteversion could assist in adjusting stem anteversion and reduce the risk of dislocation after THA.

Adoption of Robotic Arm-Assisted Total Hip Arthroplasty Results in Reliable Clinical and Radiographic Outcomes at Minimum Two-Year Follow Up

2021 ◽  
Author(s):  
Matthew Hepinstall ◽  
Harrison Zucker ◽  
Chelsea Matzko ◽  
Morteza Meftah ◽  
Michael Mont
Keyword(s):  
Total Hip Arthroplasty ◽  
Clinical Outcomes ◽  
Hip Arthroplasty ◽  
Case Series ◽  
Robotic Arm ◽  
Complication Rates ◽  
Total Hip ◽  
Surgical Assistance ◽  
Published Evidence

Introduction: Longevity and success of total hip arthroplasty (THA) is largely dependent on component positioning. While use of robotic platforms can improve this positioning, published evidence on its clinical benefits is limited. Therefore, the aim of this study was to assess the clinical outcomes of THA with robotic surgical assistance. Materials and Methods: We conducted an analysis of robotic arm-assisted primary THAs performed by a single surgeon utilizing a posterior approach. A total of 99 patients (107 cases) who had a minimum two-year follow up were identified. Their mean age was 61 years (range, 33 to 84 years), and their mean body mass index was 30.5 kg/m2 (range, 18.5 to 49.1 kg/m2). There were 56% female patients and primary osteoarthritis was the principal hip diagnosis in 88.8%. Operative times, lengths of hospital stay, and discharge dispositions were recorded, along with any complications. Modified Harris Hip Scores (HHS) were calculated to quantify clinical outcomes. Results: Mean postoperative increases in HHS at 2- to 5.7-year follow up was 33 points (range, 6 to 77 points). There were no complications attributable to the use of robotic assistance. Surgical-site complications were rare; one case underwent a revision for prosthetic joint infection (0.93%) but there were no dislocations, periprosthetic fractures, or cases of mechanical implant loosening. There was no evidence of progressive radiolucencies or radiographic failure. Discussion: Robotic arm-assisted THA resulted in low complication rates at minimum two-year follow up, with clinical outcomes comparable to those reported with manual surgery.1–4 The haptically-guided acetabular bone preparation enabled reliable cementless acetabular fixation and there were no adverse events related to the use of the robot. Dislocations were avoided in this case series. Randomized controlled clinical trials are needed to compare manual to robotic surgery and to investigate whether the precision found with this functional planning will reliably reduce the incidence of dislocations.

Early to medium-term outcomes of uncemented ceramic-bearing total hip arthroplasty in teenagers for paediatric hip conditions

2020 ◽  
Vol 102-B (11) ◽  
pp. 1491-1496
Author(s):  
Pranai K. Buddhdev ◽  
Ivor S. Vanhegan ◽  
Tahir Khan ◽  
Aresh Hashemi-Nejad
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
Adolescent And Young Adult ◽  
Medium Term ◽  
Total Hip ◽  
Custom Made ◽  
The Mean ◽  
Custom Made Prostheses

Aims Despite advances in the treatment of paediatric hip disease, adolescent and young adult patients can develop early onset end-stage osteoarthritis. The aims of this study were to address the indications and medium-term outcomes for total hip arthroplasty (THA) with ceramic bearings for teenage patients. Methods Surgery was performed by a single surgeon working in the paediatric orthopaedic unit of a tertiary referral hospital. Databases were interrogated from 2003 to 2017 for all teenage patients undergoing THA with a minimum 2.3 year follow-up. Data capture included patient demographics, the underlying hip pathology, number of previous surgeries, and THA prostheses used. Institutional ethical approval was granted to contact patients for prospective clinical outcomes and obtain up-to-date radiographs. In total, 60 primary hips were implanted in 51 patients (35 female, 16 male) with nine bilateral cases. The mean age was 16.7 years (12 to 19) and mean follow-up was 9.3 years (2.3 to 16.8). Results The most common indication for teenage hip arthroplasty was avascular necrosis secondary to slipped upper femoral epiphysis (31%; n = 16). Overall, 64% of patients (n = 33) had undergone multiple previous operations. The survival at follow-up was 97%; two patients required revision for aseptic loosening (one femoral stem, one acetabular component). Both patients had fused hips noted at the time of arthroplasty. A further two patients had radiolucent lines but were asymptomatic. At latest follow-up the mean Oxford Hip Score was 44 (31 to 48) and a Visual Analogue Scale measurement of 1.5, indicating satisfactory function. Conclusion Operating on this cohort can be complicated by multiple previous surgeries and distorted anatomy, which in some cases require custom-made prostheses. We have demonstrated a good outcome with low revision rate in this complex group of patients. Cite this article: Bone Joint J 2020;102-B(11):1491–1496.

Midterm outcomes of total hip arthroplasty with a modular Birmingham head

2019 ◽  
pp. 112070001987738 ◽  
Author(s):  
Duncan W Cushnie ◽  
Brent A Lanting ◽  
Richard McCalden ◽  
Douglas DR Naudie ◽  
James L Howard
Keyword(s):  
Soft Tissue ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
Tissue Reaction ◽  
Harris Hip Score ◽  
Total Hip ◽  
Tissue Reactions ◽  
Clinical Records

Introduction: Birmingham Hip Resurfacing (BHR) implants may be combined with a conventional femoral stem to create a modular metal-on-metal total hip arthroplasty (BHR MoM THA). There is little outcome data regarding this construct. This study examines midterm outcomes of BHR MoM THA compared to oxidised zirconium total hip arthroplasty (THA). Methods: A retrospective institutional review identified all patients receiving BHR MoM THA between April 2005 and February 2011 and a matched control cohort of zirconium THA patients. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Harris Hip Score (HHS), and SF-12 Health status scores were obtained. Revisions and complications were collected from clinical records. Radiographs were assessed for evidence of component malposition, loosening, osteolysis, or heterotopic ossification. Results: 63 modular BHR MoM THA were identified in 61 patients (36 with BHR cups, 27 with R3 cups) and 63 zirconium THA in 58 matched controls. Mean follow-up was 58 months. 14 BHR MoM THA hips (22.2%) were revised (4 infections, 1 dislocation, 9 soft tissue reactions) compared to 3 (4.8%) zirconium THA (all infections). At latest follow-up, 18.4% of surviving BHR MoM THA hips were painful compared to 0.5% of zirconium THA controls ( p < 0.001). WOMAC, HHS, and SF-12 did not differ significantly between surviving members of the 2 groups. Discussion: BHR MoM THA demonstrated a high revision rate, largely for adverse local soft tissue reaction and pain. Among those not revised, many reported some residual pain despite similar quality of life measures to those who received zirconium THA.

Outcomes and survivorship after conversion of failed hip hemiarthroplasty to total hip arthroplasty

2019 ◽  
pp. 112070001989142 ◽  
Author(s):  
Nana O Sarpong ◽  
Matthew J Grosso ◽  
Akshay Lakra ◽  
Carl L Herndon ◽  
Emma Jennings ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Total Hip Arthroplasty ◽  
Femoral Component ◽  
Hip Arthroplasty ◽  
Revision Surgery ◽  
Complication Rates ◽  
Conversion Surgery ◽  
Total Hip ◽  
Estimated Blood Loss

Background: Arthroplasty is the treatment of choice for elderly patients with displaced femoral neck fractures. When compared to total hip arthroplasty (THA), higher revision rates have been reported for hemiarthroplasty (HA). Conversion of failed HA to THA can be complex, especially in the elderly population at risk for revision surgery complications. We report a single institution’s experience with conversion of failed HA to THA at mid-term follow-up. Methods: We identified patients converted from failed HA to THA from 2006 to 2016. Clinical data including indication for index and conversion surgery, maintenance or revision of femoral component during conversion, operative time, estimated blood loss, postoperative complications, and need for revision surgery were collected. Descriptive statistics were analysed in SPSS. Results: The cohort included 21 men and 39 women (mean age of 74.5 years). The mean follow-up after conversion HA to THA was 2.8 years. During conversion surgery, the femoral component was revised in 75.0% and retained in 25.0% of cases. After conversion HA to THA, the rate of major complications and re-revision at 2 years was 11.7% and 10.0%, respectively. Femoral revision versus retention did not affect complication rates (11.1% vs. 6.7%; p = 0.31) or re-revision rates (8.9% vs. 13.3%; p = 1.0). Conclusions: In this high-risk population, mid-term follow-up demonstrated tolerable complication and re-revision rates, the majority of which were for instability. We observed high rates of femoral component revision during conversion THA, although this did not increase the likelihood of postoperative complications or need for future surgery.

scholarly journals Results of Conversion from Failed Austin-Moore Hemiarthroplasty to Cementless Total Hip Arthroplasty in Octogenarian Patients with Advanced Acetabular Erosion: A Minimum of 5 Years of Follow-Up

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Tsan-Wen Huang ◽  
Chih-Hsiang Chang ◽  
Fu-Chun Chang ◽  
Chun-Chieh Chen ◽  
Kuo-Chin Huang ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
Femoral Neck Fractures ◽  
Total Hip ◽  
Cementless Total Hip Arthroplasty ◽  
Mid Term Results ◽  
Acetabular Erosion ◽  
Austin Moore

Austin-Moore hemiarthroplasty (HA) had been selectively used for elderly patients with femoral neck fractures. With increasing life span and activity, the sequela of Austin-Moore HA make the implant no longer favorable. The treatment of failed Austin-Moore HA with advanced acetabular erosion is challenging; however, little has been published regarding this topic. The aim of this study was to evaluate the mid-term results of using cementless total hip arthroplasty (THA) in octogenarians. Between 2008 and 2011, 47 patients (32 women and 15 men) with an average age of 86 years (range 83-89 years) were enrolled in this retrospective study. After an average follow-up period of 6.2 years (range 5.0-7.8 years), no migration or loosening of the cup or femoral stem was found. Harris hip scores improved from 36 (range 15-42) preoperatively to 87 (range 80-90). There were no complications directly associated with the procedure except for superficial infections in two patients. Our results suggest that using cementless THA can result in favorable radiographic and clinical outcomes in octogenarian patients.

Perioperative Fracture Risk and Two-Year Survivorship of a Short Tapered Femoral Stem following Direct Anterior Approach Cementless Total Hip Arthroplasty with a Fracture Table

2020 ◽  
Vol 04 (01) ◽  
pp. 033-037
Author(s):  
Samantha Andrews ◽  
Gregory J. Harbison ◽  
Ian Hasegawa ◽  
Emily Unebasami ◽  
Cass Nakasone
Keyword(s):  
Total Hip Arthroplasty ◽  
Aseptic Loosening ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Femoral Stem ◽  
Direct Anterior Approach ◽  
Total Hip ◽  
Fracture Table ◽  
Short Femoral Stem

AbstractThe cementless, tapered wedge, short femoral stem implant is commonly used in direct anterior approach (DAA) total hip arthroplasty (THA). The lack of access and visualization, however, may increase the risk of perioperative fracture and early failure. Therefore, the current study examined perioperative complications and 2-year implant survivorship following DAA THA performed using a fracture table and short, tapered wedge femoral stem. A retrospective analysis was conducted on patients having undergone DAA THA with a cementless, tapered wedge, short femoral stem. Perioperative fractures were noted and survivorship was determined by the incidence of revision surgery within a minimum 2-year follow-up period. A total 366 consecutive patients (441 hips) were identified in the cohort. Four patients (6 hips; 1.4%) were lost to follow-up and three patients died from unrelated causes. Average follow-up time for the remaining 359 patients (435 hips) was 32.9 ± 10.2 months. There were no intraoperative factures but three perioperative fractures within two weeks. Aseptic loosening occurred in one stem at 13 months, resulting in a 99.1% survival rate with a mean survival time of 23.8 ± 0.1 months (95% confidence interval: 23.6–24.0 months). The use of a short, tapered wedge femoral stem and a fracture table for DAA THA resulted in 0.7% periprosthetic fractures and only one aseptic loosening within 2 years. These results suggest that proper femoral exposure with the use of a fracture table and a short, tapered wedge femoral stem does not appear to increase the risk of periprosthetic femoral fracture.

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