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Zhou Y, Fraval A, Vertullo CJ, Du P, Babazadeh S, Stevens J. Patient and Surgical Factors Associated With Long-Term Mortality Outcomes Up to Fifteen Years After Total Hip and Knee Arthroplasty: An Australian Orthopaedic Association National Joint Replacement Registry Study. J Arthroplasty 2025; 40:1471-1477. [PMID: 39551411 DOI: 10.1016/j.arth.2024.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2024] [Revised: 11/07/2024] [Accepted: 11/11/2024] [Indexed: 11/19/2024] Open
Abstract
BACKGROUND Mortality rates following total hip arthroplasty (THA) and total knee arthroplasty (TKA) arthroplasty display distinct temporal patterns often attributed to patient selection bias, perioperative optimization, and comorbidities. Understanding these mortality patterns is essential for epidemiological and health economic longitudinal modeling. METHODS We conducted a national registry-based cohort study in Australia using data from 1999 to 2022, examining primary and revision THA and TKA procedures for osteoarthritis. We assessed patient factors (age, sex, body mass index, and American Society of Anaesthesiologists score), and surgical factors (procedure, fixation, bearing surface, and implant volume) in relation to long-term mortality. Standardized mortality ratios were calculated by comparing observed and expected deaths based on national mortality rates. RESULTS Our study included 540,181 THA and 880,036 TKA procedures. Temporal trends in mortality rates were observed, with a reduction in mortality rate observed up to seven years for both primary THA and primary TKA after the index procedure and an increased mortality rate observed thereafter. All patient factors were associated with differences in mortality rates, with younger (age range, 45 to 49 years) patients for primary TKA demonstrating the strongest association with mortality excess (15 years; standardized mortality ratios 2.02; 95% confidence interval 1.66 to 2.46). Revision procedures were associated with higher mortality rates compared to their respective primary procedures at all time points. CONCLUSIONS Our study finds noncausal associations between patient and surgical factors and mortality up to fifteen years following THA and TKA for osteoarthritis in Australia. These findings are crucial for calibrating epidemiological and economic models and enhancing the precision of longitudinal outcome predictions for arthroplasty patients. While limitations exist, our study informs clinical practice, healthcare policies, and future research in arthroplasty surgery on a national scale, with potential relevance to similar populations worldwide. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Yushy Zhou
- Department of Surgery, The University of Melbourne, Melbourne, Australia; Department of Orthopaedic Surgery, St. Vincent's Hospital Melbourne, Melbourne, Australia
| | - Andrew Fraval
- Department of Orthopaedic Surgery, St. Vincent's Hospital Melbourne, Melbourne, Australia
| | - Christopher J Vertullo
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia; Menzies Health Institute, Griffith University, Queensland, Australia
| | - Peivao Du
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Sina Babazadeh
- Department of Orthopaedic Surgery, St. Vincent's Hospital Melbourne, Melbourne, Australia
| | - Jarrad Stevens
- Department of Orthopaedic Surgery, St. Vincent's Hospital Melbourne, Melbourne, Australia
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Tsuchiya M, Fukushima K, Ohashi Y, Mamorita N, Saito H, Uchida K, Uchiyama K, Takahira N, Takaso M. Is the increase in the number of total hip arthroplasties in Japan due to an aging society? J Orthop Sci 2025; 30:451-455. [PMID: 38955575 DOI: 10.1016/j.jos.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 06/05/2024] [Accepted: 06/11/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND The number of total hip arthroplasty (THA) is increasing globally, including Japan. The Japanese Orthopaedic Association has been conducting a registry of joint replacement surgery, but there may be a gap between the reported numbers of THA in the registry and the actual number. This study aimed to investigate the exact number of THA and assess the trends in Japan using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB). METHODS We downloaded data from 2014 to 2019 from the NDB Open Data. Data on primary THA were extracted, and we calculated the annual number and number for each 10-year age group and sex. We also compared the number and trends between elderly and non-elderly groups. RESULTS During the study period, number of THAs increased by approximately 20,000, showing a continuous upward trend. The highest number of THAs were performed on patients in their 60s, except for the years 2014 and 2019. Comparison of the numbers in 2014 and 2019 by age group showed an increase in the number in patients in their 90s (by 2.05 times). There were significantly a greater number of elderly patients (P < 0.001). The number of THAs performed was higher in women than in men (P < 0.001). CONCLUSION The number of THAs in Japan increased substantially from 2014 to 2019, despite a decrease in population. Significantly higher number of THAs were performed on elderly patients in Japan, which might be due to an aging society. The NDB data is highly valuable for epidemiological research in Japan, as it might enable the early detection of issues occurring during THA, facilitating their prompt integration into daily clinical practice.
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Affiliation(s)
- Maho Tsuchiya
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1, Kitasato, Minami-Ku, Sagamihara City, Kanagawa 252-0374, Japan
| | - Kensuke Fukushima
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1, Kitasato, Minami-Ku, Sagamihara City, Kanagawa 252-0374, Japan.
| | - Yoshihisa Ohashi
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1, Kitasato, Minami-Ku, Sagamihara City, Kanagawa 252-0374, Japan
| | - Noritaka Mamorita
- Department of Medical Informatics, Kitasato University School of Allied Health Sciences, 1-15-1, Kitasato, Minami-Ku, Sagamihara City, Kanagawa 252-0373, Japan
| | - Hiroki Saito
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1, Kitasato, Minami-Ku, Sagamihara City, Kanagawa 252-0374, Japan
| | - Kentaro Uchida
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1, Kitasato, Minami-Ku, Sagamihara City, Kanagawa 252-0374, Japan
| | - Katsufumi Uchiyama
- Department of Patient Safety and Healthcare Administration, School of Medicine, Kitasato University, 1-15-1, Kitasato, Minami-ku, Sagamihara City, Kanagawa 252-0374, Japan
| | - Naonobu Takahira
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0373, Japan
| | - Masashi Takaso
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1, Kitasato, Minami-Ku, Sagamihara City, Kanagawa 252-0374, Japan
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D'Ambrosi R, Anghilieri FM, Valli F, Palminteri G, Bandettini G, Arcuri B, Mariani I, Mangiavini L, Ursino N, Migliorini F. No difference in the level of sports activity between single versus dual mobility total hip arthroplasty in adults: a clinical trial. Eur J Med Res 2025; 30:212. [PMID: 40148984 PMCID: PMC11951615 DOI: 10.1186/s40001-025-02470-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 03/17/2025] [Indexed: 03/29/2025] Open
Abstract
Current evidence on the quality of sports activity in patients younger than 65 following dual mobility (DM) total hip arthroplasty (THA) is lacking, and whether this coupling allows better performance than single mobility (SM) still needs to be fully clarified. This clinical trial compared sport-related patient-reported outcome measures (PROMs) of the traditional SM versus DM implants in active patients younger than 65. All THAs were performed using a minimally invasive posterolateral approach, polyethylene liner and ceramic head. All implants were cementless. The University of California, Los Angeles (UCLA) activity scores, the High-Activity Arthroplasty Score (HAAS), the visual analogue scale for pain (VAS), and the Harris Hip Score (HHS) were administered to each patient. Patient assessment was conducted on admission, at 12, and at a minimum of 24 months postoperatively. A total of 403 patients were included in the study: 372 SM and 31 DM. The mean age was 56.3 ± 7.2 years. The mean length of the follow-up was 51.3 ± 21.0 months. The present clinical trial found no difference in UCLA, HHS, HAAS, and VAS. Patients returned at a similar level of sports activity in both groups.Level of evidence Level II, prospective group-controlled clinical trial.
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Affiliation(s)
- Riccardo D'Ambrosi
- IRCCS Orthopedic Institute Galeazzi, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | | | | | - Giovanni Palminteri
- Scuola Di Specializzazione in Ortopedia e Traumatologia, Università Degli Studi Di Milano, Milan, Italy
| | | | - Baldo Arcuri
- IRCCS Orthopedic Institute Galeazzi, Milan, Italy
| | - Ilaria Mariani
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy
| | - Laura Mangiavini
- IRCCS Orthopedic Institute Galeazzi, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | | | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy.
- Department of Life Sciences, Health, and Health Professions, Link Campus University, 00165, Rome, Italy.
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Allen MJ, Brain D, Crawford R, Senanayake S, Harris IA, Elliott LM, Hinchcliff R, McCreanor V, McPhail SM. Factors influencing prosthesis selection and variation: a survey of orthopaedic surgeons in Australia. BMJ Open 2025; 15:e088986. [PMID: 40054871 PMCID: PMC11891528 DOI: 10.1136/bmjopen-2024-088986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 01/20/2025] [Indexed: 03/12/2025] Open
Abstract
BACKGROUND There is increasing demand for knee and hip arthroplasty with considerable health system cost implications. Despite the high surgical costs relating to the prosthesis used, little is known about which factors are most influential in prosthesis choice, nor is it clear what level of variation may be warranted for clinical reasons. OBJECTIVES This study had dual objectives: (1) identify factors influencing prosthesis selection for total hip arthroplasty (THA) and total knee arthroplasty (TKA) and (2) develop a working definition for unwarranted variation in THA and TKA implant selection. DESIGN A three-stage prospective study: (1) develop and pilot a questionnaire with input from orthopaedic surgeons; (2) a cross-sectional survey with orthopaedic surgeons across Australia and (3) an expert panel to finalise the working definition of unwarranted variation. SETTING AND PARTICIPANTS Study activities were conducted both virtually and in person, primarily with hospital-based orthopaedic surgeons and orthopaedic registrars across Australia, but also included health economists and health administrators in the expert panel stage. RESULTS Revision rates, familiarity with an implant and implant quality were prioritised when choosing a prosthesis, while other factors, including cost, were reported to have limited influence. Technological advancement and revision rates were influential for past changes in prostheses, and strong clinical evidence is expected to precede future changes. The consensus was reached on a working definition of unwarranted variation that focused on implants with revision rates of 20% or higher compared with published benchmarks. The use of multiple cost thresholds was recommended for defining narrow and broad definitions of unwarranted variation. CONCLUSION Study findings provide valuable insights into the decision-making process for prosthesis selection, as well as what surgeons believe might constitute unwarranted variation. This information can advance our understanding of the magnitude and impact of unwarranted variation in prosthesis selection, as well as inform strategies to address it.
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Affiliation(s)
- Michelle J Allen
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - David Brain
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ross Crawford
- Faculty of Engineering, Queensland University of Technology, Brisbane, Queensland, Australia
- The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Sameera Senanayake
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Duke-NUS Graduate Medical School, Singapore
| | - Ian A Harris
- Ingham Institute, University of New South Wales, South Western Sydney Clinical School, Liverpool, New South Wales, Australia
| | - Lana M Elliott
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Reece Hinchcliff
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- School of Applied Psychology, Griffith University, Nathan, Queensland, Australia
| | - Victoria McCreanor
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Hunter Medical Research Institute, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Digital Health and Informatics Directorate, Metro South Hospital and Health Service, Woolloongabba, Queensland, Australia
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Le Stum M, Le Goff-Pronost M, Stindel E, Dardenne G. Incidence rate of total knee arthroplasties in eleven European countries: Do they reach a plateau? PLoS One 2025; 20:e0312701. [PMID: 39774372 PMCID: PMC11706380 DOI: 10.1371/journal.pone.0312701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Accepted: 10/11/2024] [Indexed: 01/11/2025] Open
Abstract
BACKGROUND From several decades, the evolutions of the Incidence Rate (IR) of Primary Knee Arthroplasties are continuously increasing worldwide and have been widely studied in several countries. Some recent works have highlighted the fact that the IR is following a sigmoid curve composed of an exponential growth followed by a linear phase and finished by a plateau. Our objective is to assess the IR evolution of eleven European countries, representing thus a large proportion of this continent, regarding this sigmoid. METHODS IRs of primary knee arthroplasties for Austria, Denmark, Finland, France, Germany, Hungary, Italy, Poland, Spain, Sweden, and the United Kingdom between 2005 and 2019 were retrieved from the EUROSTAT database. Several regression models were fitted to each country's IRs: Poisson, linear, asymptotic, logistic, and Gompertz regression. For each country and each model, the RMSE (Root Mean Square Error) and R2 were calculated and used to estimate their position with respect to this sigmoid curve. RESULTS The best regression models for knee arthroplasties varied following countries. Logistic and Gompertz regressions had the lowest RMSE and R2 values for Austria, Denmark, Germany, Sweden, and the UK. Hungary, Italy, and Poland favored the Poisson regression model. Finland and Spain presented difficulties in determining the optimal model (linear or Poisson), while France faced challenges in choosing between logistic, Gompertz, and linear regression. CONCLUSION In conclusion, the growth dynamics of IR differ across European countries. Some countries seem to have already reached a plateau and will therefore experience slight growth in the future.
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Affiliation(s)
- Mathieu Le Stum
- Université de Brest, UBO, LATIM, UMR 1101, Brest, France
- Institut National de la Santé et de la Recherche Médicale, INSERM, Laboratory for Medical Information Processing (LATIM), UMR1101, Brest, France
| | | | - Eric Stindel
- Institut National de la Santé et de la Recherche Médicale, INSERM, Laboratory for Medical Information Processing (LATIM), UMR1101, Brest, France
- Centre Hospitalo-Universitaire de Brest, CHRU Brest, LATIM, UMR 1101, Brest, France
| | - Guillaume Dardenne
- Université de Brest, UBO, LATIM, UMR 1101, Brest, France
- Institut National de la Santé et de la Recherche Médicale, INSERM, Laboratory for Medical Information Processing (LATIM), UMR1101, Brest, France
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Baroni S, Oliviero S, La Mattina AA, Maglio M, Martini L, Fini M, Viceconti M. Calibration of Aseptic Loosening Simulation for Coatings Osteoinductive Effect. Ann Biomed Eng 2025; 53:34-47. [PMID: 39120770 PMCID: PMC11782331 DOI: 10.1007/s10439-024-03588-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 07/20/2024] [Indexed: 08/10/2024]
Abstract
The risk of aseptic loosening in cementless hip stems can be reduced by improving osseointegration with osteoinductive coatings favoring long-term implant stability. Osseointegration is usually evaluated in vivo studies, which, however, do not reproduce the mechanically driven adaptation process. This study aims to develop an in silico model to predict implant osseointegration and the effect of induced micromotion on long-term stability, including a calibration of the material osteoinductivity with conventional in vivo studies. A Finite Element model of the tibia implanted with pins was generated, exploiting bone-to-implant contact measures of cylindrical titanium alloys implanted in rabbits' tibiae. The evolution of the contact status between bone and implant was modeled using a finite state machine, which updated the contact state at each iteration based on relative micromotion, shear and tensile stresses, and bone-to-implant distance. The model was calibrated with in vivo data by identifying the maximum bridgeable gap. Afterward, a push-out test was simulated to predict the axial load that caused the macroscopic mobilization of the pin. The bone-implant bridgeable gap ranged between 50 μm and 80 μm. Predicted push-out strength ranged from 19 N to 21 N (5.4 MPa-3.4 MPa) depending on final bone-to-implant contact. Push-out strength agrees with experimental measurements from a previous animal study (4 ± 1 MPa), carried out using the same implant material, coated, or uncoated. This method can partially replace in vivo studies and predict the long-term stability of cementless hip stems.
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Affiliation(s)
- Sofia Baroni
- Department of Industrial Engineering, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
| | - Sara Oliviero
- Department of Industrial Engineering, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | | | - Melania Maglio
- SC Scienze e Tecnologie Chirurgiche, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Lucia Martini
- SC Scienze e Tecnologie Chirurgiche, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Milena Fini
- Scientific Direction, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Viceconti
- Department of Industrial Engineering, Alma Mater Studiorum - University of Bologna, Bologna, Italy
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano1/10, 40136, Bologna, Italy
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Blümel S, Hanauer M, Heimann A, Tannast M, Schwab JM. Cost and resource comparison analysis for THA in Switzerland and Austria. Int J Technol Assess Health Care 2024; 40:e36. [PMID: 39417297 PMCID: PMC11569899 DOI: 10.1017/s0266462324000321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 04/21/2024] [Accepted: 05/04/2024] [Indexed: 10/19/2024]
Abstract
OBJECTIVES Total hip arthroplasty (THA) is an orthopedic intervention that generates substantial costs to national healthcare systems due to the number of interventions and the cost per intervention. We performed a cost comparison analysis in Austria and Switzerland. METHODS Data from the national joint arthroplasty register in Switzerland and internal information from the national healthcare services in Austria and Switzerland were compared for patient demographics, interventional characteristics, and costs adjusted for inflation and purchasing power from 2015 to 2021. RESULTS The average age for primary THA in Austria was from 67.4 to 67.8 years with 55.9-57.2 percent female patients and from 68.5 to 69.3 years with 52.4-53.8 percent female patients in Switzerland. The annual incidence rate for primary THA rose from 210.28/100k to 216.6/100k in Austria and from 212/100k to 250/100k in Switzerland. After correction for inflation, costs were -1.91 percent lower in Austria in 2021 than in 2015 and -2.57 percent lower in Switzerland. After correction for purchasing power, costs were higher in Austria. The average hospital stay after THA in Austria was reduced by 20 percent (11.7 days/2015 vs. 9.4 days/2021) and 25 percent in Switzerland (8.4 days/2015 vs. 6.4 days/2021). Revision rate was 2.5-3.2 percent in Austria and 2.8-3.2 percent in Switzerland. CONCLUSIONS The patient population was comparable while patients undergoing primary THA in Austria stay longer in hospital and have relatively higher costs when adjusted for currency, purchasing power, and inflation. The use of standardized registers would be helpful to compare outcomes and costs.
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Affiliation(s)
- Stefan Blümel
- Department of Orthopedic Surgery, HFR Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
- WU Vienna University of Economics and Business, Wien, Austria
| | - Matthieu Hanauer
- Department of Orthopedic Surgery, HFR Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Alexander Heimann
- Department of Orthopedic Surgery, HFR Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Moritz Tannast
- Department of Orthopedic Surgery, HFR Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Joseph M. Schwab
- Department of Orthopedic Surgery, HFR Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
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Schöner L, Kuklinski D, Wittich L, Steinbeck V, Langenberger B, Breitkreuz T, Compes F, Kretzler M, Marschall U, Klauser W, Citak M, Matziolis G, Schrednitzki D, Grasböck K, Vogel J, Pross C, Busse R, Geissler A. Cost-effectiveness of a patient-reported outcome-based remote monitoring and alert intervention for early detection of critical recovery after joint replacement: A randomised controlled trial. PLoS Med 2024; 21:e1004459. [PMID: 39383175 PMCID: PMC11463742 DOI: 10.1371/journal.pmed.1004459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 08/14/2024] [Indexed: 10/11/2024] Open
Abstract
BACKGROUND While the effectiveness of patient-reported outcome measures (PROMs) as an intervention to impact patient pathways has been established for cancer care, it is unknown for other indications. We assessed the cost-effectiveness of a PROM-based monitoring and alert intervention for early detection of critical recovery paths following hip and knee replacement. METHODS AND FINDINGS The cost-effectiveness analysis (CEA) is based on a multicentre randomised controlled trial encompassing 3,697 patients with hip replacement and 3,110 patients with knee replacement enrolled from 2019 to 2020 in 9 German hospitals. The analysis was conducted with a subset of 546 hip and 492 knee replacement cases with longitudinal cost data from 24 statutory health insurances. Patients were randomised 1:1 to a PROM-based remote monitoring and alert intervention or to a standard care group. All patients were assessed at 12-months post-surgery via digitally collected PROMs. Patients within the intervention group were additionally assessed at 1-, 3-, and 6-months post-surgery to be contacted in case of critical recovery paths. For the effect evaluation, a PROM-based composite measure (PRO-CM) was developed, combining changes across various PROMs in a single index ranging from 0 to 100. The PRO-CM included 6 PROMs focused on quality of life and various aspects of physical and mental health. The primary outcome was the incremental cost-effectiveness ratio (ICER). The intervention group showed incremental outcomes of 2.54 units PRO-CM (95% confidence interval (CI) [0.93, 4.14]; p = 0.002) for patients with hip and 0.87 (95% CI [-0.94, 2.67]; p = 0.347) for patients with knee replacement. Within the 12-months post-surgery period the intervention group had less costs of 376.43€ (95% CI [-639.74, -113.12]; p = 0.005) in patients with hip, and 375.50€ (95% CI [-767.40, 16.39]; p = 0.060) in patients with knee replacement, revealing a dominant ICER for both procedures. However, it remains unclear which step of the multistage intervention contributes most to the positive effect. CONCLUSIONS The intervention significantly improved patient outcomes at lower costs in patients with hip replacements when compared with standard care. Further it showed a nonsignificant cost reduction in knee replacement patients. This reinforces the notion that PROMs can be utilised as a cost-effective instrument for remote monitoring in standard care settings. TRIAL REGISTRATION Registration: German Register for Clinical Studies (DRKS) under DRKS00019916.
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Affiliation(s)
- Lukas Schöner
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
| | - David Kuklinski
- Chair of Health Economics, Policy and Management, School of Medicine, University of St. Gallen, St. Gallen Switzerland
| | - Laura Wittich
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
| | - Viktoria Steinbeck
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
| | - Benedikt Langenberger
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
| | | | - Felix Compes
- Heartbeat Medical Solutions GmbH, Cologne, Germany
| | | | | | | | | | | | | | | | - Justus Vogel
- Chair of Health Economics, Policy and Management, School of Medicine, University of St. Gallen, St. Gallen Switzerland
| | - Christoph Pross
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
| | - Reinhard Busse
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
| | - Alexander Geissler
- Chair of Health Economics, Policy and Management, School of Medicine, University of St. Gallen, St. Gallen Switzerland
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Richter-Bisson ZW, Nie HY, Hedberg YS. Serum protein albumin and chromium: Mechanistic insights into the interaction between ions, nanoparticles, and protein. Int J Biol Macromol 2024; 278:134845. [PMID: 39159799 DOI: 10.1016/j.ijbiomac.2024.134845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 08/14/2024] [Accepted: 08/16/2024] [Indexed: 08/21/2024]
Abstract
The interaction of human proteins and metal species, both ions and nanoparticles, is poorly understood despite their growing importance. These materials are the by-products of corrosion processes and are of relevance for food and drug manufacturing, nanomedicine, and biomedical implant corrosion. Here, we study the interaction of Cr(III) ions and chromium oxide nanoparticles with bovine serum albumin in physiological conditions. This study combined electrophoretic mobility measurements, spectroscopy, and time-of-flight secondary ion mass spectrometry with principal component analysis. It was determined that neither metal species resulted in global albumin unfolding. The Cr(III) ions interacted strongly with amino acids found in previously discovered metal binding sites, but also were most strongly implicated in the interaction with negatively charged acid residues, suggesting an electrostatic interaction. Bovine serum albumin (BSA) was found to bind to the Cr2O3 nanoparticles in a preferential orientation, due to electrostatic interactions between the positive amino acid residues and the negative chromium oxide nanoparticle surface. These findings ameliorate our understanding of the interaction between trivalent chromium ions and nanoparticles, and biological macromolecules.
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Affiliation(s)
| | - Heng-Yong Nie
- Surface Science Western, Western University, London, ON N6G 0J3, Canada; Department of Physics and Astronomy, Western University, London, ON N6A 3K7, Canada
| | - Yolanda Susanne Hedberg
- Department of Chemistry, Western University, London, ON N6A 5B7, Canada; Surface Science Western, Western University, London, ON N6G 0J3, Canada; Lawson Health Research Institute, London, ON N6C 2R5, Canada.
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Doyle TR, Davey MS, Toale JP, O'Driscoll C, Murphy CG. Simultaneous bilateral total hip arthroplasty-a survey of Irish orthopaedic surgeons' practice. Ir J Med Sci 2024; 193:2349-2354. [PMID: 38837013 PMCID: PMC11450025 DOI: 10.1007/s11845-024-03726-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 05/24/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Bilateral total hip arthroplasty may be performed simultaneously (SIMTHA) or in two staged operations. AIM To assess attitudes towards and utilization of SIMTHA in Irish orthopaedic practice, and to assess patient and surgeon factors which are associated with the management of bilateral hip arthritis. METHODS A 16-question electronic survey (Google Forms) was distributed via email to consultant Irish orthopaedic surgeons who perform total hip arthroplasty, followed by a reminder 1 month later. A p value < 0.05 was considered significant. RESULTS There were 53 responses from arthroplasty surgeons, with 28% reporting they never perform SIMTHA, 26% have performed ≤ 5 SIMTHA, and 46% do ≥ 1 SIMTHA per year. Amongst the 15 surgeons who do not do SIMTHA, 60% reported a preference for staged arthroplasty, 20% felt it was not feasible in their institution, and a third reported a lack of experience with SIMTHA. There was a significant association between not performing SIMTHA and years of consultant experience (p = 0.002). There were no institutional guidelines on eligibility criteria for SIMTHA. The most common time interval for staged bilateral arthroplasty was 6-12 weeks (60%). Overall, 56% of surgeons felt SIMTHA is underutilised in the Irish healthcare system; this was associated with greater SIMTHA volume (p = 0.023). CONCLUSION Half of the Irish arthroplasty surgeons report SIMTHA is a regular aspect of their practice. Performing SIMTHA is associated with greater arthroplasty volume, more recent consultant appointments, and a perception that the operation is underutilised.
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Affiliation(s)
- Tom R Doyle
- Department of Orthopaedics, Galway University Hospital, Galway, Ireland.
- Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Martin S Davey
- Department of Orthopaedics, Galway University Hospital, Galway, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - James P Toale
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Conor O'Driscoll
- Department of Orthopaedics, Galway University Hospital, Galway, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Colin G Murphy
- Department of Orthopaedics, Galway University Hospital, Galway, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
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11
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Zaballa E, D'angelo S, Barea C, Ntani G, Hannouche D, Cooper C, Lübbeke A, Walker-Bone K. Intensive physical activity following total hip arthroplasty increased the revision risk after 15 years: a cohort study of 973 patients from the Geneva Arthroplasty Register. Acta Orthop 2024; 95:446-453. [PMID: 39145680 PMCID: PMC11325854 DOI: 10.2340/17453674.2024.41192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 06/30/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND AND PURPOSE Younger recipients of total hip arthroplasty (THA) highly prioritize returning to preoperative levels of physical activity (PA). Surgeons have tended to give cautious advice concerning high-impact sports participation, but there have been few long-term studies. The purpose of our study was to investigate the risk of revision arthroplasty in relation to postoperative PA levels. METHODS Patients registered in the Geneva Arthroplasty Register (GAR) who had elective THA when they were aged < 65 years were studied. Postoperative PA was collected prospectively 5-yearly using the UCLA activity scale. Cox proportional hazards models were used to estimate associations between PA and risk of revision THA. RESULTS Amongst 1,370 eligible subjects, median age at THA 58 years (interquartile range 51-61), UCLA scores were available for 973 (71%). During follow-up over 15 years, there were 79 revisions, giving a cumulative risk of 7.4% (95% confidence interval [CI] 5.8-9.4). After adjusting for covariates, we found an increased risk of revision for each unit increase in postoperative PA (HR 1.2, CI 1.1-1.4), and among people performing the most intensive PA (HR 2.7, CI 1.3-5.6) compared with those who were inactive. CONCLUSION The overall risk of revision was small but intensive and moderate PA may be associated with an increased risk of revision.
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Affiliation(s)
- Elena Zaballa
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK; MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | - Stefania D'angelo
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK; MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | - Christophe Barea
- Division of Orthopaedic Surgery and Traumatology, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Georgia Ntani
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK; MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | - Didier Hannouche
- Division of Orthopaedic Surgery and Traumatology, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Anne Lübbeke
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Karen Walker-Bone
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK; MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK; Monash Centre for Occupational and Environmental Health, Monash University, Melbourne, Australia
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12
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Schumacher N, Geiger F, Spors S, Bader R, Haubelt C, Kluess D. Detection of Total Hip Replacement Loosening Based on Structure-Borne Sound: Influence of the Position of the Sensor on the Hip Stem. SENSORS (BASEL, SWITZERLAND) 2024; 24:4594. [PMID: 39065992 PMCID: PMC11280482 DOI: 10.3390/s24144594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 07/11/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024]
Abstract
Accurate detection of implant loosening is crucial for early intervention in total hip replacements, but current imaging methods lack sensitivity and specificity. Vibration methods, already successful in dentistry, represent a promising approach. In order to detect loosening of the total hip replacement, excitation and measurement should be performed intracorporeally to minimize the influence of soft tissue on damping of the signals. However, only implants with a single sensor intracorporeally integrated into the implant for detecting vibrations have been presented in the literature. Considering different mode shapes, the sensor's position on the implant is assumed to influence the signals. In the work at hand, the influence of the position of the sensor on the recording of the vibrations on the implant was investigated. For this purpose, a simplified test setup was created with a titanium rod implanted in a cylinder of artificial cancellous bone. Mechanical stimulation via an exciter attached to the rod was recorded by three accelerometers at varying positions along the titanium rod. Three states of peri-implant loosening within the bone stock were simulated by extracting the bone material around the titanium rod, and different markers were analyzed to distinguish between these states of loosening. In addition, a modal analysis was performed using the finite element method to analyze the mode shapes. Distinct differences in the signals recorded by the acceleration sensors within defects highlight the influence of sensor position on mode detection and natural frequencies. Thus, using multiple sensors could be advantageous in accurately detecting all modes and determining the implant loosening state more precisely.
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Affiliation(s)
- Nico Schumacher
- Applied Microelectronics and Computer Engineering, University of Rostock, 18059 Rostock, Germany;
| | - Franziska Geiger
- Department of Orthopaedics, Rostock University Medical Center, 18057 Rostock, Germany; (R.B.); (D.K.)
| | - Sascha Spors
- Institute of Communications Engineering, University of Rostock, 18059 Rostock, Germany;
| | - Rainer Bader
- Department of Orthopaedics, Rostock University Medical Center, 18057 Rostock, Germany; (R.B.); (D.K.)
| | - Christian Haubelt
- Applied Microelectronics and Computer Engineering, University of Rostock, 18059 Rostock, Germany;
| | - Daniel Kluess
- Department of Orthopaedics, Rostock University Medical Center, 18057 Rostock, Germany; (R.B.); (D.K.)
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13
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Naufal ER, Wouthuyzen-Bakker M, Soriano A, Young SW, Higuera-Rueda CA, Otero JE, Fillingham YA, Fehring TK, Springer BD, Shadbolt C, Tay ML, Aboltins C, Stevens J, Darby J, Poy Lorenzo YS, Choong PFM, Dowsey MM, Babazadeh S. The Orthopaedic Device Infection Network: Building an Evidence Base for the Treatment of Periprosthetic Joint Infection Through International Collaboration. J Arthroplasty 2024; 39:1391-1393. [PMID: 38490566 DOI: 10.1016/j.arth.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 03/17/2024] Open
Affiliation(s)
- Elise R Naufal
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Australia
| | - Marjan Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Alex Soriano
- Department of Infectious Diseases, University of Barcelona, IDIBAPS, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Simon W Young
- Faculty of Medical and Health Sciences (FMHS), Department of Surgery, Department of Orthopaedic Surgery, University of Auckland, North Shore Hospital, Auckland, New Zealand
| | | | - Jesse E Otero
- Atrium Health - Musculoskeletal Institute, OrthoCarolina - Hip & Knee Center, Charlotte, North Carolina
| | - Yale A Fillingham
- Rothman Orthopaedic Institute at Thomas Jeferson University, Philadelphia, Pennsylvania
| | | | | | - Cade Shadbolt
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Australia
| | - Mei Lin Tay
- Faculty of Medical and Health Sciences (FMHS), Department of Surgery, Department of Orthopaedic Surgery, University of Auckland, North Shore Hospital, Auckland, New Zealand
| | - Craig Aboltins
- Department of Infectious Diseases, Northern Hospital, Melbourne, Australia
| | - Jarrad Stevens
- Department of Orthopaedic Surgery, St. Vincent's Hospital Melbourne, Melbourne, Australia
| | - Jonathan Darby
- Department of Infectious Diseases, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Yves S Poy Lorenzo
- Pharmacy Department, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia; Department of Medicine, St Vincent's Hospital Melbourne, University of Melbourne, Melbourne, Australia
| | - Peter F M Choong
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Australia
| | - Michelle M Dowsey
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Australia
| | - Sina Babazadeh
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Australia; Department of Orthopaedics, St Vincent's Hospital Melbourne, Melbourne, Australia
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14
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Ponds NHM, Landman EBM, Whitehouse MR, Blom AW, Grimm B, Bolink SAAN. Wearable sensor-based measures of step-up transfers are supplementary to patient-reported outcome measures following total joint arthroplasty. Disabil Rehabil 2024; 46:2251-2258. [PMID: 37272492 DOI: 10.1080/09638288.2023.2219066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 05/20/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE This study investigated the longitudinal assessment of step-up performance in patients undergoing total joint arthroplasty (TJA) and correlation with subjective patient reported outcome measures (PROMs). METHODS In this sub-analysis of the ADAPT study, PROMs were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Block step-up (BS) transfers were assessed by wearable-derived measures of time. 76 patients undergoing TJA were included. Subgroups were formed isolating the worst performing quartile (low functioning (LF)) from the high functioning (HF), and outcomes were compared. RESULTS One-year post-surgery, WOMAC function demonstrated strong correlations to WOMAC pain (Pearson's r = 0.67-0.84) and moderate correlations to BS performance (Pearson's r = 0.31-0.54). Both WOMAC and BS significantly improved with a larger effect size for the HF subgroup (0.62 vs. 0.43; p < 0.05). Patients designated to the LF subgroup at 3 months had increased odds of representing the LF subgroup at 12 months (WOMAC = 19; BS = 4). WOMAC defined 18 LF patients at 12 months follow-up. BS performance identified 9 additional LF patients. CONCLUSIONS WOMAC function scores seem pain dominated. Measures of BS performance allow assessment of otherwise hidden residual functional impairment. Lower functioning 3 months post-surgery is predictive of longer-term impairment.
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Affiliation(s)
- N H M Ponds
- Department of Orthopaedic Surgery, Deventer Hospital, Deventer, The Netherlands
| | - E B M Landman
- Department of Orthopaedic Surgery, Deventer Hospital, Deventer, The Netherlands
| | - M R Whitehouse
- Musculoskeletal Research Unit, Bristol Medical School, Bristol, United Kingdom
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, United Kingdom of Great Britain and Northern Ireland
| | - A W Blom
- Musculoskeletal Research Unit, Bristol Medical School, Bristol, United Kingdom
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, United Kingdom of Great Britain and Northern Ireland
| | - B Grimm
- Department of Human Motion, Orthopaedics, Sports Medicine, Digital Methods (HOSD), Luxembourg Institute of Health, Luxembourg
| | - S A A N Bolink
- Department of Orthopaedic Surgery, Deventer Hospital, Deventer, The Netherlands
- Musculoskeletal Research Unit, Bristol Medical School, Bristol, United Kingdom
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15
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Bengoa F, López A, Rojas N, Dabed D, Diaz-Ledezma C. Total Hip Arthroplasty in Chile Is Characterized By Low Utilization Rates and Disparity in Access. HSS J 2024; 20:208-213. [PMID: 39281987 PMCID: PMC11393634 DOI: 10.1177/15563316231171865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/02/2023] [Indexed: 09/18/2024]
Abstract
Background: Disparity in access to total hip arthroplasty (THA) is an internationally recognized phenomenon influenced by social and geographical factors. The Organisation for Economic Co-operation and Development (OECD) employs the utilization rates of THA to evaluate and compare healthcare utilization by its 37 country members, including Chile. Purpose: We sought to describe THA utilization rates in the elderly Chilean population and to compare it with data from other OECD countries. In addition, we sought to identify whether sociodemographic variables influence access to THA in Chile. Methods: We conducted a retrospective review of THA cases performed in Chile between 2016 and 2018 in patients aged 65 years and older in a large database regulated by the Ministry of Health; 8970 patients were included. Mean utilization rates (MURs) of THA within Chile's 346 administrative-territorial divisions (called communes) were calculated. We analyzed associations between the communal MUR and poverty, rurality, insurance type, and geographical health administration dependency. Results: The national MUR of THA in the elderly population in Chile was 144/100,000 for the period studied. The median communal MUR was 107 (interquartile range [IQR]: 66-153). A lower MUR of THA was observed in communes with higher poverty levels, higher rurality, and a lower rates of private insurance. After negative binomial regression analysis, only rurality rate and geographical healthcare service dependency were associated with MUR. Conclusions: This retrospective database study suggests that the utilization of THA in Chile is unequal and well below the average of other OECD countries. Higher rates of rurality and administrative healthcare dependence (a geographical/administrative factor) were associated with disparities in access to THA within Chile.
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Affiliation(s)
- Francisco Bengoa
- Department of Orthopaedic Surgery, The University of British Columbia, Vancouver, BC, Canada
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16
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Schiavi P, Pogliacomi F, Bergamaschi M, Ceccarelli F, Vaienti E. Evaluation of Outcome after Total Hip Arthroplasty for Femoral Neck Fracture: Which Factors Are Relevant for Better Results? J Clin Med 2024; 13:1849. [PMID: 38610614 PMCID: PMC11012496 DOI: 10.3390/jcm13071849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/04/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Femoral neck fractures (FNFs) are frequent orthopedic injuries in elderly patients. Despite improvements in clinical monitoring and advances in surgical procedures, 1-year mortality remains between 15% and 30%. The aim of this study is to identify variables that lead to better outcomes in patients treated with total hip arthroplasty (THA) for FNFs. Methods: All patients who underwent cementless THA for FNF from January 2018 to December 2022 were identified. Patients aged more than 80 years old and with other post-traumatic lesions were excluded. Patient data and demographic characteristics were collected. The following data were also registered: time trauma/surgery, surgical approach, operative time, intraoperative complications, surgeon arthroplasty-trained or not, and anesthesia type. In order to search for any predictive factors of better short- and long-term outcomes, we performed different logistic regression analyses. Results: A total of 92 patients were included. From multivariable logistic regression models, we derived that a direct anterior surgical approach and an American Society of Anesthesiologists (ASA) classification < 3 can predict improved short-term outcomes. Moreover, THAs performed by surgeons with specific training in arthroplasty have a lower probability of revision at 1 year. Mortality at 1 year was ultimately influenced by the ASA classification. Conclusions: A direct anterior approach and specific arthroplasty training of the surgeon appear to be able to improve the short- and long-term follow-up of THA after FNF.
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Affiliation(s)
- Paolo Schiavi
- Orthopedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy; (F.P.); (M.B.); (F.C.); (E.V.)
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17
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Choi MH, Jung JY, Peng Z, Grosskopf S, Suehling M, Hofmann C, Pak S. Development and Validation of a Deep-Learning-Based Algorithm for Detecting and Classifying Metallic Implants in Abdominal and Spinal CT Topograms. Diagnostics (Basel) 2024; 14:668. [PMID: 38611581 PMCID: PMC11011303 DOI: 10.3390/diagnostics14070668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/14/2024] Open
Abstract
PURPOSE To develop and validate a deep-learning-based algorithm (DLA) that is designed to segment and classify metallic objects in topograms of abdominal and spinal CT. METHODS DLA training for implant segmentation and classification was based on a U-net-like architecture with 263 annotated hip implant topograms and 2127 annotated spine implant topograms. The trained DLA was validated with internal and external datasets. Two radiologists independently reviewed the external dataset consisting of 2178 abdomen anteroposterior (AP) topograms and 515 spine AP and lateral topograms, all collected in a consecutive manner. Sensitivity and specificity were calculated per pixel row and per patient. Pairwise intersection over union (IoU) was also calculated between the DLA and the two radiologists. RESULTS The performance parameters of the DLA were consistently >95% in internal validation per pixel row and per patient. DLA can save 27.4% of reconstruction time on average in patients with metallic implants compared to the existing iMAR. The sensitivity and specificity of the DLA during external validation were greater than 90% for the detection of spine implants on three different topograms and for the detection of hip implants on abdominal AP and spinal AP topograms. The IoU was greater than 0.9 between the DLA and the radiologists. However, the DLA training could not be performed for hip implants on spine lateral topograms. CONCLUSIONS A prototype DLA to detect metallic implants of the spine and hip on abdominal and spinal CT topograms improves the scan workflow with good performance for both spine and hip implants.
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Affiliation(s)
- Moon-Hyung Choi
- Department of Radiology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea;
| | - Joon-Yong Jung
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Zhigang Peng
- Siemens Medical Solutions USA, Inc., Malvern, PA 19355, USA;
| | - Stefan Grosskopf
- Siemens Healthcare GmbH, Computed Tomography, 91301 Forchheim, Germany; (S.G.); (M.S.); (C.H.)
| | - Michael Suehling
- Siemens Healthcare GmbH, Computed Tomography, 91301 Forchheim, Germany; (S.G.); (M.S.); (C.H.)
| | - Christian Hofmann
- Siemens Healthcare GmbH, Computed Tomography, 91301 Forchheim, Germany; (S.G.); (M.S.); (C.H.)
| | - Seongyong Pak
- Siemens Healthineers Ltd., Seoul 06620, Republic of Korea;
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18
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Wu CJ, Penrose C, Ryan SP, Bolognesi MP, Seyler TM, Wellman SS. Subsequent total joint arthroplasty: Are we learning from the first stage? World J Orthop 2024; 15:230-237. [PMID: 38596183 PMCID: PMC10999970 DOI: 10.5312/wjo.v15.i3.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/15/2024] [Accepted: 02/02/2024] [Indexed: 03/15/2024] Open
Abstract
BACKGROUND With the increasing incidence of total joint arthroplasty (TJA), there is a desire to reduce peri-operative complications and resource utilization. As degenerative conditions progress in multiple joints, many patients undergo multiple procedures. AIM To determine if both physicians and patients learn from the patient's initial arthroplasty, resulting in improved outcomes following the second procedure. METHODS The institutional database was retrospectively queried for primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). Patients with only unilateral THA or TKA, and patients undergoing same-day bilateral TJA, were excluded. Patient demographics, comorbidities, and implant sizes were collected at the time of each procedure and patients were stratified by first vs second surgery. Outcome metrics evaluated included operative time, length of stay (LOS), disposition, 90-d readmissions and emergency department (ED) visits. RESULTS A total of 642 patients, including 364 undergoing staged bilateral TKA and 278 undergoing bilateral THA, were analyzed. There was no significant difference in demographics or comorbidities between the first and second procedure, which were separated by a mean of 285 d. For THA and TKA, LOS was significantly less for the second surgery, with 66% of patients having a shorter hospitalization (P < 0.001). THA patients had significantly decreased operative time only when the same sized implant was utilized (P = 0.025). The vast majority (93.3%) of patients were discharged to the same type of location following their second surgery. However, when a change in disposition was present from the first surgery, patients were significantly more likely to be discharged to home after the second procedure (P = 0.033). There was no difference between procedures for post-operative readmissions (P = 0.438) or ED visits (P = 0.915). CONCLUSION After gaining valuable experience recovering from the initial surgery, a patient's perioperative outcomes are improved for their second TJA. This may be the result of increased confidence and decreased anxiety, and it supports the theory that enhanced patient education pre-operatively may improve outcomes. For the surgical team, the second procedure of a staged THA is more efficient, although this finding did not hold for TKA.
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Affiliation(s)
- Christine Jiang Wu
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC 27710, United States
| | - Colin Penrose
- Department of Orthopaedic Surgery, Midwest Center for Joint Replacement, Indianapolis, IN 46241, United States
| | - Sean Patrick Ryan
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC 27710, United States
| | - Michael Paul Bolognesi
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC 27710, United States
| | - Thorsten Markus Seyler
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC 27710, United States
| | - Samuel Secord Wellman
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC 27710, United States
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19
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Polus JS, Vasarhelyi EM, Lanting BA, Teeter MG. Acetabular cup fixation with and without screws following primary total hip arthroplasty: migration evaluated by radiostereometric analysis. Hip Int 2024; 34:42-48. [PMID: 37016808 PMCID: PMC10787387 DOI: 10.1177/11207000231164711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 02/25/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND Early cup migration after total hip arthroplasty (THA) is correlated to late revision due to aseptic loosening. However, the use of screws for increased cup stability remains unclear and debated. The purpose of this study is to assess acetabular migration between cups fixated with and without the use of screws. METHODS Patients underwent primary THA using either a direct anterior (DA) or a direct lateral (DL) approach. The DA surgeon routinely supplemented cup fixation with 1 or 2 screws while the DL surgeon used no screws. At 7 follow-up visits up to 2 years post operation, patients underwent radiostereometric analysis (RSA) imaging for implant migration tracking. The primary outcome was defined as proximal cup migration measured with model-based RSA. RESULTS 68 patients were assessed up to 2 years post operation, n = 43 received screws and n = 25 did not. The use of screws had a significant effect on cup migration (p = 0.018). From 2 weeks to 2 years post operation, the total mean migration was 0.403 ± 0.681 mm and 0.129 ± 0.272 mm (p = 0.319) for cups with and without screws, respectively. The number of screws used also had a significant impact, with cups fixated with 1 screw migrating more than cups fixated with 2 (p = 0.013, mean difference 0.712 mm). CONCLUSIONS Acetabular cups fixated with only 1 screw resulted in greater migration than cups with no screws or 2 screws, though the mean magnitude was well under the 1.0 mm threshold for unacceptable migration. However, 3 of the 24 patients who received only 1 screw exceeded the 1.0 mm threshold for unacceptable migration. Ultimately, the results of this study show that the use of 2 screws to supplement cup fixation can provide good implant stability that is equivalent to a secure press-fit component with no screws.Clinical trial registration: ClinicalTrials.gov (NCT03558217).
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Affiliation(s)
- Jennifer S Polus
- School of Biomedical Engineering, Western University, London, Ontario, Canada
- Imaging Research Laboratories, Robarts Research Institute, Western University, London, Ontario, Canada
- School of Biomedical Engineering, Collaborative Specialization in Musculoskeletal Health Research, and Bone and Joint Institute, Western University, Canada
| | - Edward M Vasarhelyi
- Division of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Brent A Lanting
- Division of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Matthew G Teeter
- School of Biomedical Engineering, Western University, London, Ontario, Canada
- Imaging Research Laboratories, Robarts Research Institute, Western University, London, Ontario, Canada
- School of Biomedical Engineering, Collaborative Specialization in Musculoskeletal Health Research, and Bone and Joint Institute, Western University, Canada
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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20
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Mehta SP, Ellis AP, Meadows S, Lu S, Bullock M, Oliashirazi A. Rasch Analysis of Joint Replacement Version for Hip Disability and Osteoarthritis Outcome in Individuals With Advanced Osteoarthritis of Hip Awaiting Total Hip Arthroplasty Surgery. Arch Phys Med Rehabil 2023; 104:2084-2091. [PMID: 37290491 DOI: 10.1016/j.apmr.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/20/2023] [Accepted: 05/08/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The objective of this study was to examine measurement properties of the Joint replacement version for Hip Disability and Osteoarthritis Outcome Score (HOOS-JR) using Rasch analysis in patients with osteoarthritis of hip (HOA). DESIGN Cross-sectional clinical measurement SETTING: Patient outcomes database at a tertiary care hospital PARTICIPANTS: Convenience sampling of patients with HOA scheduled for total hip arthroplasty (N=327) OUTCOME MEASURES AND ANALYSIS: The data for pre-surgery assessments for patients with HOA were extracted from an existing database. Variables extracted included HOOS-JR scores, demographic information (age, sex), health-related data, and anthropometric variables. The assumptions of Rasch model such as the test of fit, fit residuals, ordering of item thresholds, factor structure, DIF, internal consistency and Pearson separation index were examined for the HOOS-JR scores. RESULTS The HOOS-JR showed adequate overall fit to the Rasch model, logically ordered response thresholds, no floor or ceiling effects, and high internal consistency (Cronbach's alpha of 0.91). The HOOS-JR did not satisfy the assumption of unidimensionality, albeit the violation of this assumption was marginal (6.12% over 5%). Person-item threshold distribution (difference between person and item means were equal to 0.92 which was less than 1 logit unit) confirmed that the HOOS-JR scores were well targeted. CONCLUSIONS Given that the violation of unidimensionality for HOOS-JR was marginal, we recommend further studies to validate this finding. Results broadly support the use of HOOS-JR for assessing hip health in patients with HOA.
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Affiliation(s)
- Saurabh P Mehta
- Physical Therapy Program, East Tennessee State University, Johnson City, TN; Dept. of Orthopedic Surgery, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV.
| | | | | | - Steve Lu
- School of Rehabilitation Science, McMaster University, Hamilton, Canada; Roth McFarlane Hand and Upper Limb Centre, St Joseph's Health Care London, London, Canada
| | - Matthew Bullock
- Dept. of Orthopedic Surgery, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV
| | - Ali Oliashirazi
- Dept. of Orthopedic Surgery, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV
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21
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Wolf MA, Winter P, Landgraeber S, Orth P. Comparison of the scientific performance in hip and knee arthroplasty between the leading continents. Front Surg 2023; 10:1223905. [PMID: 38046102 PMCID: PMC10691481 DOI: 10.3389/fsurg.2023.1223905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/19/2023] [Indexed: 12/05/2023] Open
Abstract
Background Scientific progress in the field of knee and hip arthroplasty has enabled the preservation of mobility and quality of life in the case of patients with many primary degenerative and (post-) traumatic joint diseases. This comparative study aims to investigate differences in scientific performance between the leading continents in the field of hip and knee arthroplasty. Methods Using specific search terms all studies published by the scientific leading continents Europe, North America, Asia and Oceania listed in the Web of Science databases were included. All identified publications were analysed and comparative conclusions were drawn regarding the qualitative and quantitative scientific merit of each continent. Results Europe, followed by North America, Asia, and Oceania, had the highest overall number of publications in the field of arthroplasty. Since 2000, there has been a strong increase in knee arthroplasty publication rate, particular pronounced in Asia. Studies performed and published in North America and those on knee arthroplasty received the highest number of fundings. Publications regarding hip arthroplasty achieved the highest average citation rate. In contradistinction to the others, in North America most funding was provided by private agencies. Conclusion Although Europe showed the highest total number of publications, authors and institutions, arthroplasty research from North America received greater scientific attention and financial support. Measured by citations, publications on hip arthroplasty attained higher scientific interest and studies on knee arthroplasty received higher economic affection.
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Affiliation(s)
- Milan Anton Wolf
- Department of Orthopaedic Surgery, Saarland University, Homburg, Germany
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Murao M, Nankaku M, Kawano T, Goto K, Kuroda Y, Kawai T, Ikeguchi R, Matsuda S. Reproducibility, criterion-related validity, and minimal clinically important difference of the stair negotiation test after total Hip arthroplasty. Physiother Theory Pract 2023; 39:2438-2445. [PMID: 35581533 DOI: 10.1080/09593985.2022.2078255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 03/10/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To determine the reproducibility, criterion-related validity, and minimal clinically important difference (MCID) of the stair negotiation test (SNT) after total hip arthroplasty (THA). METHODS Sixty patients who underwent THA were included in this study. They performed the SNT and rated their difficulty in stair negotiation (question 7 of the Oxford Hip Score [OHSQ7]) before and 6 months after surgery. The SNT determined the time taken by a patient to ascend, turn around, and descend the stairs (15 cm × 4 steps) and was measured twice each time. As a measure of reproducibility, the intraclass correlation coefficient (ICC1,1) was calculated using the preoperative SNT. As an index of criterion-related validity, Spearman's rank correlation coefficient was used to evaluate the relationship between the better score of two trials in the preoperative SNT and the OHSQ7. The MCID of the SNT was calculated using the distribution-based method and the anchor-based method. The change in the OHSQ7 between before and after surgery was used as an anchor in the latter method. RESULTS The ICC1,1 of the SNT was 0.97. The SNT was significantly correlated with the OHSQ7 (r = 0.40, p < .05). Moreover, the anchor-based MCID of the SNT was 1.98 seconds. CONCLUSION The SNT is an objective assessable test of stair negotiation ability in post-THA patients that has good reproducibility and moderate criterion-related validity. Changes in the SNT beyond the MCID (1.98 seconds) represent clinically important changes in stair negotiation ability.
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Affiliation(s)
- Masanobu Murao
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Manabu Nankaku
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Takumi Kawano
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Koji Goto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yutaka Kuroda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshiyuki Kawai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryosuke Ikeguchi
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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23
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Rampersaud YR, Sundararajan K, Docter S, Perruccio AV, Gandhi R, Adams D, Briggs N, Davey JR, Fehlings M, Lewis SJ, Magtoto R, Massicotte E, Sarro A, Syed K, Mahomed NN, Veillette C. Hospital spending and length of stay attributable to perioperative adverse events for inpatient hip, knee, and spine surgery: a retrospective cohort study. BMC Health Serv Res 2023; 23:1150. [PMID: 37880706 PMCID: PMC10598977 DOI: 10.1186/s12913-023-10055-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 09/23/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND The incremental hospital cost and length of stay (LOS) associated with adverse events (AEs) has not been well characterized for planned and unplanned inpatient spine, hip, and knee surgeries. METHODS Retrospective cohort study of hip, knee, and spine surgeries at an academic hospital in 2011-2012. Adverse events were prospectively collected for 3,063 inpatient cases using the Orthopaedic Surgical AdVerse Event Severity (OrthoSAVES) reporting tool. Case costs were retrospectively obtained and inflated to equivalent 2021 CAD values. Propensity score methodology was used to assess the cost and LOS attributable to AEs, controlling for a variety of patient and procedure factors. RESULTS The sample was 55% female and average age was 64; 79% of admissions were planned. 30% of cases had one or more AEs (82% had low-severity AEs at worst). The incremental cost and LOS attributable to AEs were $8,500 (95% confidence interval [CI]: 5100-11,800) and 4.7 days (95% CI: 3.4-5.9) per admission. This corresponded to a cumulative $7.8 M (14% of total cohort cost) and 4,290 bed-days (19% of cohort bed-days) attributable to AEs. Incremental estimates varied substantially by (1) admission type (planned: $4,700/2.4 days; unplanned: $20,700/11.5 days), (2) AE severity (low: $4,000/3.1 days; high: $29,500/11.9 days), and (3) anatomical region (spine: $19,800/9 days; hip: $4,900/3.8 days; knee: $1,900/1.5 days). Despite only 21% of admissions being unplanned, adverse events in these admissions cumulatively accounted for 59% of costs and 62% of bed-days attributable to AEs. CONCLUSIONS This study comprehensively demonstrates the considerable cost and LOS attributable to AEs in orthopaedic and spine admissions. In particular, the incremental cost and LOS attributable to AEs per admission were almost five times as high among unplanned admissions compared to planned admissions. Mitigation strategies focused on unplanned surgeries may result in significant quality improvement and cost savings in the healthcare system.
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Affiliation(s)
- Y Raja Rampersaud
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada.
- Krembil Research Institute, University Health Network, Toronto, ON, Canada.
- Department of Surgery, University of Toronto, Toronto, ON, Canada.
- Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada.
| | - Kala Sundararajan
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Shgufta Docter
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
| | - Anthony V Perruccio
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Rajiv Gandhi
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Diana Adams
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
| | - Natasha Briggs
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
| | - J Rod Davey
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Michael Fehlings
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada
| | - Stephen J Lewis
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada
| | - Rosalie Magtoto
- Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada
| | - Eric Massicotte
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada
| | - Angela Sarro
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada
| | - Khalid Syed
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Nizar N Mahomed
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Christian Veillette
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
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Sun Y, Cheng KY, Kanniyappan H, Ramachandran RA, Neto MQ, McNallan M, Pourzal R, Lundberg H, Mathew MT. Fretting-corrosion Apparatus with Low Magnitude Micro-motion (≤5 μm): Development and Preliminary Outcome. RESEARCH SQUARE 2023:rs.3.rs-3359897. [PMID: 37886457 PMCID: PMC10602084 DOI: 10.21203/rs.3.rs-3359897/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Fretting-corrosion is one of the failure processes in many applications, including biomedical implants. For example, the modern design of hip implants with multiple components offers better flexibility and inventory storage. However, it will trigger the fretting at the implant interfaces with a small displacement amplitude (< 5 µm) and usually in a partial slip region. Although many studies have been reported on the fretting, they have high displacement amplitude and are in the gross slip region. It is imperative to have an apparatus to overcome such limitations, specifically for hip implant applications. Therefore, this study describes the development of a fretting-corrosion apparatus with low micro-motion (≤ 5 µm) that can simultaneously monitor the corrosion process. Initial experiments with Ti6Al4V-Ti6Al4V in 0.9% saline, Ti6Al4V-Ti6Al4V in bovine calf serum (BCS), and ZrO2-Ti6Al4V in BCS were conducted to validate the system. As a result, the fretting regime of all groups remained partially slip region throughout the 3600 cycles, and the possible failure mechanisms are proposed in this manuscript.
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Affiliation(s)
- Yani Sun
- University of Illinois at Chicago
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25
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Szilágyiné Lakatos T, Lukács B, Nagy AC, Jenei Z, Veres-Balajti I. Efficiency of Printed Patient Information Leaflets Written for Total Knee and Hip Arthroplasty Patients to Reduce Their Fear of Surgery. Geriatrics (Basel) 2023; 8:89. [PMID: 37736889 PMCID: PMC10514843 DOI: 10.3390/geriatrics8050089] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 09/23/2023] Open
Abstract
Background: Patient education plays a key role in health care. In our study, we created a new information guide for patients waiting for total knee (TKA) or hip (THA) arthroplasty. The goal of our study was to create patient education material that would reduce patients' fear of surgery and improve their postoperative lifestyle. Methods: Patients in the intervention group (n = 44) received newly developed paper-based patient education material before surgery. The surgical fear questionnaire (SFQ) was used to assess fear reduction. A self-designed assessment questionnaire was used to measure the effectiveness of the leaflet among the intervention group patients. Results: The SFQ scores decreased significantly both in patients with TKA (median 37.50 IQR 30.00-40.00 vs. median 20.00 IQR 16.00-24.00) and THA (median 34.50 IQR 28.00-42.00 vs. median 20.00 IQR 16.00-22.00). A control group with TKA (median 37.50 IQR 30.00-40.00 vs. median 64.50 IQR 54.00-82.00) and THA (median 34.50 IQR 28.00-42.00 vs. median 73.00 IQR 56.00-81.00) was also included. An assessment of the content, usability, and clarity of the new leaflet showed that patients rated the new leaflet as almost entirely usable (median score 12.00-10.00). Conclusions: Our results suggest that new printed patient education material may reduce the fear of surgery.
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Affiliation(s)
- Tünde Szilágyiné Lakatos
- Department of Medical Rehabilitation and Physical Medicine, Faculty of Medicine, University of Debrecen, 4031 Debrecen, Hungary;
| | - Balázs Lukács
- Department of Physiotherapy, Faculty of Health Sciences, Institute of Health Sciences, University of Debrecen, 4028 Debrecen, Hungary; (B.L.); (I.V.-B.)
| | - Attila Csaba Nagy
- Department of Health Informatics, Faculty of Health Sciences, Institute of Health Sciences, University of Debrecen, 4028 Debrecen, Hungary;
| | - Zoltán Jenei
- Department of Medical Rehabilitation and Physical Medicine, Faculty of Medicine, University of Debrecen, 4031 Debrecen, Hungary;
| | - Ilona Veres-Balajti
- Department of Physiotherapy, Faculty of Health Sciences, Institute of Health Sciences, University of Debrecen, 4028 Debrecen, Hungary; (B.L.); (I.V.-B.)
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26
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Jennison T, MacGregor A, Goldberg A. Hip arthroplasty practice across the Organisation for Economic Co-operation and Development (OECD) over the last decade. Ann R Coll Surg Engl 2023; 105:645-652. [PMID: 37652085 PMCID: PMC10471436 DOI: 10.1308/rcsann.2022.0101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION There are large variations in the number of hip replacements performed between countries, demonstrating large health inequalities; however, there has been limited research on this variation. The aims of this paper were to compare rates of hip replacements using Organisation for Economic Co-operation and Development (OECD) data for the period 2008-2018. The study also compared changes in the number of hip replacements in the total population and in only those aged over 65, and looked for a correlation of health expenditure and gross domestic product (GDP) with rates of hip replacements. METHODS The OECD collects annual data from all member countries on the numbers of hip replacements, healthcare expenditure and GDP. Data analysis was undertaken using STATA. Descriptive statistics and Pearson's correlation coefficient were performed. RESULTS The mean number of hip replacements performed in OECD countries in 2018 was 191.5 per 100,000 population per year. The largest number was 310.6 in Germany and the lowest was 8.6 in Mexico. There has been a 21.7% increase in the mean number of hip replacements across OECD countries. There was a moderate and significant Pearson coefficient of 0.468 (p = 0.009) between the number of hip replacements performed per 100,000 population in 2018 and GDP per person, and a strong and significant correlation with health expenditure (R = 0.784, p < 0.001). There was a moderate correlation (R = 0.645, p = 0.003) between the percentage change in the number of hip replacements performed per 100,000 population and the percentage change in healthcare expenditure per person between 2008 and 2018. CONCLUSIONS There is 36-fold variation in the practice of hip replacements across the OECD and the number of hip replacements has increased by more than 20% over the past decade. The number of hip replacements performed appears to be correlated with health expenditure in each country and may indicate a need that can only be met by increasing health expenditure.
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Affiliation(s)
- T Jennison
- Cardiff and Vale University Health Board, UK
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Moldovan F, Moldovan L, Bataga T. A Comprehensive Research on the Prevalence and Evolution Trend of Orthopedic Surgeries in Romania. Healthcare (Basel) 2023; 11:1866. [PMID: 37444700 DOI: 10.3390/healthcare11131866] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/03/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
Accurate knowledge of the prevalence and trends of orthopedic surgeries can facilitate the design of medical plans for effective treatments. The National Endoprosthetic Registry (NER) in Romania provides statistics on endoprosthetic activity (hip, knee), cases of fractures and bone tumors as a result of the legal obligations to report interventions performed by all orthopedic traumatology hospitals/wards in the country. The aim of this study is to describe the annual volumes of orthopedic surgeries between 2001 and 2022 in Romania and analyze the current and future evolution trends of the studied surgeries, gender differences and regional differences based on a complete survey carried out at a national level. For the period 2001-2022, we extracted from the NER the annual volumes of orthopedic interventions performed. With these data, we studied the prevalence and estimated, with the support of an original calculation methodology, the variation trends of orthopedic surgeries in two situations: over the entire 21-year period, respectively, and over the period 2001-2020, which does not include the pandemic period. For hip replacement surgery and knee replacement surgery, we showed the prevalence by subcategory of interventions, gender distribution, regional prevalence and regional density calculated by the annual averages of the total number of cases reported per 100,000 people in the 40 counties of the country and the capital, Bucharest. We also determined the variations in hip and knee arthroplasty revision burdens, calculated as a percentage between the number of revisions and the number of primary interventions in the same period. We determined the regional densities of revision burdens. The total number of orthopedic surgeries in the period 2001-2022 was 1,557,247, of which 189,881 were hip replacement surgeries; 51,035 were knee replacement surgeries; 11,085 were revision hip arthroplasty; 1497 were revision knee arthroplasty; 541,440 were operated fractures; and 16,418 were operated bone tumors. The growth rates of surgical interventions are hip replacement surgery, +8.19%; knee replacement surgery, +19.55%; revision hip arthroplasty, +9.43%; and revision knee arthroplasty, +28.57%. With these data, we have estimated a doubling of the volume of primary and revision interventions of the hip until 2034 and the knee until 2027, respectively. Operated bone tumors register an annual decrease of -4.52% thanks to modern treatments. There are clear gender differences; for primary hip interventions, the proportion of women is 58.82%, and for knee interventions, the proportion of women is 76.42%. This is the first research that, with the support of exhaustive data from the NER, analyzes for the period 2001-2022 the annual number of orthopedic surgeries in Romania. It allows knowledge of the large, anticipated increases in orthopedic surgery and provides a quantitative basis for future policy decisions related to the need for medical personnel and material resources.
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Affiliation(s)
- Flaviu Moldovan
- Orthopedics-Traumatology Department, Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Liviu Moldovan
- Faculty of Engineering and Information Technology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Tiberiu Bataga
- Orthopedics-Traumatology Department, Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
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Poulsen AG, Gravesen JD, Madsen MN, Mikkelsen LR, Bandholm T, Rossen CB. Patient perspectives on home-based rehabilitation exercise and general physical activity after total hip arthroplasty: A qualitative study (PHETHAS-2). F1000Res 2023; 10:382. [PMID: 37359253 PMCID: PMC10285331 DOI: 10.12688/f1000research.51684.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 07/20/2023] Open
Abstract
Background: Home-based rehabilitation exercise following Total Hip Arthroplasty (THA) shows similar outcomes compared to supervised outpatient rehabilitation exercise. Little is known about patients' experiences with home-based rehabilitation, and this study aimed to investigate how patients perceived home-based rehabilitation exercise and general physical activity after THA, focusing on facilitators and barriers. Methods: Semi-structured interviews of qualitative design were conducted with 22 patients who had undergone THA and who had performed home-based rehabilitation exercise. The study took place in a regional hospital in Denmark between January 2018 and May 2019. Data were analyzed using an interpretive thematic analysis approach, with theoretical underpinning from the concept 'conduct of everyday life'. The study is embedded within the Pragmatic Home-Based Exercise Therapy after Total Hip Arthroplasty-Silkeborg trial (PHETHAS-1). Results: The main theme, 'wishing to return to the well-known everyday life', and four subthemes were identified. Generally, participants found the home-based rehabilitation exercise boring but were motivated by the goal of returning to their well-known everyday life and performing their usual general physical activities, though some lacked contact to physiotherapist. Participants enrolled in the PHETHAS-1 study used the enrollment as part of their motivation for doing the exercises. Both pain and the absence of pain were identified as barriers for doing home-based rehabilitation exercise. Pain could cause insecurity about possible medical complications, while the absence of pain could lead to the rehabilitation exercise being perceived as pointless. Conclusions: The overall goal of returning to the well-known everyday life served as a facilitator for undertaking home-based rehabilitation exercise after THA along with the flexibility regarding time and place for performing exercises. Boring exercises as well as both pain and no pain were identified as barriers to the performance of home-based rehabilitation exercise. Participants were motivated towards performing general physical activities which were part of their everyday life.
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Affiliation(s)
- Anne Grøndahl Poulsen
- Research Unit, Elective Surgery Center, Silkeborg Regional Hospital, Silkeborg, 8600, Denmark
| | | | - Merete Nørgaard Madsen
- Research Unit, Elective Surgery Center, Silkeborg Regional Hospital, Silkeborg, 8600, Denmark
| | - Lone Ramer Mikkelsen
- Research Unit, Elective Surgery Center, Silkeborg Regional Hospital, Silkeborg, 8600, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, 8000, Denmark
| | - Thomas Bandholm
- Physical Medicine & Rehabilitation Research – Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Clinical Research Center and Department of Orthopedic Surgery, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, 2650, Denmark
| | - Camilla Blach Rossen
- Research Unit, Elective Surgery Center, Silkeborg Regional Hospital, Silkeborg, 8600, Denmark
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Poulsen AG, Gravesen JD, Madsen MN, Mikkelsen LR, Bandholm T, Rossen CB. Patient perspectives on home-based rehabilitation exercise and general physical activity after total hip arthroplasty: A qualitative study (PHETHAS-2). F1000Res 2023; 10:382. [PMID: 37359253 PMCID: PMC10285331 DOI: 10.12688/f1000research.51684.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 01/04/2024] Open
Abstract
Background: Home-based rehabilitation exercise following Total Hip Arthroplasty (THA) shows similar outcomes compared to supervised outpatient rehabilitation exercise. Little is known about patients' experiences with home-based rehabilitation, and this study aimed to investigate how patients perceived home-based rehabilitation exercise and general physical activity after THA, focusing on facilitators and barriers. Methods: Semi-structured interviews of qualitative design were conducted with 22 patients who had undergone THA and who had performed home-based rehabilitation exercise. The study took place in a regional hospital in Denmark between January 2018 and May 2019. Data were analyzed using an interpretive thematic analysis approach, with theoretical underpinning from the concept 'conduct of everyday life'. The study is embedded within the Pragmatic Home-Based Exercise Therapy after Total Hip Arthroplasty-Silkeborg trial (PHETHAS-1). Results: The main theme, 'wishing to return to the well-known everyday life', and four subthemes were identified. Generally, participants found the home-based rehabilitation exercise boring but were motivated by the goal of returning to their well-known everyday life and performing their usual general physical activities, though some lacked contact to physiotherapist. Participants enrolled in the PHETHAS-1 study used the enrollment as part of their motivation for doing the exercises. Both pain and the absence of pain were identified as barriers for doing home-based rehabilitation exercise. Pain could cause insecurity about possible medical complications, while the absence of pain could lead to the rehabilitation exercise being perceived as pointless. Conclusions: The overall goal of returning to the well-known everyday life served as a facilitator for undertaking home-based rehabilitation exercise after THA along with the flexibility regarding time and place for performing exercises. Boring exercises as well as both pain and no pain were identified as barriers to the performance of home-based rehabilitation exercise. Participants were motivated towards performing general physical activities which were part of their everyday life.
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Affiliation(s)
- Anne Grøndahl Poulsen
- Research Unit, Elective Surgery Center, Silkeborg Regional Hospital, Silkeborg, 8600, Denmark
| | | | - Merete Nørgaard Madsen
- Research Unit, Elective Surgery Center, Silkeborg Regional Hospital, Silkeborg, 8600, Denmark
| | - Lone Ramer Mikkelsen
- Research Unit, Elective Surgery Center, Silkeborg Regional Hospital, Silkeborg, 8600, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, 8000, Denmark
| | - Thomas Bandholm
- Physical Medicine & Rehabilitation Research – Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Clinical Research Center and Department of Orthopedic Surgery, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, 2650, Denmark
| | - Camilla Blach Rossen
- Research Unit, Elective Surgery Center, Silkeborg Regional Hospital, Silkeborg, 8600, Denmark
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Chen XT, Christ AB, Chung BC, Ton A, Ballatori AM, Shahrestani S, Gettleman BS, Heckmann ND. Cemented versus Cementless Femoral Fixation for Elective Primary Total Hip Arthroplasty: A Nationwide Analysis of Short-Term Complication and Readmission Rates. J Clin Med 2023; 12:3945. [PMID: 37373640 DOI: 10.3390/jcm12123945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
Cementless fixation during total hip arthroplasty (THA) is the predominant mode of fixation utilized for both acetabular and femoral components during elective primary THAs performed in the United States. This study aims to compare early complication and readmission rates between primary THA patients receiving cemented versus cementless femoral fixation. The 2016-2017 National Readmissions Database was queried to identify patients undergoing elective primary THA. Postoperative complication and readmission rates at 30, 90, and 180 days were compared between cemented and cementless cohorts. Univariate analysis was conducted to compare differences between cohorts. Multivariate analysis was performed to account for confounding variables. Of 447,902 patients, 35,226 (7.9%) received cemented femoral fixation, while 412,676 (92.1%) did not. The cemented group was older (70.0 vs. 64.8, p < 0.001), more female (65.0% vs. 54.3%, p < 0.001), and more comorbid (CCI 3.65 vs. 3.22, p < 0.001) compared to the cementless group. On univariate analysis, the cemented cohort had decreased odds of periprosthetic fracture at 30 days postoperatively (OR: 0.556, 95%-CI 0.424-0.729, p < 0.0001), but higher odds of hip dislocation, periprosthetic joint infection, aseptic loosening, wound dehiscence, readmission, medical complications, and death at all timepoints. On multivariate analysis, the cemented fixation cohort demonstrated reduced odds of periprosthetic fracture at all postoperative timepoints: 30 (OR: 0.350, 95%-CI 0.233-0.506, p < 0.0001), 90 (OR: 0.544, 95%-CI 0.400-0.725, p < 0.0001), and 180 days (OR: 0.573, 95%-CI 0.396-0.803, p = 0.002). Cemented femoral fixation was associated with significantly fewer short-term periprosthetic fractures, but more unplanned readmissions, deaths, and postoperative complications compared to cementless femoral fixation in patients undergoing elective THA.
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Affiliation(s)
- Xiao T Chen
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 91803, USA
| | - Alexander B Christ
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 91803, USA
| | - Brian C Chung
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 91803, USA
| | - Andy Ton
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 91803, USA
| | - Alexander M Ballatori
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 91803, USA
| | - Shane Shahrestani
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 91803, USA
| | | | - Nathanael D Heckmann
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 91803, USA
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31
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Hauer G, Sadoghi P, Smolle M, Zaussinger S, Friesenbichler J, Leithner A, Maurer-Ertl W. Sexual activity after short-stem total hip arthroplasty. Does stem size matter? Arch Orthop Trauma Surg 2023; 143:3613-3619. [PMID: 36114870 PMCID: PMC10192171 DOI: 10.1007/s00402-022-04614-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/03/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND Sexual activity is an important component of quality of life. To date, no studies have examined the impact of stem design on return to sexual activity (RTS) and quality of sex life after total hip arthroplasty (THA). METHODS A questionnaire was designed to assess preoperative and postoperative sexual habits, joint awareness and physical activity in working-age patients undergoing short-stem (n = 176) or straight-stem (n = 97) THA. RESULTS No differences were noted in time until RTS based on the stem design (short stems vs. straight stems; 6 [IQR: 4-10] vs. 6 [4-10] weeks; p = 0.996). Multivariate analysis revealed that higher patient BMI (p = 0.04), female gender (p < 0.001) and lower FJS-12 (p = 0.006) were significantly associated with delayed RTS. Improved hip mobility and reduced pain mainly contribute to improved quality of sexual activity postoperatively. CONCLUSION This study, hence, indicates that stem design has no impact on time until resumption of sexual activity in patients < 65 years. Female obese individuals who are aware of their artificial joint in daily life are at increased risk of delayed RTS after surgery. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Georg Hauer
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Patrick Sadoghi
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
| | - Maria Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Sabrina Zaussinger
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Joerg Friesenbichler
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Werner Maurer-Ertl
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
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32
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Dudoniene V, Adomaitytė A, Žlibinaitė L. Randomized controlled trial to compare conventional physiotherapy with task-oriented exercises after total hip replacement. J Back Musculoskelet Rehabil 2023:BMR220340. [PMID: 37248880 DOI: 10.3233/bmr-220340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Different interventions are used during rehabilitation after hip replacement surgery, but it is unclear if task-oriented exercise is more effective than conventional physiotherapy. OBJECTIVE This study compared the effectiveness of conventional physiotherapy (CPT) programme with task-oriented exercise (TOE) on hip pain, function, static and dynamic balance during the early rehabilitation stage after total hip replacement. METHODS This randomized controlled parallel-group trial was executed in an inpatient physical medicine and rehabilitation centre. The study included 40 patients who were randomly classified into CPT and TOE groups (n= 20 in each). Hip pain (assessed by visual analogue scale), function in the operated leg (assessed by modified Harris Hip Score, mHHS), static balance (assessed by Abili Balance analyser system) and dynamic balance (assessed by Berg Balance Scale) were evaluated at baseline and after 18 days of rehabilitation. Cohen's effect size (d) was calculated. RESULTS Greater pain reduction (p< 0.05; d= 0.08) was observed after TOE (1.6 ± 0.68 scores) compared with the CPT programme (2.2 ± 0.83 scores). Hip function assessed by the modified mHHS improved more (p< 0.05; d= 0.30) in the TOE group (73.45 ± 6.23 scores) than in the CPT group (54.90 ± 6.28 scores). Static balance improved significantly in both groups after the interventions but did not differ significantly between the groups. The improvement in dynamic balance was significantly greater (p< 0.05; d= 0.45) after TOE (50.55 ± 1.57 scores) than after CPT (38.55 ± 3.43 scores). CONCLUSION Both interventions reduced pain and improved function of the operated leg and static and dynamic balance. The effect on hip function was superior for TOE compared with CPT.
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33
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Zaballa E, Dennison E, Walker-Bone K. Function and employment after total hip replacement in older adults: A narrative review. Maturitas 2023; 167:8-16. [PMID: 36302339 DOI: 10.1016/j.maturitas.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/12/2022] [Accepted: 09/04/2022] [Indexed: 10/14/2022]
Abstract
The burden of osteoarthritis (OA) has increased steadily due to an aging population, increasing life expectancy, obesity and lifestyle factors. Total hip replacement has become one of the most prevalent and successful operations globally and it is projected that demand will continue to grow as the incidence of OA continues to increase. Patients undergoing the operation expect much-improved function and pain relief but also increasingly need to return to work postoperatively, especially given the growing demand for the procedure and the encouragement of older people to continue working by most governments in the developed world. This review provides an overview of function and employment outcomes after hip arthroplasty. Despite the generally good success rate, some patients do not attain good functional outcomes and it is important that we develop ways to identify these patients preoperatively. We describe the effect of demographic, clinical and other factors on functional outcomes, as well as trajectories of physical function and pain recovery beyond the first few weeks after total hip replacement. Regarding employment outcomes, many people in work preoperatively are likely to resume to work after recovery; however, patients feel that they lack guidance from clinicians about returning to work postoperatively. Our review encompasses factors associated with return to work, timing of return to work, and potential temporary or permanent limitations that people might experience at work depending on type of employment.
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Affiliation(s)
- Elena Zaballa
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK; MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK.
| | - Elaine Dennison
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.
| | - Karen Walker-Bone
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK; MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK; Monash Centre for Occupational and Environmental Health, Monash University, Melbourne, Australia.
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34
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Hu J, Wang Q, Hu J, Kang P, Yang J. Efficacy of Ultrasound-Guided Pericapsular Nerve Group (PENG) Block Combined With Local Infiltration Analgesia on Postoperative Pain After Total Hip Arthroplasty: A Prospective, Double-Blind, Randomized Controlled Trial. J Arthroplasty 2022; 38:1096-1103. [PMID: 36529195 DOI: 10.1016/j.arth.2022.12.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 12/02/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND This study examined whether pericapsular nerve group (PENG) block combined with local infiltration analgesia (LIA) could improve pain management and functional recovery after total hip arthroplasty. METHODS All patients were randomly assigned to receive PENG block combined with LIA (PENG group) or sham PENG block and LIA (Sham group). The primary outcome was cumulative morphine consumption within 24 hours after surgery. Secondary outcomes were pain scores on a visual analog scale (VAS); time to first rescue analgesia; cumulative morphine consumption during hospitalization; intraoperative consumption of opioids; postoperative recovery; and postoperative complications. RESULTS PENG patients consumed significantly less morphine within the first 24 hours and throughout hospitalization and smaller amounts of intraoperative opioids. There were significantly lower pain scores at rest and during motion within 24 hours in PENG patients. PENG patients took significantly longer until the first rescue analgesia and showed significantly better postoperative rehabilitation. However, the absolute change in morphine consumption and VAS scores did not exceed the reported minimal clinically important differences (morphine consumption: 10 mg; VAS scores: 1.5 at rest and 1.8 during movement). The two groups showed no difference in quadriceps muscle strength and postoperative complications. CONCLUSION PENG block combined with LIA could improve postoperative pain relief, reduce opioid use, and enhance recovery in total hip arthroplasty patients, without weakening the quadriceps muscle strength. This work justifies further trials to examine the safety and efficacy of this block and to explore maximal effective volume of local anesthetic for motor-sparing PENG block.
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Affiliation(s)
- Jian Hu
- Department of Anesthesiology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Sichuan Province, Chengdu, China
| | - Qiuru Wang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jie Hu
- Department of Anesthesiology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Sichuan Province, Chengdu, China
| | - Pengde Kang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Yang
- Department of Anesthesiology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Sichuan Province, Chengdu, China
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35
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Kjeldgaard HK, Meyer HE, O'Flaherty M, Apalset EM, Dahl C, Emaus N, Fenstad AM, Furnes O, Gjertsen JE, Hoff M, Schei B, Søgaard AJ, Tell GS, Holvik K. Impact of Total Hip Replacements on the Incidence of Hip Fractures in Norway During 1999-2019. A Norwegian Epidemiologic Osteoporosis Studies (NOREPOS) Study. J Bone Miner Res 2022; 37:1936-1943. [PMID: 35877138 PMCID: PMC9804722 DOI: 10.1002/jbmr.4660] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/06/2022] [Accepted: 07/21/2022] [Indexed: 01/07/2023]
Abstract
The knowledge about why hip fracture rates in Norway have declined is sparse. Concurrent with decreasing hip fracture rates, the rates of total hip replacements (THRs) have increased. We wanted to investigate if hip fracture rates continued to decline, and whether the increase in THRs had any influence on this decline, assuming that living with a hip prosthesis precludes fracture of the operated hip. Information on hip fractures in Norway 1999-2019 was available from the Norwegian Epidemiologic Osteoporosis Studies (NOREPOS) hip fracture database and population size were available in official population tables from Statistics Norway. Primary THRs (for any cause except hip fracture) 1989-2019 were obtained from the Norwegian Arthroplasty Register. We calculated the annual age-standardized incidence rates of hip fracture by sex for the period 1999-2019. The hip fracture rates in a scenario with no hip prostheses were calculated by subtracting 0.5 persons from the population at risk for each prevalent hip prosthesis, considering that each person has two hips at risk of fracture. We estimated how much of the decline could be attributed to the increased prevalence of hip prostheses. From 1999 to 2019, age-standardized incidence rates of hip fracture decreased by 27% in women and 20% in men. The rates remained stable in those under 70 years and decreased in those 70 years and above. Excluding replaced hips from the population at risk led to higher incidence rates, and this impact was considerably larger at higher ages. The increased prevalence of hip prostheses over the period accounted for approximately 18% (20% in women and 11% in men) of the observed decline in hip fracture rates. In conclusion, the incidence of hip fractures continued to decline, and the increasing number of people living with hip prostheses contributed significantly to the observed declining time trends. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Helena Kames Kjeldgaard
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Haakon E Meyer
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway.,Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
| | - Martin O'Flaherty
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK
| | - Ellen M Apalset
- Bergen Group of Epidemiology and Biomarkers in Rheumatic Disease, Department of Rheumatology, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Cecilie Dahl
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
| | - Nina Emaus
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Anne Marie Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Ove Furnes
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jan-Erik Gjertsen
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Mari Hoff
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Rheumatology, St. Olavs University Hospital, Trondheim, Norway
| | - Berit Schei
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim, Norway
| | - Anne Johanne Søgaard
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Kristin Holvik
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
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36
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Soares Dos Santos MP, Bernardo RMC. Bioelectronic multifunctional bone implants: recent trends. Bioelectron Med 2022; 8:15. [PMID: 36127721 PMCID: PMC9490885 DOI: 10.1186/s42234-022-00097-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/23/2022] [Indexed: 12/04/2022] Open
Abstract
The concept of Instrumented Smart Implant emerged as a leading research topic that aims to revolutionize the field of orthopaedic implantology. These implants have been designed incorporating biophysical therapeutic actuation, bone-implant interface sensing, implant-clinician communication and self-powering ability. The ultimate goal is to implement revist interface, controlled by clinicians/surgeons without troubling the quotidian activities of patients. Developing such high-performance technologies is of utmost importance, as bone replacements are among the most performed surgeries worldwide and implant failure rates can still exceed 10%. In this review paper, an overview to the major breakthroughs carried out in the scope of multifunctional smart bone implants is provided. One can conclude that many challenges must be overcome to successfully develop them as revision-free implants, but their many strengths highlight a huge potential to effectively establish a new generation of high-sophisticated biodevices.
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Affiliation(s)
- Marco P Soares Dos Santos
- Department of Mechanical Engineering, Centre for Mechanical Technology & Automation (TEMA), Intelligent Systems Associate Laboratory (LASI), University of Aveiro, Aveiro, Portugal.
| | - Rodrigo M C Bernardo
- Department of Mechanical Engineering, Centre for Mechanical Technology & Automation (TEMA), Intelligent Systems Associate Laboratory (LASI), University of Aveiro, Aveiro, Portugal
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37
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Moore ML, Brinkman JC, Pollock JR, Deckey DG, Makovicka JL, Bingham JS. Patients are Most Interested in Which Hip Arthroplasty Approach? A 15-year Google Trends Analysis. Arthroplast Today 2022; 17:192-197. [PMID: 36254208 PMCID: PMC9568677 DOI: 10.1016/j.artd.2022.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 11/17/2022] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- M. Lane Moore
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ USA
| | - Joseph C. Brinkman
- Mayo Clinic Department of Orthopedic Surgery, Phoenix, AZ, USA
- Corresponding author. Mayo Clinic Department of Orthopedic Surgery, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA. Tel.: +1 480 301 9506.
| | | | - David G. Deckey
- Mayo Clinic Department of Orthopedic Surgery, Phoenix, AZ, USA
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38
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Rees JL, Craig R, Nagra N, Baldwin M, Lane JCE, Price A, Beard DJ, Abram S, Judge A, Prieto-Alhambra D, Furniss D, Carr AJ. Serious adverse event rates and reoperation after arthroscopic shoulder surgery: population based cohort study. BMJ 2022; 378:e069901. [PMID: 35938625 PMCID: PMC9258605 DOI: 10.1136/bmj-2021-069901] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To provide clinicians and patients with accurate risk estimates of serious adverse events after common elective shoulder arthroscopic procedures, including reoperation within one year. DESIGN Population based cohort study. SETTING Hospital Episode Statistics for NHS England, including civil registration mortality data from the Office for National Statistics. PARTICIPANTS 288 250 arthroscopic shoulder procedures performed in 261 248 patients aged ≥16 years between 1 April 2009 and 31 March 2017. Elective procedures were grouped into subacromial decompression, rotator cuff repair, acromioclavicular joint excision, glenohumeral stabilisation, and frozen shoulder release. MAIN OUTCOME MEASURES The primary outcomes were rates of serious adverse events (mortality, pulmonary embolism, pneumonia, myocardial infarction, acute kidney injury, stroke, and urinary tract infection) requiring inpatient care within 90 days post-surgery. Secondary outcomes were specific adverse event rates at 90 days, and reoperations (including for deep infection) within one year. RESULTS The overall rate of complications within 90 days after arthroscopic shoulder surgery (including reoperation) was low at 1.2% (95% confidence interval 1.2% to 1.3%), with one in 81 patients at risk, and varied according to type of procedure, from 0.6% (0.5% to 0.8%) for glenohumeral stabilisation to 1.7% (1.5% to 1.8%) for frozen shoulder release. After adjustment for age, comorbidities, and sex, no effect of procedure type was observed. Pneumonia was the most common adverse event (0.3%, 0.3% to 0.4%), with one in 303 patients at risk. Pulmonary embolic events were rare, at 0.1% (0.1% to 0.1%), with one in 1428 patients at risk. At one year, the overall rate for reoperation was 3.8% (3.8% to 3.9%), with one in 26 patients at risk, ranging from 2.7% (2.5% to 3.0%) for glenohumeral stabilisation to 5.7% (5.4% to 6.1%) for frozen shoulder release. The overall rate of further surgery for deep infection was low, at 0.1% (0.1% to 0.1%), with one in 1111 patients at risk, but was higher after rotator cuff repair (0.2%, 0.2% to 0.2%), with one in 526 patients at risk. Over the study period the number of arthroscopic shoulder procedures increased, except for subacromial decompression, which decreased. CONCLUSIONS The findings of this study suggest that risks of serious adverse events associated with common shoulder arthroscopy procedures are low. Nevertheless, serious complications do occur, and include the risk of reoperation in one in 26 patients within one year. STUDY REGISTRATION Clinical. TRIALS gov NCT03573765.
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Affiliation(s)
- Jonathan L Rees
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Richard Craig
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Navraj Nagra
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Mathew Baldwin
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Jennifer C E Lane
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Andrew Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - David J Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Simon Abram
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
- Musculoskeletal Research Unit, Translational Health Sciences, University of Bristol, Bristol, UK
| | - Daniel Prieto-Alhambra
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Dominic Furniss
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Andrew J Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
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Zaballa E, Ntani G, Harris EC, Lübbeke A, Arden NK, Hannouche D, Cooper C, Walker-Bone K. Feasibility and sustainability of working in different types of jobs after total hip arthroplasty: analysis of longitudinal data from two cohorts. Occup Environ Med 2022; 79:486-493. [PMID: 35027440 DOI: 10.1136/oemed-2021-107970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/22/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate the rates of return to work and workability among working-age people following total hip arthroplasty (THA). METHODS Participants from the Geneva Arthroplasty Registry and the Clinical Outcomes for Arthroplasty Study aged 18-64 years when they had primary THA and with at least 5 years' follow-up were mailed a questionnaire 2017-2019. Information was collected about preoperative and post-THA employment along with exposure to physically demanding activities at work or in leisure. Patterns of change of job were explored. Survival analyses using Cox proportional hazard models were created to explore risk factors for having to stop work because of difficulties with the replaced hip. RESULTS In total, 825 returned a questionnaire (response 58%), 392 (48%) men, mean age 58 years, median follow-up 7.5 years post-THA. The majority (93%) of those who worked preoperatively returned to work, mostly in the same sector but higher rates of non-return (36%-41%) were seen among process, plant and machine operatives and workers in elementary occupations. 7% reported subsequently leaving work because of their replaced hip and the risk of this was strongly associated with: standing >4 hours/day (HR 3.81, 95% CI 1.62 to 8.96); kneeling/squatting (HR 3.32, 95% CI 1.46 to 7.55) and/or carrying/lifting ≥10 kg (HR 5.43, 95% CI 2.29 to 12.88). CONCLUSIONS It may be more difficult to return to some (particularly physically demanding) jobs post-THA than others. Rehabilitation may need to be targeted to these types of workers or it may be that redeployment or job change counselling are required.
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Affiliation(s)
- Elena Zaballa
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK .,MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | - Georgia Ntani
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.,MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | - E Clare Harris
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.,MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | - Anne Lübbeke
- Division of Orthopaedic Surgery and Traumatology, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Nigel K Arden
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Didier Hannouche
- Division of Orthopaedic Surgery and Traumatology, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.,NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Karen Walker-Bone
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.,MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
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Langton DJ, Bhalekar RM, Joyce TJ, Rushton SP, Wainwright BJ, Nargol ME, Shyam N, Lie BA, Pabbruwe MB, Stewart AJ, Waller S, Natu S, Ren R, Hornick R, Darlay R, Su EP, Nargol AVF. The influence of HLA genotype on the development of metal hypersensitivity following joint replacement. COMMUNICATIONS MEDICINE 2022; 2:73. [PMID: 35761834 PMCID: PMC9232575 DOI: 10.1038/s43856-022-00137-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 06/07/2022] [Indexed: 12/27/2022] Open
Abstract
Background Over five million joint replacements are performed across the world each year. Cobalt chrome (CoCr) components are used in most of these procedures. Some patients develop delayed-type hypersensitivity (DTH) responses to CoCr implants, resulting in tissue damage and revision surgery. DTH is unpredictable and genetic links have yet to be definitively established. Methods At a single site, we carried out an initial investigation to identify HLA alleles associated with development of DTH following metal-on-metal hip arthroplasty. We then recruited patients from other centres to train and validate an algorithm incorporating patient age, gender, HLA genotype, and blood metal concentrations to predict the development of DTH. Accuracy of the modelling was assessed using performance metrics including time-dependent receiver operator curves. Results Using next-generation sequencing, here we determine the HLA genotypes of 606 patients. 176 of these patients had experienced failure of their prostheses; the remaining 430 remain asymptomatic at a mean follow up of twelve years. We demonstrate that the development of DTH is associated with patient age, gender, the magnitude of metal exposure, and the presence of certain HLA class II alleles. We show that the predictive algorithm developed from this investigation performs to an accuracy suitable for clinical use, with weighted mean survival probability errors of 1.8% and 3.1% for pre-operative and post-operative models respectively. Conclusions The development of DTH following joint replacement appears to be determined by the interaction between implant wear and a patient's genotype. The algorithm described in this paper may improve implant selection and help direct patient surveillance following surgery. Further consideration should be given towards understanding patient-specific responses to different biomaterials.
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Affiliation(s)
- David J. Langton
- ExplantLab, The Biosphere, Newcastle Helix, Newcastle-upon-Tyne, England
| | - Rohan M. Bhalekar
- ExplantLab, The Biosphere, Newcastle Helix, Newcastle-upon-Tyne, England
| | | | | | | | - Matthew E. Nargol
- ExplantLab, The Biosphere, Newcastle Helix, Newcastle-upon-Tyne, England
| | - Nish Shyam
- ExplantLab, The Biosphere, Newcastle Helix, Newcastle-upon-Tyne, England
| | - Benedicte A. Lie
- Department of Medical Genetics, University of Oslo and Oslo University Hospital, Oslo, Norway
| | | | - Alan J. Stewart
- School of Medicine, University of St Andrews, St Andrews, Scotland
| | - Susan Waller
- University Hospital of North Tees, Stockton, England
| | - Shonali Natu
- University Hospital of North Tees, Stockton, England
| | - Renee Ren
- Hospital for Special Surgery, New York, USA
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Factors related to Israeli orthopedic surgery residents' career plans and their views on arthroplasty as a career. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022. [DOI: 10.1016/j.ijso.2022.100498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lützner C, Deckert S, Günther KP, Postler AE, Lützner J, Schmitt J, Limb D, Lange T. Indication Criteria for Total Hip Arthroplasty in Patients with Hip Osteoarthritis—Recommendations from a German Consensus Initiative. Medicina (B Aires) 2022; 58:medicina58050574. [PMID: 35629991 PMCID: PMC9146188 DOI: 10.3390/medicina58050574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Osteoarthritis of the hip (hip OA) is a leading cause of pain and disability in elderly people. If non-surgical therapies become ineffective, patients may consider total hip arthroplasty (THA). The biggest challenge in recommending a THA is identifying patients for whom the benefits of this procedure outweigh the potential risks. The aim of this initiative was to develop a clinical practice guideline with accompanying algorithm to guide consultations on THA, supported by a pocket-sized checklist. Methods: The initiative “Evidence- and consensus-based indication criteria for total hip replacement (EKIT-Hip)” used a stepwise approach, starting with an inauguration workshop, where a multidisciplinary German stakeholder panel from various scientific societies agreed on the working process. A Project Coordinating Group (PCG) was formed, and it performed a comprehensive systematic literature search of guidelines and systematic reviews related to the indication criteria for THA, as well as factors influencing outcomes. Based on best-available evidence, preliminary recommendations were formulated by the PCG and discussed with the stakeholder panel during a consensus meeting. In addition, the panel was asked to assess the feasibility of an extracted algorithm and to approve a final checklist. Results: In total, 31 recommendations were approved by 29 representatives of 23 societies. These were used to underpin an algorithm (EKIT-Algorithm), which indicates the minimum requirements for a THA (confirmed diagnosis of hip OA, present and documented individual burden of illness, ineffectiveness of non-surgical therapies, and absence of any contraindications). Once these criteria are fulfilled, further considerations should encompass the medical implications of modifiable risk factors and patients’ individual treatment goals, as discussed during shared decision making. The subsequently developed checklist (EKIT-Checklist) lists relevant criteria for decision making. Conclusions: Adherence to the EKIT-Algorithm, conveniently accessed via the EKIT-Checklist, should improve the standardization of decision making leading to a recommendation for THA. By applying minimum requirements and patient-related risk factors, as well as considering patients’ individual goals, it is possible to identify patients for whom the benefits of THA may exceed the potential risks.
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Affiliation(s)
- Cornelia Lützner
- University Center of Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany; (C.L.); (A.E.P.); (J.L.)
| | - Stefanie Deckert
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany; (S.D.); (J.S.); (T.L.)
| | - Klaus-Peter Günther
- University Center of Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany; (C.L.); (A.E.P.); (J.L.)
- Correspondence:
| | - Anne Elisabeth Postler
- University Center of Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany; (C.L.); (A.E.P.); (J.L.)
| | - Jörg Lützner
- University Center of Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany; (C.L.); (A.E.P.); (J.L.)
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany; (S.D.); (J.S.); (T.L.)
| | - David Limb
- Chapel Allerton Hospital, Leeds Teaching Hospitals Trust, Harehills Lane, Leeds LS7 4SA, UK;
| | - Toni Lange
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany; (S.D.); (J.S.); (T.L.)
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Ground reaction forces and external hip joint moments predict in vivo hip contact forces during gait. J Biomech 2022; 135:111037. [DOI: 10.1016/j.jbiomech.2022.111037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/21/2022] [Accepted: 03/09/2022] [Indexed: 11/23/2022]
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Laigaard J, Karlsen A, Maagaard M, Rosenberg LK, Creutzburg A, Lunn TH, Mathiesen O, Overgaard S. Perioperative prevention of persistent pain after total hip and knee arthroplasty-Protocol for two systematic reviews. Acta Anaesthesiol Scand 2022; 66:772-777. [PMID: 35325472 PMCID: PMC9315006 DOI: 10.1111/aas.14061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/12/2022] [Indexed: 11/30/2022]
Abstract
Background Between 9% and 20% of patients experience moderate to severe persistent postoperative pain after total hip or knee arthroplasty. Severe immediate postoperative pain limits rehabilitation and is associated with the development of persistent postoperative pain. Therefore, perioperative analgesic and physiotherapeutic interventions are of interest to reduce persistent pain. In two systematic reviews with identical methodology, we aim to investigate the effects of (a) perioperative analgesic interventions and (b) physiotherapeutic interventions in reducing persistent pain after total hip and knee arthroplasty. Methods We will include randomised and cluster‐randomised controlled trials on perioperative analgesic and physiotherapeutic interventions for patients undergoing elective total hip or knee arthroplasty for osteoarthritis. After contact with the authors, trials without pain data 3–24 months postoperatively will be excluded. Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and reference lists will be searched for eligible trials. Two authors will independently screen, extract data and assess the risk of bias. The primary outcome is pain scores 3–24 months postoperatively. Meta‐analyses will be performed for interventions with two or more trials. We will conduct trial sequential analyses and assign Grading of Recommendations, Assessment, Development and Evaluation (GRADE) ratings. Conclusion No previous review on reduction of persistent postoperative pain has included non‐pharmacological or invasive analgesic techniques. These two reviews with identical methodology will summarise the evidence of analgesic and physiotherapeutic perioperative interventions to prevent persistent pain. PROSPERO registration CRD42021284175.
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Affiliation(s)
- Jens Laigaard
- Department of Anesthesiology Centre for Anaesthesiological Research Zealand University Hospital Køge Denmark
- Department of Orthopaedic Surgery and Traumatology Copenhagen University Hospital Bispebjerg and Frederiksberg Copenhagen Denmark
| | - Anders Karlsen
- Department of Anesthesiology Centre for Anaesthesiological Research Zealand University Hospital Køge Denmark
| | - Mathias Maagaard
- Department of Anesthesiology Centre for Anaesthesiological Research Zealand University Hospital Køge Denmark
| | - Lukas Kristian Rosenberg
- Department of Orthopaedic Surgery and Traumatology Copenhagen University Hospital Bispebjerg and Frederiksberg Copenhagen Denmark
| | - Andreas Creutzburg
- Department of Anaesthesia Centre of Head and Orthopaedics, Rigshospitalet Copenhagen Denmark
| | - Troels Haxholdt Lunn
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
- Department of Anesthesia and Intensive Care Copenhagen University Hospital Bispebjerg and Frederiksberg Copenhagen Denmark
| | - Ole Mathiesen
- Department of Anesthesiology Centre for Anaesthesiological Research Zealand University Hospital Køge Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology Copenhagen University Hospital Bispebjerg and Frederiksberg Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
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Haffer H, Bender A, Krump A, Hardt S, Winkler T, Damm P. Is Training With Gym Machines Safe After Hip Arthroplasty?—An In Vivo Load Investigation. Front Bioeng Biotechnol 2022; 10:857682. [PMID: 35402408 PMCID: PMC8989469 DOI: 10.3389/fbioe.2022.857682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/07/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Training with gym machines is one of the most popular physical activities after total hip arthroplasty (THA). However, to date, there are no evidence-based recommendations for physical activity after THA, worldwide. The aim of the study is to evaluate the in vivo hip joint loads during exercises on four widely used gym machines in order to provide a source for an evidence-based patient counselling for arthroplasty surgeons. Methods: The in vivo hip joint loads in seven patients (59.6 ± 6.4 years, 28.6 ± 2.1 kg/m2) with instrumented hip implants were assessed. The resulting force (Fres), bending moment (Mbend), and torsional moment (Mtors) were evaluated during the training on leg curl/leg extension machines (loads: 20, 30, and 40 kg), leg press machine [backrest: 10°, 30°, and 60°; load: 50, 75, and 100%BW (bodyweight)], and a rope pull machine (abduction/adduction/flexion/extension; each ipsi- and contralateral; load 10 kg). These loads were compared with the loads during walking on treadmill at 4 km/h (median peak values: Fres 303%BW, Mbend 4.25%BWm, and Mtors 2.70%BWm). Results: In each of the four performed exercises with a total of 23 different load conditions or exercise modes analyzed, a significantly lower or not different load was detected with respect to Fres, Mbend, and Mtors measured while walking with 4 km/h. Nevertheless, Fres and Mbend demonstrated a trend to increased loading during the ipsilateral monopod standing rope pull exercises hip flexion, extension, and abduction. Conclusion: Based on our investigation, we assume that the investigated gym machines and external loads can be considered mainly as low-impact sports (with some exceptions) and thus as safe physical activity after THA. Due to the fact that the examinations were conducted in the mean 17.4 months after THA, the applicability of the results to the immediate postoperative period is limited.
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Affiliation(s)
- Henryk Haffer
- Center for Musculoskeletal Surgery Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Alwina Bender
- Julius Wolff Institute, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Alexander Krump
- Julius Wolff Institute, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Sebastian Hardt
- Center for Musculoskeletal Surgery Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Tobias Winkler
- Center for Musculoskeletal Surgery Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Julius Wolff Institute, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Philipp Damm
- Julius Wolff Institute, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- *Correspondence: Philipp Damm,
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Bender A, Damm P, Hommel H, Duda GN. Overstretching Expectations May Endanger the Success of the “Millennium Surgery”. Front Bioeng Biotechnol 2022; 10:789629. [PMID: 35237570 PMCID: PMC8882767 DOI: 10.3389/fbioe.2022.789629] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/07/2022] [Indexed: 11/13/2022] Open
Abstract
Total hip arthroplasty (THA) is an extremely successful treatment strategy. Patient expectations, however, have increased; if not properly guided by surgeons, at present, patients expect next to pain-free restoration of the joint and a fast return to work and sports. While the revision rates after THA also increased in younger patients, knowledge on musculoskeletal loads still remains sparse, and the current recommendations on postoperative rehabilitation are based on expert opinions only. The aim of this study was to unravel biomechanical contact conditions in “working age” (<60 years, 53.5 ± 3.0 years) and “retirement age” (>60 years, 67.7 ± 8.6 years) patients during activities recommended post-THA. We hypothesized that working age patients would show substantially increased hip contact loads compared to older patients. The in vivo joint contact force (Fres) and torsion torque (Mtors), reflecting the main contact load situation, experienced during activities of daily living and sports activities were measured in a unique group of 16 patients with instrumented THA. We summarized patient activities and sports recommendations after THA mentioned within the literature using PubMed (without claim of completeness). The measurements showed that younger working age patients experienced significant (p = 0.050) increased Mtors (21.52 ± 9.11 Nm) than older retirement age patients (13.99 ± 7.89 Nm) by walking. Bowling, as a recommended low-impact sport, was associated with Fres of up to 5436 N and Mtors of up to 108 Nm in the working age group, which were higher than the Fres (5276 N) and Mtors (71 Nm) during high-impact soccer. Based on our results, age was proven to be a discriminator in joint loading, with working age patients presenting with increased loads compared to retirement age patients, already during daily activities. The current patient recommendations have led to further increased joint loadings. If THA cannot be delayed in a patient, we propose counselling patients on a carefully considered return to sports, focusing on low-impact activities, as indicated hereby. The findings from this work illustrate the need to provide critical feedback to patient expectations when returning to work and sports activities. Patients returning to more intensive sports activities should be carefully monitored and advised to avoid as much overloading as possible.
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Affiliation(s)
- Alwina Bender
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius-Wolff-Institute, Berlin, Germany
| | - Philipp Damm
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius-Wolff-Institute, Berlin, Germany
- *Correspondence: Philipp Damm,
| | - Hagen Hommel
- Department of Orthopaedics, Märkisch-Oderland Hospital, Brandenburg Medical School Theodor Fontane, Wriezen, Germany
| | - Georg N. Duda
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius-Wolff-Institute, Berlin, Germany
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de Sousa BM, Correia CR, Ferreira JAF, Mano JF, Furlani EP, Soares Dos Santos MP, Vieira SI. Capacitive interdigitated system of high osteoinductive/conductive performance for personalized acting-sensing implants. NPJ Regen Med 2021; 6:80. [PMID: 34815414 PMCID: PMC8611088 DOI: 10.1038/s41536-021-00184-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 10/19/2021] [Indexed: 11/15/2022] Open
Abstract
Replacement orthopedic surgeries are among the most common surgeries worldwide, but clinically used passive implants cannot prevent failure rates and inherent revision arthroplasties. Optimized non-instrumented implants, resorting to preclinically tested bioactive coatings, improve initial osseointegration but lack long-term personalized actuation on the bone-implant interface. Novel bioelectronic devices comprising biophysical stimulators and sensing systems are thus emerging, aiming for long-term control of peri-implant bone growth through biointerface monitoring. These acting-sensing dual systems require high frequency (HF) operations able to stimulate osteoinduction/osteoconduction, including matrix maturation and mineralization. A sensing-compatible capacitive stimulator of thin interdigitated electrodes and delivering an electrical 60 kHz HF stimulation, 30 min/day, is here shown to promote osteoconduction in pre-osteoblasts and osteoinduction in human adipose-derived mesenchymal stem cells (hASCs). HF stimulation through this capacitive interdigitated system had significant effects on osteoblasts' collagen-I synthesis, matrix, and mineral deposition. A proteomic analysis of microvesicles released from electrically-stimulated osteoblasts revealed regulation of osteodifferentiation and mineralization-related proteins (e.g. Tgfb3, Ttyh3, Itih1, Aldh1a1). Proteomics data are available via ProteomeXchange with the identifier PXD028551. Further, under HF stimulation, hASCs exhibited higher osteogenic commitment and enhanced hydroxyapatite deposition. These promising osteoinductive/conductive capacitive stimulators will integrate novel bioelectronic implants able to monitor the bone-implant interface and deliver personalized stimulation to peri-implant tissues.
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Affiliation(s)
- Bárbara M de Sousa
- Department of Medical Sciences, Institute of Biomedicine (iBiMED), University of Aveiro, 3810-193, Aveiro, Portugal
| | - Clara R Correia
- Department of Chemistry, CICECO - Aveiro Institute of Materials, University of Aveiro, 3810-193, Aveiro, Portugal
| | - Jorge A F Ferreira
- Department of Mechanical Engineering, Centre for Mechanical Technology & Automation (TEMA), University of Aveiro, 3810-193, Aveiro, Portugal
| | - João F Mano
- Department of Chemistry, CICECO - Aveiro Institute of Materials, University of Aveiro, 3810-193, Aveiro, Portugal
| | - Edward P Furlani
- Department of Chemical and Biological Engineering, Department of Electrical Engineering, University at Buffalo (SUNY), Buffalo, NY, 14260, USA
| | - Marco P Soares Dos Santos
- Department of Mechanical Engineering, Centre for Mechanical Technology & Automation (TEMA), University of Aveiro, 3810-193, Aveiro, Portugal.
- Faculty of Engineering, Associated Laboratory for Energy, Transports and Aeronautics (LAETA), University of Porto, 4200-465, Porto, Portugal.
| | - Sandra I Vieira
- Department of Medical Sciences, Institute of Biomedicine (iBiMED), University of Aveiro, 3810-193, Aveiro, Portugal.
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Schwarz JS, Lygrisse KA, Roof MA, Long WJ, Schwarzkopf RM, Hepinstall MS. Early, Mid-Term, and Late-Term Aseptic Femoral Revisions After THA: Comparing Causes, Complications, and Resource Utilization. J Arthroplasty 2021; 36:3551-3555. [PMID: 34175193 DOI: 10.1016/j.arth.2021.05.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/11/2021] [Accepted: 05/31/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Registry data suggest increasing rates of early revisions after total hip arthroplasty (THA). We sought to analyze modes of failure over time after index THA to identify risk factors for early revision. METHODS We identified 208 aseptic femoral revision THAs performed between February 2011 and July 2019 using an institutional database. We compared demographics, diagnoses, complications, and resource utilization between aseptic femoral revision THA occurring within 90 days (early), 91 days to 2 years (mid), and greater than 2 years (late) after index arthroplasty. RESULTS Early revisions were 33% of revisions at our institution in the time period analyzed. Periprosthetic fractures were 81% of early, 27% of mid, and 21% of late femoral revisions (P < .01). Women were more likely to have early revisions than men (75% vs 53% of mid and 48% of late revisions; P < .01). Patients who had early revisions were older (67.97 ± 10.06) at the time of primary surgery than those who had mid and late revisions (64.41 ± 12.10 and 57.63 ± 12.52, respectively, P < .01). Index implants were uncemented in 99% of early, 96% of mid, and 64% of late revisions (P < .01). Early revisions had longer postoperative length of stay (4.4 ± 3.3) than mid and late revisions (3.0 ± 2.2 and 3.7 ± 2.1, respectively, P = .02). In addition, 58% of early revisions were discharged to an inpatient facility compared with 36% of mid and 41% of late revisions (P = .03). CONCLUSION Early aseptic femoral revisions largely occur in older women with uncemented primary implants and primarily due to periprosthetic fractures. Reducing the incidence of periprosthetic fractures is critical to decreasing the large health care utilization of early revisions.
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Affiliation(s)
- Julia S Schwarz
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | | | - Mackenzie A Roof
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - William J Long
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
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Performance of a Piezoelectric Energy Harvesting System for an Energy-Autonomous Instrumented Total Hip Replacement: Experimental and Numerical Evaluation. MATERIALS 2021; 14:ma14185151. [PMID: 34576375 PMCID: PMC8470322 DOI: 10.3390/ma14185151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 01/16/2023]
Abstract
Instrumented implants can improve the clinical outcome of total hip replacements (THRs). To overcome the drawbacks of external energy supply and batteries, energy harvesting is a promising approach to power energy-autonomous implants. Therefore, we recently presented a new piezoelectric-based energy harvesting concept for THRs. In this study, the performance of the proposed energy harvesting system was numerically and experimentally investigated. First, we numerically reproduced our previous results for the physiologically based loading situation in a simplified setup. Thereafter, this configuration was experimentally realised by the implantation of a functional model of the energy harvesting concept into an artificial bone segment. Additionally, the piezoelectric element alone was investigated to analyse the predictive power of the numerical model. We measured the generated voltage for a load profile for walking and calculated the power output. The maximum power for the directly loaded piezoelectric element and the functional model were 28.6 and 10.2 µW, respectively. Numerically, 72.7 µW was calculated. The curve progressions were qualitatively in good accordance with the numerical data. The deviations were explained by sensitivity analysis and model simplifications, e.g., material data or lower acting force levels by malalignment and differences between virtual and experimental implantation. The findings verify the feasibility of the proposed energy harvesting concept and form the basis for design optimisations with increased power output.
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Katano H, Ozeki N, Kohno Y, Nakagawa Y, Koga H, Watanabe T, Jinno T, Sekiya I. Trends in arthroplasty in Japan by a complete survey, 2014-2017. J Orthop Sci 2021; 26:812-822. [PMID: 32933832 DOI: 10.1016/j.jos.2020.07.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/02/2020] [Accepted: 07/20/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Precise knowledge of the prevalence and trends of arthroplasty can facilitate the design of medical plans for efficient treatments. The National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) Open Data Japan provides statistics about the annual number of arthroplasties (knee, hip, shoulder, finger, elbow, and foot/ankle) through health insurance claim numbers for these surgeries. The purpose of this study was to document the annual arthroplasty numbers between 2014 and 2017 in Japan and to analyze their four-year trends, gender differences, age distributions, and regional differences as revealed by the complete survey. METHODS Numbers of arthroplasty surgeries were extracted from the NDB Open Data Japan for 2014-2017. For "knee", "hip", "shoulder", "finger", "elbow", and "foot/ankle" arthroplasties, we showed the annual arthroplasty numbers, annual arthroplasty numbers by age group, annual arthroplasty numbers in individual prefectures, and annual arthroplasty numbers per 100,000 population in individual prefectures. RESULTS The annual arthroplasty numbers in 2017 were 146,189 for all joints, 82,304 for knees, 59,029 for hips, 2454 for shoulders, 1551 for fingers, 536 for elbows, and 291 for feet/ankles. For the four years up to 2017, the rate of alteration in the number of arthroplasties was +14% for total arthroplasties, +9% for knees, +21% for hip joints, +97% for shoulders, + 8% for fingers, -10% for elbows, and +25% for feet/ankles. The proportion of females was 70-90% and the peak age was between the late 60s and late 70s for all joints. Variations in arthroplasty numbers per population by prefecture appeared to be small for knees and hips and large for other joints. CONCLUSIONS We revealed the annual total number of arthroplasties for each joint in Japan using the NDB Open Data Japan for the first time.
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Affiliation(s)
- Hisako Katano
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Nobutake Ozeki
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuji Kohno
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yusuke Nakagawa
- Department of Joint Surgery and Sports Medicine, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshifumi Watanabe
- Second Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya-shi, 343-8555 Saitama, Japan
| | - Tetsuya Jinno
- Second Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya-shi, 343-8555 Saitama, Japan
| | - Ichiro Sekiya
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
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