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Sample records for hip replacement dislocation

  1. Dislocation of total hip replacement in patients with fractures of the femoral neck

    OpenAIRE

    Enocson, Anders; Hedbeck, Carl-Johan; Tidermark, Jan; Pettersson, Hans; Ponzer, Sari; Lapidus, Lasse J

    2009-01-01

    Background Total hip replacement is increasingly used in active, relatively healthy elderly patients with fractures of the femoral neck. Dislocation of the prosthesis is a severe complication, and there is still controversy regarding the optimal surgical approach and its influence on stability. We analyzed factors influencing the stability of the total hip replacement, paying special attention to the surgical approach. Patients and methods We included 713 consecutive hips in a series of 698 p...

  2. Chronic asymptomatic dislocation of a total hip replacement: a case report

    Directory of Open Access Journals (Sweden)

    Lidder Surjit

    2009-08-01

    Full Text Available Abstract Introduction Dislocation of a prosthetic hip is the second most common complication after thromboembolic disease in patients undergoing total hip arthroplasty, with an incidence reported as 0.5 to 20%. Although the period of greatest risk for dislocation has been reported to be within the first few months after surgery, late dislocation occurs more commonly then previously thought. Case presentation A 60-year-old man underwent a right Exeter cemented total hip replacement and was subsequently discharged after appropriate follow-up. He next presented 8 years later complaining of pain in the left groin. An anterioposterior radiograph of the pelvis revealed degenerative changes in the left hip and a dislocated right total hip replacement. The dislocated femoral component had formed a neoacetabulum within the ilium, in which it was freely articulating. He remained pain-free on this side, had 5 cm of true leg length shortening with a good range of movement and was very pleased with his hip replacement. He was later placed on the waiting list for a left total hip replacement. Conclusion This case illustrates that a dislocated total hip replacement may occasionally not cause symptoms that cause significant discomfort or reduction in range of movement. The prosthetic femoral head can form a neoacetabulum allowing a full range of pain-free movement. Furthermore it emphasises that with an increased trend to earlier hospital discharge and shorter follow-up, potential complications may be missed. We urge a low index of suspicion for potential complications and suggest that regular review with radiographic follow-up should be made.

  3. Dislocation of total hip replacement in patients with fractures of the femoral neck.

    Science.gov (United States)

    Enocson, Anders; Hedbeck, Carl-Johan; Tidermark, Jan; Pettersson, Hans; Ponzer, Sari; Lapidus, Lasse J

    2009-04-01

    Total hip replacement is increasingly used in active, relatively healthy elderly patients with fractures of the femoral neck. Dislocation of the prosthesis is a severe complication, and there is still controversy regarding the optimal surgical approach and its influence on stability. We analyzed factors influencing the stability of the total hip replacement, paying special attention to the surgical approach. We included 713 consecutive hips in a series of 698 patients (573 females) who had undergone a primary total hip replacement (n = 311) for a non-pathological, displaced femoral neck fracture (Garden III or IV) or a secondary total hip replacement (n = 402) due to a fracture-healing complication after a femoral neck fracture. We used Cox regression to evaluate factors associated with prosthetic dislocation after the operation. Age, sex, indication for surgery, the surgeon's experience, femoral head size, and surgical approach were tested as independent factors in the model. The overall dislocation rate was 6%. The anterolateral surgical approach was associated with a lower risk of dislocation than the posterolateral approach with or without posterior repair (2%, 12%, and 14%, respectively (p replacement in patients with femoral neck fractures.

  4. The dislocating hip replacement - revision with a dual mobility cup in 56 consecutive patients

    DEFF Research Database (Denmark)

    Jakobsen, Thomas; Kappel, Andreas; Hansen, Flemming

    2014-01-01

    INTRODUCTION: Recurrent dislocations of hip replacements are a difficult challenge. One treatment option for recurrent dislocations is the use of a dual mobility cup. The aim of this study was to retrospective investigate the effect of dual mobility cups as a treatment for recurrent dislocations...... with a Saturne dual mobility cup (Amplitude, Neyron, France). The mean follow-up period was 44 months (SD 30, range 0.1-119). RESULTS: One patient (1.8%) experienced a re-dislocation. Three patients (5.3%) had to be revised. One due to disintegration between the femoral head and inner shell, one due to loosening...... of the acetabular component, and one due to infection. Harris Hip Score improved from a mean of 76 before index surgery to 87 within one year after index surgery. CONCLUSION: This study advocates the use of a dual mobility cup for treatment of recurrent dislocations of THR. However, studies with a longer follow up...

  5. Hip joint replacement

    Science.gov (United States)

    Hip arthroplasty; Total hip replacement; Hip hemiarthroplasty; Arthritis - hip replacement; Osteoarthritis - hip replacement ... Your hip joint is made up of 2 major parts. One or both parts may be replaced during surgery: ...

  6. Femoral head fracture without hip dislocation

    Directory of Open Access Journals (Sweden)

    Aggarwal Aditya K

    2013-10-01

    Full Text Available 【Abstract】Femoral head fractures without dislocation or subluxation are extremely rare injuries. We report a neglected case of isolated comminuted fracture of femoral head without hip dislocation or subluxation of one year duration in a 36-year-old patient who sustained a high en- ergy trauma due to road traffic accident. He presented with painful right hip and inability to bear full weight on right lower limb with Harris hip score of 39. He received cementless total hip replacement. At latest follow-up of 2.3 years, functional outcome was excellent with Harris hip score of 95. Such isolated injuries have been described only once in the literature and have not been classified till now. The purpose of this report is to highlight the extreme rarity, possible mechanism involved and a novel classification system to classify such injuries. Key words: Femur head; Hip dislocation; Classification; Arthroplasty, replacement, hip

  7. Hip dysplasia and congenital hip dislocation

    Energy Technology Data Exchange (ETDEWEB)

    Lingg, G.; Nebel, G.; von Torklus, D.

    1981-11-01

    In human genetics and orthopedics quite different answers have been given to the question of hereditary transmission and frequency of hip dysplasia in families of children with congenital hip dislocation. We therefore have made roentgenometric measurements of 110 parents of children with congenital hip dislocation. In 25% we found abnormal flat acetabulae, whereas 12% had pathologic deep hips. This may propose a new concept of morphology of congenital hip dysplasia.

  8. Hip Replacement Surgery

    Science.gov (United States)

    ... Outreach Initiative Breadcrumb Home Health Topics English Español Hip Replacement Surgery Basics In-Depth Download Download EPUB ... PDF What is it? Points To Remember About Hip Replacement Surgery Hip replacement surgery removes damaged or ...

  9. Traumatic hip dislocations in children

    International Nuclear Information System (INIS)

    Minhas, M.S.

    2010-01-01

    Objectives: To evaluate clinical features, treatment and relationship to the time period between dislocation, reduction and early complications of traumatic dislocation of hip in children. Methods: Case series conducted at Jinnah Post Graduate Medical Centre Karachi from July 2005 to August 2009. Children with traumatic hip dislocation up to fifteen years of age who presented in last four years were included in this study. Their clinical information, etiology, associated injuries, duration, method of reduction and early complications are evaluated through emergency room proforma and indoor record. Follow up of patient was updated in outpatient department. Results: We had eight patients, six boys and two girls. Youngest 2.4 years and eldest was 12 years with mean age of 6.2 +- 3.8 years. All presented with posterior hip dislocation. Etiology was road traffic accident in two and history of fall in remaining six patients. Average duration of time between dislocation and reduction was 19 hours range 3-72 hours. Dislocated hips were reduced under General Anaesthesia in two patients and under sedation analgesia in six patients. No complications were noted in eight cases with mean 18.75 +- 13.23 months follows up. Conclusion: Traumatic hip dislocation in children is not rare. Slight trauma causes dislocation in younger age and immediate closed reduction and Immobilization reduces complications. (author

  10. Hip joint replacement - slideshow

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/presentations/100006.htm Hip joint replacement - series—Normal anatomy To use the ... to slide 5 out of 5 Overview The hip joint is made up of two major parts: ...

  11. Late total hip arthroplasty dislocation due to yoga

    Directory of Open Access Journals (Sweden)

    Murillo Adrados, MD

    2018-06-01

    Full Text Available Yoga has become a popular form of exercise, recreation, and meditation for adults in the United States. As the popularity of both yoga and the incidence of hip replacements have both coincidentally increased over the last 2 decades, we imagine that the number of total hip replacement patients partaking in the practice of yoga has also increased. There are no clear guidelines available for yoga practice following hip replacement. To date, there have been no published reports of prosthetic hip dislocations during yoga. We present 2 cases of late total hip dislocations during yoga and provide a review of the available orthopaedic literature and our recommendations on patient restrictions and education with respect to practicing yoga after a hip replacement.

  12. Imaging findings of anterior hip dislocations

    Energy Technology Data Exchange (ETDEWEB)

    Pfeifer, Kyle [Mallinckrodt Institute of Radiology, Department of Radiology, St. Louis, MO (United States); Leslie, Michael [Yale School of Medicine, Department of Orthopedics and Rehabilitation, New Haven, CT (United States); Menn, Kirsten; Haims, Andrew [Yale University School of Medicine, Department of Radiology and Biomedical Imaging, New Haven, CT (United States)

    2017-06-15

    Anterior hip dislocations are rare orthopedic emergencies resulting from high-energy trauma and have unique imaging characteristics on radiography, computed tomography (CT), and magnetic resonance imaging (MRI). Imaging findings on CT and MRI allow for the prompt recognition and classification of anterior hip dislocations, which guides patient management and reduces complications. The purpose of this article is to review imaging findings of anterior hip dislocations, specifically focusing on CT and MRI. (orig.)

  13. Atraumatic Anterior Dislocation of the Hip Joint

    Directory of Open Access Journals (Sweden)

    Tadahiko Ohtsuru

    2015-01-01

    Full Text Available Dislocation of the hip joint in adults is usually caused by high-energy trauma such as road traffic accidents or falls from heights. Posterior dislocation is observed in most cases. However, atraumatic anterior dislocation of the hip joint is extremely rare. We present a case of atraumatic anterior dislocation of the hip joint that was induced by an activity of daily living. The possible causes of this dislocation were anterior capsule insufficiency due to developmental dysplasia of the hip, posterior pelvic tilt following thoracolumbar kyphosis due to vertebral fracture, and acetabular anterior coverage changes by postural factor. Acetabular anterior coverage changes in the sagittal plane were measured using a tomosynthesis imaging system. This system was useful for elucidation of the dislocation mechanism in the present case.

  14. Traumatic hip dislocation: early MRI findings

    International Nuclear Information System (INIS)

    Laorr, A.; Greenspan, A.; Anderson, M.W.; Moehring, H.D.; McKinley, T.

    1995-01-01

    Objective of this study was to present the spectrum of early magnetic resonance imaging (MRI) findings following traumatic dislocation of the femoral head, and to identify any associated injuries. Prospective MRI of both hips was performed on 18 patients within 5 weeks of a traumatic femoral head dislocation. The interval between the time of injury and the imaging studies ranged from 2 to 35 days. Posterior dislocation was present in 14 patients and anterior dislocation in 4 patients. In the majority of cases, we performed axial T1, coronal T1, and coronal T2 * (MPGR) sequences. MRI can effectively identify and quantify the muscle injury and joint effusion that invariably accompany traumatic hip dislocations. It is also useful for demonstrating trabecular bone contusion (trabecular injury) and iliofemoral ligament injury, which occur commonly with acute hip dislocation. (orig./VHE)

  15. Supracondylar correction osteotomy to prevent repetitive posterior dislocation of a hip prosthesis

    NARCIS (Netherlands)

    Haverkamp, D.; Marti, R. K.

    2008-01-01

    Recurrent dislocation of a total hip prosthesis can be a challenging and often disappointing problem. This case report describes a 78-year-old woman who had recurrent posterior dislocations of a revision total hip replacement (THR) that occurred on flexion and internal rotation of the hip. The

  16. BILATERAL PATHOLOGICAL HIP DISLOCATION IN CHILDREN

    Directory of Open Access Journals (Sweden)

    Yuriy E. Garkavenko

    2017-03-01

    Full Text Available Introduction. Pathological dislocation of the hip is one of the most severe complications of acute hematogenous osteomyelitis. The program of treatment for children with pathological hip dislocation is complex, but it has been sufficiently developed and implemented very successfully. At the same time, the available literature provides no cases of treating children with bilateral pathological hip dislocations after hematogenous osteomyelitis. There is no information on the incidence of such cases or in regards to remote functional results. Materials and methods. The results of the treatment of 18 children with bilateral pathological dislocation of the hip after hematogenous osteomyelitis are presented, which constituted 23.1% of the total number of patients (78 who underwent surgery in 2000–2016 for the diagnosis of pathological hip dislocation. Both hip joints were surgically operated on in 12 patients, while one hip joint was operated on in 6 patients. To assess the anatomical and functional state of hip joints, the clinical and roentgenological diagnostic techniques were used. Results and discussion. To stabilize and restore the function of the hip joints, 18 children underwent 30 surgical interventions: simple open hip reduction (19 and open hip reduction with hip arthroplasty with one (6 or two (5 demineralized osteochondral allogeneic grafts. The decision regarding the possibility of performing surgical intervention on the second hip joint was made only after a child's check-up examination was complete and after positive information about the anatomical and functional state of the operated hip joint was obtained. According to these criteria, 14 (77.8% children underwent surgical treatment of the second hip joint 1–1.5 years after the course of conservative measures to restore the range of motion in the previously operated hip joint. Over a period of 1–12 years, 17 patients were examined, 10 of which underwent an operation on both

  17. Hip Replacement: MedlinePlus Health Topic

    Science.gov (United States)

    ... invasive hip replacement (Medical Encyclopedia) Also in Spanish Topic Image MedlinePlus Email Updates Get Hip Replacement updates ... replacement - precautions Minimally invasive hip replacement Related Health Topics Hip Injuries and Disorders National Institutes of Health ...

  18. Radiological evaluation of failed total hip replacement

    International Nuclear Information System (INIS)

    Raspa, V.; Aldrovandi, S.; Pompei, G.

    1988-01-01

    The retrospective study of 50 operated cases of cemented total hip replacement and a review of the literature enabled the authors to define the radiological features of the above-mentioned condition. These features include one or more of the following signs: calcar reabsorption, lacunar erosions, modified relatioships between the prosthesis components, sepsis and loosening, periarticular calcifications dislocation and fracture of prosthesis components. Careful evaluation of these radiological features is extremely important for both an early diagnosis of failed total hip replacement and the choice of an adequate surgical treatment

  19. Screening for congenital dislocation of the hip

    International Nuclear Information System (INIS)

    Fendel, H.

    1987-01-01

    Although the prevalence of (idiopathic) congenital dislocation of the hip (CDH) within the Member States of the European Community is not exactly known, it must be considered as a major problem of public health care and protection. By assessment of available data one can assume that between 1 and 2% of all newborns have dislocation or instability of one or both hips. There is a female predominance of 4:1 and some risk factors are known. The reasons of a higher prevalence in some areas are not yet well understood. Most of instable hips will spontaneously become stable within the first days or weeks of life. However, a considerable number of infants (less than 1%) will remain with instable hips which may dislocate. Dislocation either present at birth or as a result of persistent instability leads to subsequent hip deformation. This is a serious event for each affected individual, and is a heavy load on health care and social costs for the public. Treatment of CDH is easy and usually effective when started early, i.e. before the fourth month of life. The earlier treatment is started the easier, shorter, safer and less expensive it is and its impairment on child development and mother-child interaction can be held to a minimum. Screening for CDH is therefore the most important part of health protection in early infancy. However, this paper concludes that neither sonography nor X-ray examinations are appropriate for CDH screening

  20. Posterior Dislocation of the Hip

    African Journals Online (AJOL)

    than 24 hours, and 13 more than 48 hours after injury. (Table II). TABLE If. RESULTS PLOITED AGAINST DELAY IN. REDUCTION OF THE DISLOCATION. Time from injury. (h). Excellent. Poor and fair. Total. 48. 7. 6. 13. Reduction, as a rule, was effected under general anaes-.

  1. Surgical hip dislocation for treatment of cam femoroacetabular impingement

    Directory of Open Access Journals (Sweden)

    Milind M Chaudhary

    2015-01-01

    Conclusion: Cam femoroacetabular Impingement causing pain and limitation of hip movements was treated by open osteochondroplasty after surgical hip dislocation. This reduced pain, improved hip motion and gave good to excellent results in the short term.

  2. Results of hip arthroplasty using Paavilainen technique in patients with congenitally dislocated hip

    Directory of Open Access Journals (Sweden)

    R. M. Tikhilov

    2014-01-01

    Full Text Available The purpose of the study was to analyze the medium- and long-term results of hip arthroplasty using Paavilainen technique in patients with the congenitally dislocated hip. Methods: From 2001 to 2012 180 operations were carried out were using the Paavilainen technique in 140 patients with high dislocation of the hip (Crowe IV. All patients were clinically evaluated using the Harris Hip Score (HHS, VAS and radiography. Statistical analysis was performed using the Pearson correlation coefficients, multiple regression analysis and classification trees analysis. Results: The average Harris score improved from preoperative 41.6 (40,3-43,5 to 79.3 (77,9-82,7 at final follow-up, and the difference was significant. Early complications were 9% (the most frequent were fractures of the proximal femur, later - 16.7% (pseudoarthrosis of the greater trochanter, 13.9%; disclocations-1,1%, aseptic loosening of the components - 1.7%, reoperation performed in 8.3% of cases. Such factors as age and limb length has statistically significant effect on functional outcomes. Established predictive model allows to get the best possible functional outcome in such patients with severe dysplasia. Conclusions: Total Hip arthroplasty using the Paavilainen technique is an effective method of surgical treatment in patients with the congenitally dislocated hip, but it is technically difficult operation with a high incidence of complications in comparison with standard primary total hip replacement.

  3. Dislocation of primary total hip arthroplasty and the risk of redislocation.

    LENUS (Irish Health Repository)

    Brennan, Stephen A

    2012-09-01

    6554 primary total hip arthroplasties were reviewed. Risk factors for dislocation were analysed to assess which were important in terms of predicting recurrent instability. The patients risk of having a second dislocation was independently associated with the surgical approach adopted (p = 0.03) and the time to first dislocation from the primary hip replacement (p = 0.002). Early dislocators whose surgery was performed through an anterolateral approach had less recurrence than late dislocators through a posterior or transtrochanteric approach. None of the other risk factors including head size (p = 0.59), modularity (p = 0.54), mechanism of dislocation (p = 0.23), leg length discrepancy (p = 0.69) and acetabular inclination (p = 0.31) were influential. The use of an abduction brace was not useful in preventing a further dislocation with 69.2% of those braced re-dislocating compared to 68.5% who were not braced (p = 0.96).

  4. Congenital hip dislocation: Radiological screening or diagnosis?

    International Nuclear Information System (INIS)

    Kalifa, G.; Faure, C.

    1987-01-01

    Congenital hip dislocation is a perfect example of public health problems: its incidence is high 0.6, to 2% of newborns in France and an early detection allows an easy and successful treatment. The current situation in our country is not satisfactory for several reasons: - Too many children are treated without reasons because of misleading radiological pictures; - Conversely, some dislocations are discovered only at the walking age, the treatment becoming then more difficult and less effective; - Almost 300,000 radiological examinations of the hip for screening are performed each year and among them 100,000 in newborns. This is not satisfactory as it is commonly admitted now that radiological examination at birth is unreliable and frequently misleading. For all these reasons a special working group has been settled up by the General Direction of Health, including physicians of different practices, from different specialities. The conclusion of this group will be published in a special booklet and can be summarized as follows: The group recommends to perform detection of congenital hip dislocation mainly by the clinical examination. This examination may be difficult but it must be performed very early, the first day of life, repeated several times, at the end of the first week and during the first, second, and third month. Every baby in this country must undergo several clinical examinations up to one year of age

  5. Hip Resurfacing: An Alternative to Conventional Hip Replacement?

    Science.gov (United States)

    ... Is hip resurfacing a good alternative to hip replacement? Answers from Mark Spangehl, M.D. Hip resurfacing has lost favor with many surgeons ... women with poor bone quality. Unlike traditional hip replacement, hip resurfacing doesn't completely replace the "ball" ...

  6. Superior dislocation hip with anterior column acetabular fracture ...

    African Journals Online (AJOL)

    Superior variety of anterior dislocation of the hip is a rare injury. Its occurrence with acetabular fractures has been documented infrequently. We report a case of superior dislocation of the hip with anterior column acetabular fracture. Open reduction of the hip and internal fixation of the fracture was carried out using a twin ...

  7. Traumatic Anterior Dislocation of Hip in a Child- Case Report

    Directory of Open Access Journals (Sweden)

    S Ahmad

    2015-03-01

    Full Text Available Traumatic hip dislocation in children is relatively rare accounting for about 5% of all hip dislocations. Most of the hip dislocations seen in children are of the posterior type but the much rarer anterior and anterior-inferior (obturator types have also been described. We present the case of an eight years old girl with an obturator type of hip dislocation following trivial trauma. She was treated with closed reduction and immobilisation in skin traction for three weeks. She was followed up closely for one year and did not develop any complications during that period.

  8. Perineal anterior dislocation of the hip with avulsion fracture of ...

    African Journals Online (AJOL)

    Traumatic anterior dislocation of the hip is rare even in children. Very uncommon also is the perineal variant of the inferior type of anterior dislocation with concomitant avulsion fracture of the greater trochanter. We report such a case highlighting the peculiarity of its management. No similar case of triumvirate injury of the hip ...

  9. Adventure sports and sexual freedom hip replacement: the tripolar hip.

    Science.gov (United States)

    Pritchett, James W

    2018-01-01

    Certain athletic activities and lifestyles require a completely stable and very mobile hip. Total hip replacement with a natural femoral head size and two mobile-bearing surfaces (i.e., a "tripolar" prosthesis) is the most stable prosthesis. Elegant design and wear-resistant bearing surfaces are the keys to long-term implant survivorship. The hypothesis is that a ceramic-coated tripolar prosthesis using highly cross-linked polyethylene can provide full function and complete stability with low wear. This study sought to determine: (1) patient-reported outcomes, (2) functional outcomes, (3) implant survivorship and complications, and (4) postoperative sexual limitations. Between 1998 and 2011, the author performed 160 primary total hip replacements using tripolar prostheses in patients participating in adventure sports and other physically demanding activities. The institutional review board approved this study. The inclusion criteria were patients who needed unrestricted activity and who were not candidates for or did not choose hip resurfacing. Patients were followed every second year and assessed with radiographs, Harris Hip Score, WOMAC, SF-12, and UCLA functional outcome scores. Patients were asked about symptoms of instability and satisfaction with their hip replacement. Patients were asked both preoperatively and 2 years postoperatively four questions about their sexual activity. Mean follow-up was 11 years. At 2 years' postoperatively, 98% of patients reported their satisfaction as excellent or good and 99% were not limited for sexual activity following surgery. Seventy-four percent of patients reported they were recovered within 6 weeks of surgery. There were no dislocations. There were three revision procedures for implant loosening, infection, and periprosthetic fracture, but there were no failures of the tripolar articulation. The mean postoperative UCLA score was the highly athletic score of 8. There were no signs of osteolysis, wear, or metal

  10. Anterior Hip Dislocation in a Football Player: A Case Report

    Directory of Open Access Journals (Sweden)

    Alexander Schuh

    2009-01-01

    Full Text Available Hip dislocations during sporting activities represent only 2%–5% of all hip dislocations. Most hip dislocations in sports can be categorised as “less complicated traumatic hip dislocations” by the Stewart-Milford classification due to the fact that minimal force is involved. The incidence of avascular necrosis of the femoral head greatly increases if the time to reduction is more than six hours. We report the case of a 38-year-old football player who suffered hip dislocation while kicking the ball with the medial aspect of the right foot in an external rotated manner of the right hip. Closed reduction was performed within 2 hours; postoperative follow-up was uneventful. Six months later the patient is out of any complaints; there is no sign of AVN of the femoral head.

  11. Hip dislocations after 2,734 elective unilateral fast-track total hip arthroplasties

    DEFF Research Database (Denmark)

    Jørgensen, Christoffer Calov; Kjærsgaard-Andersen, Per; Kehlet, Henrik

    2014-01-01

    STUDY DESIGN: Retrospective review of prospectively collected data. OBJECTIVE: To investigate the incidence of hip dislocation 90 days after total hip arthroplasty in relation to time after surgery, mechanism of dislocation and predisposing factors. METHODS: Prospective data on preoperative patient.......31-3.40)] but not hospital stay of hip...

  12. Risks of hip and knee replacement

    Science.gov (United States)

    ... is normal to lose blood during and after hip or knee replacement surgery. Some people need a ... clot form are higher during and soon after hip or knee replacement surgery. Sitting or lying down ...

  13. Neglected Posterior Dislocation of Hip in Children - A Case Report.

    Science.gov (United States)

    Pal, Chandra Prakash; Kumar, Deepak; Sadana, Ashwani; Dinkar, Karuna Shankar

    2014-01-01

    Traumatic dislocation of the hip in children is a rare injury. We report the outcome of 2 patients of neglected hip dislocation which were treated by open reduction and internal fixation by k-wires. We treat 2 children both girls (one was of 4 years and other was 7 years of age). In both cases dislocation was unilateral and was not associated with any facture. Both cases were of posterior dislocation. in both cases open reduction and internal fixation was done by k wires. Hip spica was applied post operatively in both cases. The k wire was removed at 3 to 4 weeks. Patients were allowed to bear weight from gradual to full weight bearing after 6 weeks. We conclude that open reduction is a satisfactory treatment for neglected hip dislocation. It prevents not only deformity but also maintains limb length.

  14. Bilateral Posterior Native Hip Dislocations after Fall from Standing

    Directory of Open Access Journals (Sweden)

    Jane Xiao

    2017-10-01

    Full Text Available We present a case of bilateral posterior native hip dislocations after a fall from standing. This exceedingly rare diagnosis is classically associated with younger patients whose bones are strong enough to dislocate rather than fracture in the setting of a high-momentum collision. We present an unusual case of an 88-year-old male with native hips who sustained a low-energy collision after falling from standing and was found to have bilateral posterior hip dislocations without associated pelvis or femur fractures.

  15. Hip arthroscopy versus open surgical dislocation for femoroacetabular impingement

    Science.gov (United States)

    Zhang, Dagang; Chen, Long; Wang, Guanglin

    2016-01-01

    Abstract Background: This meta-analysis aims to evaluate the efficacy and safety of hip arthroscopy versus open surgical dislocation for treating femoroacetabular impingement (FAI) through published clinical trials. Methods: We conducted a comprehensive literature search using PUBMED, EMBASE, and the Cochrane Central Register of Controlled Trials databases for relevant studies on hip arthroscopy and open surgical dislocation as treatment options for FAI. Results: Compared with open surgical dislocation, hip arthroscopy resulted in significantly higher Nonarthritic Hip Scores (NAHS) at 3- and 12-month follow-ups, a significant improvement in NAHS from preoperation to 3 months postoperation, and a significantly lower reoperation rate. Open surgical dislocation resulted in a significantly improved alpha angle by the Dunn view in patients with cam osteoplasty from preoperation to postoperation, compared with hip arthroscopy. This meta-analysis demonstrated no significant differences in the modified Harris Hip Score, Hip Outcome Score-Activities of Daily Living, or Hip Outcome Score-Sport Specific Subscale at 12 months of follow-up, or in complications (including nerve damage, wound infection, and wound dehiscence). Conclusion: Hip arthroscopy resulted in higher NAHS and lower reoperation rates, but had less improvement in alpha angle in patients with cam osteoplasty, than open surgical dislocation. PMID:27741133

  16. CT findings of traumatic posterior hip dislocation after reduction

    International Nuclear Information System (INIS)

    Moon, Sung Kyoung; Park, Ji Seon; Ryu, Kyung Nam; Jin, Wook; Jin Wook

    2008-01-01

    To evaluate the CT images of reduced hips after posterior hip dislocation and to propose specific diagnostic criteria based on the CT results. We retrospectively reviewed the CT findings on 18 reduced hips from 17 patients with radiographs and clinical histories of traumatic posterior hip dislocations by evaluating 18 corresponding CT scans for joint space asymmetry, intra-articular abnormalities (intra-articular fat obliteration, loose bodies, and joint effusion), changes in posterior soft tissue (capsule, muscles, and adjacent fat), the presence, and location of fractures (acetabulum and femoral head). All 18 hips (100%) showed posterior soft tissue changes. In total, 17 hips (94.4%) had intra-articular abnormalities and 15 hips (83.3%) had joint space asymmetries. In addition, 17 hips (94.4%) had fractures involving the acetabula (15 cases, 88.2%) the femoral head (13 cases, 76.5%), or on both sides (11 cases, 64.7%). The most frequent fracture location was in he posterior wall (13/15, 86.7%) of the acetabulum and in the anterior aspect (10/13, 76.9%) of the femoral head. Patients with a prior history of posterior hip dislocation showed specific CT findings after reduction, suggesting the possibility of previous posterior hip dislocations in patients

  17. Management of neglected traumatic posterior dislocations of the hip ...

    African Journals Online (AJOL)

    is essential to prevent further severe disability, after which further ... often seen after road traffic accidents in developing countries. ... lack of money for transport and treatment. This .... 4 Kalasen H J. Traumatic Dislocation of the hip in children.

  18. recurrent traumatic posterior hip dislocation in labral avulsion

    African Journals Online (AJOL)

    2003; 54(3):520-529. 5. Dameron, T.B Jr. Bucket-handle tear of acetabular labrum accompanying posterior dislocation of the hip. J Bone Joint Surg Am. 1959; 41(1): 131-134. 6. Lieberman, J.R., Altchek, D.W. and Salvati,. E.A. Recurrent dislocation of a hip with a labral lesion: treatment with a modified Bankart-type repair.

  19. Management of neglected traumatic posterior dislocations of the hip ...

    African Journals Online (AJOL)

    Within a period of six months, three men were admitted following falls which had occurred more than one week previously. They had all sustained minor trauma but directly after the injury they were unable to bear weight on the affected limb. All three had Grade 1 posterior dislocations of the hip. Although the dislocation had ...

  20. Infantile and congenital hip dislocation: Assessment by MR imaging

    International Nuclear Information System (INIS)

    Johnson, N.D.; Wood, B.P.; Jackman, K.V.

    1986-01-01

    Dislocations of the infant hip, particularly those that responded poorly to standard treatment, were imaged using a 1.5-T MR imaging unit. Excellent detail of the cartilaginous structures of the femoral head, acetabulum, labrum, pulvinar, and capsular abnormalities was achieved. The most detailed images were obtained using a 3-inch surface coil. The shape and orientation of the acetabulum and femoral head cannot otherwise be as well evaluated, nor can their relationship be as clearly established. Technical factors and considerations of imaging with a 1.5-T magnet, the anatomy of the normal and dislocated hip, and observed variations in acetabular shape and orientation are discussed. MR imaging reliably demonstrates dislocation, and the prolonged T2 of synovial fluid produced an ''arthrogram'' effect, which is useful in the treatment of complicated hip dislocation

  1. Traumatic Posterior Dislocation of Hip in Child: A Case Report

    Directory of Open Access Journals (Sweden)

    Dinesh Dhar

    2017-07-01

    Full Text Available Traumatic hip dislocation in children is uncommon, but like in adults, it is an orthopedic emergency. We report a rare case of traumatic posterior dislocation left hip in a 9 year old boy following a motor vehicle accident. The dislocation was promptly reduced by closed manipulation in Accident and Emergency Department with the application of above knee skin traction which was maintained for 3 weeks  followed by non-weight bearing crutch walking for another 6 weeks. On follow up, the patient had a good outcome without any evidence of avascular necrosis (AVN. In this rare case report a literature review of pediatric hip dislocation with treatment recommendations have been highlighted.

  2. CUSTOM TRIFLANGE ACETABULAR COMPONENTS IN REVISION HIP REPLACEMENT (EXPERIENCE REVIEW

    Directory of Open Access Journals (Sweden)

    A. A. Korytkin

    2017-01-01

    Full Text Available Extensive defects of acetabulum especially accompanied by pelvis discontinuity at the level of acetabulum pose a serious challenge in revision hip replacement and create additional complexity in fixing the acetabular component. One of the perspective options to solve the above issue is the use of custom triflange acetabular components (CTAC designed based on preoperative computer tomography given the specifics of bone defects of the patient. Purpose of the study — to evaluate the outcomes of CTAC use in revision hip replacement.Materials and methods. The authors analyzed treatment outcomes of 12 patients after revision hip replacement using additive techniques of computer simulation and 3D printing CTAC. Follow up period after the surgery averaged 7±3 months (from one to ten months. 7 out of 12 patients had acetabular defects of Paprosky 3B type, 4 patients had defects of Paprosky 3A and in one patient — of Paprosky 2C.Results. Two out of twelve patients had prosthesis dislocations that required revision hip surgery, one of those patients underwent open reduction of dislocation with wound debridement, another patient underwent replacement of articulating couple of acetabular component. Total scores under Harris Hip Score and paint VAS score prior to treatment was 28±7 and 7±1 points respectively, postoperative scores were 76±9 and 3±1 respectively.Conclusion. The application of additive techniques for revision hip replacement in patients with extensive acetabular and pelvic defects allows to make a precise preoperative planning, to restore joint rotation center, to reconstruct bone defects and to securely fix triflange acetabular component that altogether significantly improve treatment outcomes and patients satisfaction with the surgery.

  3. Congenital dislocation of knee with ipsilateral developmental dysplasia of hip

    Directory of Open Access Journals (Sweden)

    Sameer Kakar

    2017-01-01

    Full Text Available We present a rare case of a newborn having congenital knee dislocation (CDK with ipsilateral developmental dysplasia of hip (DDH. This case report shows how abnormal intrauterine pressure leads to dislocation of various joints in utero. We managed this conservatively with Pavlik Harness for DDH and serial corrective casting with manipulation for CDK with a satisfactory result after follow-up of 6 months.

  4. Differentiating subluxation from developmental dislocation of the hip

    Directory of Open Access Journals (Sweden)

    Joao O. Tavares

    2012-02-01

    Full Text Available The radiological and clinical picture of a developmental hip dislocation and a severe subluxation are identical. According to Leveuf and Wiberg the diagnosis can only be made by arthrography. The differential diagnosis is critical, as treatment differs dependent on the diagnosis. In this study, the diagnosis of subluxation was based on a plain radiograph of the pelvis. A radiograph of the pelvis with the hips abducted at least 45° and internally rotated (AIR view was used to differentiate these two entities. In subluxations, the femoral head will relocate into the acetabulum with perfect or near perfect reconstitution of the Shenton’s line. It will fail to do so in true dislocations. Five patients, mean age 14.6 months (range 9 to 20 months, presented with delayed diagnosis of hip dysplasia. The examination revealed minimal or no limitation of hip abduction, a leg length discrepancy, and a Trendelenburg gait in the three walking age girls. The radiograph suggested a hip dislocation. The diagnosis of hip subluxation was based on the relocation of the femoral head with the abduction/internal rotation radiograph. All were successfully treated with an Ilfeld abduction splint. None had examination with general anesthesia, arthrograms, traction or immobilization in spica cast. Avoiding over diagnosis of hip dislocation in cases of subluxation is important. This is necessary to prevent overtreatment and to accurately assess the results of treatment. The abduction/internal rotation view may achieve this goal while avoiding diagnostic and therapeutic procedures, such as arthrograms, cast immobilization and surgery.

  5. Ipsilateral open anterior hip dislocation and open posterior elbow dislocation in an adult

    Directory of Open Access Journals (Sweden)

    Kumar Sunil

    2014-02-01

    Full Text Available 【Abstract】Open anterior dislocation of the hip is a very rare injury, especially in adults. It is a hyperabduction, external rotation and extension injury. Its combination with open posterior dislocation of the elbow has not been described in English language-based medical literature. Primary resuscitation, debridement, urgent reduction of dislocation, and adequate antibiotic support resulted in good clinical outcome in our patient. At 18 months follow-up, no signs of avascular necrosis of the femoral head or infection were observed.

  6. Voluntary habitual dislocation of the hip in children

    Energy Technology Data Exchange (ETDEWEB)

    Pettersson, H; Theander, G; Danielsson, L [Malmoe Allmaenna Sjukhus, Malmoe (Sweden). Dept. of Diagnostic Radiology

    1980-01-01

    The clinical and radiologic findings in a child with habitual voluntary dislocation of the hip are reported. Observations made in this case and in 6 others on record suggest that this rare condition is a specific pediatric entity with a good prognosis.

  7. Delayed cementless total hip arthroplasty for neglected dislocation of hip combined with complex acetabular fracture and deficient bone stock

    Directory of Open Access Journals (Sweden)

    Gavaskar Ashok S

    2012-12-01

    Full Text Available 【Abstract】Total hip arthroplasty (THA for an un-treated acetabular fracture is technically challenging and the long-term result is not so favorable. A 45-year-old fe-male patient with untreated column and comminuted poste-rior wall fracture of the acetabulum was treated in our insti-tution by reconstruction of the posterior wall using iliac strut autograft and plate stabilization of the posterior col-umn with cancellous grafting and cementless THA in a single stage. At 3 years’ follow-up, the patient was independently mobile without limb length discrepancy. Radiological evalu-ation showed well integrated components and bone grafts. No evidence of aseptic loosening or osteolysis was found. This report aims to emphasize that bony acetabular recon-struction allows the use of primary hip components, which improves prosthesis longevity and preserves bone stock for a future revision. Key words: Acetabulum; Fractures, bone; Hip dislocation; Arthroplasty, replacement, hip

  8. Resection arthroplasty of the hip in paralytic dislocations.

    Science.gov (United States)

    Kalen, V; Gamble, J G

    1984-06-01

    The chronically dislocated paralytic hip causes postural difficulties, nursing and hygiene problems, and pain. Therapeutic options are limited. This study reviews the results of resection arthroplasty on 18 hips of 15 such patients. This procedure has many complications, including hip ankylosis, heterotopic ossification, abduction contracture and bony overgrowth. Despite this, all of the nursing goals were achieved and most patients had relief of pain. The operation is most successful in the skeletally mature patients, and it relies on soft-tissue interposition between the bony fragments and postoperative positioning to ensure optimum posture.

  9. A RARE CASE OF IPSILATERAL HIP AND KNEE DISLOCATION

    Directory of Open Access Journals (Sweden)

    Deepak

    2015-06-01

    Full Text Available High velocity road traffic accidents leads to complicated lower limb injuries. Such injuries demand highly experienced surgeon and are associated with high morbidity and mortality. Hip or knee dislocations are two different orthopaedic emergencies. Concomitant fracture dislocation of the hip and knee is rare and very few cases have been reported in the literature. A 45 year old man with history of fall from motorcycle came to the casualty. He had ipsilateral hip and knee dislocation. Immediately patient was shifted to operation theatre and closed reduction was performed under general anaesthesia. Reduction was confirmed under fluoroscopy and post-operative x-rays were taken. The functional results were excellent. After 2 months patient made an uncomplicated recovery and had satisfactory functional outcome with right hip having 110⁰ flexion and right knee flexes to 120⁰.There was no neurological deficit. The urgency, that the treating surgeon shows in managing these injuries, significantly affects the prognosis and outcome finally achieved by these patients (golden period in reducing the hip joint has been described to be 6 hours.

  10. [Efficacy analysis on hip replacement for hip-joint diseases with Parkinson disease].

    Science.gov (United States)

    Sun, Qi-Cai; Ru, Xuan-Liang; Xia, Yan-Fei; Liu, Xiao-Li; Song, Bai-Shan; Qiao, Song; Yan, Shi-Gui; Wang, Xiang-Hua

    2017-12-25

    To explore clinical efficacy of hip replacement for hip-joint diseases with Parkinson disease. From December 2011 to December 2016, 18 patients with hip-joint diseases with Parkinson disease treated by hip replacement, including 8 males and 10 females aged from 59 to 87 years old with an average of 71 years old. Among them, 3 cases were developmental dysplasia of hip, 3 cases were femoral head necrosis and 12 cases were femoral neck fracture. All patients manifested with obvious pain and limitation of stepping ability. Postoperative complications were observed and Harris score were used to compare hip joint function after operation. The incision were healed well, and pain were alleviated or disappeared, and hip joint function were improved. Eighteen patients were followed up from 1 to 3 years with an average of 2.3 years. At the latest follow up, 14 cases recovered freedom-walk, 2 cases could walk with walking stick, 1 case could walk with walking aid and 1 case was died. Among 18 patients, 2 cases were occurred dislocation, and 1 case were died for cardiac disease at 3 months after operation. Four patients were occurred slight pain. There were significant differences in Harris scores among preoperative (41.7±1.4), 6 months after operation(80.1±5.4) and the final follow-up (83.4±2.1), and 10 cases got excellent result, 4 good, 1 fair and 2 poor. Application of hip replacement for hip-joint diseases with Parkinson disease is a safe and effective clinical therapy, and has advantages of less complications and rapid recovery of hip joint function.

  11. Simultaneous anterior and posterior dislocation of hips: a case report and review of literature

    Directory of Open Access Journals (Sweden)

    Gupta Vinay

    2012-11-01

    Full Text Available 【Abstract】The presence of anterior hip dislocation along with contralateral posterior hip dislocation in the ab-sence of other major traumas is a distinctly rare injury pattern. We report such a case, along with a review of previous cases. A 40-year-old male patient after motorcycle skidding had posterior dislocation of the left hip and anterior dislo-cation of the right one without other associated injuries. The patient underwent successful closed reduction of both hips. The clinical course and follow-up assessment of the patient was uneventful. Key words: Wounds and injuries; Hip dislocation; Accidents, traffic

  12. ASYMMETRICAL BILATERAL HIP DISLOCATION WITH SEGMENTAL FRACTURE FEMUR: AN UNUSUAL CASE REPORT AND LITERATURE REVIEW

    Directory of Open Access Journals (Sweden)

    Ramesh

    2015-01-01

    Full Text Available Bilateral traumatic hip dislocation is rarely seen. A unique case is presented, consisting of asymmetric bilateral hip dislocation with associated segmental fracture femur, resulting from fall from bus. This case represents an unusual, severe combination of injuries resulting from the fall from bus under influence of alcohol. Traumatic hip dislocation represents a true orthopaedic emergency . Given the severity of associated complications, every effort should be made to ensure pr ompt diagnosis and immediate therapy. We report our experience in the management of this complex injury pattern and review the pertinent literature on this subject. Keywords: Bilateral hip dislocation , Asymmetric hip dislocation , Segmental femur fracture , Closed reduction , Fall from bus .

  13. Radiological difficulty in identifying unicompartmental knee replacement dislocation

    Directory of Open Access Journals (Sweden)

    Mr Oruaro Adebayo Onibere, MBBS, MRCS

    2017-09-01

    Full Text Available Unicondylar knee replacement is a relatively common elective orthopedic procedure but is not often seen in the Emergency Department setting. Familiarity with normal clinical and radiological appearances is difficult to gain. Dislocation of the mobile bearing component “spacer” is a known complication of unicondylar knee replacements, and these patients will initially present to the accident and Emergency Department. In this setting, an accurate and prompt diagnosis is necessary to appropriately manage the patient's condition. There is normally a radiological challenge in identifying dislocated mobile bearings on plain radiographs. These patients may need to have further imaging, such as a computer tomographic scan to identify the dislocated mobile bearing.

  14. Surgical Dislocation of the Hip for the Treatment of Pre-Arthritic Hip Disease.

    Science.gov (United States)

    Beaulé, Paul E; Singh, Amardeep; Poitras, Stéphane; Parker, Gillian

    2015-09-01

    The purpose of this study was to report the clinical results of surgical dislocation of the hip in the treatment of pre-arthritic hip disease. Between 2005 and 2010, eighty-two patients (89 hips) underwent a surgical dislocation of the hip at a mean age of 30.5 years (range 14.8-51.7); 10 females and 72 males. At a mean follow-up of 7.1 years (range 5-9.6) clinical function improved significantly. 6 patients were converted to total hip arthroplasty and 3 patients underwent an arthroscopy and an additional three patients had >1mm of joint space narrowing at latest follow-up giving us a 9-year cumulative Kaplan-Meier survivorship of 86.4% (CI, 79% to 94%). Thirty-four patients underwent internal fixation removal at a mean of 12.0 months (range 0.3-40.8 months). Although effective in the treatment of early hip disease, the surgical dislocation approach carries a high re-operation rate for removal of internal fixation; consequently, less invasive approaches should be considered for less complex deformities. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Surgical hip dislocation in treatment of slipped capital femoral epiphysis

    Directory of Open Access Journals (Sweden)

    Elmarghany Mohammed

    2017-01-01

    Full Text Available Background: Most surgeons advocate in situ fixation of the slipped epiphysis with acceptance of any persistent deformity in the proximal femur [Aronsson DD, Loder RT, Breur GJ, Weinstein SL (2006 Slipped capital femoral epiphysis: current concepts. J Am Acad Orthop Surg 14, 666–679]. This residual deformity can lead to osteoarthritis due to femoroacetabular cam impingement (FAI [Leunig M, Slongo T, Ganz R (2008 Subcapital realignment in slipped capital femoral epiphysis: surgical hip dislocation and trimming of the stable trochanter to protect the perfusion of the epiphysis. Instr Course Lect 57, 499–507]. Objective: The primary aim of our study was to report the results of the technique of capital realignment with Ganz surgical hip dislocation and its reproducibility to restore hip anatomy and function. Patients and methods: This prospective case series study included 30 patients (32 hips, 13 left (Lt hips, 19 right (Rt hips with stable chronic slipped capital femoral epiphysis (SCFE after surgical correction with a modified Dunn procedure. This study included 22 males and eight females. The mean age of our patients was 14 years (10–18 years. The mean follow-up period was 14.5 months (6–36 months. Results: Thirty hips had excellent and good clinical and radiographic outcomes with respect to hip function and radiographic parameters. Two patients had fair to poor clinical outcome including three patients who developed Avascular Necrosis (AVN. The difference between those who developed AVN and those who did not develop AVN was statistically significant in postoperative clinical scores (p = 0.0000. The mean slip angle of the femoral head was 52.5° ± 14.6 preoperatively and was corrected to a mean value of 5.6° ± 8.2° with mean correction of 46.85° ± 14.9° (p = 0.0000. The mean postoperative alpha angle was 51.15° ± 4.2° with mean correction of 46.70 ± 14.20 (p = 0.0000. In our series, the mean postoperative

  16. Joint replacement in Zambia: A review of Hip & Knee Replacement ...

    African Journals Online (AJOL)

    Methods: Data captured by the different variables entered into the Joint Register covering the pre-op, intra-op and post-op period of all total hip and knee replacement surgery done at the ZIOH from 1998 to 2010 was entered into a spreadsheet after verification with individual patient medical records. This was then imported ...

  17. vein thrombosis in elective hip replacement

    African Journals Online (AJOL)

    A consensus forum was convened to evaluate the economic considerations associated with prophylaxis against thrombo-embolic disease in patients undergoing hip replacement therapy in South Africa. This forum consists of orthopaedic surgeons, vascular surgeons and a statistician. Methods. The forum was instructed to ...

  18. Magnetic resonance imaging after traumatic dislocation of the hip

    International Nuclear Information System (INIS)

    Takahashi, Kenji; Saegusa, Osamu; Saito, Masahito; Nishikawa, Satoru; Nishisu, Takashi; Kobayashi, Teruhisa; Shimizu, Kou.

    1995-01-01

    Magnetic resonance (MR) images obtained from 24 patients with traumatic dislocation of the hip was retrospectively studied. Abnormal MR images due to bone contusion appeared in a high frequency in the early phase after dislocation, and most of them normalized within 3 months after injury. Influence of bone contusion was also observed in patients with avascular necrosis of the femoral head, which made the diagnosis of avascular necrosis of the femoral head difficult. Therefore, absence of avascular necrosis of the femoral head is confirmed if normal MR images were obtained, while if there is abnormal images, careful follow-up should be continued paying special attention on the occurrence of avascular necrosis of the femoral head. (S.Y.)

  19. Magnetic resonance imaging after traumatic dislocation of the hip

    Energy Technology Data Exchange (ETDEWEB)

    Takahashi, Kenji; Saegusa, Osamu; Saito, Masahito; Nishikawa, Satoru; Nishisu, Takashi; Kobayashi, Teruhisa [Narita Red Cross Hospital, Chiba (Japan); Shimizu, Kou

    1995-10-01

    Magnetic resonance (MR) images obtained from 24 patients with traumatic dislocation of the hip was retrospectively studied. Abnormal MR images due to bone contusion appeared in a high frequency in the early phase after dislocation, and most of them normalized within 3 months after injury. Influence of bone contusion was also observed in patients with avascular necrosis of the femoral head, which made the diagnosis of avascular necrosis of the femoral head difficult. Therefore, absence of avascular necrosis of the femoral head is confirmed if normal MR images were obtained, while if there is abnormal images, careful follow-up should be continued paying special attention on the occurrence of avascular necrosis of the femoral head. (S.Y.).

  20. [Tripolar arthroplasty for recurrent total hip prosthesis dislocation].

    Science.gov (United States)

    Beaulé, P-E; Roussignol, X; Schmalzried, T-P; Udomkiat, P; Amstutz, H-C; Dujardin, F-H

    2003-05-01

    The purpose of this study was to assess the results of revision surgery for recurrent total hip prosthesis dislocation using a tripolar prosthesis composed of a conventional stem with a mobile head of an intermediary prosthesis measuring more than 40 mm and a modified cup. This technique was used in two centers in Rouen France and Los Angeles USA. Twenty-one hips in 21 patients were operated on. The mobile heads measured 40 to 47 mm. Mean patient age was 70 years (range 29-92). The indication for the tripolar prosthesis was reserved for extremely unstable hips in patients with major risk factors for recurrent dislocation. These 21 patients had experienced 95 dislocations. The acetabular cup was custom-made for the large-diameter heads. A cemented polyethylene cup was used in 14 cases and a press-fit metal-backed around a polyethylene insert in 7. The polyethylene thickness varied from 6.5 to 16 mm for the cemented cups and 4 to 5 mm for the press-fit cups. Fourteen femoral stems were left in place as were two press-fit cups where only the inserts were changed. Mean follow-up was 5.4 years (range 3-11.8). There has been no recurrent dislocation for 20 hips. One patient experienced a dislocation one week after surgery which required a second revision procedure to reposition the acetabular implant. Final outcome was good at 7.6 years for this hip. One patient who had not had any recurrent dislocation died 4 years after the revision surgery due to a cause unrelated to the prosthesis. Two patients were lost to follow-up at 3.7 and 6 years, both were pain free and had no radiological anomalies. Infection occurred in one patient undergoing chemotherapy for a myeloma; the head and neck had to be resected. For the 20 other patients, functional outcome, assessed with the UCLA score, showed improvement in pain (5.8 preoperatively, 9.2 at last follow-up), walking (4.8 and 8 respectively), function (4 and 6 respectively), and daily activities (3.3 and 5.2 respectively). A

  1. [SURGICAL HIP DISLOCATION APPROACH FOR TREATMENT OF FEMORAL HEAD FRACTURE].

    Science.gov (United States)

    Tang, Yanfeng; Liu, Youwen; Zhu, Yingjie; Li, Jianming; Li, Wuyin; Li, Qiyi; Jia, Yudong

    2015-11-01

    To discuss the value of surgical hip dislocation approach in the treatment of femoral head fracture. A retrospectively analysis was made on the clinical data of 15 patients with femoral head fractures treated through surgical hip dislocation approach between January 2010 and February 2013. There were 11 men and 4 women with an average age of 30.8 years (range, 15-63 years). The causes included traffic accident injury in 9 cases, falling injury from height in 5 cases, and sports injury in 1 case. According to Pipkin typing, 2 cases were rated as type I, 7 cases as type II, 1 case as type III, and 5 cases as type IV. The interval of injury and operation was 2-10 days (mean, 4.1 days). Reduction was performed in 10 patients within 6 hours after injury, and then bone traction was given for 4-6 weeks except 5 patients who received reduction in the other hospital. Primary healing of incision was obtained in all patients after surgery without complications of dislocation and lower limbs deep venous thrombosis. The mean follow-up time was 29.9 months (range, 25-36 months). During follow-up, there was no infection, breakage of internal fixation, or nonunion of femoral greater trochanter fracture. In 3 patients having necrosis of the femoral head, 2 had no obvious symptoms [staging as IIa and IIb respectively according to Association Research Circulation Osseous (ARCO) staging system], and 1 (stage IIIb) had nonunion of the femoral neck fracture, who underwent total hip arthroplasty (THA). In 4 patients having myositis ossificans (2 cases of grade I, 1 case of grade II, and 1 case of grade III based on Brooker grading), no treatment was given in 3 cases and the focus was removed during THA in 1 case. According to the Thompson-Epstein scale at last follow-up, the results were excellent in 9 cases, good in 3 cases, fair in 1 case, and poor in 2 cases, and the excellent and good rate was 80%. Surgical hip dislocation approach can not only protect the residual vessels of the

  2. A Rare Case of Neglected Traumatic Anterior Dislocation of Hip in a Child.

    Science.gov (United States)

    Mootha, Aditya Krishna; Mogali, Kasi Viswanadam

    2016-01-01

    Post traumatic hip dislocations are very rare in children. Neglected anterior hip dislocations in children are not described in literature so far. Here, we present a case of 6 weeks old anterior hip dislocation successfully managed by open reduction. A 9-year-old male child presented with neglected anterior hip dislocation on left side. Open reduction carried out through direct anterior approach to hip. Congruent reduction is achieved. At final follow up of 1 year, the child had unrestricted activities of daily living and no radiological signs of osteonecrosis or any joint space reduction. There is paucity of literature over neglected post traumatic anterior hip dislocations in children. The treatment options vary from closed reduction after heavy traction to sub trochanteric osteotomy. However, we feel that open reduction through direct anterior approach is the preferred mode of management whenever considered possible.

  3. Posterior Hip Dislocation with Ipsilateral Femoral Neck Fracture ...

    African Journals Online (AJOL)

    He was managed by bipolar hemiarthroplasty as opposed to total hip athroplasty due to financial constrains. This case highlights the challenge of ... of the knee revealed a communited fracture of the pa- tella at the inferior pole (Fig. 2 2). ... Our case was managed by prosthetic replacement of the proximal femur. This was ...

  4. Usefulness of Arthroscopic Treatment of Painful Hip after Acetabular Fracture or Hip Dislocation.

    Science.gov (United States)

    Hwang, Jung-Taek; Lee, Woo-Yong; Kang, Chan; Hwang, Deuk-Soo; Kim, Dong-Yeol; Zheng, Long

    2015-12-01

    Painful hip following hip dislocation or acetabular fracture can be an important signal for early degeneration and progression to osteoarthritis due to intraarticular pathology. However, there is limited literature discussing the use of arthroscopy for the treatment of painful hip. The purpose of this retrospective study was to analyze the effectiveness and benefit of arthroscopic treatment for patients with a painful hip after major trauma. From July 2003 to February 2013, we reviewed 13 patients who underwent arthroscopic treatment after acetabular fracture or hip dislocation and were followed up for a minimum of 2 postoperative years. The degree of osteoarthritis based on the Tonnis classification pre- and postoperatively at final follow-up was determined. Clinical outcomes were evaluated using visual analogue scale for pain (VAS) and modified Harris hip score (MHHS), and range of motion (ROM) of the hip pre- and postoperatively at final follow-up. There were nine male and four female patients with a mean age at surgery of 28 years (range, 20 to 50 years). The mean follow-up period of the patients was 59.8 months (range, 24 to 115 months), and the mean interval between initial trauma and arthroscopic treatment was 40.8 months (range, 1 to 144 months). At the final follow-up, VAS and MHHS improved significantly from 6.3 and 53.4 to 3.0 and 88.3, respectively (p = 0.002 and p hip flexion, abduction, adduction, external rotation, and internal rotation as minor improvements from 113.1°, 38.5°, 28.5°, 36.5°, and 22.7° to 118.5°, 39.0°, 29.2°, 38.9°, and 26.5° were observed, respectively (p = 0.070, p = 0.414, p = 0.317, p = 0.084, and p = 0.136, respectively). None of the patients exhibited progression of osteoarthritis of the hip at the final follow-up. Arthroscopic treatment after acetabular fracture or hip dislocation is effective and delays the progression of traumatic osteoarthritis.

  5. Exercise therapy may postpone total hip replacement surgery in patients with hip osteoarthritis

    DEFF Research Database (Denmark)

    Svege, Ida; Nordsletten, Lars; Fernandes, Linda

    2015-01-01

    Exercise treatment is recommended for all patients with hip osteoarthritis (OA), but its effect on the long-term need for total hip replacement (THR) is unknown.......Exercise treatment is recommended for all patients with hip osteoarthritis (OA), but its effect on the long-term need for total hip replacement (THR) is unknown....

  6. Experience of the posterior lip augmentation device in a regional hip arthroplasty unit as a treatment for recurrent dislocation.

    Science.gov (United States)

    Hoggett, L; Cross, C; Helm, T

    2017-12-01

    Dislocation after total hip arthroplasty (THA) remains a significant complication of the procedure and is the third leading cause for revision THA. One technique for treatment of this complication is the use of the posterior lip augmentation device (PLAD). We describe our experience using the PLAD including complication rates. A retrospective review of 55 PLADs (54 patients) was carried out following identification from electronic theatre records. Basic patient demographics, operative records and radiographs were collected and reviewed and data was analysed using Microsoft Excel. Failure of the PLAD was defined as further operative intervention after PLAD insertion and included: dislocation, implant breakage, infection and revision of the THA for loosening of either component. 55 PLADs were implanted in 54 patients with an average age of 77 years. There was a significant preponderance of females and a variety of surgical approaches had been used for the original hip replacement, including trochanteric osteotomy, posterior and antero-lateral. 9 (16%) patients had recurrent dislocations,1 (2%) failed secondary to screw breakage, 3 (5%) had and infection requiring intervention and 2 (4%) underwent further revision for aseptic loosening of the femoral component. The overall failure rate was 25% with 14 patients requiring intervention post PLAD. Our results are inferior to other published results and indicate that the PLAD should be used with caution for recurrent dislocations of the Charnley hip replacement.

  7. Reconstruction of the Acetabulum in Developmental Dysplasia of the Hip in Total Hip Replacement

    Directory of Open Access Journals (Sweden)

    Vasileios Sakellariou

    2014-09-01

    Full Text Available Developmental dysplasia of the hip (DDH or congenital hip dysplasia (CDH is the most prevalent developmental childhood hip disorder. It includes a wide spectrum of hip abnormalities ranging from dysplasia to subluxation and complete dislocation of the hip joint. The natural history of neglected DDH in adults is highly variable. The mean age of onset of symptoms is 34.5 years for dysplastic DDH, 32.5 years for low dislocation, 31.2 years for high dislocation with a false acetabulum, and 46.4 years for high dislocation without a false acetabulum. Thorough understanding of the bony and soft tissue deformities induced by dysplasia is crucial for the success of total hip arthroplasty. It is important to evaluate the existing acetabular deformity three-dimensionally, and customize the correction in accordance with the quantity and location of ace tabular deficiencies. Acetabular reconstruction in patients with DDH is hallenging. Interpretation of published data is difficult and should be done with caution because most series include patients with different types of hip disease. In general, the complication rate associated with THA is higher in patients with hip dysplasia than it is in patients with osteoarthritis. Overall, clinical and functional outcomes following THA in patients hip dysplasia (DDH differ from those treated for primary hip osteoarthritis, possibly due to the lower age and level of activity. Although function scores decline with age, the scores for pain and range of motion presented with a statistically significant improvement in the long-term.

  8. Hip or knee replacement - in the hospital after

    Science.gov (United States)

    Hip replacement surgery - after - self-care; Knee replacement surgery - after - self-care ... taking walks in the hallways with help. After knee replacement, some surgeons recommend using a continuous passive ...

  9. Traumatic anterior hip dislocation in a 12-year-old child

    Directory of Open Access Journals (Sweden)

    Gupta Vinay

    2013-04-01

    Full Text Available 【Abstract】Hip dislocation in children can occur congenitally in isolation or in conjunction with other con-genital abnormalities. Traumatic hip dislocations in children are relatively uncommon and anterior dislocation of hip joint is even rarer. We report such a case following unusual mode of injury in a 12-year-old child. The patient underwent suc-cessful emergent closed reduction of left hip. The clinical course and follow-up assessment of the patient was other-wise uneventful. At 2 years’ follow-up there was no evi-dence of osteoarthritis, coxa magna, heterotrophic calcification, in congruency of the joints or avascular ne-crosis of the head of femur. Key words: Hip; Dislocations; Child

  10. BILATERAL ASYMMETRIC TRAUMATIC HIP DISLOCATION IN AN ADULT - A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Venkateswarlu

    2015-11-01

    Full Text Available Bilateral asymmetric traumatic hip dislocation without an associated fracture of the pelvis or femur occurring in an young adult with no previous history of hip abnormality or ligamentous laxity is a rarity. There were only 58 such cases reported in literature till date. Here is a 28 year old male patient presented to our Department of Orthopaedics and Traumatology, Rangaraya Medical College, Kakinada, Andhrapradesh, India with a history of fall from mango tree with bilateral asymmetric traumatic hip dislocation. The mode if injury is fall from a height. The dislocations were promptly reduced by closed method. Serial follow-up revealed no complications.

  11. Ultrasound-Guided Femoral Nerve Block to Facilitate the Closed Reduction of a Dislocated Hip Prosthesis

    Directory of Open Access Journals (Sweden)

    Edward Carlin

    2017-10-01

    Full Text Available Prosthetic hip dislocation is a common but unfortunate complication in patients who have undergone total hip arthroplasty. Successful closed reduction in the emergency department leads to a reduced length of stay and rate of hospitalization. 1, 2 The use of regional anesthesia by femoral nerve block represents a novel approach for controlling pain in patients with hip pathologies. 3 Ultrasound-guided approaches have been used with great success for controlling pain in patients with hip fractures. 4, 5 Here we report the case of a 90-year-old male who presented with a dislocated hip prosthesis, which was subsequently corrected with closed reduction following delivery of regional anesthesia to the femoral nerve under ultrasound guidance. To our knowledge, this represents the first reported use of an ultrasound-guided femoral nerve block to facilitate closed reduction of a dislocated prosthetic hip, and highlights a novel approach that avoids the use of procedural sedation in an elderly patient.

  12. Renal function after elective total hip replacement

    DEFF Research Database (Denmark)

    Perregaard, Helene; Damholt, Mette B; Solgaard, Søren

    2016-01-01

    Background and purpose - Acute kidney injury (AKI) is associated with increased short-term and long-term mortality in intensive care populations and in several surgical specialties, but there are very few data concerning orthopedic populations. We have studied the incidence of AKI and the prevale......Background and purpose - Acute kidney injury (AKI) is associated with increased short-term and long-term mortality in intensive care populations and in several surgical specialties, but there are very few data concerning orthopedic populations. We have studied the incidence of AKI...... and the prevalence of chronic kidney disease (CKD) in an elective population of orthopedic patients undergoing primary total hip replacement, hypothesizing that chronic kidney disease predisposes to AKI. Patients and methods - This was a single-center, population-based, retrospective, registry-based cohort study...... involving all primary elective total hip replacements performed from January 2003 through December 2012. Patient demographics and creatinine values were registered. We evaluated the presence of CKD and AKI according to the international guidelines for kidney disease (KDIGO Acute Kidney Injury Workgroup 2013...

  13. A Rare Case of Morel-Lavallee Syndrome Complicating an Anterior Dislocation of Hip Joint.

    Science.gov (United States)

    Nekkanti, Supreeth; Vijay, C; Theja, Sujana; Shankar, R Ravi; Verma, Anubhav

    2016-01-01

    Hip dislocations are serious injuries as hip joint is an extremely stable joint. It requires a significant amount of force to produce such an injury. Anterior dislocations are uncommon. Potential complications of anterior hip dislocations are a neurovascular injury to femoral vessels or acetabular fractures. We report a rare late complication of Morel-Lavallee syndrome occurring 3 weeks after an anterior dislocation of the hip in a 43-year-old male. The patient presented to us with history. Morel-Lavallee syndrome is a rare complication. However if diagnosed early can be successfully treated with minimal burden to the patient. The authors recommend surgeons to have a high index of suspicion for this syndrome and a stringent follow-up examination of the patient.

  14. Evaluating healthcare resource utilization and outcomes for surgical hip dislocation and hip arthroscopy for femoroacetabular impingement.

    Science.gov (United States)

    de Sa, Darren; Horner, Nolan S; MacDonald, Austin; Simunovic, Nicole; Slobogean, Gerard; Philippon, Marc J; Belzile, Etienne L; Karlsson, Jon; Ayeni, Olufemi R

    2016-12-01

    Surgical hip dislocation (SHD) and hip arthroscopy are surgical methods used to correct deformity associated with femoroacetabular impingement (FAI). Though both of these approaches appear to benefit patients, no studies exist comparing healthcare resource utilization of the two surgical approaches. This systematic review examines the literature and the records of two surgeons to evaluate the resource utilization associated with treating symptomatic FAI via these two methods. EMBASE, MEDLINE and PubMed were searched for relevant articles. The articles were systematically screened, and data was abstracted in duplicate. To further supplement resource utilization data, a retrospective chart review of two surgeon's patient data (one using SHD and another using an arthroscopic approach) was completed. Experts in pharmacy, physiotherapy, radiology, anaesthesia, physiatry and the local hospital finance department were also consulted. There were 52 studies included with a total of 460 patients (535 hips) and 3886 patients (4147 hips) who underwent SHD and arthroscopic surgery for FAI, respectively. Regardless of approach, most patients treated for symptomatic FAI improved across various outcomes measures with low complication rates. Surgical time across all approaches was similar, averaging 118 ± 2 min. On a per patient basis, hip arthroscopy ($10,976) uses approximately 41 % of the resources of SHD ($24,379). There were no significant differences in outcomes for FAI treated with SHD or arthroscopy. However, with regard to healthcare resource utilization based on the OHIP healthcare system, hip arthroscopy uses substantially less resources than SHD within the first post-operative year. Systematic Review of Level IV Studies, Level IV.

  15. Steel syndrome: dislocated hips and radial heads, carpal coalition, scoliosis, short stature, and characteristic facial features.

    Science.gov (United States)

    Flynn, John M; Ramirez, Norman; Betz, Randal; Mulcahey, Mary Jane; Pino, Franz; Herrera-Soto, Jose A; Carlo, Simon; Cornier, Alberto S

    2010-01-01

    A syndrome of children with short stature, bilateral hip dislocations, radial head dislocations, carpal coalitions, scoliosis, and cavus feet in Puerto Rican children, was reported by Steel et al in 1993. The syndrome was described as a unique entity with dismal results after conventional treatment of dislocated hips. The purpose of this study is to reevaluate this patient population with a longer follow-up and delineate the clinical and radiologic features, treatment outcomes, and the genetic characteristics. This is a retrospective cohort study of 32 patients in whom we evaluated the clinical, imaging data, and genetic characteristics. We compare the findings and quality of life in patients with this syndrome who have had attempts at reduction of the hips versus those who did not have the treatment. Congenital hip dislocations were present in 100% of the patients. There was no attempt at reduction in 39% (25/64) of the hips. In the remaining 61% (39/64), the hips were treated with a variety of modalities fraught with complications. Of those treated, 85% (33/39) remain dislocated, the rest of the hips continue subluxated with acetabular dysplasia and pain. The group of hips that were not treated reported fewer complaints and limitation in daily activities compared with the hips that had attempts at reduction. Steel syndrome is a distinct clinical entity characterized by short stature, bilateral hip and radial head dislocation, carpal coalition, scoliosis, cavus feet, and characteristic facial features with dismal results for attempts at reduction of the hips. Prognostic Study Level II.

  16. Traumatic fracture-dislocation of the hip following rugby tackle: a case report

    Directory of Open Access Journals (Sweden)

    Venkatachalam Santosh

    2009-12-01

    Full Text Available Abstract Posterior fracture-dislocation of hip is uncommonly encountered in rugby injuries. We report such a case in an adult while playing rugby. The treating orthopaedician can be caught unaware and injuries in such sports can be potentially misdiagnosed as hip sprains. Immediate reduction of the dislocation was performed in theatres. The fracture was fixed with two lag screws and a neutralization plate. This led to early rehabilitation and speedy recovery with return to sporting activities by 12 months.

  17. Traumatic posterior dislocation of the hip in a 3-year-old child.

    LENUS (Irish Health Repository)

    Forde, James C

    2012-02-01

    We report the case of a traumatic posterior dislocation of the hip in a 3-year-old boy. After a fall in the garden, the boy was brought to our emergency department where an x-ray confirmed a posterior dislocation of his right hip. A successful prompt reduction was performed in the operating room under general anesthesia. This uncommon injury represents an orthopedic emergency and requires prompt reduction to lessen the risk of complications including avascular necrosis of the femoral head.

  18. Segmental blood pressure after total hip replacement

    DEFF Research Database (Denmark)

    Gebuhr, Peter Henrik; Soelberg, M; Henriksen, Jens Henrik Sahl

    1992-01-01

    Twenty-nine patients due to have a total hip replacement had their systemic systolic and segmental blood pressures measured prior to operation and 1 and 6 weeks postoperatively. No patients had signs of ischemia. The segmental blood pressure was measured at the ankle and at the toes. A significant...... drop was found in all pressures 1 week postoperatively. The decrease followed the systemic pressure and was restored to normal after 6 weeks. In a group of six patients with preoperatively decreased ankle pressure, a significant transient further decrease in the ankle-toe gradient pressure was found...... on the operated side. None of the patients had symptoms from the lowered pressure. We conclude that in patients without signs of ischemia, the postoperative segmental pressure decrease is reversible and therefore not dangerous....

  19. Non-Traumatic Anterior Dislocation of a Total Knee Replacement Associated with Neurovascular Injury

    Science.gov (United States)

    Aderinto, Joseph; Gross, Allan E; Rittenhouse, Bryan

    2009-01-01

    Prosthetic total knee replacements rarely dislocate. When dislocation does occur, it is usually in a posterior direction in association with a posterior stabilised, cruciate-sacrificing prosthesis. Neurovascular injury is unusual. In this report, we describe a case of anterior dislocation of a cruciate-retaining total knee replacement in a 67-year-old woman. The dislocation occurred in the absence of overt trauma and resulted in severe neurovascular injury. PMID:19686618

  20. Primary total hip replacement for displaced subcapital fractures of the femur.

    Science.gov (United States)

    Taine, W H; Armour, P C

    1985-03-01

    The management of displaced subcapital fracture of the hip is still controversial because of the high incidence of complications after internal fixation or hemiarthroplasty. To avoid some of these complications we have used primary total hip replacement for independently mobile patients over 65 years of age. A total of 163 cases, operated on over four years, have been reviewed. There were relatively more dislocations after operation for fracture than after total replacement for arthritis, and these were associated with a posterior approach to the hip. Only seven revision operations have been required. Of 57 patients who were interviewed an average of 42 months after replacement, 62% had excellent or good results as assessed by the Harris hip score. All the others had major systemic disease which affected their assessment. This inadequacy of current systems of hip assessment is discussed. It is concluded that total hip replacement is the best management for a selected group of patients with this injury, and that further prospective studies are indicated.

  1. Surgical hip dislocation according to Ganz for excision of osteochondromas in patients with multiple hereditary exostoses

    NARCIS (Netherlands)

    Sorel, J. C.; Façee Schaeffer, M.; Homan, A. S.; Scholtes, V. A B; Kempen, D. H R; Ham, S. J.

    2016-01-01

    Aims We report a prospective cohort study of the midterm results of surgical dislocation of the hip (according to Ganz) to perform resection of osteochondromas involving the femoral neck in patients with multiple hereditary exostoses (MHE). Methods Hip range of movement (ROM) was assessed pre-and

  2. A Case Report of Simultaneous Anterior and Posterior Traumatic Dislocation of the Hips

    Directory of Open Access Journals (Sweden)

    A. Ebrahim Pour

    2006-10-01

    Full Text Available Introduction: Bilateral hip dislocation (especially asymmetric type occurs rarely. By review of literature (published since 1951 till 2004, we found 15 cases of bilateral asymmetric hip dislocation (age between 3 and 36 years that contained 12 cases in males. All of the patients were treated using closed reduction and then traction. There was no considerable difference between the results of treatment in these patients and unilateral hip dislocations.Case Report: The case was a 39 years old man who had bilateral hip dislocation in a head on automobile collision while standing at the back of a van. The position of left hip was in adduction, flexion and internal rotation and the position of right hip was in abduction, flexion and external rotation. Closed reduction was conducted, first for left hip and then for right hip using traction and counter-traction. Then skeletal traction was applied for 8 weeks. The patient started PWB during 4 weeks after the end of traction, then FWB.Conclusion: After 6 months, control radiography did not show any sign of AVN or other lesion and patient’s walking was painless.

  3. [Acute traumatic and especially neglected traumatic hip dislocations are very rare in children].

    Science.gov (United States)

    Fernandez, F F; Wirth, T; Eberhardt, O

    2012-09-01

    We report about the first hip arthroscopies of extracapsular neglected hip dislocations with concomitant injuries in two children (2 and 4 years old). The major problem of traumatic hip dislocation is avascular necrosis. Further problems are possible concomitant injuries. It is important not to cause further damage by therapeutic procedures. In a 4-year-old child the hip could be reduced under visualization and in a 2-year-old child with epiphyseal fracture the extent of the operation could be reduced. In both children large avulsion injuries of the ligamentum capitis femoris could be resected via hip arthroscopy. Hip arthroscopy can reduce surgical morbidity considerably and can possibly contribute to prevention of the feared avascular necrosis of the femoral head.

  4. Unconstrained tripolar implants for primary total hip arthroplasty in patients at risk for dislocation.

    Science.gov (United States)

    Guyen, Olivier; Pibarot, Vincent; Vaz, Gualter; Chevillotte, Christophe; Carret, Jean-Paul; Bejui-Hugues, Jacques

    2007-09-01

    We performed a retrospective study on 167 primary total hip arthroplasty (THA) procedures in 163 patients at high risk for instability to assess the reliability of unconstrained tripolar implants (press-fit outer metal shell articulating a bipolar polyethylene component) in preventing dislocations. Eighty-four percent of the patients had at least 2 risk factors for dislocation. The mean follow-up length was 40.2 months. No dislocation was observed. Harris hip scores improved significantly. Six hips were revised, and no aseptic loosening of the cup was observed. The tripolar implant was extremely successful in achieving stability. However, because of the current lack of data documenting polyethylene wear at additional bearing, the routine use of tripolar implants in primary THA is discouraged and should be considered at the present time only for selected patients at high risk for dislocation and with limited activities.

  5. Entrapment of the acetabular labrum following reduction of traumatic hip dislocation in a child

    Energy Technology Data Exchange (ETDEWEB)

    Chun, K.A. [The Catholic University of Korea Uijongbu St. Mary' s Hospital, Department of Radiology, Uijongbu, Kyunggi-Do 480-130 (Korea); University of Iowa Hospitals and Clinics, Department of Radiology, Iowa City (United States); Morcuende, J. [University of Iowa Hospitals and Clinics, Department of Orthopaedic Surgery, Iowa City (United States); El-Khoury, G.Y. [University of Iowa Hospitals and Clinics, Department of Radiology, Iowa City (United States)

    2004-12-01

    In traumatic hip dislocation, concentric reduction can be prevented by various causes. Soft-tissue interposition, such as entrapment of the acetabular labrum, is a rare but important cause of failed reduction of a hip. Early diagnosis of incomplete reduction due to interposition of soft tissue is important, because delayed treatment is associated with a greater incidence of avascular necrosis of the femoral head and early onset of osteoarthritis. This report describes a case of acetabular labral entrapment following reduction of traumatic hip dislocation in a child. The importance of CT and MRI in arriving at an early diagnosis is emphasized. (orig.)

  6. Entrapment of the acetabular labrum following reduction of traumatic hip dislocation in a child

    International Nuclear Information System (INIS)

    Chun, K.A.; Morcuende, J.; El-Khoury, G.Y.

    2004-01-01

    In traumatic hip dislocation, concentric reduction can be prevented by various causes. Soft-tissue interposition, such as entrapment of the acetabular labrum, is a rare but important cause of failed reduction of a hip. Early diagnosis of incomplete reduction due to interposition of soft tissue is important, because delayed treatment is associated with a greater incidence of avascular necrosis of the femoral head and early onset of osteoarthritis. This report describes a case of acetabular labral entrapment following reduction of traumatic hip dislocation in a child. The importance of CT and MRI in arriving at an early diagnosis is emphasized. (orig.)

  7. Managing dislocations of the hip, knee, and ankle in the emergency department [digest].

    Science.gov (United States)

    Arnold, Caylyne; Fayos, Zane; Bruner, David; Arnold, Dylan; Gupta, Nachi; Nusbaum, Jeffrey

    2017-12-20

    Dislocation of the major joints of the lower extremities--hip, knee, and ankle--can occur due to motor-vehicle crashes, falls, and sports injuries. Hip dislocations are the most common, and they require emergent management to prevent avascular necrosis of the femoral head. Knee dislocations are uncommon but potentially dangerous injuries that can result in amputation due to the potential for missed secondary injury, especially if they are reduced spontaneously. Isolated ankle dislocations are relatively rare, as most ankle dislocations involve an associated fracture. This review presents an algorithmic approach to management that ensures that pain relief, imaging, reduction, vascular monitoring, and emergent orthopedic consultation are carried out in a timely fashion. [Points & Pearls is a digest of Emergency Medicine Practice.].

  8. Managing dislocations of the hip, knee, and ankle in the emergency department

    Science.gov (United States)

    Arnold, Caylyne; Fayos, Zane; Bruner, David; Arnold, Dylan

    2017-12-01

    Dislocation of the major joints of the lower extremities--hip, knee, and ankle--can occur due to motor-vehicle crashes, falls, and sports injuries. Hip dislocations are the most common, and they require emergent management to prevent avascular necrosis of the femoral head. Knee dislocations are uncommon but potentially dangerous injuries that can result in amputation due to the potential for missed secondary injury, especially if they are reduced spontaneously. Isolated ankle dislocations are relatively rare, as most ankle dislocations involve an associated fracture. This review presents an algorithmic approach to management that ensures that pain relief, imaging, reduction, vascular monitoring, and emergent orthopedic consultation are carried out in a timely fashion. Copyright © 2017 EB Medicine. All rights reserved.

  9. Systematic Review and Meta-Analysis of Avascular Necrosis and Posttraumatic Arthritis After Traumatic Hip Dislocation.

    Science.gov (United States)

    Kellam, Patrick; Ostrum, Robert F

    2016-01-01

    To determine the incidence rate and associative factors for the development of avascular necrosis (AVN) and posttraumatic arthritis (PTA) after traumatic hip dislocation and time to reduction. A comprehensive search of databases including PubMed, Cochrane Database, and Embase through April 2014 for English articles reporting complications of AVN and PTA after hip dislocation was performed. Inclusion criteria were English-only studies, a patient population of adults, study outcomes of AVN and/or PTA reported, and articles reported at least type I dislocations. Two authors independently extracted data from the selected studies and the data collected were compared to verify agreement. Random-effects models were used for meta-analysis. The overall event rate of AVN and PTA was calculated and stratified based on Thompson-Epstein of the hip dislocation. Odds ratios were calculated for those articles that reported rates of AVN based on time to reduction. For anterior dislocations, the event rate for AVN ranged from 0.087 to 0.333, whereas the event rate for PTA ranged from 0.125 to 0.700. Analysis of posterior dislocations revealed that the event rate for AVN ranged from 0.106 to 0.430; additionally, the event rate for PTA ranged from 0.194 to 0.586. For posterior hip dislocations and type I and II anterior dislocations, the severity of the injury correlates with an increase in the development of AVN and PTA. The odds ratio of AVN for those hip dislocations reduced after 12 hours versus those reduced before 12 hours was 5.627. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  10. TOTAL HIP REPLACEMENT IN LEGG-CALVÉ-PERTHES DISEASE

    DEFF Research Database (Denmark)

    Froberg, Lonnie; Christensen, Finn; Pedersen, Niels Wisbech

    2009-01-01

    INTRODUCTION Poor long-time results in patients with Legg-Calvé-Perthes disease (LCP) are most often due to degenerative hip disease. The purpose of this study was to investigate if patients with LCP have an increased rate of total hip replacement (THR) compared to sex- and age-matched persons....... MATERIAL AND METHODS 167 LCP patients presented to our institution from 1941 to 1962. All patients were treated conservatively by a Thomas splint. Retrospectively medical records and radiographs were retrieved. Data from the Danish Hip Replacement Register and the Registries of the National Board of Health...... to follow-up and 3) patients with previous surgery to pelvis or lower limbs. 135 patients (156 hips) were enrolled in this study and 32 patients (35 hips) were excluded. RESULTS 20 hips out of 156 hips in patients with LCP have had a THR. Mean age at operation for the women was 50 years and 44 years...

  11. Process optimized minimally invasive total hip replacement

    Directory of Open Access Journals (Sweden)

    Philipp Gebel

    2012-02-01

    Full Text Available The purpose of this study was to analyse a new concept of using the the minimally invasive direct anterior approach (DAA in total hip replacement (THR in combination with the leg positioner (Rotex- Table and a modified retractor system (Condor. We evaluated retrospectively the first 100 primary THR operated with the new concept between 2009 and 2010, regarding operation data, radiological and clinical outcome (HOOS. All surgeries were perfomed in a standardized operation technique including navigation. The average age of the patients was 68 years (37 to 92 years, with a mean BMI of 26.5 (17 to 43. The mean time of surgery was 80 min. (55 to 130 min. The blood loss showed an average of 511.5 mL (200 to 1000 mL. No intra-operative complications occurred. The postoperative complication rate was 6%. The HOOS increased from 43 points pre-operatively to 90 (max 100 points 3 months after surgery. The radiological analysis showed an average cup inclination of 43° and a leg length discrepancy in a range of +/- 5 mm in 99%. The presented technique led to excellent clinic results, showed low complication rates and allowed correct implant positions although manpower was saved.

  12. STUDY OF FUNCTIONAL RESULTS OF CEMENTED TOTAL HIP REPLACEMENT BY MOORE’S APPROACH

    Directory of Open Access Journals (Sweden)

    Arunim

    2016-02-01

    Full Text Available INTRODUCTION The total hip replacement (THR has probably become the surgical procedure of choice for vide variety of hip joint disabling diseases. The prosthesis used for THR is often grouped into cemented, cement-less and hybrid ones. There has been increasing trends in use of cement-less components citing more number of complications namely loosening, increased infection rate etc. however with additional cost factors as well. We conducted this study to ascertain whether in a developing country like ours should we really switch over to un-cemented hip replacements dreading such complications or can we still use cemented prosthesis with equally good if not better results. METHODS A study of functional results of cemented total hip replacement was done in patients with varied age groups ranging from 40 years to 75 years with the average age being 54.8 years. 20 patients with 21 diseased hips were treated with cemented total hip replacement by Moore’s posterior approach at NSCB Subharti medical college, Meerut, UP from December 2010 to December 2013 and reviewed thereafter with an average follow-up period of 4.2 years. Average surgical time required was one and half hour. Patients were asked to come for follow up on 1st month, 3rd month and 6th month and then every 6 months and were assessed as per modified Harris Hip Score. RESULTS All the patients were evaluated according to the Modified Harris Hip Scoring system. The results showed 14(67% hips with excellent results, 4(19% with good results, and 3(14% hips with fair results. No poor outcome was noted in this study. 2 cases of dislocation (10% were noted one on the 5th post-operative day and the other occurred after the patient was discharged from the institution. CONCLUSIONS The management of diseased and destroyed hips with chronic pain with cemented total hip replacement is effective and gives stable, mobile and painless hip joint to the patient. Functional results are excellent and

  13. Prognostic factors after a traumatic hip dislocation. A long-term retrospective study.

    Science.gov (United States)

    Moreta, J; Foruria, X; Sánchez, A; Aguirre, U

    Traumatic hip dislocations can have devastating complications such as osteoarthritis or osteonecrosis. The aim of this study was to identify the variables and prognostic factors associated with clinical and radiological outcome after a traumatic hip dislocation at long-term follow-up. A review was performed of all dislocations and fracture-dislocations of the hip from January 1999 to December 2012. A computed tomography scan was performed after reduction in all cases. The Harris Hip Score and modified Merle-d'Aubigné-Postel method were used for clinical evaluation and radiological assessment was performed according to the Thompson and Epstein classification. There were 30 cases in 29 patients with a mean follow-up of 11 years (range, 4-17). The great majority were simple dislocations (21; 70%) vs. complex dislocations (9; 30%). Closed reduction was performed in less than 6h in all except one case (29; 96.7%). All of the patients with simple dislocations had an excellent outcome without radiological signs of osteoarthritis at the end of the follow-up (P<.01). Overall, arthritic signs had developed in 4 patients (13.3%) and avascular necrosis was noted in 3 patients (10%). Five patients with intraarticular fragments were treated non-operatively, and 3 of them developed arthritic changes (P<.05). Our study suggests that complex dislocations are associated with poorer functional and radiological outcomes than simple dislocations. We also found a strong association between intraarticular fragments and osteoarthritis, so surgical fragment removal could be considered in these cases. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. Changes of the hip joints associated with chronic subluxation and dislocation: CT and plain radiography analysis

    International Nuclear Information System (INIS)

    Yang, Ik; Ryu, Kyung Nam; Lee, Sun Wha; Choi, Woo Suk; Lee, Eil Seong

    1993-01-01

    Secondary osteoarthritis of the hip joint is a common disease and is frequently followed by chronic subluxation and dislocation. Twenty four cases of the secondary osteoarthritis associated with chronic subluxation and dislocation of the hip joints were evaluated with plain radiography and computed tomography. We retrospectively analyzed 1) the osteoarthritis and calcification of the acetabular labrum, 2) the thickness of the quadrilateral plate of the ilium, and 3) anteroposterior diameter of the acetabulum. The changes of the hip joints in subluxation (n=14) revealed ossification of the acetabular labrum in 12 cases (86%), thickening of the quadrilateral plate of the ilium in 11 cases (78%) but anteroposterior diameter of the acetabulum was not changed. The changes of the hip joints in dislocation (n=10) revealed no evidence of the ossification of the acetabular labrum, thickening of the quadrilateral plate of the ilium in 10 cases (100%) and decreased anteroposterior diameter of the acetabulum. We conclude that CT findings of subluxation and dislocation of the hip joints can be helpful in the evaluation of the secondary osteoarthritis of the hip joints

  15. Late septic hip dislocation with multifocal osteomyelitis and malaria: a case report.

    Science.gov (United States)

    Sreenivas, T; Menon, Jagdish; Nataraj, A R

    2012-12-01

    A 9-year-old boy presented with high-grade fever associated with pain and swelling in right hip and left leg of 1-week duration. Pus was found on diagnostic aspiration of the right hip joint. Emergency arthrotomy was performed through anterior approach with drill holes in proximal femur and culture showed MRSA. Intravenous antibiotics were given for 4 weeks. Patient symptomatically improved in immediate postoperative period and in bed hip mobilization was started. On eighth postoperative day, child developed high-grade intermittent fever with chills and rigors and diagnosed as plasmodium falciparum malaria. Fever subsided with antimalarial treatment. On twenty-first day, patient complained pain in right hip and X-ray showed posterior hip dislocation with osteomyelitis of proximal femur. Closed reduction and hip spica application was done under general anesthesia. At follow-up, the clinical result was fair with resolution of infection and stiff hip.

  16. Primary total hip replacement versus hip resurfacing - hospital considerations.

    Science.gov (United States)

    Ward, William G; Carter, Christina J; Barone, Marisa; Jinnah, Riyaz

    2011-01-01

    Multiple factors regarding surgical procedures and patient selection affect hospital staffing needs as well as hospital revenues. In order to better understand the potential impact on hospitals that hip arthroplasty device selection (standard total hip arthroplasty vs. resurfacing) creates, a review of all primary hip arthroplasties performed at one institution was designed to identify factors that impacted hospital staffing needs and revenue generation. All primary hip arthroplasties undertaken over three fiscal years (2008 to 2010) were reviewed, utilizing only hospital business office data and medical records data that had been previously extracted prior for billing purposes. Analysis confirmed differing demographics for two hip arthroplasty populations, with the resurfacing patients (compared to the conventional total hip arthroplasty population) consisting of younger patients (mean age, 50 vs. 61 years), who were more often male (75% vs. 45%), were more likely to have osteoarthritis as their primary diagnosis (83 vs. 67%) and were more often covered by managed care or commercial insurance (83 vs. 34%). They also had shorter hospital stays (mean length of stay, 2.3 vs. 4.1 days) and consequently provided a more favorable financial revenue stream to the hospital on a per patient basis. Several trends appeared during the study periods. There was a steady increase in all procedures in all groups except for the resurfacings, which decreased 26% in males and 53% in females between 2009 and 2010. Differences were observed in the demographics of patients presenting for resurfacing, compared to those presenting for conventional total hip arthroplasty. In addition to the revenue stream considerations, institutions undertaking a resurfacing program must commit the resources and planning in order to rehabilitate these patients more expeditiously than is usually required with conventional hip arthroplasty patients.

  17. Acetabular cup position and risk of dislocation in primary total hip arthroplasty

    DEFF Research Database (Denmark)

    Seagrave, Kurt G; Troelsen, Anders; Malchau, Henrik

    2017-01-01

    Background and purpose - Hip dislocation is one of the most common complications following total hip arthroplasty (THA). Several factors that affect dislocation have been identified, including acetabular cup positioning. Optimal values for cup inclination and anteversion are debatable. We performed...... a systematic review to describe the different methods for measuring cup placement, target zones for cup positioning, and the association between cup positioning and dislocation following primary THA. Methods - A systematic search of literature in the PubMed database was performed (January and February 2016......) to identify articles that compared acetabular cup positioning and the risk of dislocation. Surgical approach and methods for measurement of cup angles were also considered. Results - 28 articles were determined to be relevant to our research question. Some articles demonstrated that cup positioning influenced...

  18. Subluxation and dislocation of the hip in children with spina bifida (review

    Directory of Open Access Journals (Sweden)

    A. G. Baindurashvili

    2013-01-01

    Full Text Available Subluxation or dislocation of the hip joint develops in 30-50% children with spina bifida during the first 2-3 years of life. These problems results from force disbalance between muscle group and other structural changes of the hip and pelvis components of the joint. The goal of treatment subluxation and dislocation of the hip joint in children with spina bifida is to make comfortable daily functions, eliminate the pain, provide the mobility and social independent. Management of subluxation and dislocation in children with spina bifida had changed in the last years because of the analysis long-term results. Indications for surgical treatment were determined more clearly, what made the results of treatment better.

  19. Total hip replacement surgery in Ethiopia | Gokcen | East and ...

    African Journals Online (AJOL)

    Background: Total hip replacement (THR) surgery has evolved over years to the point that it has been considered as "the operation of the century". For developed countries, arthroplasty is well established for the management of various joint disorders and has completely revolutionised the treatment of the arthritic hip.

  20. Total hip replacements at Kikuyu Hospital, Kenya | Kingori | East ...

    African Journals Online (AJOL)

    Background: Total joint arthroplasty is a highly effective procedure that is frequently performed in elderly patients. This is not so in the third world and is not frequently performed. Total hip replacement (THR) relieves the pain and functional disability experienced by patients with moderate to severe arthritis of the hip, ...

  1. Analgesia after total hip replacement: epidural versus psoas ...

    African Journals Online (AJOL)

    tive analgesia following total hip replacement surgery. The research design was a ... matoma, intra-abdominal injury and pain due to spasm of the lumbar paravertebral ..... 2. Brown DL. Spinal, epidural, and caudal anesthesia In: Miller RD, ed.

  2. Surgical dislocation of the hip in patients with femoroacetabular impingement: Surgical techniques and our experience

    Directory of Open Access Journals (Sweden)

    Mladenović Marko

    2015-01-01

    Full Text Available Background/Aim. Arthrosis of the hip is the most common cause of a hip joint disorders. The aim of this study was to present our experience in the application of a safe surgical dislocation of the hip in patients with minor morphological changes in the hip joint, which, through the mechanism of femoroacetabular impingement, cause damage to the acetabular labrum and adjacent cartilage as an early sign of the hip arthrosis. Methods. We have operated 51 patients with different morphological bone changes in the hip area and resultant soft tissue damage of the acetabular labrum and its adjacent cartilage. Surgical technique that we applied in this group of patients, was adapted to our needs and capabilities and it was minimaly modified compared to the original procedure. Results. The surgical technique presented in this paper, proved to be a good method of treatment of bone and soft tissue pathomorphological changes of the hip in patients with femoroacetabular impingement. We had no cases with avascular necrosis of the femoral head, and two patients had nonunion of the greater trochanter, 9 patients developed paraarticular ossification, without subjective symptoms, while 3 patients suffered from postoperative pain in the groin during more energetic physical activities. Conclusion. Utilization of our partly modified surgical technique of controlled and safe dislocation of the hip can solve all the bone and soft tissue problems in patients with femoroacetibular impingement to stop already developed osteoarthritis of the hip or to prevent mild form of it.

  3. Radiological examinations of complications after total hip replacement Pt. 1

    International Nuclear Information System (INIS)

    Luzsa, Gyoergy; Reti, Peter; Lakatos, Jozsef

    1985-01-01

    The radiological findings of complications after total hip replacement are summarized by analizing the data of control examinations of the operated patients at the National Institute for Rheumatology and Physiotherapy. In this first part the types of total hip replacements and the radiological methods (native x-ray, fistulography, arthrography, needle biopsy and scintigraphy using sup(99m)Tc isotope) are surveyed, and the radiological findings of the septic surgical complications are described. (author)

  4. Early diagnosis of congenital dislocation of the hip

    International Nuclear Information System (INIS)

    Grill, F.

    1984-01-01

    Neonatal hip examination is only effective with the help of a large number of experts. Teamwork between pediatrician, pediatric orthopedic surgeon and general practitioner seems to be essential. Best results can be achieved with a hip examination during the first 4 days of life and controls with 3 months and with 12 months. The technic of clinical examination and diagnosis is described. Because of hip dysplasias without any clinical signs the importance of an x-ray of the hip with an age of 3 months is emphasized. (Author)

  5. Ultrasound screening and follow-up of congenital hip dislocation

    International Nuclear Information System (INIS)

    Ballerini, G.; Avanzini, A.; Colombo, T.; Micucci, E.

    1990-01-01

    US screening for hip dysplasia was performed on 1421 full-term newborns. The study was aimed at: 1) evaluating US feasibility in an unselected maternity ward population; 2) determining the frequency of the different types of hips, and correlating ours with literature data; 3) evaluating the efficacy of both an early prevention and treatment. All US examination were performed within the first week of life and the 2842 hips classified according to Graf. At birth, normal hips (Ia, Ib) were 2064 (72.6%) (group I); Physiologically immature hips (IIa) were 721 (25.4%) (group II); pathological hips (group III) were: 43 (1.5%) IIc, 8 (o.3%) IId, 6 (0.2%) III. Hips in group B were cheked at 3 months: 502 were normal, 51 were type IIb, and 1 was type IId: the latter 52 hips were treated and normalized in the following months. Hips in group C (types IIc, IId, and III=57 hips) were treated and cheked every seventh week until normalization. Our experience confirm US value in the evaluation of hip dysplasia in the newborn. In our opinion, the use of this method shoul be encouraged, although US screening of all newborns remains controversial on a cost-benefit ratio. Multicentric studies will better define US sensitivity, specificity and reliability. The correlation of ours results with literature data was difficult, because study populations are not always homogeneous. As for therapy, we found the plastic splint very effective and easy to use: In 2 cases, Milgram devices were used for a few months

  6. Primary extra-cranial meningioma following total hip replacement

    Energy Technology Data Exchange (ETDEWEB)

    Campbell, T.J.; Beggs, I. [Royal Infirmary, Department of Radiology, Edinburgh (United Kingdom); Patton, J.T.; Porter, D. [Royal Infirmary, Department of Orthopaedics, Edinburgh (United Kingdom); Salter, D.M.; Al-Nafussi, A. [Royal Infirmary, Department of Pathology, Edinburgh (United Kingdom)

    2009-01-15

    A 61-year-old man presented with pain at the left hip and decreased mobility 10 years after total hip replacement. Imaging demonstrated a large destructive expansile mass adjacent to the prosthesis. Histological analysis confirmed the presence of an extra-cranial meningioma. Primary tumours after total hip replacement are rare and include soft tissue sarcomas, bone sarcomas and lymphomas. To our knowledge, no previous cases of primary extracranial meningioma have been identified. The imaging features, histology, pathogenesis and differential diagnosis are discussed. (orig.)

  7. Surgical dislocation of the hip and the management of femoroacetabular impingement: results of the Christchurch experience.

    Science.gov (United States)

    Kempthorne, Joshua T; Armour, Paul C; Rietveld, John A; Hooper, Gary J

    2011-06-01

    Surgical dislocation of the hip has been developed to deal with the problems causing femoroacetabular impingement (FAI). This is a relatively recent procedure that was historically reserved for larger areas specializing in hip surgery. We hypothesized that surgical dislocation can be used for symptomatic FAI in a typical Australasian tertiary orthopaedic centre with acceptable results. This prospective study reviews the results of 53 surgical dislocations in this setting, looking particularly at functional outcomes and early complications. There were significant improvements in the Western Ontario and McMaster University Osteoarthritis Index score at 1, 2, 3 and 4 years post-operatively. Western Ontario and McMaster University Osteoarthritis Index scores increased by 23, 28, 34 and 35 points, respectively (P 0.0039). There was no significant improvement in hip range of motion. There were two (4%) early failures with conversion to total hip arthroplasty, and no cases of post-operative avascular necrosis of the femoral head. We believe that as the diagnosis of FAI and conservative nonarthroplasty surgery of the hip gains wider acceptance, it will become a procedure that should be offered to all appropriate patients in an attempt to delay or limit total hip arthroplasty in this young age group.

  8. Posterior Hip Dislocation: Need For Prompt Care | Akiode | Nigerian ...

    African Journals Online (AJOL)

    on collision and involving drivers mostly, 9 (50%). The right hip was more commonly affected. The commonest associated injury was acetabular fracture. 14 cases had correct diagnosis suspected at presentation. The majority (66.7%) were ...

  9. 21 CFR 890.3665 - Congenital hip dislocation abduction splint.

    Science.gov (United States)

    2010-04-01

    ... SERVICES (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Prosthetic Devices § 890... abduction splint is a device intended for medical purposes to stabilize the hips of a young child with...

  10. Recurrent spontaneous hip dislocation in a patient with neurofibromatosis type 1: a case report.

    LENUS (Irish Health Repository)

    Galbraith, John G

    2011-01-01

    Neurofibromatosis type-1 is a common genetic disorder which often affects the skeleton. Skeletal manifestations of neurofibromatosis type-1 include scoliosis, congenital pseudarthrosis of the tibia and intraosseous cystic lesions. Dislocation of the hip associated with neurofibromatosis type-1 is a rare occurrence and is underreported in the literature.

  11. Recurrent spontaneous hip dislocation in a patient with neurofibromatosis type 1: a case report

    Directory of Open Access Journals (Sweden)

    Harty James A

    2011-03-01

    Full Text Available Abstract Introduction Neurofibromatosis type-1 is a common genetic disorder which often affects the skeleton. Skeletal manifestations of neurofibromatosis type-1 include scoliosis, congenital pseudarthrosis of the tibia and intraosseous cystic lesions. Dislocation of the hip associated with neurofibromatosis type-1 is a rare occurrence and is underreported in the literature. Case presentation We report a case of hip dislocation resulting from an intra-articular neurofibroma in an 18-year-old Caucasian woman following minor trauma. This was originally suggested by the abnormalities on early radiographs of her pelvis and later confirmed with computed tomography and magnetic resonance imaging. Treatment was successful with skeletal traction for six weeks with no further hip dislocations at a 12-year follow-up. Conclusion This case illustrates the radiological features of this rare complication of neurofibromatosis type-1 using the modalities of plain radiograph, magnetic resonance imaging and computed tomography reconstruction. The radiological images give a clear insight into the mechanism by which neurofibromatosis type-1 leads to hip dislocation. It also demonstrates one treatment option with excellent results on long-term follow-up.

  12. Missed posterior dislocation of the hip in a head-injured patient with ...

    African Journals Online (AJOL)

    Background: Head injury increases the risk of missed diagnosis by making patient-derived history impossible. The risk of missing a posterior dislocation of the hip in a head-injured patient is aggravated when an ipsilateral femoral shaft fracture co-exists. Adequate radiological evaluation of bone and joints is therefore of ...

  13. The futility of the roentgen-screening of infants for congenital dislocation of the hip

    International Nuclear Information System (INIS)

    Fendel, H.; Fuhrmann, G.; Schneider, K.

    1987-01-01

    Already the very first issue of the journal 'Fortschritte auf dem Gebiet der Roentgenstrahlen' founded in 1897 contains an article by Albert Hoffa which deals with congenital dislocation of the hip. This is an indication that radiology has been concerned with this disorder from its beginning. This paper discusses the incidence of the disease and the ineffectiveness of mass radiological screening

  14. Incidence and pattern of congenital dislocation of the hip in Aseer ...

    African Journals Online (AJOL)

    Objective: The aim of this paper is to determine the incidence, pattern, predisposing risk factors, treatment modalities and outcome of congenital dislocation of the hip (CDH) in the Aseer region of Saudin Arabia. Methods: A retrospective study of 300 cases of CDH seen during a 4year period between 1996 to 1999 was ...

  15. TOTAL HIP REPLACEMENTS AT KIKUYU HOSPITAL, KENYA

    African Journals Online (AJOL)

    equipments, few trained personnel and the high cost of implants. It is mainly in the ..... function more affected than the sensory a day after. There was a foot drop. .... 60: Issue 2, 217-. 220. 13. NIH Consensus Development Panel on Total Hip.

  16. Unilateral Congenital Knee and Hip Dislocation with Bilateral Clubfoot – A rare Packaging disorder

    Directory of Open Access Journals (Sweden)

    Mukesh Tiwari

    2013-04-01

    Full Text Available ntroduction: Reduced intrauterine space gives rise to ‘packaging disorder’ which may involve joint dislocations or contractures. We present an unique case where mutiple joints were dislocated involving left congenital knee dislocation (CDK, bilateral congenital hip dislocation (CDH and congenital talipes equino varus (CTEVdeformities. Case Report: A preterm baby boy born to mother with diagnosed oligohydramios presented with left CDK bilateral DDH and CTEV. The knee dislocation was treated first with gradual streaching and weekly above knee cast. At 7th week good flexion was achieved at both knees and abduction splint for DDH (using double diaper with ponseti cast for CTEV was done. At one year follow up all joints were reduced and maintained well with baby able to stand with support. Conclusion: Packaging disorders may present with multiple dislocations and deformities. Early intervention with serial casting and manipulation minimises disability and prevents ambulatory problems. In our case there was a good response to manipulation and serial casting. This differs from cases with inherent pathology like arthrogryposis where response to treatment is not so good. Keywords: Congenital genu recurvatum, Develpmental dysplasia hip, CTEV, Clubfoot, serial manipulation, packaging disorders

  17. Hip dislocation in cerebral palsy: evolution of the contralateral side after reconstructive surgery

    Directory of Open Access Journals (Sweden)

    João Caetano Munhoz Abdo

    2016-06-01

    Full Text Available ABSTRACT OBJECTIVE: To evaluate the progression of the contralateral hip after unilateral reconstruction of hip dislocation in patients classified as GMFCS IV-V; and to identify potential prognostic factors for their evolution. METHODS: This was a retrospective study on 17 patients with spastic cerebral palsy, who were classified on the GMFCS scale (Gross Motor Functional Classification System as degrees IV and V, and who underwent unilateral reconstruction surgery to treat hip dislocation (adductor release, femoral varus osteotomy and acetabuloplasty. The minimum postoperative follow-up was 30 months. The clinical parameters evaluated were sex, age at time of surgery, length of follow-up after surgery and range of abduction. The treatment parameters were use/nonuse of femoral shortening, application of botulinum toxin and any previous muscle releases. The radiographic parameters were Reimer's extrusion index (REI, acetabular angle (AA and the continuity of Shenton's line. RESULTS: Among the 17 patients evaluated, eight presented dislocation (group I and nine did not (group II. Group I comprised three males and five females; group II comprised one male and eight females. The mean age at the time of surgery among the group I patients was 62 months and the mean follow-up was 62 months. In group II, these were 98 and 83 months, respectively. There was a trend in which patients of greater age did not evolve with contralateral dislocation. Among the nine patients with the combination of REI < 30% and AA < 25°, only one presented dislocation during the follow-up. Contralateral subluxation occurred within the first two years after the surgery. CONCLUSION: Hips presenting REI < 30° and AA < 25° do not tend to evolve to subluxation and can be kept under observation. Preoperative clinical and radiographic measurements alone are not useful for indicating the natural evolution of non- operated hips. The critical period for subluxation is the first two

  18. Features rehabilitation of infants with congenital hip dislocation on the stages of conservative treatment

    Directory of Open Access Journals (Sweden)

    Sergei Yurievich Voloshin

    2015-06-01

    Full Text Available Congenital dislocation of the hip is one of the most common diseases in children leading to disability, which is difficult to diagnose in the first days of life. In the structure of congenital orthopedic diseases congenital dislocation of the hip holds one of the first places. This determines the importance and urgency of the problem, as the most complete restoration of anatomical structures and functions of the hip joint in children occurs in the early diagnosis and comprehensive, timely begun treatment. Rehabilitation of children in the first year of life should be early, systematic, comprehensive and differentiated. Technique of rehabilitation stages conservative treatment includes: wearing functional tires, gymnastics, massage, physiotherapy, therapeutic swimming. This prevents the progression of the disease, the development of early and late complications, does not violate the static-dynamic functions without delay verticalization.

  19. Confronting hip resurfacing and big femoral head replacement gait analysis

    Directory of Open Access Journals (Sweden)

    Panagiotis K. Karampinas

    2014-03-01

    Full Text Available Improved hip kinematics and bone preservation have been reported after resurfacing total hip replacement (THRS. On the other hand, hip kinematics with standard total hip replacement (THR is optimized with large diameter femoral heads (BFH-THR. The purpose of this study is to evaluate the functional outcomes of THRS and BFH-THR and correlate these results to bone preservation or the large femoral heads. Thirty-one patients were included in the study. Gait speed, postural balance, proprioception and overall performance. Our results demonstrated a non-statistically significant improvement in gait, postural balance and proprioception in the THRS confronting to BFH-THR group. THRS provide identical outcomes to traditional BFH-THR. The THRS choice as bone preserving procedure in younger patients is still to be evaluated.

  20. Spontaneous Relocation of a Posterior Dislocation of Mobile Bearing in a Medial Unicompartmental Knee Replacement

    Science.gov (United States)

    Noureddine, Hussein; Aird, Jaimes; Latimer, Paul

    2012-01-01

    We describe a case of spontaneous relocation of a posterior dislocation of the mobile bearing in a medial unicompartmental knee replacement, prior to surgical intervention. We are unaware of any similar cases in the published literature. This paper highlights some clinical issues around this type of dislocation. PMID:23259116

  1. Spontaneous Relocation of a Posterior Dislocation of Mobile Bearing in a Medial Unicompartmental Knee Replacement

    Directory of Open Access Journals (Sweden)

    Hussein Noureddine

    2012-01-01

    Full Text Available We describe a case of spontaneous relocation of a posterior dislocation of the mobile bearing in a medial unicompartmental knee replacement, prior to surgical intervention. We are unaware of any similar cases in the published literature. This paper highlights some clinical issues around this type of dislocation.

  2. Managing infection in the revision total hip replacement patient.

    Science.gov (United States)

    Halley, D K

    1993-01-01

    Deep infection is one of the most devastating complications in total hip replacement. This dreaded complication is presented in considerable detail with special emphasis on prevention, diagnosis, and various methods of surgical and antibiotic treatment. Basic fundamentals of antibiotic therapy are reviewed. In addition, guidelines are given for the indications of surgical intervention, the type and staging of operative procedures, with detailed techniques of the various operative procedures used to treat the infected total hip implant patient.

  3. Our Approach to the Spastic Hip Subluxation and Dislocation in Children with Cerebral Palsy

    Directory of Open Access Journals (Sweden)

    Pavel Šponer

    2006-01-01

    Full Text Available The purpose of this study was to evaluate the effectiveness of our approach to the spastic hip subluxation and dislocation in children with cerebral palsy. We evaluated 56 hips in our consecutive patients who had been operated on at our department between January 2003 and December 2005. There were done soft-tissue release procedures in 42 hips, osseous reconstructive surgery in 11 hips and osseous palliative surgery in 3 hips. The duration of follow-ups was 1–3 years after surgery. We achieved good result in 15 hips after soft-tissue release, fifteen hips had a fair result, nine a poor result and three a failure. No redislocation was observed after osseous surgery in our patients. Two patients observed no pain after osseous palliative surgery, transient pain in the hip was in one case. In all hips the range of motion (abduction was increased. The personal hygiene and possibilities of rehabilitation were improved. Childhood is the optimal time to intervene to maximize the function of the patient with cerebral palsy. The musculoskeletal treatment of the child prevents future problems with pain and deformity.

  4. Failure rate of cemented and uncemented total hip replacements

    DEFF Research Database (Denmark)

    Makela, K. T.; Matilainen, M.; Pulkkinen, P.

    2014-01-01

    ). Participants 347 899 total hip replacements performed during 1995-2011. Main outcome measures Probability of implant survival (Kaplan-Meier analysis) along with implant survival with revision for any reason as endpoint (Cox multiple regression) adjusted for age, sex, and diagnosis in age groups 55-64, 65......Objective To assess the failure rate of cemented, uncemented, hybrid, and reverse hybrid total hip replacements in patients aged 55 years or older. Design Register study. Setting Nordic Arthroplasty Register Association database (combined data from Sweden, Norway, Denmark, and Finland......-74, and 75 years or older. Results The proportion of total hip replacements using uncemented implants increased rapidly towards the end of the study period. The 10 year survival of cemented implants in patients aged 65 to 74 and 75 or older (93.8%, 95% confidence interval 93.6% to 94.0% and 95.9%, 95...

  5. Preoperative Education for Hip and Knee Replacement: Never Stop Learning.

    Science.gov (United States)

    Edwards, Paul K; Mears, Simon C; Lowry Barnes, C

    2017-09-01

    Participation in alternative payment models has focused efforts to improve outcomes and patient satisfaction while also lowering cost for elective hip and knee replacement. The purpose of this review is to determine if preoperative education classes for elective hip and knee replacement achieve these goals. Recent literature demonstrates that patients who attend education classes prior to surgery have decreased anxiety, better post-operative pain control, more realistic expectations of surgery, and a better understanding of their surgery. As a result, comprehensive clinical pathways incorporating a preoperative education program for elective hip and knee replacement lead to lower hospital length of stay, higher home discharge, lower readmission, and improved cost. In summary, we report convincing evidence that preoperative education classes are an essential element to successful participation in alternative payment models such as the Bundle Payment Care Initiative.

  6. ANTERIOR SUPERIOR DISLOCATION OF THE HIP JOINT: A ...

    African Journals Online (AJOL)

    Owing to the ligamentous and muscle forces around the hip, it is only rarely ... operating table, the femoral head was exposed via an anterior approach and found just below the sartorius muscle. The ligamentum teres was found avulsed, and the iliopubic .... of the socket tearing the iliofemoral ligament in the process, or ...

  7. A very rare case with neglected hip dislocation coexisted with posterior acetabular lip fracture

    Directory of Open Access Journals (Sweden)

    Samet Karabulut

    2011-06-01

    Full Text Available Neglected hip dislocation is a rare situation among children. The coexistence of acetabulum fracture is less common. The result of treatment depends on the time of diagnosis. Early treatment is mandatory in such cases. Seven years old female brought to our outpatient clinic with the complaints of right hip pain and walking difficulty. Her parents said that she had fallen from a horse one month ago. X-ray and CT showed a posterior dislocation of her right hip and a fracture on her right posterior acetabular lip. We performed an open reduction via posterior approach. Because the hip was unstable we fixed the femoral head to the acetabulum by a Kirshner wire. Pelvipedal cast was applied after the operation for 6 weeks. After 6 months avascular necrosis (AVN developed on her right femoral head, the range of motion (ROM of the hip was restricted and she had minimal pain on her right hip. J Clin Exp Invest 2011;2(2:228-31

  8. THE INFLUENCE OF THE SURGICAL APPROACH CONCERNING DISLOCATION IN TOTAL HIP ARTHROPLASTY.

    Science.gov (United States)

    Vicente, José Ricardo Negreiros; Pires, André Fernandes; Lee, Bruno Takasaki; Leonhardt, Marcos Camargo; Ejnisman, Leandro; Croci, Alberto Tesconi

    2009-01-01

    Our primary aim was to evaluate the occurrence of dislocation of non-cemented total hip arthroplasty, when using the posterior and the direct lateral approaches. We performed a comparative retrospective study with 232 patients submitted to non-cemented total hip arthroplasty, due to the diagnosis of primary or secondary osteoarthritis. The posterior approach was used in 105 patients while direct lateral approach was used in 127 patients. There was only one prosthesis model and the same rehabilitation program and post-operative care was used for all patients. We checked the occurrence of dislocation, the acetabular positioning and also the size of the components. There was only one case of dislocation, treated with closed reduction successfully. This was a 47 year-old female, submitted to direct lateral approach. The mean follow-up time for both groups was 23.7 months, ranging from six to 42 months. The authors conclude that the prevalence of total hip arthroplasty dislocation is similar for both approaches, and educational measures besides the use of a higher femoral offset seem to reduce the risk of this complication.

  9. UK survey of occupational therapist's and physiotherapist's experiences and attitudes towards hip replacement precautions and equipment.

    Science.gov (United States)

    Smith, T O; Sackley, C M

    2016-05-25

    Total hip replacement (THR) is one of the most common orthopaedic procedures in the United Kingdom (UK). Historically, people following THR have been provided with hip precautions and equipment such as: raised toilet seats and furniture rises, in order to reduce the risks of dislocation post-operation. The purpose of this study was to determine current practices in the provision of these interventions in the UK for people following primary THR. A 27-question, self-administered online survey was developed and distributed to UK physiotherapists and occupational therapists involved in the management of people following primary THR (target respondents). The survey included questions regarding the current practices in the provision of equipment and hip precautions for THR patients, and physiotherapist's and occupational therapist's attitudes towards these practices. The survey was disseminated through print and web-based/social media channels. 170 health professionals (87 physiotherapists and 83 occupational therapists), responded to the survey. Commonly prescribed equipment in respondent's health trusts were raised toilet seats (95 %), toilet frames and rails (88 %), furniture raises (79 %), helping hands/grabbers (77 %), perching stools (75 %) and long-handled shoe horns (75 %). Hip precautions were routinely prescribed by 97 % of respondents. Hip precautions were most frequently taught in a pre-operative group (52 % of respondents). Similarly equipment was most frequently provided pre-operatively (61 % respondents), and most commonly by occupational therapists (74 % respondents). There was variability in the advice provided on the duration of hip precautions and equipment from up to 6 weeks post-operatively to life-time usage. Current practice on hip precautions and provision of equipment is not full representative of clinician's perceptions of best care after THR. Future research is warranted to determine whether and to whom hip precautions and equipment

  10. Ethamsylate and blood loss in total hip replacement.

    Science.gov (United States)

    Keith, I

    1979-01-01

    Nineteen consecutive patients undergoing total hip replacement under epidural anaesthesia were randomly divided into two groups. The treatment group received 1000 mg of ethamsylate intravenously before induction of anaesthesia. Blood lost during surgery was measured by a colorimetric technique. Closed suction drains were used and all blood lost after operation collected for measurement. Ethamsylate did not decrease the average volumes of blood lost during or after the operation. Neither did it reduce the requirements for blood transfusion. Although there were no side-effects attributable to ethamyslate, there seems to be no indication for its use in total hip replacement under epidural anaesthesia.

  11. Hip dislocation following the treatment of femoral neck fracture: Case report

    Directory of Open Access Journals (Sweden)

    Vukašinović Zoran

    2010-01-01

    Full Text Available Introduction. Femoral neck fractures are very rare in young patients and are frequently complicated by femoral head osteonecrosis and femoral neck nonunion. Case Outline. A 19-year-old girl with hip dislocation following the treatment of the femoral neck fracture is presented. The femoral neck fracture was initially treated by open reduction and three-screw fixation. After detecting the nonunion of femoral neck, valgus osteotomy was done. Secondary, iatrogenic, hip dislocation appeared. The patient had pains, and in clinical findings a shorter leg and limited range of motion in the hip - altogether 40 degrees. She was then successfully treated by open reduction, together with Chiari pelvic osteotomy and joint transfixation. Transfixation pin was removed three weeks following the operation. After that, the patient was put into the abduction device and physical therapy was started. The mentioned regimen lasted four months after the surgery, then the abduction device was removed and walking started. Full weight bearing was allowed eight months after surgery. Conclusion. As we have not found the literature data concerning the above mentioned problem, we solved it in the way that we usually do for the treatment of developmental dislocation of the hip in adolescence.

  12. Sexual activity after total hip replacement in Korean patients: how they do, what they want, and how to improve.

    Science.gov (United States)

    Yoon, Byung-Ho; Lee, Kyung-Hag; Noh, Serae; Ha, Yong-Chan; Lee, Young-Kyun; Koo, Kyung-Hoi

    2013-12-01

    Concerns of patients on sexual activity after total hip arthroplasty have not been well studied in Asian patients. This study aimed to determine the following: (1) what are the concerns of patients related to sexual activity after total hip arthroplasty? (2) what are the changes in sexual activity after total hip replacement in Korean patients? Details of sexual activity and concerns were obtained using a questionnaire designed specifically for the study. The questionnaire was administered to 64 patients in a face-to-face interview at an outpatient clinic. Preoperatively, 53.1% of patients experienced difficulties, primarily due to hip pathology and limitations of motion. The median time to the resumption of sexual activity was 3 months postoperatively, and most patients had no increase in the frequency of sexual activity after the total hip replacement. In 39.1% of patients were seen having difficulties with leg positioning following total hip replacement, and they were likely to change coital positions. The most common concern regarding sexual activity of patients was the fear of dislocation. Furthermore, patients with a higher stress level had lower satisfaction rates. Most patients were unable to obtain information on sexual activity following the total hip arthroplasty, and they did not consult with a physician due to the private nature of the topic. Dislocation was the most common concern of patients during sexual activity following a total hip arthroplasty, and a higher stress level was found to be associated with a lower satisfaction rate. Because most patients were unprepared to consult a physician, the provision of appropriate information before a consultation might be beneficial.

  13. Radiological evaluation of painful total hip replacement

    International Nuclear Information System (INIS)

    Tehranzadeh, J.; Schneider, R.; Freiberger, R.H.

    1981-01-01

    Ninety-four cases of clinically failed, cemented, total hip prostheses requiring surgery were reviewed to determine the accuracy of preoperative plain radiography, culture of aspirated fluid, arthrography, and bone scanning. When radiopaque cement had been used to embed the prosthesis, plain radiography was highly accurate in detecting a loose femoral component, less so in detecting a loose acetabular component. Culture of aspirated fluid was accurate in diagnosing infection. A positive arthrogram identified loosening with good accuracy; however, a negative arthrogram did not reliably exclude loosening. 99 mTc bone scans frequently differentiated loosening from loosening with infection. The suggested sequence of diagnostic tests is plain radiography followed by bone scanning. If the bone scan shows diffuse augmented uptake, culture of aspirated fluid followed by arthrography is indicated

  14. A Water Rehabilitation Program in Patients with Hip Osteoarthritis Before and After Total Hip Replacement.

    Science.gov (United States)

    Łyp, Marek; Kaczor, Ryszard; Cabak, Anna; Tederko, Piotr; Włostowska, Ewa; Stanisławska, Iwona; Szypuła, Jan; Tomaszewski, Wiesław

    2016-07-25

    BACKGROUND Pain associated with coxarthrosis, typically occurring in middle-aged and elderly patients, very commonly causes considerable limitation of motor fitness and dependence on pharmacotherapy. This article provides an assessment of a rehabilitation program with tailored water exercises in patients with osteoarthritis before and after total hip replacement. MATERIAL AND METHODS A total of 192 patients (the mean age 61.03±10.89) suffering from hip osteoarthritis (OA) were evaluated before and after total hip replacement (THR). The clinical study covered measurements of hip active ranges of motion (HAROM) and the forces generated by pelvis stabilizer muscles. Pain intensity was assessed according to analogue-visual scale of pain (VAS) and according to the Modified Laitinen Questionnaire. The patients were divided into 6 groups (4 treatment and 2 control). We compared 2 rehabilitation programs using kinesitherapy and low-frequency magnetic field. One of them also had specially designed exercises in the water. Statistical analysis was carried out at the significance level α=0.05. This was a cross-sectional study. RESULTS A positive effect of water exercises on a number of parameters was found in patients with OA both before and after total hip replacement surgery. We noted a significant reduction of pain (pwater exercises most significantly reduced pain in patients with OA before and after total hip replacement surgery. 2. Inclusion of water exercises in a rehabilitation program can reduce the use of medicines in patient with OA and after THR.

  15. Total hip and knee joint replacement: perioperative clinical aspects

    Directory of Open Access Journals (Sweden)

    Luciana Pereira Almeida de Piano

    2010-09-01

    Full Text Available Objective: To understand the profile of patients undergoing hip and knee replacement during two years, and to compare the data obtained with the literature. Methods: A total of 323 medical records were reviewed to analyze the perioperative data of patients submitted to hip and knee replacement. Results: Osteoarthritis was the main indication for both procedures and male patients were heavier than females (p < 0.05. Hypertension was the prevalent disease among patients. Blood loss was more frequent in knee surgery than in the hip. Conclusions: The profile of patients undergoing total arthroplasty improved substantially over the past decade due to shorter hospital stay, lower risk of thromboembolic events and no infection as compared to previous reports.

  16. Risk factors for renal dysfunction after total hip joint replacement

    DEFF Research Database (Denmark)

    Hassan, Basim Kamil; Sahlström, Arne; Dessau, Ram Benny Christian

    2015-01-01

    BACKGROUND AND PURPOSE OF THE STUDY: Renal injury and dysfunction are serious complications after major surgery, which may lead to increased morbidity and mortality. The objective of our study was to identify the possible risk factors for renal dysfunction after total hip joint replacement surger...... creatinine. Smoking, diabetes mellitus, high BMI, gender, and duration of surgery were not identified as significant risk factors........ METHODS: A retrospective study was conducted among 599 consecutive primary hip joint replacements performed between January 2011 and December 2013. According to the RIFLE criteria, increased postoperative serum creatinine was considered indicative of postoperative renal injury. The Welch two-sample test......, hypertension, general anesthesia, high ASA scores, low intra-operative systolic BP, and prophylactic dicloxacillin as significant risk factors. Low baseline systolic BP, low baseline diastolic blood pressure, and hip fracture diagnosis were independent risk factors for postoperative increase in serum...

  17. Continuous quality improvement program for hip and knee replacement.

    Science.gov (United States)

    Marshall, Deborah A; Christiansen, Tanya; Smith, Christopher; Squire Howden, Jane; Werle, Jason; Faris, Peter; Frank, Cy

    2015-01-01

    Improving quality of care and maximizing efficiency are priorities in hip and knee replacement, where surgical demand and costs increase as the population ages. The authors describe the integrated structure and processes from the Continuous Quality Improvement (CQI) Program for Hip and Knee Replacement Surgical Care and summarize lessons learned from implementation. The Triple Aim framework and 6 dimensions of quality care are overarching constructs of the CQI program. A validated, evidence-based clinical pathway that measures quality across the continuum of care was adopted. Working collaboratively, multidisciplinary experts embedded the CQI program into everyday practices in clinics across Alberta. Currently, 83% of surgeons participate in the CQI program, representing 95% of the total volume of hip and knee surgeries. Biannual reports provide feedback to improve care processes, infrastructure planning, and patient outcomes. CQI programs evaluating health care services inform choices to optimize care and improve efficiencies through continuous knowledge translation. © The Author(s) 2014.

  18. Apixaban versus enoxaparin for thromboprophylaxis after hip replacement

    DEFF Research Database (Denmark)

    Lassen, Michael Rud; Gallus, Alexander; Raskob, Gary E

    2010-01-01

    There are various regimens for thromboprophylaxis after hip replacement. Low-molecular-weight heparins such as enoxaparin predominantly inhibit factor Xa but also inhibit thrombin to some degree. Orally active, specific factor Xa inhibitors such as apixaban may provide effective thromboprophylaxis...

  19. Anesthesia for a patient with Fanconi anemia for developmental dislocation of the hip: a case report

    Directory of Open Access Journals (Sweden)

    Zafer Dogan

    2014-05-01

    Full Text Available Fanconi anemia is a rare autosomal recessive inherited bone marrow failure syndrome with congenital and hematological abnormalities. Literature regarding the anesthetic management in these patients is limited. A management of a developmental dislocation of the hip was described in a patient with fanconi anemia. Because of the heterogeneous nature, a patient with fanconi anemia should be established thorough preoperative evaluation in order to diagnose on clinical features. In conclusion, we preferred caudal anesthesia in this patient with fanconi anemia without thrombocytopenia, because of avoiding from N2O, reducing amount of anesthetic, existing microcephaly, hypothyroidism and elevated liver enzymes, providing postoperative analgesia, and reducing amount of analgesic used postoperatively. Keywords: Fanconi anemia, Caudal anesthesia, Developmental dislocation of the hip

  20. Automatic measurement system for congenital hip dislocation using a computed radiography

    International Nuclear Information System (INIS)

    Komori, M.; Minato, K.; Hirakawa, A.; Kuwahara, M.

    1988-01-01

    Acetabular angle which is a diagnostic parameter of congenital hip dislocation has been measured manually in conventional X-ray film system. Using digital image directly provided from a computed radiography, an automatic measurement system was developed for this parameter. The process of the measurement was completed within a reasonable time, and accurate enough. The system was combined with an image database, so that it would be a measurement tool of PACS

  1. OUTCOMES OF PALLIATIVE ORTHOPEDIC SURGERY FOR HIP DISLOCATION IN PATIENTS WITH CEREBRAL PALSY

    OpenAIRE

    R. R. Bidyamshin; S. O. Ryabykh; G. M. Chibirov; D. A. Popkov

    2016-01-01

    Introduction. Hip dislocation is the key problem in patients with severe cerebral palsy (GMFCS IV, V) older than 10 years that affects life quality and limits functional capabilities. In the present study the authors evaluated the efficiency of the proximal femoral resection arthroplasty (pfra) and valgus proximal osteotomy of the femur (VPOF) associated with femoral head resection for pain control, improvement of postural management, hygiene and verticalization with total weight-bearing and ...

  2. A Water Rehabilitation Program in Patients with Hip Osteoarthritis Before and After Total Hip Replacement

    OpenAIRE

    ?yp, Marek; Kaczor, Ryszard; Cabak, Anna; Tederko, Piotr; W?ostowska, Ewa; Stanis?awska, Iwona; Szypu?a, Jan; Tomaszewski, Wies?aw

    2016-01-01

    Background Pain associated with coxarthrosis, typically occurring in middle-aged and elderly patients, very commonly causes considerable limitation of motor fitness and dependence on pharmacotherapy. This article provides an assessment of a rehabilitation program with tailored water exercises in patients with osteoarthritis before and after total hip replacement. Material/Methods A total of 192 patients (the mean age 61.03?10.89) suffering from hip osteoarthritis (OA) were evaluated before an...

  3. Pseudo-Acetabulum due to Heterotopic Ossification in a Child with Post Traumatic Neglected Posterior Hip Dislocation.

    Science.gov (United States)

    Pathak, Aditya C; Patil, Atul K; Sheth, Binoti; Bansal, Rohan

    2012-01-01

    Traumatic neglected dislocations of hip in children are rare entity. Neglected traumatic dislocations of hip in children along with heterotopic ossification are still rare. Post traumatic neglected hip dislocations are to be diagnosed as early as possible and have to be treated with precision and aggression as the outcome of treatment for the same is not predictable. 5 year female with post-traumatic neglected hip dislocation with heterotopic ossification forming a pseudoacetabulum postero-superiorly in which femur head was lodged. The girl was operated by open reduction using Moore's Posterior approach and showed good results. Here is a mention of a rare case with a good 18 months follow up with no complication. Post-traumatic neglected posterior hip dislocation mostly requires open reduction and relocation of femoral head in original acetabulum with concentric reduction. Heterotopic ossification is a rare but known complication of traumatic dislocation of hip in children. Good results can be achieved in such cases and regular follow-up of patient is required post-operatively.

  4. Hip Joint Replacement Using Monofilament Polypropylene Surgical Mesh: An Animal Model

    Directory of Open Access Journals (Sweden)

    Jacek Białecki

    2014-01-01

    Full Text Available Hip joint dysplasia is a deformation of the articular elements (pelvic acetabulum, head of the femur, and/or ligament of the head of the femur leading to laxity of the hip components and dislocation of the femoral head from the pelvic acetabulum. Diagnosis is based on symptoms observed during clinical and radiological examinations. There are two treatment options: conservative and surgical. The classic surgical procedures are juvenile pubic symphysiodesis (JPS, triple pelvic osteotomy (TPO, total hip replacement (THR, and femoral head and neck resection (FHNE. The aim of this experiment was to present an original technique of filling the acetabulum with a polypropylene implant, resting the femoral neck directly on the mesh. The experiment was performed on eight sheep. The clinical value of the new surgical technique was evaluated using clinical, radiological, and histological methods. This technique helps decrease the loss of limb length by supporting the femoral neck on the mesh equivalent to the femoral head. It also reduces joint pain and leads to the formation of stable and mobile pseudarthrosis. The mesh manifested osteoprotective properties and enabled the formation of a stiff-elastic connection within the hip joint. The method is very cost-effective and the technique itself is simple to perform.

  5. Comparative study of radiography and scintigraphy for loosening and infection of prosthetic hip replacement

    Energy Technology Data Exchange (ETDEWEB)

    Park, Mi Sook; Lee, Sun Wha; Choi, Woo Suk; Lim, Joo Won; Song, Han Joon; Ahn, Chi Yul [College of Medicine, Kyung Hee University, Seoul (Korea, Republic of)

    1987-10-15

    Prosthetic hip replacement is associated with certain complications which result in a painful hip. Many of these, e. g. prosthetic dislocation, fracture, trochanteric avulsion, and heterotopic calcification are easily diagnosed by conventional radiography. However, radiographic evaluation for infection and/pr loosening of prosthesis as major complications requiring reoperation often contributes little to the resolution of the diagnostic problem. The authors made a comparative study of plain radiography and scintigraphy of 39 cases performed revision at Kyung Hee University Hospital from Sep. '81-to Aug. '86. The results were as follows: 1. In 39 revised prosthetic hip replacement, 26 cases (67%) of loosening without infection and 11 cases (28%) of infection were proven. 2. In loosening of prosthesis, plain radiography showed true positive rate of 76% and true negative rate of 60%, and scintigraphy showed true positive rate of 75% and true negative rate of 95%. 3. In infection of prosthesis, plain radiography revealed true positive rate of 55% and true negative rate of 96%, and scintigraphy revealed true positive rate of 100% and true negative rate of 83%. 4. Scintigraphy and plain radiography were useful as complementary procedure in evaluating and differentiating loosening and/or infection of prosthetic component.

  6. Comparative study of radiography and scintigraphy for loosening and infection of prosthetic hip replacement

    International Nuclear Information System (INIS)

    Park, Mi Sook; Lee, Sun Wha; Choi, Woo Suk; Lim, Joo Won; Song, Han Joon; Ahn, Chi Yul

    1987-01-01

    Prosthetic hip replacement is associated with certain complications which result in a painful hip. Many of these, e. g. prosthetic dislocation, fracture, trochanteric avulsion, and heterotopic calcification are easily diagnosed by conventional radiography. However, radiographic evaluation for infection and/pr loosening of prosthesis as major complications requiring reoperation often contributes little to the resolution of the diagnostic problem. The authors made a comparative study of plain radiography and scintigraphy of 39 cases performed revision at Kyung Hee University Hospital from Sep. '81-to Aug. '86. The results were as follows: 1. In 39 revised prosthetic hip replacement, 26 cases (67%) of loosening without infection and 11 cases (28%) of infection were proven. 2. In loosening of prosthesis, plain radiography showed true positive rate of 76% and true negative rate of 60%, and scintigraphy showed true positive rate of 75% and true negative rate of 95%. 3. In infection of prosthesis, plain radiography revealed true positive rate of 55% and true negative rate of 96%, and scintigraphy revealed true positive rate of 100% and true negative rate of 83%. 4. Scintigraphy and plain radiography were useful as complementary procedure in evaluating and differentiating loosening and/or infection of prosthetic component

  7. Reliability and concurrent validity of the Dutch hip and knee replacement expectations surveys

    NARCIS (Netherlands)

    van den Akker-Scheek, Inge; van Raay, Jos J. A. M.; Reininga, Inge H. F.; Bulstra, Sjoerd K.; Zijlstra, Wiebren; Stevens, Martin

    2010-01-01

    Background: Preoperative expectations of outcome of total hip and knee arthroplasty are important determinants of patients' satisfaction and functional outcome. Aims of the study were (1) to translate the Hospital for Special Surgery Hip Replacement Expectations Survey and Knee Replacement

  8. The application of MRI in the infantile congenital dislocation of the hip

    International Nuclear Information System (INIS)

    Liu Hongsheng; Guo Qiyong; Ye Binbin

    2004-01-01

    Objective: To evaluate the efficacy of MRI in infantile congenital dislocation of the hip (CDH), and to provide a reasonable basis for clinical examination. Methods: Forty-seven infants (< 3 years) with untreated CDH were examined by using MR imaging. Three types were classified according to the standard of Ogden and Dunn, and then the bony and cartilaginous hip parameters of all hips, including the bony acetabular index (BAI), cartilaginous acetabular index (CAI), bony acetabular quotient (BAQ), and cartilaginous acetabular quotient (CAQ), were measured except in the type III hips. Results: For the normal hips, dislocated hips, the type I hips, and the type II hips, BAI was (25.24 ± 3.70) degree, (38.12 ± 4.07) degree, (35.59 ± 2.86) degree, and (39.64 ± 3.97) degree, respectively, CAI was (8.49 ± 2.15) degree, (17.25 ± 2.41) degree, (15.85 ± 2.00) degree, and (18.08 ± 2.26) degree, respectively, BAQ was 0.199 ± 0.026, 0.126 ± 0.028, 0.131 ± 0.028, and 0.124 ± 0.028, respectively, CAQ was 0.195 ± 0.027, 0.120 ± 0.027, 0.120 ± 0.023, and 0.121 ± 0.030, respectively. The BAI and CAI of the type II hips were higher than those of the type I, and BAQ and CAQ were lower. There was a linear correlation between BAI and CAI (r=0.876) and between BAQ and CAQ (r=0.706), respectively. MRI demonstrated that bony changes as loss of sphericity and diminished aperture of the acetabulum, and cartilage changes as the distortion and overgrowth in CDH. Conclusion: MR imaging is not only a very useful imaging modality for assessment of the bony, cartilaginous, and soft-tissue structures of the infantile hip, but also an excellent tool in the diagnosis and treatment of CDH. (author)

  9. Salter%u2019s Innominate Osteotomy in the Treatment of Congenital Hip Dislocation

    Directory of Open Access Journals (Sweden)

    Eyup Cagatay Zengin

    2014-03-01

    Full Text Available Aim: Developmental displazy of hip is much seenillness which interest orthopaedic surgery in Turkey and around the world. In early times of illness conservative treatment is succesful but late times of illness surgery is necessary. Salter’s innominate osteotomy, since its initial description in 1961, has become a well-established surgical procedure in the treatment of congenital dislocation of the hip.Material and Method: We reviewed 59 patients with 74 congenitally dislocated hips, all managed by open reduction and Salter’s innominate osteotomy. Mean follow-up period was 4,2 years (range, 2 to 7 years; %82,4 of the hips had a excellent clinical result, and %75,7 were excellent radiologically. The patients who underwent Salter’s innominate osteotomy before the age of 3 had beter clinical and radiological results (%90,4 and %82,5, respectively. The radiographs of the unilateral normal hips were compared to the surgically treated hips according to their acetabular index angles, center-edge angles of Wiberg and femoral neck-shaft angles. No statistical differences were found between these two groups. The Kalamchi-McEwen classification of avascular necrosis. The late radiographic signs of types 2, 3 and 4 avasculer necrosis were seen in %10,8 of this series. Discussion: The results show that Salter’s innominate osteotomy provides good lateral coverage of the femoral head. The results are beter if the operation is performed between the ages 18 months and 3 years.

  10. Persistently High Hip Circumference after Bariatric Surgery Is a Major Hurdle to Successful Hip Replacement

    Directory of Open Access Journals (Sweden)

    Menachem M. Meller

    2014-01-01

    Full Text Available The prevalence of class III obesity (BMI≥40 kg/m2 in black women is 18%. As class III obesity leads to hip joint deterioration, black women frequently present for orthopedic care. Weight loss associated with bariatric surgery should lead to enhanced success of hip replacements. However, we present a case of a black woman who underwent Roux-en-Y gastric bypass with the expectation that weight loss would make her a better surgical candidate for hip replacement. Her gastric bypass was successful as her BMI declined from 52.0 kg/m2 to 33.7 kg/m2. However, her hip circumference after weight loss remained persistently high. Therefore, at surgery the soft tissue tunnel geometry presented major challenges. Tunnel depth and immobility of the soft tissue interfered with retractor placement, tissue reflection, and surgical access to the acetabulum. Therefore a traditional cup placement could not be achieved. Instead, a hemiarthroplasty was performed. After surgery her pain and reliance on external support decreased. But her functional independence never improved. This case demonstrates that a lower BMI after bariatric surgery may improve the metabolic profile and decrease anesthesia risk, but the success of total hip arthroplasties remains problematic if fat mass in the operative field (i.e., high hip circumference remains high.

  11. The tribology of metal-on-metal total hip replacements.

    Science.gov (United States)

    Scholes, S C; Unsworth, A

    2006-02-01

    Total hip surgery is an effective way of alleviating the pain and discomfort caused by diseased or damaged joints. However, in the majority of cases, these joints have a finite life. The main reason for failure is osteolysis (bone resorption). It is well documented that an important cause of osteolysis, and therefore the subsequent loosening and failure of conventional metal- or ceramic-on-ultra-high molecular weight polyethylene joints, is the body's immunological response to the polyethylene wear particles. To avoid this, interest has been renewed in metal-on-metal joints. The intention of this paper is to review the studies that have taken place within different laboratories to determine the tribological performance of new-generation metal-on-metal total hip replacements. These types of joint offer a potential solution to enhance the longevity of prosthetic hip systems; however, problems may arise owing to the effects of metal ion release, which are, as yet, not fully understood.

  12. Influence of Minimally Invasive Total Hip Replacement on Hip Reaction Forces and Their Orientations

    NARCIS (Netherlands)

    Weber, Tim; Al-Munajjed, Amir A.; Verkerke, Gijsbertus Jacob; Dendorfer, Sebastian; Renkawitz, Tobias

    2014-01-01

    Minimally invasive surgery (MIS) is becoming increasingly popular. Supporters claim that the main advantages of MIS total hip replacement (THR) are less pain and a faster rehabilitation and recovery. Critics claim that safety and efficacy of MIS are yet to be determined. We focused on a

  13. Three-dimensional CT and MR imaging in congenital dislocation of the hip: Technical considerations

    International Nuclear Information System (INIS)

    Lang, P.; Steiger, P.; Lindquist, T.; Skinner, S.; Moore, S.; Chafetz, N.I.; Genant, H.K.

    1987-01-01

    Two-dimensional (2D) software techniques were developed to generate diagnostic-quality three-dimensional (3D) MR studies in two patients with congenital dislocation of the hip. Comparable 3D CT studies were obtained in two other patients. Unsharp masks were divided into the original MR images to correct for local variations in signal intensity. Combinations of first- and second-echo images improved the object contrast. Pixels with insufficient homogeneity relative to their neighboring data were excluded. CT did not require 2D preprocessing. Three-dimensional CT and MR images demonstrated subluxation and dislocation. 3D MR, in contrast to CT, demonstrated the cartilaginous femoral head. The described 2D MR preprocessing provides diagnostic-quality 3D MR studies. It will be useful for generating 3D MR images of other anatomic structures

  14. Proximal femoral resection and articulated hip distraction with an external fixator for the treatment of painful spastic hip dislocations in pediatric patients with spastic quadriplegia.

    Science.gov (United States)

    Lampropulos, Mario; Puigdevall, Miguel H; Zapozko, Daniel; Malvárez, Héctor R

    2008-01-01

    We describe the results obtained with an alternative method of treatment for spastic painful hip dislocations in nonambulatory patients, which consists of a proximal femoral resection with capsular interposition arthroplasty, and the addition of a hinged external fixator for postoperative articulated hip distraction to allow for an immediate upright position and the ability to sit in a wheelchair. We performed this technique in three patients (four hips) with a mean age at the time of surgery of 15 years. Postoperatively, clinical improvement was observed in all four hips, with respect to pain relief, sitting tolerance, perineal care and functional range of motion.

  15. Cemented total hip replacement cable debris and acetabular construct durability.

    Science.gov (United States)

    Altenburg, Aaron J; Callaghan, John J; Yehyawi, Tameem M; Pedersen, Douglas R; Liu, Steve S; Leinen, Jessica A; Dahl, Kevin A; Goetz, Devon D; Brown, Thomas D; Johnston, Richard C

    2009-07-01

    wire groups, respectively, at twenty years (p = 0.03). Because cable trochanteric attachment led to significantly greater polyethylene wear, osteolysis, acetabular loosening, and acetabular revision, presumably due to third-body metallic debris generation in this cemented total hip replacement construct, surgeons should be aware of the deleterious effects of third-body debris and avoid the use of potential debris generators in the total hip arthroplasty construct. If cable is used and fretting is recognized, especially with intra-articular migration of metallic material or nonunion of the greater trochanter, consideration should be given to cable removal.

  16. Anesthesia for a patient with Fanconi anemia for developmental dislocation of the hip: a case report

    Directory of Open Access Journals (Sweden)

    Zafer Dogan

    2014-06-01

    Full Text Available Fanconi anemia is a rare autosomal recessive inherited bone marrow failure syndrome with congenital and hematological abnormalities. Literature regarding the anesthetic management in these patients is limited. A management of a developmental dislocation of the hip was described in a patient with fanconi anemia. Because of the heterogeneous nature, a patient with fanconi anemia should be established thorough preoperative evaluation in order to diagnose on clinical features. In conclusion, we preferred caudal anesthesia in this patient with fanconi anemia without thrombocytopenia, because of avoiding from N2O, reducing amount of anesthetic, existing microcephaly, hypothyroidism and elevated liver enzymes, providing postoperative analgesia, and reducing amount of analgesic used postoperatively.

  17. Comparison of Procedural Sedation for the Reduction of Dislocated Total Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Jonathan E. dela Cruz

    2014-02-01

    Full Text Available Introduction: Various types of sedation can be used for the reduction of a dislocated total hip arthroplasty. Traditionally, an Opiate/Benzodiazepine combination has been employed. The use of other pharmacologic agents, such as Etomidate and Propofol, has more recently gained popularity. Currently no studies directly comparing these sedation agents have been carried out. The purpose of this study is to compare differences in reduction and sedation outcomes including recovery times of these three different sedation agents. Methods: A retrospective chart review was performed examining 198 patient’s charts who presented with dislocated total hip arthroplasty at two academic affiliated medical centers. The patients were organized into groups according to the type of sedation agent used during their reduction. The percentages of reduction and sedation complications were calculated along with overall recovery times. Reduction complications included fracture, skin or neurovascular injury, and failure of reduction requiring general anesthesia. Sedation complications included use of bag-valve mask and artificial airway, intubation, prolonged recovery, use of a reversal agent, and inability to achieve sedation. The data were then compared for each sedation agent. Results: The reduction complications rates found were 8.7% in the Propofol group, 24.68% in the Etomidate, and 28.85% in the Opiate/Benzodiazepine groups. The reduction complication rate in the Propofol group was significantly different than those of the other two agents (p≤0.01. Sedation complications were found to happen 7.25% of the time in the Propofol group, 11.69% in the Etomidate group, and 21.25% in the Opiate/ Benzodiazepine group with Propofol having complication rates significantly different than that of the Opiate/Benzodiazepine group (p=0.02. Average lengths of recovery were 25.17 minutes for Propofol, 30.83 minutes for Etomidate, and 44.35 minutes for Opiate/ Benzodiazepine with

  18. Locked Central Fracture Dislocation of the Hip in a Child after Low-Energy Trauma

    Directory of Open Access Journals (Sweden)

    Alexandre H. Nehme

    2017-01-01

    Full Text Available We present the case of a 13-year-old boy who sustained a locked central fracture dislocation of the right acetabulum following a bicycle fall. Immediate external reduction maneuvers under general anesthesia were unsuccessful due to intrapelvic entrapment of the femoral head. Open reduction internal fixation was achieved 48 hours later. After an initial satisfactory postoperative course, the patient ended up developing severe hip osteoarthritis 16 months after the procedure. The rarity of this injury in children is discussed, with its possible implications on joint congruity and potential growth injury.

  19. Dual mobility cups for preventing early hip arthroplasty dislocation in patients at risk: experience in a county hospital

    Directory of Open Access Journals (Sweden)

    Sebastian S. Mukka

    2013-06-01

    Full Text Available Dislocation remains a major concern after hip arthroplasty. We asked whether dual mobility cups (DMC would improve early hip stability in patients with high risk of dislocation. We followed 34 patients (21 females, 13 males treated between 2009 and 2012 with cemented DMC for hip revisions caused recurrent hip prosthetic dislocation or as a primary procedure in patients with high risk of instability. Functional outcome and quality of life were evaluated using Harris Hip Score and EQ-5D respectively. We found that the cemented DMC gave stability in 94%. Seven patients (20% were re-operated due to infection. One patient sustained a periprosthetic fracture. At follow-up (6 to 36 months, mean 18, the mean Harris hip score was 67 (standard deviation: 14 and mean EQ-5D was 0.76 (standard deviation: 0.12. We concluded that treating patients with high risk of dislocation with DMC can give good stability. However, complications such as postoperative infection can be frequent and should be managed carefully.

  20. Weight-bearing radiography in total hip replacement

    International Nuclear Information System (INIS)

    Turula, K.B.; Haajanen, J.; Friberg, O.; Lindholm, T.S.; Tallroth, K.

    1985-01-01

    Serial anteroposterior (AP) radiographs of the weight-bearing pelvis and hips were taken of 29 patients with total hip replacement (THR). For constant positioning the patient stands with straight knees on a board with a block between the heels. A U-shaped mercury level strapped to the patient provides a horizontal reference line on the radiograph. On the average, individual variation of pelvic tilt in serial films was 1 0 and pelvic rotation 3.5 0 confirming satisfactory reproducibility. The horizontal reference enables estimation of pre- and postoperative leg length inequality (LLI) and of the angle of the acetabular cup (AA). Reproducibility allows assessment of the exact position of the femoral component and quantitative evaluation of radiolucency and bone resorption around the prosthetic implant in the follow-up of THR. (orig.)

  1. The current state of bearing surfaces in total hip replacement.

    Science.gov (United States)

    Rajpura, A; Kendoff, D; Board, T N

    2014-02-01

    We reviewed the literature on the currently available choices of bearing surface in total hip replacement (THR). We present a detailed description of the properties of articulating surfaces review the understanding of the advantages and disadvantages of existing bearing couples. Recent technological developments in the field of polyethylene and ceramics have altered the risk of fracture and the rate of wear, although the use of metal-on-metal bearings has largely fallen out of favour, owing to concerns about reactions to metal debris. As expected, all bearing surface combinations have advantages and disadvantages. A patient-based approach is recommended, balancing the risks of different options against an individual's functional demands.

  2. Cognitive dysfunction after fast-track hip and knee replacement

    DEFF Research Database (Denmark)

    Krenk, Lene; Kehlet, Henrik; Bæk Hansen, Torben

    2014-01-01

    to 2 weeks and 3 months postoperatively. LOS, pain, opioid use, inflammatory response, and sleep quality were recorded. The practice effect of repeated cognitive testing was gauged using data from a healthy community-dwelling control group (n = 161). RESULTS: Median LOS was 2 days (interquartile range...... this (23.6% of patients with early POCD had late onset vs 6.7% in non-POCD group; risk difference 16.9 (95% CI, -2.1% to 41.1%; P = 0.089). CONCLUSIONS: The incidence of POCD early after total hip and knee replacement seems to be lower after a fast-track approach than rates previously reported...

  3. Periprosthetic fracture-dislocation in a loosened total knee replacement treated by knee arthrodesis

    International Nuclear Information System (INIS)

    Lozano Moreno, Francisco Jose

    2004-01-01

    We present a patient who was operated four years before performing a total knee replacement. She fell down resulting a periprosthetic femoral fracture and a prosthetic dislocation. After evaluating different treatments, we decided to do prosthetic removal and a knee arthrodesis using an intramedullar nail. The femoral fracture was fixed with wire cerclages. Knee arthrodesis is a procedure uses as a last option for the treatment of infected or loosed arthroplasties. In our case it was difficult to consider any other reconstructive procedure due to the association of fracture, dislocation and loosening. The evolution has been satisfactory with good functional result and without pain

  4. Preoperative therapeutic exercise in frail elderly scheduled for total hip replacement: A randomized pilot trial

    NARCIS (Netherlands)

    Hoogeboom, T.J.; Dronkers, J.J.; Ende, C.H.M. van den; Oosting, E.; Meeteren, N.L.U. van

    2010-01-01

    Objective: To evaluate the feasibility and preliminary effectiveness of therapeutic exercise before total hip replacement in frail elderly. Design: A single-blind, randomized clinical pilot trial. Setting: Outpatient physiotherapy department. Subjects: Frail elderly with hip osteoarthritis awaiting

  5. Dissociation of modular total hip arthroplasty at the neck-stem interface without dislocation.

    Science.gov (United States)

    Kouzelis, A; Georgiou, C S; Megas, P

    2012-12-01

    Modular femoral and acetabular components are now widely used, but only a few complications related to the modularity itself have been reported. We describe a case of dissociation of the modular total hip arthroplasty (THA) at the femoral neck-stem interface during walking. The possible causes of this dissociation are discussed. Successful treatment was provided with surgical revision and replacement of the modular neck components. Surgeons who use modular components in hip arthroplasties should be aware of possible early complications in which the modularity of the prostheses is the major factor of failure.

  6. Does total hip replacement affect sexual quality of life?

    Science.gov (United States)

    Harmsen, Rita Th E; Haanstra, Tsjitske M; Sierevelt, Inger N; Jansma, Elise P; Nolte, Peter A; Nicolai, Melianthe P J; Wall, Peter D H; Van Royen, Barend J

    2016-05-04

    Total Hip Replacement (THR) is an effective treatment for end-stage hip osteoarthritis. Since the introduction of total joint replacement, the effect on the Sexual Quality of Life (SQoL) following THR has been addressed in scant studies. The aim of our study was to systematically review the literature, to summarise effects of THR on patients' SQoL. We searched PubMed, EMBASE and PsycINFO between January 1970 and February 9th, 2015 with search terms including Total Hip, Osteoarthritis, SQoL, and THR. Eligible studies were identified and two independent authors extracted data including details of SQoL, study quality and risk of bias. There were 12 eligible studies, which included a total of 2099 patients with an age range of 20-85 years. The methodological quality of ten studies was rated as low, and of two as moderate. Amongst the majority of patients, SQoL improved after surgery, both in terms of physical-functional and psychosocial well-being. However, changes between pre-operative and postoperative SQoL ranged extensively: for example, Sexual Dysfunction Δ 8-51% and Sexual Activity (SA) Δ 0-77%. Three studies reported that some patients never resumed SA again after surgery. In over 40 years of THR treatment, scant studies have examined the effect of THR on patients' SQoL. This review suggests that SQol improves after THR, although the magnitude of effects varies highly. However, the quality of the supporting evidence was rated as low to moderate. This suggests a need for more high quality evidence about the effects of THR on SQoL.

  7. Multi-ligament instability after early dislocation of a primary total knee replacement - case report.

    Science.gov (United States)

    Sisak, Krisztian; Lloyd, John; Fiddian, Nick

    2011-01-01

    Peripheral nerve blocks have found increased popularity in providing prolonged post-operative analgesia following total knee replacement surgery. They generally provide effective analgesia with fewer complications than epidurals. This report describes an acute low-energy knee dislocation after a well balanced, fixed bearing, cruciate-retaining primary total knee replacement performed under a spinal anaesthetic with combined complimentary femoral and sciatic nerve blocks. The dislocation was not accompanied by neurovascular compromise. Due to the subsequent instability and injury to both collaterals, the posterior cruciate ligament and posterolateral corner structures, the knee was treated with a rotating-hinge revision total knee replacement. The dislocation occurred whilst the peripheral nerve blocks (PNB) were still working. We review our incidence of PNB related complications and conclude that PNB remain a safe and effective analgesia for total knee replacements. However, we advocate that ward staff and patients should be sufficiently educated to ensure that unaided post-operative mobilisation is prevented until such a time that patients have regained complete voluntary muscle control. Copyright © 2009 Elsevier B.V. All rights reserved.

  8. Ranking of computed tomography in congenital hip dysplasia and hip dislocation

    Energy Technology Data Exchange (ETDEWEB)

    Lingg, G.; Nebel, G.; Thomas, W.; Hering, L.

    1983-12-01

    A lot of methods of measurement have been developed to record precisely the degrees of luxation and the deviations from the normal form in the hip joints of the child and adult. The orthopaedic surgeon needs those data for a preoperative ''coxometric program'' before performing acetabuloplastic operations with osteotomia, osteotomia of the pelvis and combined operations. Computed tomography yields a series of informations and of possibilities of measurements which can determine the operative procedure in particular. These informations concern among other things the dimensions of the dysplasia of the acetabulum in the horizontal plane with the extension of the posterior lip and the angle of the acetabular opening, furthermore the physiological or pathological congruence between the head of the femur and the acetabulum, the angle of antetorsion of the neck of the femur and, in the small infant, the direct noninvasive imaging of the tube of the capsule with imaging of possible obstacles to reposition.

  9. Cognitive dysfunction after fast-track hip and knee replacement.

    Science.gov (United States)

    Krenk, Lene; Kehlet, Henrik; Bæk Hansen, Torben; Solgaard, Søren; Soballe, Kjeld; Rasmussen, Lars Simon

    2014-05-01

    Postoperative cognitive dysfunction (POCD) is reported to occur after major surgery in as many as 20% of patients, elderly patients may especially experience problems in the weeks and months after surgery. Recent studies vary greatly in methods of evaluation and diagnosis of POCD, and the pathogenic mechanisms are still unclear. We evaluated a large uniform cohort of elderly patients in a standardized approach, after major joint replacement surgery (total hip and knee replacement). Patients were in an optimized perioperative approach (fast track) with multimodal opioid-sparing analgesia, early mobilization, and short length of stay (LOS ≤3 days) and discharged to home. In a prospective multicenter study, we included 225 patients aged ≥60 years undergoing well-defined fast-track total hip or total knee replacement. Patients had neuropsychological testing preoperatively and 1 to 2 weeks and 3 months postoperatively. LOS, pain, opioid use, inflammatory response, and sleep quality were recorded. The practice effect of repeated cognitive testing was gauged using data from a healthy community-dwelling control group (n = 161). Median LOS was 2 days (interquartile range 2-3). The incidence of POCD at 1 to 2 weeks was 9.1% (95% confidence interval [CI], 5.4%-13.1%) and 8.0% (95% CI, 4.5%-12.0%) at 3 months. There was no statistically significant difference between patients with and without early POCD, regarding pain, opioid use, sleep quality, or C-reactive protein response, although the CIs were wide. Patients with early POCD had a higher Mini Mental State Examination score preoperatively (difference in medians 0.5 [95% CI, -1.0% to 0.0%]; P = 0.034). If there was an association between early POCD and late POCD, the sample size was unfortunately too small to verify this (23.6% of patients with early POCD had late onset vs 6.7% in non-POCD group; risk difference 16.9 (95% CI, -2.1% to 41.1%; P = 0.089). The incidence of POCD early after total hip and knee replacement

  10. Increased body mass index is a predisposition for treatment by total hip replacement

    DEFF Research Database (Denmark)

    Jacobsen, Steffen; Sonne-Holm, Stig

    2005-01-01

    We investigated the radiological and epidemiological data of 4,151 subjects followed up from 1976 to 2003 to determine individual risk factors for hip osteoarthritis (OA), hip pain and/or treatment by total hip replacement (THR). Pelvic radiographs recorded in 1992 were assessed for evidence of hip......-joint degeneration and dysplasia. Sequential body mass index (BMI) measurements from 1976 to 1992, age, exposure to daily lifting and hip dysplasia were entered into logistic regression analyses. The prevalence of hip dysplasia ranged from 5.4% to 12.8% depending on the radiographical index used. Radiological hip OA...

  11. A 4 year-old child with posterior hip dislocation and simultaneous subtrochanteric and anterior column fracture

    Directory of Open Access Journals (Sweden)

    Mousavian Alireza

    2013-09-01

    Full Text Available Traumatic hip dislocation is an uncommon injury in children and consists of less than 5% of their dislocations; but it’s one of the real orthopedic urgency. Its mechanism is low energy trauma in below 6 years old and high energy trauma above it.One of the common associated complications with hip dislocation is posterior wall injuries but column fractures are very rare. We reported an uncommon case of posterior hip dislocation with simultaneous subtrochanteric fracture and anterior column fracture, in which close reduction was impossible. Because of sever associated injuries surgery was done with 48 hours delay including open reduction of dislocation and fracture, and internally fixation of the subtrochanteric fracture with 3.5mm locked plate.In 6 month follow up that was done in ICU, range of motion and stability was good and union sign was visible on radiography. After 15 months the patient general conditions was good and no sign of avascular necrosis was seen

  12. Palliative surgery for acetabular metastasis with pathological central dislocation of the hip joint after radiation therapy. A case report

    International Nuclear Information System (INIS)

    Hoshi, Manabu; Takada, Jun; Oebisu, Naoto; Nakamura, Hiroaki; Taguchi, Susumu; Takami, Masatsugu

    2012-01-01

    Orthopedic surgery for bone metastases is mainly a palliative treatment. Pathological central dislocation of the hip joint secondary to osteonecrosis of acetabular metastasis after radiation therapy brings severe suffering to cancer patients. We performed minimally invasive palliative surgery for an elderly woman, and excellent pain relief was achieved. An 80-year-old female suffering from right hip pain was referred to our hospital. She had undergone surgery for lung cancer 5 years previously and her right acetabulum was subsequently affected by metastasis. With the aim of controlling the metastasis, radiation therapy was performed. Two years later, pathological central dislocation of the hip joint occurred with sudden onset of severe pain, and she was unable to maintain a sitting position and became bedridden. After she was referred to our hospital, we created an intentional pseudarthrosis in the femoral neck for palliation. After the surgery, excellent pain relief and remarkably improved mobility were achieved during her limited remaining lifetime. In this report, we introduce a novel method of producing a pseudarthrosis in the femoral neck for pathological dislocation. This procedure is a minimally invasive treatment and an alternative option for palliative surgery for pathological dislocation of the hip joint due to osteonecrosis after radiation therapy. (author)

  13. Dislocations

    Science.gov (United States)

    ... Fitness Diseases & Conditions Infections Drugs & Alcohol School & Jobs Sports Expert Answers (Q&A) Staying Safe Videos for Educators Search English Español First Aid: ... bones become separated. Dislocations are caused by falls and hard impacts, such as in sports injuries, and are more common in teens than ...

  14. Hip Dislocation and Dystocia in Early Medieval Times: Possible Evidence of Labor Maneuver.

    Science.gov (United States)

    Malgosa, Assumpció; Carrascal, Susana; Piga, Giampaolo; Isidro, Albert

    2016-12-01

    In ancient times, maternal mortality would occur frequently, particularly during labor. Evidence of dystocia resulting in the death of a pregnant woman is very infrequent in paleopathologic literature, with only a few cases being demonstrated. In the early medieval site of Casserres, the skeleton of a young woman with a fetus in the pelvic region was found. Some abnormal findings of the maternal skeleton were evaluated, including a sacral anomaly, femoral head wound, the rare position of the lower left limb with the femoral head dislodged anteriorly and cephalad from the socket, and a fibular fracture. Examining the anomalies all together, a case of anterior hip dislocation related to a McRoberts-like maneuver performed during labor is a plausible explanation of the findings.

  15. Klippel–Trenaunay syndrome in combination with congenital dislocation of the hip

    Directory of Open Access Journals (Sweden)

    Peng Hu

    2013-04-01

    Full Text Available Klippel–Trenaunay syndrome (KTS is a rare and sporadic disorder characterized by the triad of capillary malformations, venous varicosities, and limb hypertrophy. The clinical manifestations of KTS are heterogeneous. In this report, we present a unique case of KTS in combination with congenital dislocation of the hip (CDH in a 4-day-old female neonate. The patient had a widespread port-wine stain surrounded by regions of unaffected skin in a mosaic pattern, cutaneous hemangioma on the upper lip, left-sided hemihypertrophy involving the entire body, and also evidence of left CDH (based on the results of a physical examination and radiographic interpretation. We present this case for the rarity of presentation, discuss the relationship between KTS and CDH, and the treatment options available with a brief review of the literature.

  16. Magnetic resonance imaging of congenital dislocation of the hip with avascular necrosis of the femoral head

    Energy Technology Data Exchange (ETDEWEB)

    Hayashi, Nobuhiko; Ikeda, Takeshi; Wada, Ikuo [Nagoya City Univ. (Japan). Faculty of Medicine; and others

    1991-04-01

    Magnetic resonance imaging (MRI) was performed on 22 patients (24 joints) with congenital dislocation of the hip (CDH) with avascular necrosis. T1 and T2 weighted images were obtained using spin echo techniques. Since positive images of the articular cartilage were obtained, it was possible to clearly image flattening or thickening of the articular cartilage of the femoral head and acetabulum in the coronal and in the axial plane of the T1 weighted image. There was a high intensity region in the femoral head with avascular necrosis in the coronal T2 weighted image. The wideness of the region increased with severity. Much information can be obtained with MRI and it is a useful technique in evaluating the pathology of CDH with avascular necrosis. (author).

  17. Magnetic resonance imaging of congenital dislocation of the hip with avascular necrosis of the femoral head

    International Nuclear Information System (INIS)

    Hayashi, Nobuhiko; Ikeda, Takeshi; Wada, Ikuo

    1991-01-01

    Magnetic resonance imaging (MRI) was performed on 22 patients (24 joints) with congenital dislocation of the hip (CDH) with avascular necrosis. T1 and T2 weighted images were obtained using spin echo techniques. Since positive images of the articular cartilage were obtained, it was possible to clearly image flattening or thickening of the articular cartilage of the femoral head and acetabulum in the coronal and in the axial plane of the T1 weighted image. There was a high intensity region in the femoral head with avascular necrosis in the coronal T2 weighted image. The wideness of the region increased with severity. Much information can be obtained with MRI and it is a useful technique in evaluating the pathology of CDH with avascular necrosis. (author)

  18. Patient-reported outcome of hip resurfacing arthroplasty and standard total hip replacement after short-term follow-up

    DEFF Research Database (Denmark)

    Nissen, Nina; Douw, Karla; Overgaard, Søren

    2011-01-01

    The purpose of this study was to investigate patientreported outcome in terms of satisfaction in two study groups that had undergone hip resurfacing arthro-plasty (HRA) or total hip replacement (THR). The procedure consists of placing a hollow, mushroom-shaped metal cap over the femoral head whil...... a matching metal cup is placed in the acetabulum (pelvis socket)....

  19. Increased body mass index is a predisposition for treatment by total hip replacement

    DEFF Research Database (Denmark)

    Jacobsen, Steffen; Sonne-Holm, Stig

    2005-01-01

    -joint degeneration and dysplasia. Sequential body mass index (BMI) measurements from 1976 to 1992, age, exposure to daily lifting and hip dysplasia were entered into logistic regression analyses. The prevalence of hip dysplasia ranged from 5.4% to 12.8% depending on the radiographical index used. Radiological hip OA...... prevalence was 1.0--2.5% in subjects or=60 years of age. While radiological OA was significantly influenced by hip dysplasia in men and hip dysplasia and age in women, the risk of THR being performed was only influenced by BMI assessed in 1976. Hip......We investigated the radiological and epidemiological data of 4,151 subjects followed up from 1976 to 2003 to determine individual risk factors for hip osteoarthritis (OA), hip pain and/or treatment by total hip replacement (THR). Pelvic radiographs recorded in 1992 were assessed for evidence of hip...

  20. Resumption of car driving after total hip replacement.

    Science.gov (United States)

    Abbas, Ghulam; Waheed, Abdul

    2011-04-01

    To assess periods required for resuming car driving in 130 patients who had undergone total hip replacement (THR). 80 men and 50 women aged 39 to 80 years who had been driving automatic (n=49) or manual (n=81) cars in the previous 3 months and underwent unilateral primary THR of the right (n=85) or left (n=45) hip were recruited. Patients were advised to resume driving after 6 weeks if they felt comfortable to do so. 105 (81%) patients were able to resume driving at week 6 to 8; 67 (64%) had had a right THR and 65 (62%) were manual car drivers. 22 (17%) patients were able to do so at week 12. The remaining 3 (2%) patients were not confident to drive even at week 12. No patient reported deterioration in driving ability, whereas 48 (38%) felt a subjective improvement in their driving ability. The time to resume driving varies in different patients. The advice should be individualised, depending on the patient's recovery and confidence level.

  1. Periprosthetic femoral fracture within two years after total hip replacement:

    DEFF Research Database (Denmark)

    Thien, T. M.; Chatziagorou, G.; Garellick, G.

    2014-01-01

    BACKGROUND: We used the Nordic Arthroplasty Register Association database to evaluate whether age, sex, preoperative diagnosis, fixation, and implant design influence the risk of revision arthroplasty due to periprosthetic fracture within two years from operation of a primary total hip replacement....... METHODS: Included in the study were 325,730 cemented femoral stems and 111,899 uncemented femoral stems inserted from 1995 to 2009. Seven frequently used stems (two cemented stems [Exeter and Lubinus SP II] and five uncemented stems [Bi-Metric, Corail, CLS Spotorno, ABG I, and ABG II]) were specifically...... studied. RESULTS: The incidence of revision at two years was low: 0.47% for uncemented stems and 0.07% for cemented stems. Uncemented stems were much more likely to have this complication (relative risk, 8.72 [95% confidence interval, 7.37 to 10.32]; p

  2. OUTCOMES OF PALLIATIVE ORTHOPEDIC SURGERY FOR HIP DISLOCATION IN PATIENTS WITH CEREBRAL PALSY

    Directory of Open Access Journals (Sweden)

    R. R. Bidyamshin

    2016-01-01

    Full Text Available Introduction. Hip dislocation is the key problem in patients with severe cerebral palsy (GMFCS IV, V older than 10 years that affects life quality and limits functional capabilities. In the present study the authors evaluated the efficiency of the proximal femoral resection arthroplasty (pfra and valgus proximal osteotomy of the femur (VPOF associated with femoral head resection for pain control, improvement of postural management, hygiene and verticalization with total weight-bearing and correction of accompanying orthopaedic deformities. Material and мethods. A retrospective study compared two groups of patients where PFRA (7 cases, 13 hips or VPOF (14 patients, 23 hips were performed. Level V of GMFCS was reported in 10 patients, and level IV of GMFCS – in 11 patients. The mean age at time of surgery was 15.3±3.9 y.o. PFRA was performed in 7 cases (13 joints and VPOF – in 14 patients (23 joints. Results. The authors did not observe any difference between the methods in respect of pain control, postural management, comfortable sitting position and hygiene. The verticalization with total weight-bearing and life quality improvement was achieved only after PVOF with femoral head resection associated with simultaneous knee and foot deformity correction performed according to the principles of Single-Event Multilevel Orthopedic Surgery. Conclusion. Both palliative methods allow to control pain syndrome, to achieve satisfactory postural management, comfortable sitting position and hygiene. But only VPOF with simultaneous knee and foot deformity correction provides possibility to verticalize the patient with weight-bearing using different orthopedic devices.

  3. Case Study of a physiotherapy treatment of a patient after total hip replacement

    OpenAIRE

    Havlíčková, Barbora

    2013-01-01

    The bachelor's thesis consists of two parts. The general part includes anatomy and kinesiology of the hip joint and also the topic of coxarthrosis as the most common reason for the total hip replacement surgery. An integral part of this part is the elaboration of a rehabilitation plan for patients undergoing such procedure. The practical part of the thesis is conceived a case study of a patient after total hip replacement because of coxarthrosis. Finally, the thesis includes the therapeutic o...

  4. Prevalence of hip dislocation among children with cerebral palsy in regions with and without a surveillance programme: a cross sectional study in Sweden and Norway

    Directory of Open Access Journals (Sweden)

    Elkamil Areej I

    2011-12-01

    Full Text Available Abstract Background Hip dislocation is a serious complication among children with cerebral palsy (CP. The aim of this study was to compare the prevalence of hip dislocation among children with CP in an area providing regular care with an area providing hip surveillance services. Methods This is a cross-sectional study in seven Norwegian counties providing regular care and one Swedish healthcare region where a hip surveillance programme was introduced in 1994. Data were provided by the Norwegian Cerebral Palsy Register and the CP Register in Southern Sweden. Children born 1996 - 2003 with moderate to severe CP, defined as Gross Motor Classification System (GMFCS levels III - V, were included. In all, 119 Norwegian and 136 Swedish children fulfilled the criteria. In Norway, data on hip operations and radiographs of the hips were collected from medical records, while these data are collected routinely in the Swedish register. The hip migration percentage was measured on the recent radiographs. Hip dislocation was defined as a migration percent of 100%. Results The proportion of children at GMFCS levels III - V was 34% in the Norwegian and 38% in the Swedish population. In the Norwegian population, hip dislocation was diagnosed in 18 children (15.1%; CI: 9.8 - 22.6 compared with only one child (0.7%; 95% CI: 0.01 - 4.0 in Southern Sweden (p = Conclusions The surveillance programme reduced the number of hip dislocations and the proportion of children undergoing hip surgery was lower. However, with the surveillance programme the first operation was performed at a younger age. Our results strongly support the effectiveness of a specifically designed follow-up programme for the prevention of hip dislocation in children with CP.

  5. Total hip replacement for Mseleni Joint Disease undertaken in a ...

    African Journals Online (AJOL)

    found that hip surgery in this setting is of great benefit to Mseleni Joint Disease ... Conclusions: Hip surgery in this setting is of great benefit to the Mseleni Joint Disease patients but further attention .... The total hip score was divided into pain.

  6. Screening for congenital dislocation of the hip in the newborn: The role of clinical, ultrasonographic and radiographic examination

    International Nuclear Information System (INIS)

    Dunn, P.M.

    1987-01-01

    The concept of examining all young infants for congenital dislocation of the hip (CDH) dates back to Le Damany in 1914, though it was Ortolani who stimulated widespread clinical screening with the publication of his method of examination in 1948. His technique was improved by Barlow and others and is now often referred to as the Ortolani/Barlow manoeuvre. Meanwhile, following the method of Hilgenreiner, Putti advocated in 1933 radiological screening of all newborn hips. In 1958 Andren and Von Rosen described their new radiological technique in which hip subluxation was provoked prior to x-ray. Although radiological examination has been criticised as a screening method, it is still apparently widely used in Europe, especially in German-speaking countries. More recently dynamic sonographic examination of the hips has been used for neonatal screening

  7. Avascular necrosis as a complication of the treatment of dislocation of the hip in children with cerebral palsy.

    Science.gov (United States)

    Koch, A; Jozwiak, M; Idzior, M; Molinska-Glura, M; Szulc, A

    2015-02-01

    We investigated the incidence and risk factors for the development of avascular necrosis (AVN) of the femoral head in the course of treatment of children with cerebral palsy (CP) and dislocation of the hip. All underwent open reduction, proximal femoral and Dega pelvic osteotomy. The inclusion criteria were: a predominantly spastic form of CP, dislocation of the hip (migration percentage, MP > 80%), Gross Motor Function Classification System, (GMFCS) grade IV to V, a primary surgical procedure and follow-up of > one year. There were 81 consecutive children (40 girls and 41 boys) in the study. Their mean age was nine years (3.5 to 13.8) and mean follow-up was 5.5 years (1.6 to 15.1). Radiological evaluation included measurement of the MP, the acetabular index (AI), the epiphyseal shaft angle (ESA) and the pelvic femoral angle (PFA). The presence and grade of AVN were assessed radiologically according to the Kruczynski classification. Signs of AVN (grades I to V) were seen in 79 hips (68.7%). A total of 23 hips (18%) were classified between grades III and V. Although open reduction of the hip combined with femoral and Dega osteotomy is an effective form of treatment for children with CP and dislocation of the hip, there were signs of avascular necrosis in about two-thirds of the children. There was a strong correlation between post-operative pain and the severity of the grade of AVN. ©2015 The British Editorial Society of Bone & Joint Surgery.

  8. Evaluation of the effect of the reduction of the hip spastic dislocation in adolescent and young adult with cerebral paralysis

    International Nuclear Information System (INIS)

    Contreras Calderon, Jose; Zambrano, Gladis Cecilia; Villanueva, Erland; Turriago, Camilo Andres

    2006-01-01

    We present the results obtained in the Instituto de Ortopedia Infantil Roosevelt for the treatment of the hip dislocation in adolescent patients and young adults with spastic cerebral palsy with the open reduction of the hip, accompanied by femoral osteotomy and, if as necessary, pelvic osteotomy. 14 hips (10 patients) were intervened from January of 1996 to July of 2003. Pain was completely released in 54 percent and improved in 36 percent of cases. Abduction improved in 63 percent of patients allowing the perinea cleaning in 63 percent and better tolerance to scar in 64% of the cases. Our complications were one patient developed a sacred pressure ulcer with the spica cast treated with a free flap transposition; one hip had redislocation at 31 months from surgery; another hip had instability without clinical repercussion; one patient had a not displaced supracondylar femoral fracture treated with immobilization. The results of our study showed that the open reduction of the spastic hip in adolescents and young adults is a procedure that improves, in most of the cases, the stability, mobility and pain of the hip and provides better quality life for these patients

  9. Ipsilateral Traumatic Posterior Hip Dislocation, Posterior Wall and Transverse Acetabular Fracture with Trochanteric Fracture in an adult: Report of First Case

    Directory of Open Access Journals (Sweden)

    Skand Sinha

    2013-10-01

    Full Text Available Introduction: Posterior dislocation of the hip joint with associated acetabular and intertrochanteric fracture is a complex injury. Early recognition, prompt and stable reduction is needed of successful outcome. Case Report: 45 year old male patient presented with posterior dislocation of the hip with transverse fracture with posterior wall fracture of acetabulam and intertrochanteric fracture on the ipsilateral side. The complex fracture geometry was confirmed by CT scan. The patient was successfully managed by open reduction and internal fixation of intertrochanteric fracture was achieved with dynamic hip screw (DHS plate fixation followed by fixation of acetabular fracture with reconstruction plate. Conclusion: Hip dislocation combined with acetabular fracture is an uncommon injury; this article presents a unique case of posterior wall and transverse fractures of ipsilateral acetabulum with intertrochanteric fracture in a patient who sustained traumatic posterior hip dislocation. Early surgical intervention is important for satisfactory outcomes of such complex fracture-dislocation injuries. Keywords: Hip dislocation; acetabular fractures; intertrochanteric fracture; operative treatment.

  10. Early Results of Total Hip·Joint Replacement

    African Journals Online (AJOL)

    1974-09-28

    Sep 28, 1974 ... The majority (61%) of operations were done by the author, ... results of these conversion operations are considered .... Surgical and Postoperative Management .... slack. Dislocations are easily reduced by manipulation under.

  11. Prevalence of Total Hip and Knee Replacement in the United States.

    Science.gov (United States)

    Maradit Kremers, Hilal; Larson, Dirk R; Crowson, Cynthia S; Kremers, Walter K; Washington, Raynard E; Steiner, Claudia A; Jiranek, William A; Berry, Daniel J

    2015-09-02

    Descriptive epidemiology of total joint replacement procedures is limited to annual procedure volumes (incidence). The prevalence of the growing number of individuals living with a total hip or total knee replacement is currently unknown. Our objective was to estimate the prevalence of total hip and total knee replacement in the United States. Prevalence was estimated using the counting method by combining historical incidence data from the National Hospital Discharge Survey and the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases from 1969 to 2010 with general population census and mortality counts. We accounted for relative differences in mortality rates between those who have had total hip or knee replacement and the general population. The 2010 prevalence of total hip and total knee replacement in the total U.S. population was 0.83% and 1.52%, respectively. Prevalence was higher among women than among men and increased with age, reaching 5.26% for total hip replacement and 10.38% for total knee replacement at eighty years. These estimates corresponded to 2.5 million individuals (1.4 million women and 1.1 million men) with total hip replacement and 4.7 million individuals (3.0 million women and 1.7 million men) with total knee replacement in 2010. Secular trends indicated a substantial rise in prevalence over time and a shift to younger ages. Around 7 million Americans are living with a hip or knee replacement, and consequently, in most cases, are mobile, despite advanced arthritis. These numbers underscore the substantial public health impact of total hip and knee arthroplasties. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

  12. Distribution of polyethylene wear debris and bone particles in granuloma tissue around total hip joint replacements

    Czech Academy of Sciences Publication Activity Database

    Zolotarevova, E.; Lapčíková, Monika; Šlouf, Miroslav; Entlicher, G.; Pokorný, D.; Veselý, F.; Sosna, A.

    2008-01-01

    Roč. 18, č. 2 (2008), s. 173-174 ISSN 1120-7000. [Domestic Meeting of the European Hip Society /8./. 11.06.2008-13.06.2008, Madrid] R&D Projects: GA MŠk 2B06096 Institutional research plan: CEZ:AV0Z40500505 Keywords : wear debris * bone particles * total hip joint replacement Subject RIV: CD - Macromolecular Chemistry www. hip -int.com

  13. Immediate mobilisation with complete weight bearing after uncemented total hip replacement in elderly

    Directory of Open Access Journals (Sweden)

    Sankarlingam P, Shivraj V, V R Subramaniyam

    2014-11-01

    Full Text Available This prospective study was analyzed in 23 patients who were allowed to do immediate weight bearing after uncemented total hip arthroplasty. Immediate mobilization shortened the hospital stay and facilitated early rehabilitation of hip. Immediate mobilization was started on postoperative Day 3 rather than Day 7 without any adverse consequences to the patients. A series of 23 elderly patients of age more than 60 years, who were diagnosed with conditions such as avascular necrosis of hip, non union of fracture neck of femur, trochanteric non union and rheumatoid arthritis, underwent uncemented total hip replacement and immediate mobilization was started in our hospital. Patients were evaluated by Harris Hip Scoring Scale. All ambulated patients had painless hip and the mean Harris Hip Score was 85. There were no incidence of stem subsidence, acetabular component loosening, and heterotrophic ossification. This data concluded that early intensive rehabilitation yielded faster attainment of short-term functional milestones in fewer days.

  14. A Report Of Two Cases Of Uncemented Total Hip Replacement In ...

    African Journals Online (AJOL)

    This is a report of two sickle cell patients (HbSS) with advanced osteoarthritis of the right hip. The patients were in Ficat and Arlet\\'s stage 3 and 4 respectively. Both were females aged 23 and 46 years and they had uncemented hydroxyapatite coated omnifit (Stryker Howmedica Osteonics) total hip prosthetic replacement.

  15. Understanding Total Hip Replacement Recovery towards the Design of a Context-Aware Systems

    NARCIS (Netherlands)

    Jimenez Garcia, Juan

    2011-01-01

    Total Hip Replacement (THR) is a common procedure to improve the mobility of elderly with osteoarthritis. Presently information about the recovery process after discharge is unclear. As consequence patients and physiotherapists face uncertainties to follow an adequate trajectory for recovery.

  16. A Numerical Study of Effects of the Manufacture Perturbations to Contacts of the Total Hip Replacement

    Czech Academy of Sciences Publication Activity Database

    Koukal, M.; Fuis, Vladimír; Florian, Z.; Janíček, P.

    2011-01-01

    Roč. 18, č. 1 (2011), s. 33-42 ISSN 1802-1484 Institutional research plan: CEZ:AV0Z20760514 Keywords : total hip replacement * FEM * roundness * contact pressure * frictional moment Subject RIV: BO - Biophysics

  17. Can shared care deliver better outcomes for patients undergoing total hip replacement?

    NARCIS (Netherlands)

    Rosendal, H.; Beekum, W.T. van; Nijhof, P.; Witte, L.P. de; Schrijvers, A.J.P.

    2000-01-01

    Objectives: To assess whether shared care for patients undergoing total hip replacement delivers better outcomes compared to care as usual. Design: Prospective, observational cohort study. Setting: Two regions in the Netherlands where different organisational health care models have been

  18. What are the risk factors for dislocation in primary total hip arthroplasty? A multicenter case-control study of 128 unstable and 438 stable hips.

    Science.gov (United States)

    Fessy, M H; Putman, S; Viste, A; Isida, R; Ramdane, N; Ferreira, A; Leglise, A; Rubens-Duval, B; Bonin, N; Bonnomet, F; Combes, A; Boisgard, S; Mainard, D; Leclercq, S; Migaud, H

    2017-09-01

    Dislocation after total hip arthroplasty (THA) is a leading reason for surgical revision. The risk factors for dislocation are controversial, particularly those related to the patient and to the surgical procedure itself. The differences in opinion on the impact of these factors stem from the fact they are often evaluated using retrospective studies or in limited patient populations. This led us to carry out a prospective case-control study on a large population to determine: 1) the risk factors for dislocation after THA, 2) the features of these dislocations, and 3) the contribution of patient-related factors and surgery-related factors. Risk factors for dislocation related to the patient and procedure can be identified using a large case-control study. A multicenter, prospective case-control study was performed between January 1 and December 31, 2013. Four patients with stable THAs were matched to each patient with a dislocated THA. This led to 566 primary THA cases being included: 128 unstable, 438 stable. The primary matching factors were sex, age, initial diagnosis, surgical approach, implantation date and type of implants (bearing size, standard or dual-mobility cup). The patients with unstable THAs were 67±12 [37-73]years old on average; there were 61 women (48%) and 67 men (52%). Hip osteoarthritis (OA) was the main reason for the THA procedure in 71% (91/128) of the unstable group. The dislocation was posterior in 84 cases and anterior in 44 cases. The dislocation occurred within 3 months of the primary surgery in 48 cases (38%), 3 to 12 months after in 23 cases (18%), 1 to 5years after in 20 cases (16%), 5 to 10years after in 17 cases (13%) and more than 10years later in 20 cases. The dislocation recurred within 6 months of the initial dislocation in 23 of the 128 cases (18%). The risk factors for instability were a high ASA score with an odds ratio (OR) of 1.93 (95% CI: 1.4-2.6), neurological disability (cognitive, motor or psychiatric disorders) with

  19. Risk factors for urinary retention after hip or knee replacement: a cohort study

    OpenAIRE

    Griesdale, Donald E. G.; Neufeld, Jeremy; Dhillon, Dale; Joo, Jennifer; Sandhu, Supna; Swinton, Frank; Choi, Peter T.

    2011-01-01

    Introduction In 2006, our provincial government initiated a program to reduce wait times for total hip or knee replacements by referring patients to a single tertiary-care centre. This program provided an opportunity to identify risk factors for perioperative complications as part of a continuing quality improvement project. We report the risk of postoperative urinary retention after hip and knee replacements and the risk factors associated with this complication. Methods After local Research...

  20. The Effect of Hypotensive Anesthesia on Hepatic Function in Hip Replacement

    OpenAIRE

    Zagrekov V.I.; Zhirova T.A.; Ezhov I.Y.; Taranyuk А.V.

    2011-01-01

    The objective of the work is to assess the influence of spinal and epidural anesthesia with controlled hypotensive effect on hepatic function in patients in total hip replacement. Materials and Methods. There has been studied the dynamics of hepatic enzymes and bilirubin indexes in 80 patients in hip replacement. Depending on the anesthesia method, three groups were considered: with spinal and epidural anesthesia with controlled hypotensive effect and normotensive spinal anesthesia using ...

  1. Comparing contemporary revision burden among hip and knee joint replacement registries

    Directory of Open Access Journals (Sweden)

    Brian J. McGrory, MD, MS

    2016-06-01

    Conclusions: Revision burden has gradually decreased for hip replacements and has remained relatively constant for knee replacements both for the last 4 years and compared to historic controls. Knee revision burden was lower than hip revision burden for each period examined. Revision burden is one measure that may be helpful in following the effect of changes in surgical technique and implant design over time in registry populations and may be a helpful way to compare overall results between registries.

  2. Complications in total and partial hip and knee replacement in the San Jose Universitary Hospital Popayan

    Directory of Open Access Journals (Sweden)

    Alejandro Sandoval-Daza

    2010-03-01

    Full Text Available Introduction: Total hip and knee replacements are surgical procedures commonly used in cases of degenerative articular problems, intrarticular fractures and less common in tumor conditions. Despite its great success complications can arise. Objective: Describe complications in total knee and hip replacements. Methods: A descriptive study, cases serie was done in Hospital Universitario San José in Popayán Colombia, analyzing the period between January 2004 and January 2009, Seventy six patients were included: 53 total hips replacements, 12 cases of partial hip replacements and 11 total knee replacements. Patient's age was in the range between 27 and 97. Results: The main complications founded were: respiratory insufficiency, inability to place the prosthesis, prosthesis dislocation, anemic syndrome, acetabular protrusion, infection, iatrogenic Gushing's syndrome, discrepancy of length limb, residual pain, inability to walk, nosocomial pneumonia, renal failure and periprosthetic fracture. An average of 4, 6% mortality index, 10, 8% hip prosthesis dislocation, 9, 2% infections, all these indices over the different literature reports.

  3. Effect of cup inclination on predicted contact stress-induced volumetric wear in total hip replacement.

    Science.gov (United States)

    Rijavec, B; Košak, R; Daniel, M; Kralj-Iglič, V; Dolinar, D

    2015-01-01

    In order to increase the lifetime of the total hip endoprosthesis, it is necessary to understand mechanisms leading to its failure. In this work, we address volumetric wear of the artificial cup, in particular the effect of its inclination with respect to the vertical. Volumetric wear was calculated by using mathematical models for resultant hip force, contact stress and penetration of the prosthesis head into the cup. Relevance of the dependence of volumetric wear on inclination of the cup (its abduction angle ϑA) was assessed by the results of 95 hips with implanted endoprosthesis. Geometrical parameters obtained from standard antero-posterior radiographs were taken as input data. Volumetric wear decreases with increasing cup abduction angle ϑA. The correlation within the population of 95 hips was statistically significant (P = 0.006). Large cup abduction angle minimises predicted volumetric wear but may increase the risk for dislocation of the artificial head from the cup in the one-legged stance. Cup abduction angle and direction of the resultant hip force may compensate each other to achieve optimal position of the cup with respect to wear and dislocation in the one-legged stance for a particular patient.

  4. Use of a constrained tripolar acetabular liner to treat intraoperative instability and postoperative dislocation after total hip arthroplasty: a review of our experience.

    Science.gov (United States)

    Callaghan, John J; O'Rourke, Michael R; Goetz, Devon D; Lewallen, David G; Johnston, Richard C; Capello, William N

    2004-12-01

    Constrained acetabular components have been used to treat certain cases of intraoperative instability and postoperative dislocation after total hip arthroplasty. We report our experience with a tripolar constrained component used in these situations since 1988. The outcomes of the cases where this component was used were analyzed for component failure, component loosening, and osteolysis. At average 10-year followup, for cases treated for intraoperative instability (2 cases) or postoperative dislocation (4 cases), the component failure rate was 6% (6 of 101 hips in 5 patients). For cases where the constrained liner was cemented into a fixed cementless acetabular shell, the failure rate was 7% (2 of 31 hips in 2 patients) at 3.9-year average followup. Use of a constrained liner was not associated with an increased osteolysis or aseptic loosening rate. This tripolar constrained acetabular liner provided total hip arthroplasty construct stability in most cases in which it was used for intraoperative instability or postoperative dislocation.

  5. Cost-benefit evaluation of systematic radiological diagnosis of congenital dislocated hip

    International Nuclear Information System (INIS)

    Faure, C.; Schmit, P.; Salvat, D.

    1984-01-01

    The interest of radiological mass screening of congential dislocated hip is still debated. We have tried to evaluate the cost-benefit ratio of radiological detection at the age of 3-4 months, taking into account the socio-economic cost and radiation risk. Assuming a frequency of this disorder of 1% the average cost of treatment of one case detected by X-ray screening at the age of 3-4 months, including the price of X-ray examinations of 99 normal babies is 23.374 FF. The average cost of treatment of a case detected at walking-age, i.e. after 9 months, is 84.230 FF. The cost-benefit ratio is 3.6. In countries where the frequency reaches 2% the cost benefit ratio is 4.57. It also appears from our study that the irradiation of the patient is much smaller when the diagnosis is made earlier. Comparing the slight irradiation delivered to normal infants by this mass screening to the heavy irradiation received by a few individuals whose treatment is started after 9 months, the calculated risk of leukemia or of genetic disorder for the whole population still favours a systematic X-ray film of the pelvis at age 3-4 months. However, if it were decided to make obligatory this mass radiological detection programme during the fourth month of life, this would necessitate a serious effort to train all radiologists to obtain adequate films with the best radiation protection. (orig.)

  6. Alternative materials to improve total hip replacement tribology.

    Science.gov (United States)

    Santavirta, Seppo; Böhler, Max; Harris, William H; Konttinen, Yrjö T; Lappalainen, Reijo; Muratoglu, Orhun; Rieker, Claude; Salzer, Martin

    2003-08-01

    An improvement in tribology of bearing surfaces is an effective means of increasing the longevity of total hip replacement (THR). Currently, 3 approaches are available to achieve this aim: first, use of highly cross-linked UHMWPE; second, aluminum oxide ceramic bearings, and third, metal-on-metal bearings. Cross-linking reduces the wear resistance of UHMWPE markedly without impairment of other significant properties of the material. Simulator studies and some clinical long-term (10-22 years) follow-up surveys suggest an almost immeasurable wear of the highly cross-linked UHMWPE-based acetabular components during an expected clinical life span. Bioinert alumina ceramic (aluminum oxide) was introduced 3 decades ago for THR-bearing surfaces to improve performance and longevity. Alumina ceramic is entirely biostable and bioinert and has good mechanical properties. For correctly positioned alumina-on-alumina bearings, the annual linear wear rate has been reported to be 3.9 microm. Alumina heads have been successfully used in combination with polyethylene sockets, but as regards wear, the best results have been obtained with alumina-on-alumina bearings. In ceramic THR bearings, precise manufacture and contact surface geometry, including optimal clearance, are most important. For the currently available products, the component fracture risk is almost nonexistent (less than 1 per 1000). Metal-on-metal bearings were used in the early stage of THR surgery, although not all old designs were successful. More recent analyses of the early series have shown the advantages of metal-on-metal to be better and have led to a renaissance of this articulation. Initially, stainless steel was used because it was easy to manufacture and polish. Current metal-on-metal bearings are based on cobalt-chromium-molybdenum alloys with varying carbon contents. Such bearings are self-polishing. Linear wear rates remain at the level of a few microm a year. An improvement in technology has increased

  7. Prospective study of ascending venogram following total hip replacement or total knee replacement

    Energy Technology Data Exchange (ETDEWEB)

    Youm, Chang Seon; Suh, Jin Seok; Lee, Jong Doo; Park, Chang Yun; Kim, Young Hoo [College of Medicine, Yonsei University, Seoul (Korea, Republic of)

    1987-04-15

    The ascending leg venogram was performed in one hundred forty six lower extremities on the 7th day following total hip replacement (THR) or total knee replacement (TKR). The results were as follows; 1.Overall incidence of deep vein thrombosis (DVT) in 146 limbs who underwent THR or TKR was 10%: DVT was detected in 8 limbs among 110 limbs following THR (7%) and 6 limbs among 36 limbs following TKR (17%). 2.The anatomic distribution of DVT was as follows: In THR, 12.5% in FV, 25% in FV and PV, 25% in FV and PV and CV, 12.5% in FV and CV, and 25% in CV. In TKR, 100% in CV. 3.There were many anatomic variations in deep veins of lower extremities: Accessory SFV (41 limbs), double PV(24), accessory SFV and double PV(7), duplication of SFV and PV(3), accessory SFV and multiple PV(2), and accessory SFV and double PV(1). 4.There were multiple SFV in 37%, and 19% of these limbs had DVT. It represented statistically higher than 4% in limbs with a single SFV (P-value < 0.05). 5.The incidence of DVT was 8% in cases of multiple PV, and there was no statistically significant difference between these groups and single PV groups. 6.We could assess number of values from popliteal vein to common femoral vein in 72 limbs. Mean number of value was 5.45 and there was no statistically significant difference between groups having valve over 5 and under 5.

  8. Variation in age and physical status prior to total knee and hip replacement surgery

    DEFF Research Database (Denmark)

    Ackerman, Ilana N; Dieppe, Paul A; March, Lyn M

    2009-01-01

    OBJECTIVE: To investigate whether variation exists in the preoperative age, pain, stiffness, and physical function of people undergoing total knee replacement (TKR) and total hip replacement (THR) at several centers in Australia and Europe. METHODS: Individual Western Ontario and McMaster Univers...

  9. Survivorship of Total Hip Joint Replacements Following Isolated Liner Exchange for Wear.

    Science.gov (United States)

    Vadei, Leone; Kieser, David C; Frampton, Chris; Hooper, Gary

    2017-11-01

    Liner exchange for articular component wear in total hip joint replacements (THJRs) is a common procedure, often thought to be benign with reliable outcomes. Recent studies, however, suggest high failure rates of liner exchange revisions with significant complications. The primary aim of this study was, therefore, to analyze the survivorship of isolated liner exchange for articular component wear, and secondarily to assess the influence of patient demographics (gender, age, and American Society of Anaesthesiologists [ASA] ratings) on rerevisions following isolated liner exchange for wear. A retrospective review of the 15-year New Zealand Joint Registry (1999-2014) was performed, analyzing the outcomes of isolated liner exchange for articular component wear. The survivorship as defined as rerevision with component exchange was determined and 10-year Kaplan-Meier survivorship curves were constructed. These revision rates were compared to age, gender, and ASA rating groups using a log-rank test. The 10-year survivorship of THJR following liner exchange revision for liner wear was 75.3%. If a rerevision was required, the median time to rerevision was 1.33 years with a rerevision rate of 3.33 per 100 component years (95% confidence interval 2.68-4.08/100 component years). The principle reasons for rerevision were dislocation (48.4%) and acetabular component loosening (20.9%). There was no statistically significant difference in rerevision rates based on gender, age categories, or ASA scores. THJR isolated liner exchange for liner wear is not a benign procedure with a survivorship of 75.3% at 10 years. Surgeons contemplating liner exchange revisions should be cognisant of this risk and should adequately assess component position and stability preoperatively. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Repair of gluteus medius muscle avulsion following transgluteal hip replacement

    NARCIS (Netherlands)

    Groot, Diederik; van Ooij, Andre; Haverkamp, Daniel; Morrenhof, Wim

    2011-01-01

    During a transgluteal approach to the hip joint the anterior part of the gluteus medius and minimus muscles are detached and subsequently reattached to the greater trochanter. Avulsion or rupture of these muscles may result in weak abduction, pain and/or instability. 15 patients with these symptoms

  11. Reliability and concurrent validity of the Dutch hip and knee replacement expectations surveys.

    Science.gov (United States)

    van den Akker-Scheek, Inge; van Raay, Jos J A M; Reininga, Inge H F; Bulstra, Sjoerd K; Zijlstra, Wiebren; Stevens, Martin

    2010-10-19

    Preoperative expectations of outcome of total hip and knee arthroplasty are important determinants of patients' satisfaction and functional outcome. Aims of the study were (1) to translate the Hospital for Special Surgery Hip Replacement Expectations Survey and Knee Replacement Expectations Survey into Dutch and (2) to study test-retest reliability and concurrent validity. Patients scheduled for total hip (N = 112) or knee replacement (N = 101) were sent the Dutch Expectations Surveys twice with a 2 week interval to determine test-retest reliability. To determine concurrent validity, the Expectation WOMAC was sent. The results for the Dutch Hip Replacement Expectations Survey revealed good test-retest reliability (ICC 0.87), no bias and good internal consistency (alpha 0.86) (N = 72). The correlation between the Hip Expectations Score and the Expectation WOMAC score was 0.59 (N = 86). The results for the Dutch Knee Replacement Expectations Survey revealed good test-retest reliability (ICC 0.79), no bias and good internal consistency (alpha 0.91) (N = 46). The correlation with the Expectation WOMAC score was 0.52 (N = 57). Both Dutch Expectations Surveys are reliable instruments to determine patients' expectations before total hip or knee arthroplasty. As for concurrent validity, the correlation between both surveys and the Expectation WOMAC was moderate confirming that the same construct was determined. However, patients scored systematically lower on the Expectation WOMAC compared to the Dutch Expectation Surveys. Research on patients' expectations before total hip and knee replacement has only been performed in a limited amount of countries. With the Dutch Expectations Surveys it is now possible to determine patients' expectations in another culture and healthcare setting.

  12. Physiotherapy rehabilitation after total knee or hip replacement: an evidence-based analysis.

    Science.gov (United States)

    2005-01-01

    The objective of this health technology policy analysis was to determine, where, how, and when physiotherapy services are best delivered to optimize functional outcomes for patients after they undergo primary (first-time) total hip replacement or total knee replacement, and to determine the Ontario-specific economic impact of the best delivery strategy. The objectives of the systematic review were as follows: To determine the effectiveness of inpatient physiotherapy after discharge from an acute care hospital compared with outpatient physiotherapy delivered in either a clinic-based or home-based setting for primary total joint replacement patientsTo determine the effectiveness of outpatient physiotherapy delivered by a physiotherapist in either a clinic-based or home-based setting in addition to a home exercise program compared with a home exercise program alone for primary total joint replacement patientsTo determine the effectiveness of preoperative exercise for people who are scheduled to receive primary total knee or hip replacement surgery Total hip replacements and total knee replacements are among the most commonly performed surgical procedures in Ontario. Physiotherapy rehabilitation after first-time total hip or knee replacement surgery is accepted as the standard and essential treatment. The aim is to maximize a person's functionality and independence and minimize complications such as hip dislocation (for hip replacements), wound infection, deep vein thrombosis, and pulmonary embolism. THE THERAPY: The physiotherapy rehabilitation routine has 4 components: therapeutic exercise, transfer training, gait training, and instruction in the activities of daily living. Physiotherapy rehabilitation for people who have had total joint replacement surgery varies in where, how, and when it is delivered. In Ontario, after discharge from an acute care hospital, people who have had a primary total knee or hip replacement may receive inpatient or outpatient

  13. Limitations of cost-benefit evaluation of non-systematic radiological screening of congenital dislocatable or dislocated hip in Germany

    International Nuclear Information System (INIS)

    Weidtman, V.; Heereman, B. von; Herrmann, F.

    1987-01-01

    Cost-benefit analyses in the field of screening procedures not only comprise economic aspects, but they also require a thorough analysis of possible health risks, which are imminent in these examinations. Many publications on this topic during the past years have proven that even in such a well investigated problem, like the dislocated or dislocatable hip, this can lead to difficulties. We encountered in Germany these questions connected to hip joint screening, when we tried to analyse the data from the German General Screening Program (GGSP). It ws found that 10 times as many children were treated than one would have expected from epidemiological data. In addition a similarly large number of tentative diagnoses was found, which in summary caused great concern amongst the interested social pediatricians. It was to be expected, that the special examinations and treatments resulting from the screening of children had caused considerable and partially useless costs and unnecessary x-ray exposures. Considerable concern was stirred by information from orthopedic clinics, which reported that still cases of hip luxations and hip dysplasias are seen past the half year margin

  14. Analysis of rehabilitation activities within skilled nursing and inpatient rehabilitation facilities after hip replacement for acute hip fracture.

    Science.gov (United States)

    Munin, Michael C; Putman, Koen; Hsieh, Ching-Hui; Smout, Randall J; Tian, Wenqiang; DeJong, Gerben; Horn, Susan D

    2010-07-01

    To characterize rehabilitation services in two types of postacute facilities in patients who underwent hip replacement following a hip fracture. Multisite prospective observational cohort from 6 freestanding skilled nursing facilities and 11 inpatient rehabilitation facilities. Patients (n = 218) with hip fracture who had either hemiarthroplasty or total hip arthroplasty followed by rehabilitation at skilled nursing facilities or inpatient rehabilitation facilities were enrolled. Using a point-of-care methodology, we recorded data from actual physical therapy and occupational therapy sessions completed including functional outcomes during the postacute admission. Onset time from surgical repair to rehabilitation admission was not significantly different between sites. Average skilled nursing facilities length of stay was 24.7 +/- 13.6 days, whereas inpatient rehabilitation facilities was 13.0 +/- 5.7 days (P inpatient rehabilitation facilities. For weekdays only, these data changed to 1.6 in skilled nursing facilities and 2.6 hrs per patient in inpatient rehabilitation facilities (P inpatient rehabilitation facilities accrued more time for gait training and exercise in physical therapy, which was found to be 48% and 40% greater, respectively, through day 8. In occupational therapy, patients of inpatient rehabilitation facilities had more time allocated to lower body dressing and transfers. Significant differences in rehabilitation activities were observed, and intensity was notably different within the first 8 therapy days even though baseline demographics and medical complexity were comparable across facility types. Our data suggest that after more complex hip replacement surgery, hip fracture patients can tolerate more intensive therapy earlier within the rehabilitation program.

  15. Aquatic exercises versus land based exercises for elderly patients after a total hip replacement

    OpenAIRE

    Miroljub Jakovljevič; Renata Vauhnik

    2011-01-01

    Background: Aquatic therapy allows secure, active exercise with pain reduction using a combination of the water’s buoyancy, hydrostatic pressure, resistance and warmth. By aquatic therapy, elderly patients after total hip replacement can achieve more positive effects than by land-based exercise. The aim of the study was to investigate the use of aquatic-based exercises in the rehabilitation programme after a hip fracture surgery in elderly adults. Results: Both groups, regardless of the ty...

  16. Postoperative radiotherapy prophylaxis of periarticular ossification after total hip replacement

    International Nuclear Information System (INIS)

    Sauer, R.; Seegenschmiedt, M.H.; Andreas, P.; Goldmann, A.; Beck, H.

    1992-01-01

    Since June 1988, we have treated 77 patients or 80 hips respectively with prophylactic irradiation. Individual risk factors included severe coxarthrosis grade IV, ipsi- or contralateral heterotopic ossification and severe hip trauma. As of July 1991 60 patients with a minimum follow-up of six months could be analyzed using clinical and radiological scoring systems. The patients had been prospectively randomized in two different treatment arms: 32 patients were treated with low dose (LD), five times 2 Gy daily fractions to a total dose of 10 Gy, whereas 28 patients were treated with high dose (HD), ten times 2 Gy (eight patients) or five times 3.5 Gy (20 patients). Operative procedures and individual risk factors were equally distributed in both groups. 23 patients (38% received indometacin three times 25 mg for six weeks, 19 patients (32%) diphosphonate EHDP 20 mg/kg body weight and 18 patients (30%) had no additional medication. 56/60 (93%) patients developed no significant heterotopic ossification and/or remained without impairment of their postoperative radiological and clinical hip status according to the applied Brooker and Harris Scores. Only 4/60 (7%) patients demonstrated treatment failures developing postoperative worsening one grade of Brooker score in two patients and two and three grades of Brooker score in the two others. Only 1/49 patients experienced a treatment failure, when radiotherapy had been initiated before and at postoperative day 4 compared to 3/11 patients initiated after postoperative day 4 (p [de

  17. Postoperative Recovery of Mechanical Muscle Function in Hip Replacement Patients

    DEFF Research Database (Denmark)

    Jensen, Carsten; Aagaard, Per; Overgaard, Søren

    2011-01-01

    the posterior-lateral approach. Prior to surgery no training program was initiated but the patients were encouraged to live as usual. Post surgery all patients were allowed fully weight-bearing and they were instructed to follow a conventional home-based rehabilitation, but were otherwise not engaged in any......-test for between group comparisons while ANOVA was used for repeated measures for comparisons over time (α=0.05)   RESULTS The results were calculated as deficits in percentages of the unaffected side (A-NA/NA)*100)) in order to evaluate degree of asymmetry. Our overall side-to-side deficits for peak torque ranged...... from 32.6 to 0.4% and hip flexion deficit being significantly more impacted then the other muscle groups (32.6%).  At baseline all muscle groups showed a significant torque deficit. At 8 weeks post surgery that asymmetry had increased for 4 out of 6 muscle groups. At 26 weeks the hip adduction and hip...

  18. 21 CFR 888.3310 - Hip joint metal/polymer constrained cemented or uncemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint metal/polymer constrained cemented or... Hip joint metal/polymer constrained cemented or uncemented prosthesis. (a) Identification. A hip joint... replace a hip joint. The device prevents dislocation in more than one anatomic plane and has components...

  19. Radiography, radionuclide imaging, and asthrography in the evaluation of total hip and knee replacement

    International Nuclear Information System (INIS)

    Gelman, M.I.; Coleman, R.E.; Stevens, P.M.; Davey, B.W.

    1978-01-01

    Twenty patients with 21 total joint replacements including 17 hips and 4 knees were studied by plain film radiography, radionuclide imaging, and subtraction arthrography to evaluate these procedures for assessing prosthetic complications. Surgery was performed in 14 patients and confirmed loosening of 8 femoral and 7 acetabular hip prosthesis components and 1 femoral and 4 tibial knee prosthesis components. Plain films suggested loosening of only 9 hip components and no knee components. In contrast, radionuclide imaging and subtraction arthrography were considerably more effective in demonstrating loosening as well as other causes of the painful total joint prosthesis

  20. Concomitant posterior hip dislocation, ipsilateral intertrochanteric- and proximal tibial- fractures with popliteal artery injury: a challenging trauma mélange

    Directory of Open Access Journals (Sweden)

    Pranit N. Chotai

    2015-12-01

    Full Text Available Constellation of ipsilateral posterior hip dislocation, intertrochanteric- and proximal tibial fracture with popliteal artery injury is rare. Management of this presentation is challenging. A motor vehicle accident victim presented with these injuries, but without any initial signs of vascular compromise. Popliteal artery injury was diagnosed intra-operatively and repaired. This was followed by external fixation of tibial fracture, open reduction of dislocated hip and internal fixation of intertrochanteric fracture. Patient regained bilateral complete weight bearing and returned to pre-accident activity level. Apt surgical management including early repair of vascular injury in such a trauma mélange allows for a positive postoperative outcome.

  1. Low-Energy Traumatic Obturator Hip Dislocation with Ipsilateral Femoral Shaft Fracture in a Patient with Omolateral Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    G. Gazzotti

    2016-01-01

    Full Text Available Ipsilateral obturator hip dislocation and femoral shaft fracture are rare. We report such a case in an older woman after a low-energy injury. She had a knee prostheses in the same limb. The patient was treated by open manipulative reduction of the luxation without opening joint and open reduction and internal fixation of the femur with angular stability plate and screws. We could not find a similar case in the literature. An early diagnosis of the dislocation is crucial in order to obtain good results. Great awareness and radiologic examination are fundamental to achieve precocious diagnosis of both these rare combined injuries, as treatment in these cases is considered an emergency. The first step was an attempt to reduce the dislocation by closed means but it failed. Then we performed a short approach at the trochanteric region and used Lambotte forceps to manoeuvre the proximal femur without opening the joint achieving reduction. Thereafter the femoral shaft fracture underwent open reduction and internal fixation with an angular stable plate. After a 2-year follow-up the outcome was very good.

  2. Fractures of the greater trochanter following total hip replacement.

    Science.gov (United States)

    Brun, Ole-Christian L; Maansson, Lukas

    2013-01-01

    We studied the incidence of greater trochanteric fractures at our department following THR. In all we examined 911 patients retrospectively and found the occurance of a greater trochanteric fracture to be 3%. Patients with fractures had significantly poorer outcome on Oxford Hip score, Pain VAS, Satisfaction VAS and EQ-5D compared to THR without fractures. Greater trochanteric fracture following THR is one of the most common complications following THR. It has previously been thought to have little impact on the overall outcome following THR, but our study suggests otherwise.

  3. Prometheus payment model: application to hip and knee replacement surgery.

    Science.gov (United States)

    Rastogi, Amita; Mohr, Beth A; Williams, Jeffery O; Soobader, Mah-Jabeen; de Brantes, Francois

    2009-10-01

    The Prometheus Payment Model offers a potential solution to the failings of the current fee-for-service system and various forms of capitation. At the core of the Prometheus model are evidence-informed case rates (ECRs), which include a bundle of typical services that are informed by evidence and/or expert opinion as well as empirical data analysis, payment based on the severity of patients, and allowances for potentially avoidable complications (PACs) and other provider-specific variations in payer costs. We outline the methods and findings of the hip and knee arthroplasty ECRs with an emphasis on PACs. Of the 2076 commercially insured patients undergoing hip arthroplasty in our study, PAC costs totaled $7.8 million (14% of total costs; n = 699 index PAC stays). Similarly, PAC costs were $12.7 million (14% of total costs; n = 897 index PAC stays) for 3403 patients undergoing knee arthroplasty. By holding the providers clinically and financially responsible for PACs, and by segmenting and quantifying the type of PACs generated during and after the procedure, the Prometheus model creates an opportunity for providers to focus on the reduction of PACs, including readmissions, making the data actionable and turn the waste related to PAC costs into potential savings.

  4. Clinical and radiological evaluation of hybrid hip replacement in various disorders of hip

    Directory of Open Access Journals (Sweden)

    Dhaon B

    2005-01-01

    Full Text Available Background: High rates of loosening of cemented implants led to change in technique of fixation of the implant. Methods: Fifty-nine hips were operated in 42 patients with non-cemented acetabular and cemented femoral components between January 1999 and July 2003. The average age of the patient was 45.2 years in our study. Preoperative diagnosis was avascular necrosis (28, ankylosing spondylitis (18, fracture neck femur (9, rheumatoid arthritis (2 and osteoarthritis (2. Results: At an average follow up of 3.6 years (range 1.2-5.8 years excellent to good results were obtained 92% according to Harris hip criteria. No radiological loosening was noted in any femoral or acetabular component on follow up. One poor result was seen in a case of bilateral ankylosing spondylitis operated on one side. Conclusion: Hybrid THA provides a viable and highly acceptable method of treatment of diseases of hip in young patients.

  5. Successful staged hip replacement in septic hip osteoarthritis in osteopetrosis: a case report

    Directory of Open Access Journals (Sweden)

    Manzi Giovanni

    2012-04-01

    Full Text Available Abstract Background Osteopetrosis is a rare, inherited, bone disorder, characterized by osteosclerosis, obliteration of the medullary cavity and calcified cartilage. The autosomal dominant form is compatible with a normal life span, although fractures often result from minimal trauma, due to the pathologic nature of bone. Osteomyelitis is common in patients with osteopetrosis because of a reduced resistance to infection, attributed to the lack of marrow vascularity and impairment of white cell function. Only one case of osteomyelitis of the proximal third of the femur has been previously reported, treated with several repeated debridements and finally with femoral head resection. Here we present for the first time a case of a staged implant of a cementless total hip prosthesis for the treatment of a septic hip in femoral neck nonunion in osteopetrosis. Case presentation A 36-years-old woman, affected by autosomal dominant osteopetrosis was referred to our department because of a septic hip arthritis associated with femoral neck septic non-union, with draining fistulas. The infection occurred early after a plate osteosynthesis for a closed perthrocanteric fracture of the femur and persisted in spite of osteosynthesis removal, surgical debridement and external fixation. In our hospital the patient underwent accurate debridement, femoral head and greater trochanter resection, preparation of the diaphyseal intramedullary canal and implant of an antibiotic-loaded cement spacer. The spacer was exchanged after one month, due to infection recurrence and four months later, a cementless total hip arthroplasty was implanted, with no clinical and laboratory signs of infection recurrence at two years follow-up. Conclusions In case of hip septic arthritis and proximal femur septic non-union, femoral head resection may not be the only option available and staged total hip arthroplasty can be considered.

  6. Evaluation of Brace Treatment for Infant Hip Dislocation in a Prospective Cohort: Defining the Success Rate and Variables Associated with Failure.

    Science.gov (United States)

    Upasani, Vidyadhar V; Bomar, James D; Matheney, Travis H; Sankar, Wudbhav N; Mulpuri, Kishore; Price, Charles T; Moseley, Colin F; Kelley, Simon P; Narayanan, Unni; Clarke, Nicholas M P; Wedge, John H; Castañeda, Pablo; Kasser, James R; Foster, Bruce K; Herrera-Soto, Jose A; Cundy, Peter J; Williams, Nicole; Mubarak, Scott J

    2016-07-20

    The use of a brace has been shown to be an effective treatment for hip dislocation in infants; however, previous studies of such treatment have been single-center or retrospective. The purpose of the current study was to evaluate the success rate for brace use in the treatment of infant hip dislocation in an international, multicenter, prospective cohort, and to identify the variables associated with brace failure. All dislocations were verified with use of ultrasound or radiography prior to the initiation of treatment, and patients were followed prospectively for a minimum of 18 months. Successful treatment was defined as the use of a brace that resulted in a clinically and radiographically reduced hip, without surgical intervention. The Mann-Whitney test, chi-square analysis, and Fisher exact test were used to identify risk factors for brace failure. A multivariate logistic regression model was used to determine the probability of brace failure according to the risk factors identified. Brace treatment was successful in 162 (79%) of the 204 dislocated hips in this series. Six variables were found to be significant risk factors for failure: developing femoral nerve palsy during brace treatment (p = 0.001), treatment with a static brace (p failure, whereas hips with 4 or 5 risk factors had a 100% probability of failure. These data provide valuable information for patient families and their providers regarding the important variables that influence successful brace treatment for dislocated hips in infants. Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

  7. Ultraviolet radiation and air contamination during total hip replacement

    International Nuclear Information System (INIS)

    Carlsson, A.S.; Nilsson, B.; Walder, M.H.; Osterberg, K.

    1986-01-01

    Ultraviolet (uv) radiation of the operating room was assessed bacteriologically in an open randomized study of 30 total hip procedures. Volumetric air-sampling demonstrated that the number of colony forming units (cfu m-3) were significantly reduced (P less than 0.001) by uv light, both close to the wound and in the periphery of the operating room. No adverse effects of the uv-irradiation were observed either in the patients or the staff. In operating rooms fitted with a zonal ventilation system and with an air change rate of about 70 h-1, the addition of uv irradiation during surgery may achieve ultra clean air. However, in conventionally ventilated operating rooms uv-irradiation alone is probably not sufficient to do so

  8. Hip disability and osteoarthritis outcome score (HOOS)--validity and responsiveness in total hip replacement

    DEFF Research Database (Denmark)

    Nilsdotter, Anna K; Lohmander, L Stefan; Klässbo, Maria

    2003-01-01

    The aim of the study was to evaluate if physical functions usually associated with a younger population were of importance for an older population, and to construct an outcome measure for hip osteoarthritis with improved responsiveness compared to the Western Ontario McMaster osteoarthritis score...

  9. Does reduced movement restrictions and use of assistive devices affect rehabilitation outcome after total hip replacement?

    DEFF Research Database (Denmark)

    Mikkelsen, Lone Ramer; Petersen, Annemette Krintel; Søballe, Kjeld

    2014-01-01

    slower recovery in patient-reported function after reduction in movement restrictions and use of assistive devices, but the difference was eliminated after 6 weeks. Reduced movement restrictions did not affect the other patient-reported outcomes and led to earlier return to work. CLINICAL REHABILITATION......). This group was compared to patients included the following 3 months with less restricted hip movement and use of assistive devices according to individual needs (unrestricted group). Questionnaires on function, pain, quality of life (HOOS), anxiety (HADS), working status and patient satisfaction were.......004). Return to work 6 weeks after THR for the unrestricted group compared to restricted group was: 53% versus 32% (P=0.045). No significant differences between groups in pain, symptoms, quality of life, anxiety/depression, hip dislocations and patient satisfaction. CONCLUSION: This study showed slightly...

  10. Use of postoperative irradiation for the prevention of heterotopic bone formation after total hip replacement

    International Nuclear Information System (INIS)

    Sylvester, J.E.; Greenberg, P.; Selch, M.T.; Thomas, B.J.; Amstutz, H.

    1988-01-01

    Formation of heterotopic bone (HTB) following total hip replacement may partially or completely ankylose the joint space, causing pain and/or limiting the range of motion. Patients at high risk for formation of HTB postoperatively include those with previous HTB formation, heterotopic osteoarthritis, and active rheumatoid spondylitis. Patients in these high risk groups have a 63-69% incidence of post-operative HTB formation, usually seen radiographically by 2 months post-operation. From 1980-1986 twenty-nine hips in 28 consecutively treated patients were irradiated post-operatively at the UCLA Center for the Health Sciences. The indication for irradiation was documented HTB formation previously in 26 of the 27 hips presented below. From 1980-1982 patients received 20 Gray (Gy) in 2 Gy fractions; from 1982-1986 the dose was reduced to 10 Gy in 2 Gy fractions. Twenty-seven hips in 26 patients completed therapy and were available for evaluation, with a minimum of 2 month follow-up, and a median follow-up of 12 months. Three of 27 hips developed significant HTB (Brooker grade III or IV) post-operatively, whereas 5 of 27 hips developed minor, nonsymptomatic HTB (Brooker grade I). When irradiation was begun by postoperative day 4, 0 of 17 hips formed significant HTB. If irradiation began after post-operative day 4, 3 of 10 hips formed significant HTB (Brooker grade III or IV). These 3 hips received doses of 10 Gy in one hip and 20 Gy in the other 2 hips. There were no differences in the incidence or severity of side effects in the 10 Gy vs. the 20 Gy treatment groups. Eighteen hips received 10 Gy, 8 hips 20 Gy and, 1 hip 12 Gy. In conclusion, 10 Gy in 5 fractions appears as effective as 20 Gy in 10 fractions at preventing post-operative formation of HTB. For optimal results, treatment should begin as early as possible prior to post-operative day 4

  11. Comparative responsiveness of measures of pain and function after total hip replacement

    DEFF Research Database (Denmark)

    Nilsdotter, A K; Roos, Ewa M.; Westerlund, J P

    2001-01-01

    To compare the responsiveness of the Functional Assessment System (FAS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Medical Outcomes Study 36-item Short Form (SF-36) in patients with osteoarthritis (OA) scheduled for total hip replacement....

  12. The stability of the femoral component of a minimal invasive total hip replacement system.

    NARCIS (Netherlands)

    Willems, M.M.M.; Kooloos, J.G.M.; Gibbons, P.; Minderhoud, N.; Weernink, T.; Verdonschot, N.J.J.

    2006-01-01

    In this study, the initial stability of the femoral component of a minimal invasive total hip replacement was biomechanically evaluated during simulated normal walking and chair rising. A 20 mm diameter canal was created in the femoral necks of five fresh frozen human cadaver bones and the femoral

  13. Is Lumbosacral Plexus Block an Effective and Safe Alternative as Surgical Anesthesia for Total Hip Replacement?

    DEFF Research Database (Denmark)

    Nielsen, Niels Dalsgaard; Larsen, Jens Rolighed; Børglum, Jens

    BACKGROUND An increasing number of patients for total hip replacement presents with cardiovascular comorbidities, that render them fragile to traditional methods of anesthesia. The aim of this intended study is to compare lumbosacral plexus blockade with continuous spinal anesthesia for surgical ...

  14. Use of Tranexamic Acid during Total Endoprosthetic Replacement of the Hip Joint

    Directory of Open Access Journals (Sweden)

    D. D. Selivanov

    2010-01-01

    Full Text Available Objective: to evaluate the blood-saving activity, efficacy, and safety of tranexamic acid. Subjects and methods. Thirty-seven patients allocated into two groups were enrolled in the study of the efficacy of tranexamic acid as an agent in reducing blood loss during hip joint replacement. Group 2 patients were injected tranexamic acid, 10 mg/kg body weight, 20—30 minutes before and 3 hours after surgery in the same dosage. This resulted in a significant (48.5% reduction in total blood loss (from 1089.6 to 560.8 ml (p<0.05. No tranexamic acid-induced complications were found. The administration of tranexamic acid during total endoprosthetic replacement of the hip joint could reduce blood loss by 35 and 59.4% in the intraoperative and postoperative periods, respectively, and total blood loss by 48.4%. The use of tranexamic acid allows one to refuse transfusion of blood components during total endoprosthetic replacement of the hip joint. Key words: hip joint replacement, blood loss, tranexamic acid.

  15. Matched cohort study of topical tranexamic acid in cementless primary total hip replacement.

    Science.gov (United States)

    Sanz-Reig, Javier; Mas Martinez, Jesus; Verdu Román, Carmen; Morales Santias, Manuel; Martínez Gimenez, Enrique; Bustamante Suarez de Puga, David

    2018-03-29

    Tranexamic acid has been shown to be effective in reducing blood loss after total hip replacement. The purpose of this study was to prospectively assess the effectiveness of topical TXA use to reduce blood loss after primary total hip replacement and to compare these outcomes with those of a matched control group from a similar cohort that did not have received tranexamic acid. This is a prospective matched control study to assess the effect of a 2 g topical tranexamic acid in 50 mL physiological saline solution in total hip replacement. Primary outcomes were hemoglobin and hematocrit drop, and total blood loss. Secondary outcomes were transfusion rates, length of hospital stay, deep vein thrombosis, and pulmonary embolism events. We could match 100 patients to a control group. There were no statistical significantly differences between the two groups. The hemoglobin and hematocrit postoperative values were significantly higher in topical tranexamic acid group than in control group (P tranexamic acid group and 1163 in control group with significant differences (P = 0.001), which meant 34% reduction in total blood loss. Length of stay was lower in topical tranexamic acid group. The risk of deep vein thrombosis and pulmonary events did not increase. A single dose of 2 g tranexamic acid in 50 mL physiological saline solution topical administration was effective and safe in reducing bleeding in patients undergoing unilateral primary non-cemented total hip replacement compared to a matched control group.

  16. Femoral nerve palsy caused by ileopectineal bursitis after total hip replacement: a case report

    Directory of Open Access Journals (Sweden)

    Bähr Mathias

    2011-05-01

    Full Text Available Abstract Introduction Infectious ileopectineal bursitis is a rare complication after total hip replacement and is associated mainly with rheumatoid arthritis. The main complications are local swelling and pain, but communication of the inflamed bursa with the joint can occur, leading to subsequent cartilage damage and bone destruction. Case presentation We report a case of a 47-year-old Caucasian woman without rheumatoid arthritis who reported pain and palsy in her left leg almost one year after total hip replacement. She was diagnosed with an ileopectineal bursitis after total hip replacement, leading to femoral nerve palsy. The diagnosis was obtained by thorough clinical examination, the results of focused computed tomography and magnetic resonance imaging. Conclusion To the best of our knowledge, this is the first report of non-infectious ileopectineal bursitis in a patient without rheumatoid arthritis as a complication of total hip replacement. This rare case underlines the importance of proper neurologic examination of persistent conditions after orthopedic intervention in otherwise healthy individuals. We believe this case should be useful for a broad spectrum of medical specialties, including orthopedics, neurology, radiology, and general practice.

  17. MRI as a problem-solving tool in unexplained failed total hip replacement following conventional assessment

    International Nuclear Information System (INIS)

    Johnston, Ciaran; Kerr, Jennifer; Ford, Stephanie; Eustace, Stephen; O'Byrne, John

    2007-01-01

    To evaluate MRI as a problem-solving tool for patients with an unexplained failed total hip replacement following conventional radiological assessment. Patients' informed consent was obtained in all cases. Institutional review board approval was obtained. Twenty-eight patients with unexplained failed total hip replacements following conventional radiological assessment underwent additional MR imaging with an optimised turbo-spin echo sequence. Images were reviewed by two musculoskeletal radiologists by consensus and compared with findings at surgery, or following response to image-guided intervention or clinical follow-up. Of the 28 patients, MRI revealed an unsuspected diagnosis explaining the cause of prosthesis failure in 15 patients. In eight of 15 patients in this group, subsequent minimally invasive image-guided intervention obviated the need for revision total hip replacement. No cause for prosthesis failure was identified in 13 patients. MRI may be successfully undertaken in patients following total hip replacement, and, when performed, it frequently leads to an unsuspected diagnosis, allowing informed patient treatment. In this study it allowed the identification of an unsuspected diagnosis in over 50% of cases. (orig.)

  18. Functional exercise after total hip replacement (FEATHER): a randomised control trial.

    LENUS (Irish Health Repository)

    Monaghan, Brenda

    2012-11-01

    Prolonged physical impairments in range of movement, postural stability and walking speed are commonly reported following total hip replacement (THR). It is unclear from the current body of evidence what kind of exercises should be performed to maximize patient function and quality of life.

  19. Comparison of different treatments of hip dislocation in dog and cat

    International Nuclear Information System (INIS)

    Brass, A.; Nolte, I.

    1994-01-01

    Over a period of three years 145 dogs and 51 cats were treated because of hip luxation. Besides closed reduction various surgical procedures were performed. Follow-up examinations were done between 6 month and 4 years after treatment or by questionnaire. Closed reduction was the method of choice in most cases. Postoperative treatment with an EHMER sling was advantageous to prevent reluxation. Under certain circumstances such as degenerative joint disease, long lasting hip luxation, concomitant fracture and reluxation surgical intervention was preferred

  20. Revision hip replacement for recurrent Hydatid disease of the pelvis: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Chandrasekar Coonoor R

    2010-03-01

    Full Text Available Abstract A case of a large recurrent hydatid cyst involving the right ilium and right hip treated with excision of the cyst, Total hip replacement and revision of the acetabular component with a Tripolar articulation for cyst recurrence and acetabular component loosening is presented along with a review of the relevant literature. To our knowledge there is no reported case of Total Hip replacement and revision for hydatid disease involving the bony pelvis.

  1. Hip Dislocation Increases Roughness of Oxidized Zirconium Femoral Heads in Total Hip Arthroplasty: An Analysis of 59 Retrievals

    Science.gov (United States)

    Moussa, Mohamed E.; Esposito, Christina I.; Elpers, Marcella E.; Wright, Timothy M.; Padgett, Douglas E.

    2014-01-01

    The aims of this study were to assess damage on the surface of retrieved oxidized zirconium metal (OxZr) femoral heads, to measure surface roughness of scratches, and to evaluate the extent of surface effacement using scanning electron microscopy (SEM). Ceramic zirconia-toughened alumina (ZTA) heads were analyzed for comparison. OxZr femoral heads explanted for recurrent dislocation had the most severe damage (p<0.001). The median surface roughness of damaged OxZr femoral heads was 1.49μm, compared to 0.084μm for damaged ZTA heads and 0.052μm for undamaged OxZr (p<0.001). This may be of clinical concern because increased surface roughness has the potential to increase the wear of polyethylene liners articulating against these OxZr heads in THA. PMID:25443362

  2. Magnetic resonance imaging features of complications following hip replacement: A pictorial review

    Directory of Open Access Journals (Sweden)

    Khushboo Pilania

    2016-01-01

    Full Text Available Hip replacement surgery helps millions of people worldwide walk painlessly each year. With increasing life spans and decreased clinical threshold for surgery, this number will continue to rise. With the increase in the number of surgeries and the longevity of implants, the need for early and prompt diagnosis of complications is also rising. This essay underlines the fact that magnetic resonance imaging on a 1.5T scanner with specialized metal artefact reduction sequences is a viable technique to image the post-arthroplasty hip and has vast potential in the prompt and early diagnosis of complications in these patients.

  3. Magnetic resonance imaging features of complications following hip replacement: A pictorial review

    International Nuclear Information System (INIS)

    Pilania, Khushboo; Jankharia, Bhavin

    2016-01-01

    Hip replacement surgery helps millions of people worldwide walk painlessly each year. With increasing life spans and decreased clinical threshold for surgery, this number will continue to rise. With the increase in the number of surgeries and the longevity of implants, the need for early and prompt diagnosis of complications is also rising. This essay underlines the fact that magnetic resonance imaging on a 1.5T scanner with specialized metal artefact reduction sequences is a viable technique to image the post-arthroplasty hip and has vast potential in the prompt and early diagnosis of complications in these patients

  4. Age Related Macular Degeneration and Total Hip Replacement Due to Osteoarthritis or Fracture: Melbourne Collaborative Cohort Study.

    Directory of Open Access Journals (Sweden)

    Elaine W Chong

    Full Text Available Osteoarthritis is the leading cause of total hip replacement, accounting for more than 80% of all total hip replacements. Emerging evidence suggests that osteoarthritis has a chronic inflammatory component to its pathogenesis similar to age-related macular degeneration. We evaluated the association between age-related macular degeneration and total hip replacement as proxy for severe osteoarthritis or fractured neck of femur in the Melbourne Collaborative Cohort Study. 20,744 participants had complete data on both age-related macular degeneration assessed from colour fundus photographs taken during 2003-2007 and total hip replacement. Total hip replacements due to hip osteoarthritis and fractured neck of femur during 2001-2011 were identified by linking the cohort records to the Australian Orthopedic Association National Joint Replacement Registry. Logistic regression was used to examine the association between age-related macular degeneration and risk of total hip replacement due to osteoarthritis and fracture separately, adjusted for confounders. There were 791 cases of total hip replacement for osteoarthritis and 102 cases of total hip replacement due to fractured neck of femur. After adjustment for age, sex, body mass index, smoking, and grouped country of birth, intermediate age-related macular degeneration was directly associated with total hip replacement for osteoarthritis (odds ratio 1.22, 95% CI 1.00-1.49. Late age-related macular degeneration was directly associated with total hip replacement due to fractured neck of femur (odds ratio 5.21, 95% CI2.25-12.02. The association between intermediate age-related macular degeneration and an increased 10-year incidence of total hip replacement due to osteoarthritis suggests the possibility of similar inflammatory processes underlying both chronic diseases. The association of late age-related macular degeneration with an increased 10-year incidence of total hip replacement due to fractured

  5. The effect of education and supervised exercise vs. education alone on the time to total hip replacement in patients with severe hip osteoarthritis. A randomized clinical trial protocol.

    Science.gov (United States)

    Jensen, Carsten; Roos, Ewa M; Kjærsgaard-Andersen, Per; Overgaard, Søren

    2013-01-14

    The age- and gender-specific incidence of total hip replacement surgery has increased over the last two decades in all age groups. Recent studies indicate that non-surgical interventions are effective in reducing pain and disability, even at later stages of the disease when joint replacement is considered. We hypothesize that the time to hip replacement can be postponed in patients with severe hip osteoarthritis following participation in a patient education and supervised exercise program when compared to patients receiving patient education alone. A prospective, blinded, parallel-group multi-center trial (2 sites), with balanced randomization [1:1]. Patients with hip osteoarthritis and an indication for hip replacement surgery, aged 40 years and above, will be consecutively recruited and randomized into two treatment groups. The active treatment group will receive 3 months of supervised exercise consisting of 12 sessions of individualized, goal-based neuromuscular training, and 12 sessions of intensive resistance training plus patient education (3 sessions). The control group will receive only patient education (3 sessions). The primary end-point for assessing the effectiveness of the intervention is 12 months after baseline. However, follow-ups will also be performed once a year for at least 5 years. The primary outcome measure is the time to hip replacement surgery measured on a Kaplain-Meier survival curve from time of inclusion. Secondary outcome measures are the five subscales of the Hip disability and Osteoarthritis Outcome Score, physical activity level (UCLA activity score), and patient's global perceived effect. Other measures include pain after exercise, joint-specific adverse events, exercise adherence, general health status (EQ-5D-5L), mechanical muscle strength and performance in physical tests. A cost-effectiveness analysis will also be performed. To our knowledge, this is the first randomized clinical trial comparing a patient education plus

  6. Cost-effectiveness of enhanced recovery in hip and knee replacement: a systematic review protocol.

    Science.gov (United States)

    Murphy, Jacqueline; Pritchard, Mark G; Cheng, Lok Yin; Janarthanan, Roshni; Leal, José

    2018-03-14

    Hip and knee replacement represents a significant burden to the UK healthcare system. 'Enhanced recovery' pathways have been introduced in the National Health Service (NHS) for patients undergoing hip and knee replacement, with the aim of improving outcomes and timely recovery after surgery. To support policymaking, there is a need to evaluate the cost-effectiveness of enhanced recovery pathways across jurisdictions. Our aim is to systematically summarise the published cost-effectiveness evidence on enhanced recovery in hip and knee replacement, both as a whole and for each of the various components of enhanced recovery pathways. A systematic review will be conducted using MEDLINE, EMBASE, Econlit and the National Health Service Economic Evaluations Database. Separate search strategies were developed for each database including terms relating to hip and knee replacement/arthroplasty, economic evaluations, decision modelling and quality of life measures.We will extract peer-reviewed studies published between 2000 and 2017 reporting economic evaluations of preoperative, perioperative or postoperative enhanced recovery interventions within hip or knee replacement. Economic evaluations alongside cohort studies or based on decision models will be included. Only studies with patients undergoing elective replacement surgery of the hip or knee will be included. Data will be extracted using a predefined pro forma following best practice guidelines for economic evaluation, decision modelling and model validation.Our primary outcome will be the cost-effectiveness of enhanced recovery (entire pathway and individual components) in terms of incremental cost per quality-adjusted life year. A narrative synthesis of all studies will be presented, focussing on cost-effectiveness results, study design, quality and validation status. This systematic review is exempted from ethics approval because the work is carried out on published documents. The results of the review will be

  7. Outcome of one stage combined open reduction, pelvic and derotation femoral osteotomy in congenital dislocated hips of children younger than three years age

    International Nuclear Information System (INIS)

    Bhatti, A.; Kumar, J.; Butt, S. A.

    2014-01-01

    Objective: To determine the outcome of one-stage combined operative management of congenital dislocation of hips in children aged 18-36 months. Methods: The descriptive case series study was conducted at the Department of Orthopaedic Surgery, Jinnah Postgraduate Medical Centre, Karachi, from January 2005 to December 2011. Children aged 18-36 months suffering from congenital dislocation of hips were included. Those with Tonnis stage III and IV were managed with one-stage operative procedure without preliminary traction. The operative procedure included adductor tenotomy, open reduction, capsulorraphy, Salter's osteotomy and a femoral derotation osteotomy. Catteral's 'Test of Stability' was used after open reduction as an indicator for need of pelvic and femoral osteotomies. Follow-up ranged between 1 and 7 years. The patients were evaluated clinically on McKay's criteria and radiologically on Severin's criteria. Klisic's overall rating was used to know mean of the assessments. Results: There were 38 patients with 50 congenital dislocations of hip. There were 26(68.42%) females and 12(31.57%) males with a female-to-male ratio of 2:1. Mean age at the time of operation was 24.26+-7.6 months. Of the total, 12(31.57%) patients had bilateral involvement, 11(28.94%) had right-sided and 15(39.47%) had left- sided involvement. Right side to Left ratio was 1:1.2. At the time of last follow-up, 25(50%) hips behaved excellent on McKay's criteria. According to radiographic classification on Severin's criteria, 24(48%) hips were in excellent class. Avascular necrosis of femoral head was noted in 3(6%) hips, re-subluxation/re-dislocations were observed in 3(6%) hips and 1(2.6%) patient had 1cm femoral lengthening. Conclusion: One-stage open reduction, capsulorrapyhy, Salter's osteotomy and femoral derotation osteotomy without preliminary traction to re-locate congenital dislocation of hips in late presenting children is a safe and highly effective method. It produces a low rate of

  8. Risk factors for perioperative hyperglycemia in primary hip and knee replacements

    Science.gov (United States)

    Jämsen, Esa; Nevalainen, Pasi I; Eskelinen, Antti; Kalliovalkama, Jarkko; Moilanen, Teemu

    2015-01-01

    Background and purpose Background and purpose — Perioperative hyperglycemia has been associated with adverse outcomes in several fields of surgery. In this observational study, we identified factors associated with an increased risk of hyperglycemia following hip and knee replacement. Patients and methods Patients and methods — We prospectively monitored changes in glucose following primary hip and knee replacements in 191 patients with osteoarthritis. Possible associations of patient characteristics and operation-related factors with hyperglycemia (defined as glucose > 7.8 mmol/L in 2 consecutive measurements) and severe hyperglycemia (glucose > 10 mmol/L) were analyzed using binary logistic regression with adjustment for age, sex, operated joint, and anesthesiological risk score. Results Results — 76 patients (40%) developed hyperglycemia, and 48 of them (25% of the whole cohort) had severe hyperglycemia. Glycemic responses were similar following hip replacement and knee replacement. Previously diagnosed diabetes was associated with an increased risk of hyperglycemia and severe hyperglycemia, compared to patients with normal glucose metabolism, whereas newly diagnosed diabetes and milder glucose metabolism disorders had no effect. In patients without previously diagnosed diabetes, increased values of preoperative glycosylated hemoglobin (HbA1c) and fasting glucose on the day of operation were associated with hyperglycemia. Higher anesthesiological risk score—but none of the operation-related factors analyzed—was associated with an increased risk of hyperglycemia. Interpretation Interpretation — Perioperative hyperglycemia is common in primary hip and knee replacements. Previously diagnosed diabetes is the strongest risk factor for hyperglycemia. In patients with no history of diabetes, preoperative HbA1c and fasting glucose on the day of operation can be used to stratify the risk of hyperglycemia. PMID:25409255

  9. Feasibility of Early-Initiated Progressive Resistance Training after Total Hip Replacement

    DEFF Research Database (Denmark)

    Mikkelsen, Lone Ramer; Mechlenburg, Inger; Petersen, Annemette Krintel

    during the exercises were measured at each training session. Isometric muscle strength was measured before and 4 weeks after the THR. Findings / Results: Pain during exercises and resting pain before and after each training session was unchanged or decreased during the 4 weeks of training. Averaged...... across exercises pain during training decreased from 3.6 (sd: 2.8) at the first session to 1.52 (sd: 1.8) VAS-mm at the last session, ptraining load increased progressively for all 4 exercises during the 4 weeks of training. For example: 2nd, 5th and 8th training session. Hip......Background: Muscle atrophy, reduced hip muscle strength and function are documented within the first weeks after Total Hip Replacement (THR). Purpose / Aim of Study: The purpose of this study was to evaluate the feasibility of early-initiated progressive resistance training (PRT) after THR...

  10. EXPERIMENTAL RESEARCH OF REGENERATIVE FEATURES IN BONE TISSUES AROUND IMPLANTS AFTER ONE-STAGE BILATERAL TOTAL HIP REPLACEMENT

    Directory of Open Access Journals (Sweden)

    V. M. Mashkov

    2012-01-01

    Full Text Available Objective: to research the specific features of regenerative processes of bone tissue around implants after one-stage bilateral total hip replacement in experiment. Material and methods: 27 total hip replacement operations have been performed in 18 rabbits of breed "chinchilla" to which bipolar femoral endoprosthesis made of titanic alloy PT-38, one type-size, with friction pair metal-on-metal and neck-shaft angle 165 degrees have been implanted: total unilateral hip replacement operations have been performed in 9 animals (control group, one-stage bilateral total hip replacement operations have been performed in 9 animals (experimental group. During research they have been on radiological and clinical checking-up. After the experiment the animals had histological tests of the tissues around endoprosthesis components. Results and conclusions: After one-stage bilateral total hip replacement in early terms of research more expressed changes of bone tissue in the form of its thinning and decompaction were found around implants. One-stage bilateral total hip replacement did not essentially influence on the speed of osteogenesis around endoprothesis components in comparison with unilateral total hip replacement, so in late terms of observation in both groups the fixing of endoprothesis components did not differ.

  11. FIVE YEAR OUTCOMES OF CERAMIC-ОN-CERAMIC AND CERAMIC-ОN-POLYETHYLENE BEARINGS IN HIP JOINT REPLACEMENT

    Directory of Open Access Journals (Sweden)

    V. Yu. Murylev

    2017-01-01

    Full Text Available In view of the increasing number of hip joint replacement volume there remains the key issue of improving prosthesis survivorship which directly depends on the friction couple. Material and methods. The authors have analyzed five year outcomes of two bearing types (head and insert used in hip replacement: ceramic-on-ceramic (CoC in 324 patients and ceramic-on-polyethylene (CoP in 300 patients. Totally 550 patients were operated in the period starting 2010 till 2014, including 74 patients underwent bilateral hip replacement. The authors divided patients based on gender and also into three age groups: 20-40, 41-60 and 61-80 years old. The largest group comprised 156 women aged 41-60 years (28.4%. Additional grouping of patients was made based on gender, age and bearing diameter.36 mm diameter bearing was characterized of the most frequent use. Functional outcomes were assessed by Harris Hip Score. Statistical analysis was made with Statistica 10 software. Statistical significant was observed at p<0.05.Results.28 mm diameter bearing were rarely (19.5% applied and mainly in women which is related to need for use of smaller acetabulum components and inability to implant a larger insert.36 mm diameter bearing were used most frequently, CoC articulation of36 mm was used in men in 34% of cases and in women – in 18.12% of cases.40 mm articulations were implanted in women two times less than in men which is related to a smaller diameter of acetabulum in women. Generally, CoC bearings were implanted more often in men which can be explained by a bigger social demand as well as a higher anti-luxation stability of large diameter bearings. Dislocations of implants occurred in 5 (0.91% patients: in 4 patients with CoP bearingand in one patient with CoC articulation. Four revision procedures (0.64% were made due to deep periprosthetic infection: two surgeries in each group. Harris Hip Score evaluation in CoC group demonstrated excellent and good outcomes in

  12. The effects of the empowerment education program in older adults with total hip replacement surgery.

    Science.gov (United States)

    Huang, Tzu-Ting; Sung, Chia-Chun; Wang, Woan-Shyuan; Wang, Bi-Hwa

    2017-08-01

    To measure the effectiveness of an education empowerment program on primary (self-efficacy and self-care competence) and secondary outcomes (Activities of Daily Life, mobility, depressive mood and quality of life) for older adults with total hip replacement surgery. Degenerative arthritis is a common and serious chronic illness that impacts the quality of life of older adults. As joints continue to degenerate and the hip damaged by arthritis, activities of daily life will be difficult to perform due to severe hip pain and joint stiffness. Therefore, hip replacement surgery should be considered and effective nursing care should be provided to improve the recovery of older adults. A prospective randomized control trial. A trial was conducted from September 2013 - May 2014 in two hospitals in northern Taiwan. 108 participants were random assigned to either the education empowerment group or in the comparison group. The researchers collected baseline data at admission and outcomes on the day of discharge, one month after and three months after the discharge. After the interventions, the education empowerment group participants demonstrated significantly higher self-care competence and self-efficacy and lower depressive inclinations compared with those in the comparison group. Participants in both groups significantly improved on activities of daily life, mobility and quality of life over the course of the interventions. This education empowerment intervention was very effective in enhancing participants' outcomes. Moreover, involving both older adults and their caregivers for the participation this program is recommended for a greater impact. © 2017 John Wiley & Sons Ltd.

  13. The relationship of hospital charges and volume to surgical site infection after total hip replacement.

    Science.gov (United States)

    Boas, Rebecca; Ensor, Kelsey; Qian, Edward; Hutzler, Lorraine; Slover, James; Bosco, Joseph

    2015-05-01

    The purpose of this study was to analyze the effect of hospital volume and charges on the rate of surgical site infections for total hip replacements (THRs) in New York State (NYS). In NYS, higher volume hospitals have higher charges after THR. The study team analyzed 93,620 hip replacements performed in NYS between 2008 and 2011. Hospital charges increased significantly from $43,713 in 2008 to $50,652 in 2011 (P<.01). Compared with lower volume hospitals, patients who underwent THR at the highest volume hospitals had significantly lower surgical site infection rates (P=.003) and higher total hospital charges (P<.0001). The study team found that in the highest volume hospitals, preventing one surgical site infection was associated with $1.6 million dollars in increased charges. © 2014 by the American College of Medical Quality.

  14. The influence of optimism on functionality after total hip replacement surgery.

    Science.gov (United States)

    Balck, Friedrich; Lippmann, Maike; Jeszenszky, Csilla; Günther, Klaus-Peter; Kirschner, Stephan

    2016-08-01

    Among other factors, optimism has been shown to significantly influence the course of some diseases (cancer, HIV, coronary heart disease). This study investigated whether optimism of a patient before a total hip replacement can predict the functionality of the lower limbs 3 and 6 months after surgery. A total of 325 patients took part in the study (age: 58.7 years; w: 55%). The functionality was measured with the Western Ontario and McMaster Universities arthrosis index, and optimism with the Life Orientation Test. To analyse the influences of age, gender and optimism, general linear models were calculated. In optimistic patients, functionality improved significantly over time. The study showed a clear influence of dispositional optimism on the recovery after total hip replacement in the first 3 months after surgery. © The Author(s) 2015.

  15. [Efficacy of health education on patients with hip replacement based on the Internet].

    Science.gov (United States)

    Zhou, Yang; Yang, Tubao; Li, Yinglan; Yu, Jie; Zeng, Biyun

    2015-03-01

    To evaluate the efficacy of health education on patients with hip replacement based on the Internet, and to establish a new health education model through modern technology. A total of 300 patients with hip replacement from March to August, 2015 were enrolled in this study. The participants were divided into a control group and an experimental group according to months surgeries performed. Traditional education was applied in the control group while the multimedia source material plus the Internet platform of Joint Registration System were applied in the experimental group. Levels of anxiety, degree of satisfaction, and postoperative complications were analyzed. The levels of knowledge, attitude and behavior compliance in the patients of the experimental group were significantly improved, while the levels of postoperative anxiety were decreased compared with those in the control group (PEducation based on the Internet platform of Joint Registration System and the computer video could improve patients' knowledge, attitude, and behavior, which is worthy of clinical spread.

  16. Lifetime risk of primary total hip replacement surgery for osteoarthritis from 2003-2013

    DEFF Research Database (Denmark)

    Ackerman, Ilana N; Bohensky, Megan A; de Steiger, Richard

    2017-01-01

    OBJECTIVE: To compare the lifetime risk of total hip replacement surgery (THR) for osteoarthritis (OA) between countries, and over time. METHODS: Data on primary THR procedures performed for OA in 2003 and 2013 were extracted from national arthroplasty registries in Australia, Denmark, Finland, N....... These multi-national risk estimates can inform resource planning for OA service delivery. This article is protected by copyright. All rights reserved....

  17. Medial versus anterior open reduction for developmental hip dislocation in age-matched patients.

    Science.gov (United States)

    Hoellwarth, Jason S; Kim, Young-Jo; Millis, Michael B; Kasser, James R; Zurakowski, David; Matheney, Travis H

    2015-01-01

    The difference between medial (MAOR) and anterior (AAOR) approaches for open reduction of developmental hip dysplasia in terms of risk for avascular necrosis (AVN) and need for further corrective surgery (FCS, femoral and/or acetabular osteotomy) is unclear. This study compared age-matched cohorts undergoing either MAOR or AAOR in terms of these 2 primary outcomes. Prognostic impact of presence of ossific nucleus at time of open reduction was also investigated. Institutional review board approval was obtained. Nineteen hips (14 patients) managed by MAOR were matched with 19 hips (18 patients) managed by AAOR based on age at operation (mean 6.0; range, 1.4 to 14.9 mo). Patients with neuromuscular conditions and known connective tissue disorders were excluded. Primary outcomes assessed at minimum 2 years' follow-up included radiographic evidence of AVN (Kalamchi and MacEwen) or requiring FCS. MAOR and AAOR cohorts were similar regarding age at open reduction, sex, laterality, and follow-up duration. One hip in each group had AVN before open reduction thus were excluded from AVN analysis. At minimum 2 years postoperatively (mean 6.2; range, 1.8 to 11.7 y), 4/18 (22%) MAOR and 5/18 (28%) AAOR met the same criteria for AVN (P=1.0). No predictors of AVN could be identified by regression analysis. Presence of an ossific nucleus preoperatively was not a protective factor from AVN (P=0.27). FCS was required in 4/19 (21%) MAOR and 7/19 (37%) AAOR hips (P=0.48). However, 7/12 (54%) hips failing closed reduction required FCS compared with 4/26 (16%) hips without prior failed closed reduction (P=0.024). Cox regression analysis showed that patients who failed closed reduction had an annual risk of requiring FCS approximately 6 times that of patients without a history of failed closed reduction (hazard ratio=6.1; 95% CI, 1.5-24.4; P=0.009), independent of surgical approach (P=0.55) or length of follow-up (P=0.78). In this study of age-matched patients undergoing either MAOR or

  18. Preoperative irradiation for prevention of heterotopic ossification following prosthetic total hip replacement. Results of a prospective study in 462 hips

    Energy Technology Data Exchange (ETDEWEB)

    Koelbl, O.; Seufert, J.; Pohl, F.; Flentje, M. [Univ. Wuerzburg (Germany). Klinik and Poliklinik for Radiotherapy; Tauscher, A.; Springorum, H.W. [Caritas Hospital, Bad Mergentheim (Germany). Orthopedic Clinic; Lehmann, H. [Caritas Hospital, Bad Mergentheim (Germany). Inst. of Radiology

    2003-11-01

    Background: The effectiveness of pre- or postoperative radiotherapy for prevention of heterotopic ossification (HO) following total hip replacement (THR) has already been demonstrated in the past. Thereby, in most studies using preoperative radiotherapy patients were irradiated < 6 h before surgery. The purpose of this prospective study was to analyze the effectiveness of preoperative irradiation on the evening before surgery and to identify risk factors for HO in a homogeneous collective of patients. Patients and Methods: From July 1997 to July 2001, 416 patients (462 hips; 235 males, 227 females) received preoperative radiotherapy of the hip on the evening before surgery with a 7-Gy single fraction. The patients' median age was 67.1 years. The most frequent indication for radiotherapy was hypertrophic osteoarthritis (383 hips, 82.9%). Treatment results were assessed by comparison of pre- and postoperative hip X-rays (immediately and 6 months after surgery). The analysis of radiographs was performed according to the Brooker score. Results: The overall incidence of HO was 18.1% (n = 84), Brooker score 1 12.3% (n = 57), score 2 3.9% (n = 18), score 3 1.5% (n = 7), and score 4 0.4% (n = 2). Sex, body height, hypertrophic osteoarthritis of higher degree, size of the femoral component of the prosthesis, previous ipsi- or contralateral HO, and short course of nonsteroidal anti-inflammatory drug (diclofenac) therapy significantly influenced the HO rate in univariate analysis. In multivariate analysis, an interdependence of prosthesis size, sex and patient's height was found. From these three variables, only prosthesis size was statistically significant in multivariate analysis. The cumulative dose of diclofenac ({<=} 300 mg or > 300 mg) within the first 7 postoperative days and previous ipsi- or contralateral HO influenced the incidence of HO in multivariate analysis. Conclusion: Preoperative radiotherapy on the evening before surgery is an effective treatment

  19. Using a calliper to restore the centre of the femoral head during total hip replacement.

    Science.gov (United States)

    Hill, J C; Archbold, H A P; Diamond, O J; Orr, J F; Jaramaz, B; Beverland, D E

    2012-11-01

    Restoration of leg length and offset is an important goal in total hip replacement. This paper reports a calliper-based technique to help achieve these goals by restoring the location of the centre of the femoral head. This was validated first by using a co-ordinate measuring machine to see how closely the calliper technique could record and restore the centre of the femoral head when simulating hip replacement on Sawbone femur, and secondly by using CT in patients undergoing hip replacement. Results from the co-ordinate measuring machine showed that the centre of the femoral head was predicted by the calliper to within 4.3 mm for offset (mean 1.6 (95% confidence interval (CI) 0.4 to 2.8)) and 2.4 mm for vertical height (mean -0.6 (95% CI -1.4 to 0.2)). The CT scans showed that offset and vertical height were restored to within 8 mm (mean -1 (95% CI -2.1 to 0.6)) and -14 mm (mean 4 (95% CI 1.8 to 4.3)), respectively. Accurate assessment and restoration of the centre of the femoral head is feasible with a calliper. It is quick, inexpensive, simple to use and can be applied to any design of femoral component.

  20. Flowtron foot-pumps for prevention of venous thromboembolism in total hip and knee replacement.

    Science.gov (United States)

    Pitto, Rocco P; Koh, Chuan K

    2015-03-01

    Mechanical prophylaxis with foot-pumps provides an interesting alternative to chemical agents in the prevention of venous thomboembolism following major orthopaedic surgery procedures. The aim of this prospective study was to assess efficacy and safety of the Flowtron(®) foot-pumps system following total hip and knee replacement. The foot pumps were used as main tool for prevention of thromboembolic events, in most cases in association with a variety of chemicals. The primary endpoint of the study was to assess the incidence of deep vein thrombosis and pulmonary embolism after total hip and knee replacement. The secondary endpoints included postoperative bleeding, swelling, bruising and wound ooze. 424 consecutive patients were included in the study. Symptomatic deep vein thrombosis was detected in 7 patients (1.6%). All symptomatic deep vein thromboses were detected after discharge before the six week follow-up clinic. Five non-fatal pulmonary embolisms occurred (1.2%). Only one patient presented a major wound bleeding (0.2%). The mean difference of swelling of thigh pre-versus postoperatively was only 22.8 mm. In conclusion, thromboembolism prophylaxis after total hip and knee replacement using Flowtron(®) foot-pumps as main prevention tool of an individualised protocol appears effective and safe. This is the first clinical report related to this popular brand of foot pumps.

  1. Patterns of postural deformity in non-ambulant people with cerebral palsy: what is the relationship between the direction of scoliosis, direction of pelvic obliquity, direction of windswept hip deformity and side of hip dislocation?

    Science.gov (United States)

    Porter, David; Michael, Shona; Kirkwood, Craig

    2007-12-01

    To investigate: (a) associations between the direction of scoliosis, direction of pelvic obliquity, direction of windswept deformity and side of hip subluxation/ dislocation in non-ambulant people with cerebral palsy; and (b) the lateral distribution of these postural asymmetries. Cross-sectional observational study. Posture management services in three centres in the UK. Non-ambulant people at level five on the gross motor function classification system for cerebral palsy. Direction of pelvic obliquity and lateral spinal curvature determined from physical examination, direction of windswept hip deformity derived from range of hip abduction/adduction, and presence/side of unilateral hip subluxation defined by hip migration percentage. A total of 747 participants were included in the study, aged 6-80 years (median 18 years 10 months). Associations between the direction of scoliosis and direction of pelvic obliquity, and between the direction of windswept hip deformity and side hip subluxation/dislocation were confirmed. A significant association was also seen between the direction of scoliosis and the direction of the windswept hip deformity (P<0.001) such that the convexity of the lateral spinal curve was more likely to be opposite to the direction of windsweeping. Furthermore, significantly more windswept deformities to the right (P=0.007), hips subluxed on the left (P=0.002) and lateral lumbar/lower thoracic spinal curves convex to the left (P=0.03) were observed. The individual asymmetrical postural deformities are not unrelated in terms of direction and not equally distributed to the left/right. A pattern of postural deformity was observed.

  2. Total hip replacement with a superolateral bone graft for osteoarthritis secondary to dysplasia: a long-term follow-up

    NARCIS (Netherlands)

    de Jong, P. T.; Haverkamp, D.; van der Vis, H. M.; Marti, R. K.

    2006-01-01

    We evaluated the long-term results of 116 total hip replacements with a superolateral shelfplasty in 102 patients with osteoarthritis secondary to developmental dysplasia of the hip. After a mean follow-up of 19.5 years (11.5 to 26.0), 14 acetabular components (12%) had been revised. The cumulative

  3. CT-based quantification of bone stock in large head metal-on-metal unilateral total hip replacements

    NARCIS (Netherlands)

    Boomsma, Martijn F.; Slouwerhof, Inge; van Lingen, Christiaan; Pakvis, Dean F. M.; van Dalen, Jorn A.; Edens, Mireille A.; Ettema, Harmen B.; Verheyen, Cees C. P. M.; Maas, Mario

    2016-01-01

    To explore ipsilateral and contralateral acetabular roof bone stock density in unilateral large head MoM THA whether there is a significant lower acetabular bone stock in the hip with a metal-on-metal (MoM) total hip replacement compared to the contralateral side. Second part of this study is to

  4. Stereo-radiographic analysis of loosening processes of alloplastic hip joint replacement

    International Nuclear Information System (INIS)

    Probst, K.J.

    1980-01-01

    A computer-aided diagnostic system has been developed by which implant dislocation of an order of 0.2 mm can be detected in all three dimensions. The diagnostic system is based on a point-by-point evaluation of stereoradiographic pictures; precise localisation of the implant relative to its place of insertion is made possible by special mathematical operations which are discussed in detail in the methodical part of the book. The method has been tested in clinical practice in 351 cases (208 patients) in the period between September 1, 1977, and May 31, 1979. By taking functional pictures during adduction and abduction of the extremity carrying the endoprosthesis and then evaluating these pictures, the diagnostic system can detect dislocations of the endoprosthesis inside the bone at a given moment. Also, the fate of hip joints with endoprostheses can be followed in the framework of longitudinal research. The method described here may also help to solve other problems of clinical relevance. The only precondition for this is the imaging of the structures of interest in the X-ray picture. A program to analyze loosening processes of alloplastic knee joint implants is new being worked on which will be of great use to the increasing number of patients with alloplastic knee joint implants. (orig./MG) [de

  5. Cost-effectiveness of total hip and knee replacements for the Australian population with osteoarthritis: discrete-event simulation model.

    Directory of Open Access Journals (Sweden)

    Hideki Higashi

    Full Text Available BACKGROUND: Osteoarthritis constitutes a major musculoskeletal burden for the aged Australians. Hip and knee replacement surgeries are effective interventions once all conservative therapies to manage the symptoms have been exhausted. This study aims to evaluate the cost-effectiveness of hip and knee replacements in Australia. To our best knowledge, the study is the first attempt to account for the dual nature of hip and knee osteoarthritis in modelling the severities of right and left joints separately. METHODOLOGY/PRINCIPAL FINDINGS: We developed a discrete-event simulation model that follows up the individuals with osteoarthritis over their lifetimes. The model defines separate attributes for right and left joints and accounts for several repeat replacements. The Australian population with osteoarthritis who were 40 years of age or older in 2003 were followed up until extinct. Intervention effects were modelled by means of disability-adjusted life-years (DALYs averted. Both hip and knee replacements are highly cost effective (AUD 5,000 per DALY and AUD 12,000 per DALY respectively under an AUD 50,000/DALY threshold level. The exclusion of cost offsets, and inclusion of future unrelated health care costs in extended years of life, did not change the findings that the interventions are cost-effective (AUD 17,000 per DALY and AUD 26,000 per DALY respectively. However, there was a substantial difference between hip and knee replacements where surgeries administered for hips were more cost-effective than for knees. CONCLUSIONS/SIGNIFICANCE: Both hip and knee replacements are cost-effective interventions to improve the quality of life of people with osteoarthritis. It was also shown that the dual nature of hip and knee OA should be taken into account to provide more accurate estimation on the cost-effectiveness of hip and knee replacements.

  6. Usability Test of Exercise Games Designed for Rehabilitation of Elderly Patients After Hip Replacement Surgery: Pilot Study

    NARCIS (Netherlands)

    Y. Ling (Yun); L.P.D.M. ter Meer (Louis); Z. Yumak (Zerrin); R.C. Veltkamp (Remco)

    2017-01-01

    markdownabstractBACKGROUND: Patients who receive rehabilitation after hip replacement surgery are shown to have increased muscle strength and better functional performance. However, traditional physiotherapy is often tedious and leads to poor adherence. Exercise games, provide ways for increasing

  7. Long-Acting Morphine Following Hip or Knee Replacement: A Randomized, Double-Blind, Placebo-Controlled Trial

    Directory of Open Access Journals (Sweden)

    Shirley L Musclow

    2012-01-01

    Full Text Available BACKGROUND: Patients undergoing total hip or knee replacement surgery experience unmanaged pain during postoperative physiotherapy sessions. It was theorized that a baseline opioid would improve pain management.

  8. Prevention of deep vein thrombosis after hip replacement: randomised comparison between unfractionated heparin and low molecular weight heparin

    NARCIS (Netherlands)

    Leyvraz, P. F.; Bachmann, F.; Hoek, J.; Büller, H. R.; Postel, M.; Samama, M.; Vandenbroek, M. D.

    1991-01-01

    To evaluate the efficacy and safety of two subcutaneous prophylactic regimens for postoperative deep vein thrombosis after total hip replacement. Prospective open randomised multicentre trial. 28 European departments of orthopaedic surgery. All patients had bilateral phlebography 10 days after

  9. DIFFICULTIeS OF TOTAL HIP REPLACEMENT IN PATIENTS WITH ANKYLOSING SPONDYLITIS (case report

    Directory of Open Access Journals (Sweden)

    R. M. Tikhilov

    2016-01-01

    Full Text Available A distinctive feature of patients with ankylosing spondylitis is the formation of hip ankylosis in an extremely unfavorable functional position combined with upset of sagittal balance of the body along with a thoracolumbar kyphosis. Treatment of these patients poses considerable technical difficulties and is often associated with complications. The authors report a clinical case of a female 40 years old patient with confirmed rhizomelic spondylitis. The patient mainly complained of fixed malposition of the right lower extremity (hip ankylosis in extreme 1450 flexion and 1500 abduction combined with a severe fixed spine deformity (thoracic kyphosis 920, lumbar lordosis 170. Considering significant sagittal balance disorder it was decided to go for a two-stage procedure. Total hip arthroplasty of the right joint was performed at the first stage. At the second stage the authors corrected thoracolumbar spinal deformity by Th12 (type PSO 4 and L2 (type PSO 3 wedge resections and converging resected vertebral bodies by a multilevel fixation system with transpedicular support elements. The interval between the stages was 11 months. Two-stage treatment of this patient al-lowed to avoid adverse postoperative complications and to achieve a significant functional improvement in one year after treatment started. The sum of points before and after the treat-ment amounted respectively to 46 and 79 on Harris Hip Score, 17 and 38 points on Oxford Hip Score (OHS. To summarize, comprehensive treatment with planning of all subsequent steps prior to hip replacement is the method of choice for avoidance of postoperative complications in patients with ankylosing spondylitis accompanied by a significant upset of sagittal balance.

  10. MRI as a reliable and accurate method for assessment of posterior hip dislocation in children and adolescents without the risk of radiation exposure

    Energy Technology Data Exchange (ETDEWEB)

    Mayer, Stephanie W.; Kestel, Lauryn; Novais, Eduardo N. [Children' s Hospital Colorado and University of Colorado School of Medicine, Department of Orthopaedic Surgery, Aurora, CO (United States); Stewart, Jaime R.; Fadell, Michael F. [Children' s Hospital Colorado, University of Colorado School of Medicine, Department of Radiology, Aurora, CO (United States)

    2015-08-15

    Posterior hip dislocation in children and adolescents may involve the non-ossified posterior acetabular wall. Plain radiographs and computed tomography (CT) have been shown to underestimate injury to the unossified acetabulum as well as associated soft-tissue structures. The purpose of this study was to describe findings on radiographs, CT and magnetic resonance imaging (MRI) after posterior hip dislocation in a series of adolescents and to report the intraoperative findings, which are considered the gold standard. Measurements of the posterior wall length using MRI and CT scans were also performed. After institutional review board approval, 40 patients who sustained a traumatic posterior dislocation of the hip between September 2007 and April 2014 were identified. Inclusion criteria were (1) age younger than 16 years old and (2) availability of MRI obtained following closed reduction of the hip. Eight male patients and one female patient with an average age of 13.2 years (range: 10.1-16.2 years) underwent hip MRI following posterior dislocation. Seven of the nine patients also underwent evaluation by CT. Plain radiographs, CT scans and MRI were evaluated in all patients by a single pediatric radiologist blinded to surgical findings for joint space asymmetry, posterior wall fracture, femoral head fracture, labrum tear, complete or partial ligamentum teres rupture and presence of intra-articular fragments. Six patients underwent surgical treatment and the intraoperative findings were compared with the imaging findings. CT identified all bone injuries but underestimated the involvement of posterior wall fractures. Assessment of the posterior wall size and fracture displacement was possible with MRI. All surgically confirmed soft-tissue injuries, including avulsion of the posterior labrum, were identified preoperatively on MRI. The measurement of posterior wall length was not statistically different using CT and MRI. Intraoperative pathological findings at the time of

  11. Routine one-stage exchange for chronic infection after total hip replacement.

    Science.gov (United States)

    Jenny, Jean-Yves; Lengert, Régis; Diesinger, Yann; Gaudias, Jeannot; Boeri, Cyril; Kempf, Jean-François

    2014-12-01

    We hypothesized that a routine one-stage exchange for treatment of chronically infected total hip replacement (THR) will lead to (1) a higher rate of infection recurrence and (2) a poorer hip outcome than the published rates after two-stage exchange. Sixty-five cases have been treated consecutively with one-stage exchange. All patients have been followed for a period of three to six years or until death or infection recurrence. The five-year rate for infection recurrence was 16%. The five-year survival rate for recurrence of the index infection was 8%. Forty-two percent of the hips had a good or excellent PMA score, and 46% a good or excellent OH score. Routine one-stage exchange was not associated with a higher recurrence rate and a poorer hip function than previously published series of two-stage exchange. Therefore, there is little support to choose two-stage exchange as the routine treatment for management of chronically infected THR.

  12. Posterior dislocation of a native hip joint associated with ipsilateral per-trochanteric fracture: A rare case report

    Directory of Open Access Journals (Sweden)

    Mazin Fageir

    2018-02-01

    Full Text Available We describe a case of traumatic posterior dislocation of a native hip joint associated with ipsilateral comminuted inter-trochanteric femoral fracture. In our case, closed reduction was attempted but proved unsuccessful. Taking into account the planned subsequent intra-medullary femoral nail, open reduction through a lateral incision was undertaken. Post-operatively, the planned mobility was for a non-weight bearing period of 6 weeks followed by a partial-weight bearing period of 6 weeks before progressing to full-weight bearing. Post-operatively, the patient completed a comprehensive course of physiotherapy. At five months, he was able to walk for five miles over the course of a weekend. At six months, the patient was looking at phased return to work as a fire fighter. Radiographs taken at the time demonstrated evidence of healing to his inter-trochanteric fracture. At ten months, the patient was back to normal duties at work as a fire fighter.

  13. Experience with Designing and Implementing a Bundled Payment Program for Total Hip Replacement.

    Science.gov (United States)

    Whitcomb, Winthrop F; Lagu, Tara; Krushell, Robert J; Lehman, Andrew P; Greenbaum, Jordan; McGirr, Joan; Pekow, Penelope S; Calcasola, Stephanie; Benjamin, Evan; Mayforth, Janice; Lindenauer, Peter K

    2015-09-01

    Bundled payments, also known as episode-based payments, are intended to contain health care costs and promote quality. In 2011 a bundled payment pilot program for total hip replacement was implemented by an integrated health care delivery system in conjunction with a commercial health plan subsidiary. In July 2015 the Centers for Medicare & Medicaid Services (CMS) proposed the Comprehensive Care for Joint Replacement Model to test bundled payment for hip and knee replacement. Stakeholders were identified and a structure for program development and implementation was created. An Oversight Committee provided governance over a Clinical Model Subgroup and a Financial Model Subgroup. The pilot program included (1) a clinical model of care encompassing the period from the preoperative evaluation through the third postoperative visit, (2) a pricing model, (3) a program to share savings, and (4) a patient engagement and expectation strategy. Compared to 32 historical controls-patients treated before bundle implementation-45 post-bundle-implementation patients with total hip replacement had a similar length of hospital stay (3.0 versus 3.4 days, p=.24), higher rates of discharge to home or home with services than to a rehabilitation facility (87% versus 63%), similar adjusted median total payments ($22,272 versus $22,567, p=.43), and lower median posthospital payments ($704 versus $1,121, p=.002), and were more likely to receive guideline-consistent care (99% versus 95%, p=.05). The bundled payment pilot program was associated with similar total costs, decreased posthospital costs, fewer discharges to rehabilitation facilities, and improved quality. Successful implementation of the program hinged on buy-in from stakeholders and close collaboration between stakeholders and the clinical and financial teams.

  14. Effect of preoperative education of patients before hip or knee replacement surgery: A systematic review

    DEFF Research Database (Denmark)

    Aydin, Dogu; Klit, Jakob; Husted, Henrik

    2013-01-01

    Background Total hip (THA) and knee arthroplasty (TKA) are standard procedures for treatment of end stage osteoarthritis, and much is done to optimize results. It is usually hypothesized that education of patients before surgery reduces anxiety, secures more realistic patient expectations...... and enhances postoperative outcomes. Objectives To determine whether results reported in the literature proves an effect of preoperative education on postoperative outcomes in replacement surgery patients regarding anxiety, pain, length of hospital stay, patient satisfaction, postoperative complications...... visual) given by health professionals to patients were included. Results Seven studies involving 677 participants met the inclusion criteria. Two studies involved patients undergoing THA replacement, while five studies involved patients undergoing both THA and TKA replacement surgery. Mean number...

  15. Optimization of hip joint replacement location to decrease maximum von Mi ses Stress

    International Nuclear Information System (INIS)

    Pourjamali, H.; Najarian, S.; Katoozian, H. R.

    2001-01-01

    Hip replacement is used for inoperable femur head injuries and femur fractures where internal fixation can not be used. This operation is one of the most common orthopedic operations that many research have been done about it. Among these we can mention implant and cement materials and composites optimization and also implant shape optimization. This study was designed to optimize artificial hip joint position (placement) to decrease maximal von mi sees stress. First, a model of femur and implant were made and then a computer program was written with the ability to change the position of implant through an acceptable range in the femur. In each of these positions, the program simulated femur and implant according to finite element method and made, applied forces were weight and muscle traction. Our findings show that a small deviation of the implant from femur bone center causes a considerable decrease in von mi sees stress that consequently results in longer maintenance of the implant

  16. Preoperative widespread pain sensitization and chronic pain after hip and knee replacement: a cohort analysis

    Science.gov (United States)

    Wylde, Vikki; Sayers, Adrian; Lenguerrand, Erik; Gooberman-Hill, Rachael; Pyke, Mark; Beswick, Andrew D.; Dieppe, Paul; Blom, Ashley W.

    2015-01-01

    Abstract Chronic pain after joint replacement is common, affecting approximately 10% of patients after total hip replacement (THR) and 20% of patients after total knee replacement (TKR). Heightened generalized sensitivity to nociceptive input could be a risk factor for the development of this pain. The primary aim of this study was to investigate whether preoperative widespread pain sensitivity was associated with chronic pain after joint replacement. Data were analyzed from 254 patients receiving THR and 239 patients receiving TKR. Pain was assessed preoperatively and at 12 months after surgery using the Western Ontario and McMaster Universities Osteoarthritis Pain Scale. Preoperative widespread pain sensitivity was assessed through measurement of pressure pain thresholds (PPTs) at the forearm using an algometer. Statistical analysis was conducted using linear regression and linear mixed models, and adjustments were made for confounding variables. In both the THR and TKR cohort, lower PPTs (heightened widespread pain sensitivity) were significantly associated with higher preoperative pain severity. Lower PPTs were also significantly associated with higher pain severity at 12 months after surgery in the THR cohort. However, PPTs were not associated with the change in pain severity from preoperative to 12 months postoperative in either the TKR or THR cohort. These findings suggest that although preoperative widespread pressure pain sensitivity is associated with pain severity before and after joint replacement, it is not a predictor of the amount of pain relief that patients gain from joint replacement surgery, independent of preoperative pain severity. PMID:25599300

  17. The Symmetry of Adverse Local Tissue Reactions in Patients with Bilateral Simultaneous and Sequential ASR Hip Replacement.

    Science.gov (United States)

    Madanat, Rami; Hussey, Daniel K; Donahue, Gabrielle S; Potter, Hollis G; Wallace, Robert; Bragdon, Charles R; Muratoglu, Orhun K; Malchau, Henrik

    2015-10-01

    The purpose of this study was to evaluate whether patients with bilateral metal-on-metal (MoM) hip replacements have symmetric adverse local tissue reactions (ALTRs) at follow-up. An MRI of both hips was performed at a mean time of six years after surgery in 43 patients. The prevalence and severity of ALTRs were found to be similar in simultaneous hips but differences were observed in sequential hips. The order and timing of sequential hip arthroplasties did not affect the severity of ALTRs. Thus, in addition to metal ion exposure from an earlier MoM implant other factors may also play a role in the progression of ALTRs. Bilateral implants should be given special consideration in risk stratification algorithms for management of patients with MoM hip arthroplasty. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Can Surgeons Reduce the Risk for Dislocation After Primary Total Hip Arthroplasty Performed Using the Posterolateral Approach?

    DEFF Research Database (Denmark)

    Seagrave, Kurt G; Troelsen, Anders; Madsen, Bjørn G

    2017-01-01

    was used to identify risk factors for dislocation. Follow-up was coordinated by the Danish National Patient Registry. RESULTS: Age and American Society of Anesthesiologists scores were higher in dislocating THA compared with those in the nondislocating THA. Cup anteversion was less in dislocating THA...

  19. Novel chitosan/diclofenac coatings on medical grade stainless steel for hip replacement applications

    Science.gov (United States)

    Finšgar, Matjaž; Uzunalić, Amra Perva; Stergar, Janja; Gradišnik, Lidija; Maver, Uroš

    2016-05-01

    Corrosion resistance, biocompatibility, improved osteointegration, as well the prevention of inflammation and pain are the most desired characteristics of hip replacement implants. In this study we introduce a novel multi-layered coating on AISI 316LVM stainless steel that shows promise with regard to all mentioned characteristics. The coating is prepared from alternating layers of the biocompatible polysaccharide chitosan and the non-steroid anti-inflammatory drug (NSAID), diclofenac. Electrochemical methods were employed to characterize the corrosion behavior of coated and uncoated samples in physiological solution. It is shown that these coatings improve corrosion resistance. It was also found that these coatings release the incorporated drug in controlled, multi-mechanism manner. Adding additional layers on top of the as-prepared samples, has potential for further tailoring of the release profile and increasing the drug dose. Biocompatibility was proven on human-derived osteoblasts in several experiments. Only viable cells were found on the sample surface after incubation of the samples with the same cell line. This novel coating could prove important for prolongation of the application potential of steel-based hip replacements, which are these days often replaced by more expensive ceramic or other metal alloys.

  20. Total knee replacement influences both knee and hip joint kinematics during stair climbing

    OpenAIRE

    Saari, Tuuli; Tranberg, Roy; Zügner, Roland; Uvehammer, Johan; Kärrholm, Johan

    2004-01-01

    A gait analysis system was used to evaluate the kinematics of the hip and knee during stair ascending and descending after operation with total knee replacement. Patients with 5° varus/valgus alignment or less were selected randomly to receive either a flat or a concave tibial component with retention of the posterior cruciate ligament. Patients who had more than 5° varus/valgus alignment and/or an extension defect of 10° or more were selected randomly to receive the concave or posterior-stab...

  1. Rehabilitation of patients aged 65 and over after total hip replacement

    DEFF Research Database (Denmark)

    Hørdam, Britta

    by a randomised clinical trial by using telephone interviews and counseling postoperatively, and testing improvement in patients´health status after THR. The last study involved testing the effect of nursing intervention by providing a measurement of patients´healthrelated quality of life.......The overall aim of this thesis was to investigate improvement in health status of patients aged 65 and over after total hip replacement (THR) as a result of nursing rehabilitation. The projects conssits of three studies, first a description of patients´health status after THR, followed...

  2. A case of severe ankylosing spondylitis posted for hip replacement surgery

    Directory of Open Access Journals (Sweden)

    Nalini Kotekar

    2007-01-01

    Full Text Available A 50-year-old male patient with history of ankylosing spondylitis (AS for 30 years presented for hip replacement surgery. Airway management in ankylosing spondylitis patients presents the most serious array of intubation and airway hazards imagin-able, which is secondary to decrease in cervical spine mobility and possible temporo-mandibular joint disease. Literatures support definitive airway management and many authors consider regional anaesthesia to be contraindicated. The reasons cited include inability to gain neuraxial access and the need for urgent airway control in case of complication of regional anaesthesia.

  3. Patient-related predictors of implant failure after primary total hip replacement in the initial, short- and long-terms

    DEFF Research Database (Denmark)

    Johnsen, S.P.; Sørensen, H.T.; Lucht, Ulf

    2006-01-01

    replacement, an age of 80 years or more and hip replacement undertaken as a sequela of trauma, for avascular necrosis or paediatric conditions, were associated with an increased risk of failure. However, during six months to 8.6 years after surgery, being less than 60 years old was associated...

  4. Infection imaging with 99mTc-biotin in patients with prosthetic hip replacement

    International Nuclear Information System (INIS)

    Villa, G.; Mariani, G.; Augeri, C.; Pipino, F.; Paganelli, G.; Chinol, M.

    2002-01-01

    Full text: Although the incidence of infection in prosthetic hip joint replacements has decreased from about 10-15 % to about 0.5-2 % over the last 20 years, the total number of infections has actually increased because of the large number of patients undergoing the procedure. The most frequent clinical presentation of this complication is functional impairment and pain, with or without fever and other signs and/or symptoms of infection. The main is differentiating true infection from simple loosening with inflammation of the implanted stem. Scintigraphy with radiolabeled autologous leukocytes (WBC) represents the 'gold standard' nuclear medicine procedure for imaging infection. However, this procedure is time-consuming, expensive, and involves some biological hazard. Preliminary data, obtained during validation of the avidin/111In-biotin approach, have suggested some potential of 111ln-biotin per se to accumulate at sites of infection. In this pilot study we explored the potential of 99mTc-biotin as an infection imaging agent in pts with orthopedic infections. N4-lys-biotin was labeled with 1110 MBq. Sixteen pts bearing a total of 20 prosthetic hip replacements were enrolled in the study (9 women and 7 men, mean age 73.2 yrs). Eight pts had previously undergone removal of their hip prosthesis because of infection, while infection was suspected in the remaining 8 pts. Scintigraphy was recorded 20 min, then 1, 4 and 24 hr after the i.v. injection of 99mTc-biotin. Within 48 hrs of the 99mTc-biotin study, all pts also underwent scintigraphy with 99mTc-HMPAO-WBC. Out of the 20 hips evaluated, 15 turned out to be infected while in the remaining 5 cases pain was only caused by bone-prosthetic loosening and/or conditions other than infection. In 12/15 infected sites scintigraphy was concordantly positive with both procedures, 99mTc-biotin yielding higher target-to-nontarget ratios than 99mTc-HMPAO-WBC in 4 cases and similar values in the other cases. Discordant patterns

  5. OPTIMAL IMPROVEMENT IN FUNCTION AFTER TOTAL HIP AND KNEE REPLACEMENT: HOW DEEP DO YOU KNOW YOUR PATIENT’S MIND?

    Science.gov (United States)

    De Caro, M F; Vicenti, G; Abate, A; Picca, G; Leoncini, V; Lomuscio, M; Casalino, A; Solarino, G; Moretti, B

    2015-01-01

    Osteoarthritis (OA) of the hip and knee causes pain and loss of joint mobility, leading to limitations in physical function. When conservative treatment fails total hip and knee replacement is a cost-effective surgical option. Patients have high expectations regarding functional outcome after these procedures. If such expectations are not met, they may still be dissatisfied with the outcome of a technically successful procedure. Recently, numerous studies reported that psychological factors can influence the outcome of total knee replacement (tkr) and total hip artrhoplasty with total hip replacement (thr). We conducted a prospective study on a consecutive sample of 280 patients affected by hip or knee OA who underwent total joint replacement. At patients’ admission, Harris Hip Score (HHS) and Knee Society Score (KSS) were used to assess pain and function. Furthermore, SF-36, Mini-Mental Status Examination (MMSE), Symptom Checklist-90-R (SCL-90-R), Coping Orientation to Problems Experienced (BRIEF-COPE) and the Amsterdam Preoperative Anxiety and Information Scale (APAIS) were administered. Patients had clinical and radio graphical follow up at 1, 3 and 6 months post-operatively. The HHS and KSS values before surgery showed a linear correlation with both SCL-90-R and MMSE. None of the investigated variables influenced post-operative HHS and KSS scores; however, the improvement of functional scores resulted conditioned by SCL-90-R values, VAS score, schooling and MMSE. Psychological factors and mental status in primary total hip and knee replacement can affect outcome and patient satisfaction. Strategies focused on identification and facing of these conditions must be considered to improve outcome of total replacement.

  6. Preoperative information provided to Swedish and immigrant patients before total hip replacement.

    Science.gov (United States)

    Krupic, Ferid; Määttä, Sylvia; Garellick, Göran; Lyckhage, Elisabeth Dahlborg; Kärrholm, Johan

    2012-01-01

    Total hip replacement is an operation that usually leads to pain relief and improved health related quality of life (HRQoL). Previous studies have demonstrated the importance of information about upcoming surgery. Therefore, it was of interest to study how both immigrants, whose first language was not Swedish, and Swedish patients described pre-operative information. Individual interviews were conducted with 10 immigrants and 10 Swedish participants. The data were analysed using qualitative content analysis. The study was carried out in western Sweden from March to November 2010. The findings revealed that pre-operative information for all patients undergoing elective total hip replacement was limited. Patients from both groups expressed concern about inadequate preoperative information pertaining to the surgery, implant selection, pain relief, choice of anaesthesia, no or too short a time to put questions to the surgeon and an overall stressful situation. Adequate preoperative information is important for optimising pain relief and shortening the hospital stay. The fact that the patients overwhelmingly rated the preoperative information as inadequate may be due to several reasons. Mental distress and the two-week interval between the time when the patient received the information and the operation might have contributed to the low degree of retention.

  7. Time-based analysis of total cost of patient episodes: a case study of hip replacement.

    Science.gov (United States)

    Peltokorpi, Antti; Kujala, Jaakko

    2006-01-01

    Healthcare in the public and private sectors is facing increasing pressure to become more cost-effective. Time-based competition and work-in-progress have been used successfully to measure and improve the efficiency of industrial manufacturing. Seeks to address this issue. Presents a framework for time based management of the total cost of a patient episode and apply it to the six sigma DMAIC-process development approach. The framework is used to analyse hip replacement patient episodes in Päijät-Häme Hospital District in Finland, which has a catchment area of 210,000 inhabitants and performs an average of 230 hip replacements per year. The work-in-progress concept is applicable to healthcare--notably that the DMAIC-process development approach can be used to analyse the total cost of patient episodes. Concludes that a framework, which combines the patient-in-process and the DMAIC development approach, can be used not only to analyse the total cost of patient episode but also to improve patient process efficiency. Presents a framework that combines patient-in-process and DMAIC-process development approaches, which can be used to analyse the total cost of a patient episode in order to improve patient process efficiency.

  8. Tribology and total hip joint replacement: current concepts in mechanical simulation.

    Science.gov (United States)

    Affatato, S; Spinelli, M; Zavalloni, M; Mazzega-Fabbro, C; Viceconti, M

    2008-12-01

    Interest in the rheology and effects of interacting surfaces is as ancient as man. This subject can be represented by a recently coined word: tribology. This term is derived from the Greek word "tribos" and means the "science of rubbing". Friction, lubrication, and wear mechanism in the common English language means the precise field of interest of tribology. Wear of total hip prosthesis is a significant clinical problem that involves, nowadays, a too high a number of patients. In order to acquire further knowledge on the tribological phenomena that involve hip prosthesis wear tests are conducted on employed materials to extend lifetime of orthopaedic implants. The most basic type of test device is the material wear machine, however, a more advanced one may more accurately reproduce some of the in vivo conditions. Typically, these apparatus are called simulators, and, while there is no absolute definition of a joint simulator, its description as a mechanical rig used to test a joint replacement, under conditions approximating those occurring in the human body, is acceptable. Simulator tests, moreover, can be used to conduct accelerated protocols that replicate/simulate particularly extreme conditions, thus establishing the limits of performance for the material. Simulators vary in their level of sophistication and the international literature reveals many interpretations of the design of machines used for joint replacement testing. This paper aims to review the current state of the art of the hip joint simulators worldwide. This is specified through a schematic overview by describing, in particular, constructive solutions adopted to reproduce in vivo conditions. An exhaustive commentary on the evolution and actually existing simulation standards is proposed by the authors. The need of a shared protocol among research laboratories all over the world could lead to a consensus conference.

  9. Rates of hip and knee joint replacement amongst different ethnic groups in England: an analysis of National Joint Registry data.

    Science.gov (United States)

    Smith, M C; Ben-Shlomo, Y; Dieppe, P; Beswick, A D; Adebajo, A O; Wilkinson, J M; Blom, A W

    2017-04-01

    Despite a health care system that is free at the point of delivery, ethnic minorities may not always get care equitable to that of White patients in England. We examined whether ethnic differences exist in joint replacement rates and surgical practice in England. 373,613 hip and 428,936 knee National Joint Registry (NJR) primary replacement patients had coded ethnicity in Hospital Episode Statistics (HES). Age and gender adjusted observed/expected ratios of hip and knee replacements amongst ethnic groups were compared using indirect standardisation. Associations between ethnic group and type of procedure were explored and effects of demographic, clinical and hospital-related factors examined using multivariable logistic regression. Adjusted standardised observed/expected ratios were substantially lower in Blacks and Asians than Whites for hip replacement (Blacks 0.33 [95% CI, 0.31-0.35], Asians 0.20 [CI, 0.19-0.21]) and knee replacement (Blacks 0.64 [CI, 0.61-0.67], Asians 0.86 % [CI, 0.84-0.88]). Blacks were more likely to receive uncemented hip replacements (Blacks 52%, Whites 37%, Asians 44%; P replacements than Whites (men 10% vs 15%, P = 0.001; women 6% vs 14%, P replacement (OR 1.43 [CI, 1.11-1.84]). In England, hip and knee replacement rates and prosthesis type given differ amongst ethnic groups. Whether these reflect differences in clinical need or differential access to treatment requires urgent investigation. Copyright © 2017. Published by Elsevier Ltd.

  10. The Cost of Joint Replacement: Comparing Two Approaches to Evaluating Costs of Total Hip and Knee Arthroplasty.

    Science.gov (United States)

    Palsis, John A; Brehmer, Thomas S; Pellegrini, Vincent D; Drew, Jacob M; Sachs, Barton L

    2018-02-21

    In an era of mandatory bundled payments for total joint replacement, accurate analysis of the cost of procedures is essential for orthopaedic surgeons and their institutions to maintain viable practices. The purpose of this study was to compare traditional accounting and time-driven activity-based costing (TDABC) methods for estimating the total costs of total hip and knee arthroplasty care cycles. We calculated the overall costs of elective primary total hip and total knee replacement care cycles at our academic medical center using traditional and TDABC accounting methods. We compared the methods with respect to the overall costs of hip and knee replacement and the costs for each major cost category. The traditional accounting method resulted in higher cost estimates. The total cost per hip replacement was $22,076 (2014 USD) using traditional accounting and was $12,957 using TDABC. The total cost per knee replacement was $29,488 using traditional accounting and was $16,981 using TDABC. With respect to cost categories, estimates using traditional accounting were greater for hip and knee replacement, respectively, by $3,432 and $5,486 for personnel, by $3,398 and $3,664 for space and equipment, and by $2,289 and $3,357 for indirect costs. Implants and consumables were derived from the actual hospital purchase price; accordingly, both methods produced equivalent results. Substantial cost differences exist between accounting methods. The focus of TDABC only on resources used directly by the patient contrasts with the allocation of all operating costs, including all indirect costs and unused capacity, with traditional accounting. We expect that the true costs of hip and knee replacement care cycles are likely somewhere between estimates derived from traditional accounting methods and TDABC. TDABC offers patient-level granular cost information that better serves in the redesign of care pathways and may lead to more strategic resource-allocation decisions to optimize

  11. Fixation method does not affect restoration of rotation center in hip replacements: A single-site retrospective study

    OpenAIRE

    Wegner, Alexander; Kauther, Max Daniel; Landgraeber, Stefan; von Knoch, Marius

    2012-01-01

    Abstract Background Aseptic loosening is one of the greatest problems in hip replacement surgery. The rotation center of the hip is believed to influence the longevity of fixation. The aim of this study was to compare the influence of cemented and cementless cup fixation techniques on the position of the center of rotation because cemented cup fixation requires the removal of more bone for solid fixation than the cementless technique. Methods We retrospectively compared pre- and post-operativ...

  12. Radiography, radionuclide imaging, and asthrography in the evaluation of total hip and knee replacement. [/sup 99m/Tc-phosphate

    Energy Technology Data Exchange (ETDEWEB)

    Gelman, M.I.; Coleman, R.E.; Stevens, P.M.; Davey, B.W.

    1978-09-01

    Twenty patients with 21 total joint replacements including 17 hips and 4 knees were studied by plain film radiography, radionuclide imaging, and subtraction arthrography to evaluate these procedures for assessing prosthetic complications. Surgery was performed in 14 patients and confirmed loosening of 8 femoral and 7 acetabular hip prosthesis components and 1 femoral and 4 tibial knee prosthesis components. Plain films suggested loosening of only 9 hip components and no knee components. In contrast, radionuclide imaging and subtraction arthrography were considerably more effective in demonstrating loosening as well as other causes of the painful total joint prosthesis.

  13. Postoperative radiation therapy after hip replacement in high-risk patients for development of heterotopic bone formation

    International Nuclear Information System (INIS)

    Hashem, R.; Rene, N.; Souhami, L.; Tanzer, M.; Evans, M.

    2011-01-01

    Purpose. - To report the results of postoperative radiation therapy in preventing the development of heterotopic bone formation after hip replacement surgery in high-risk patients. Patients and methods. - Between 1991 and 2007, 44 patients were preventively treated with postoperative RT after total hip replacement. In total, 47 hips were treated. All patients were considered at high risk for developing heterotopic bone formation. Most patients (63.5%) were treated because of a history of severe osteoarthritis or ankylosing spondylitis. All patients were treated with shaped parallel-opposed fields with a single fraction of 7 Gy using 6 or 18 MV photons. Most patients (94%) received radiation therapy within 72 hours postoperative and in only three patients radiation therapy was delivered after 72 hours post-surgery (5-8 days). Results. - Minimum follow-up was 1 year. There were 18 females and 26 males. Median age was 63 years (range: 18-80). Treatments were well tolerated and no acute toxicity was seen post-radiation therapy. Only one of the 47 hips (2%) developed heterotopic bone formation. This patient received postoperative radiation therapy to both hips but only developed heterotopic bone formation in one of them. None of the three patients treated beyond 72 hours failed. To date no late toxicity has been observed. Conclusion. - The use of postoperative radiation therapy was an effective and safe treatment in the prevention of heterotopic bone formation in a high-risk group of patients undergoing total hip replacement. (authors)

  14. Development of explicit criteria for prioritization of hip and knee replacement.

    Science.gov (United States)

    Escobar, Antonio; Quintana, José M; Bilbao, Amaia; Ibañez, Berta; Arenaza, Juan C; Gutiérrez, Luis; Azkárate, Jesús; Güenaga, Jose I; Vidaurreta, Ignacio

    2007-06-01

    Among the problems to the publicly funded national health services are the waiting lists. Patients who need elective surgery generally have long waiting times before treatment. We aimed to develop a new prioritization tool for primary hip and knee replacement. Criteria were developed using a modified Delphi panel process. We convened a panel of nine members who scored the scenarios created by the research team and by patient focus groups. We studied the level of agreement among the panelists and the contribution of the variables to the ratings of the panel using linear and logistic regression models. The priority scores of the variables and their levels were synthesized using the optimal scaling and standard linear regression methods. Seven variables, pain on motion, walking functional limitations, abnormal findings on physical examination, pain at rest, other functional limitations, social role, and other pathologies that could improve with joint replacement, were considered to create the different scenarios. The panel scored 192 scenarios. The disagreement among the panelists was very low (1%) with an intra-class correlation coefficient of 0.72. Of the 192 scenarios, 45.8% were scored as urgent, 35.4% as preferred and 18.8% as ordinary. The variables that contributed most to the scores were pain on motion and walking functional limitations. When optimal scaling and regression techniques were applied, similar results were obtained. This tool can evaluate and prioritize patients on a waiting list for hip or knee replacement. We also provide a simple and easy way to use an algorithm to estimate the treatment priority for individual patients.

  15. Comparison of femoral neck fracture healing and affected limb pain after anterolateral-approach minimally invasive total hip replacement and hemiarthroplasty

    Directory of Open Access Journals (Sweden)

    Xiao-Dong Cao

    2017-04-01

    Full Text Available Objective: To study the differences in femoral neck fracture healing and affected limb pain after anterolateral-approach minimally invasive total hip replacement and hemiarthroplasty. Methods: A total of 92 patients with femoral neck fracture who received hip replacement in our hospital between May 2013 and December 2015 were selected and randomly divided into total hip and half hip group, total hip group received anterolateral-approach minimally invasive total hip replacement, half hip group received anterolateral-approach minimally invasive hemiarthroplasty, and 1 month after operation, serum was collected to detect the levels of bone metabolism markers, osteocyte cytokines, SP and CGRP. Results: 1 month after operation, serum PINP, PICP, BMP, TGF-β, FGF, IGF-I and IGF-II levels of total hip group were significantly higher than those of half hip group while TRAP5b and CatK levels were significantly lower than those of half hip group; the day after operation, serum pain media SP and CGRP levels were not significantly different between the two groups of patients; 36 h after operation, serum SP and CGRP levels of total hip group were significantly lower than those of half hip group. Conclusion: The bone metabolism after anterolateral-approach minimally invasive total hip replacement is better than that after hemiarthroplasty, and the degree of pain is less than that after hemiarthroplasty.

  16. Comparison of dual mobility cup and other surgical construts used for three hundred and sixty two first time hip revisions due to recurrent dislocations: five year results from Lithuanian arthroplasty register.

    Science.gov (United States)

    Stucinskas, Justinas; Kalvaitis, Tomas; Smailys, Alfredas; Robertsson, Otto; Tarasevicius, Sarunas

    2018-05-01

    Recently, there has been increasing interest in the use of dual mobility systems in the treatment of hip instability. The aim of this study was to investigate the re-revision rate of dual mobility cup compared to different surgical concepts when used for first-time hip revisions due to recurrent dislocations. The data were derived from the Lithuanian Arthroplasty Register. For survival analysis, we used both re-revision for all reasons and for dislocations as an end-point. Cox proportional hazards models were used to analyze the influence of various covariates (age, gender, and implant concept). A total of 1388 revisions were recorded from 2011 to 2015, of which 362 were performed due to recurrent dislocation. Of the revisions, 247 were performed using dual mobility cups, while 115 were performed using a variety of other surgical constructs including constrained acetabular cups, conventional cups, femoral head exchanges, stem exchanges or anti-luxation rings. There were 27 re-revisions of which 15 were for additional dislocations. There were only 2% re-revisions due to dislocation with dual mobility vs 9% when using other surgical constructs. Cox regression adjusting for age and gender showed that in the short-term, dual mobility cup had a lower risk of revision due to dislocation as well as for all reasons compared to the other surgical constructs. In revision of total hip arthroplasties for dislocation, significantly lower short-term re-revision rate was observed for patients revised with dual mobility cup.

  17. Higher BMC and areal BMD in children and grandchildren of individuals with hip or knee replacement.

    Science.gov (United States)

    Specker, Bonny L; Wey, Howard E; Binkley, Teresa L; Beare, Tianna M; Smith, Eric P; Rauch, Frank

    2010-04-01

    The relationship between aBMD and osteoarthritis (OA) remains unclear. We compared aBMD, BMC and bone size among children and grandchildren of Hutterites with hip or knee replacement (n=23 each) to children and grandchildren of age- and sex-matched controls (178 children and 267 grandchildren). There were no differences in anthropometric measures or activity levels between case and control probands, but femoral neck (FN) and spine (LS) aBMD and Z-scores were greater in cases than controls (0.89 vs. 0.80 g/cm2; 1.15 vs. 1.03 g/cm2; 1.5 vs. 0.8; 2.4 vs. 1.2: all pBMC (34.1 vs. 32.0, 4.58 vs. 4.27, 69.5 vs. 62.4 g) and Z-scores (1.0 vs. 0.4; 0.9 vs. 0.2; 1.3 vs. 0.2) were greater in daughters of cases than controls (hip BMC p=0.06, others p or =2 years post-menarcheal or males> or =18 years): 33 were not classified. Post-menarcheal, but not premenarcheal, granddaughters of cases had greater hip, FN and LS aBMD Z-scores (0.7 vs. -0.1; 0.6 vs. -0.1; 0.8 vs. -0.3); greater hip and spine aBMD (1.03 vs. 0.95, 1.10 vs. 0.98 g/cm2); greater femoral neck and spine BMC (4.77 vs. 4.21, 66.7 vs. 55.4 g); and greater spine bone area (60.7 vs. 56.6 cm2) compared to granddaughters of controls (all, p<0.05), which remained significant when height, weight, and age were included as covariates. Growing grandsons of cases were taller and heavier than control grandsons, and a greater hip aBMD among grandsons of cases (0.88 vs. 0.76 g/cm2) was the only bone difference that remained significant after taking into account body size differences. Grandsons who were not growing had greater spine bone area (1.19 vs. 1.08 cm2) if their grandparent had OA compared to grandsons whose grandparents did not have OA. We speculate that there is a genetic basis for OA that leads to early differences in growth patterns among boys and greater peak bone mass and aBMD among girls. Copyright 2010 Elsevier Inc. All rights reserved.

  18. Prosthetic liner wear in total hip replacement: a longitudinal 13-year study with computed tomography.

    Science.gov (United States)

    Weidenhielm, Lars; Olivecrona, Henrik; Maguire, Gerald Q; Noz, Marilyn E

    2018-06-01

    This case report follows a woman who had a total hip replacement in 1992 when she was 45 years old. Six serial computed tomography (CT) examinations over a period of 13 years provided information that allowed her revision surgery to be limited to liner replacement as opposed to replacement of the entire prosthesis. Additionally, they provided data that ruled out the presence of osteolysis and indeed none was found at surgery. In 2004, when the first CT was performed, the 3D distance the femoral head had penetrated into the cup was determined to be 2.6 mm. By 2017, femoral head penetration had progressed to 5.0 mm. The extracted liner showed wear at the thinnest part to be 5.5 mm, as measured with a micrometer. The use of modern CT techniques can identify problems, while still correctable without major surgery. Furthermore, the ability of CT to assess the direction of wear revealed that the liner wear changed from the cranial to dorsal direction.

  19. TWO-STAGE REVISION HIP REPLACEMENT PATIENS WITH SEVERE ACETABULUM DEFECT (CASE REPORT

    Directory of Open Access Journals (Sweden)

    V. V. Pavlov

    2017-01-01

    Full Text Available Favorable short-term results of arthroplasty are observed in 80–90% of cases, however, over the longer follow up period the percentage of positive outcomes is gradually reduced. Need for revision of the prosthesis or it’s components increases in proportion to time elapsed from the surgery. In addition, such revision is accompanied with a need to substitute the bone defect of the acetabulum. As a solution the authors propose to replace pelvic defects in two stages. During the first stage the defect was filled with bone allograft with platelet-rich fibrin (allografting with the use of PRF technology. After the allograft remodeling during the second stage the revision surgery is performed by implanting standard prostheses. The authors present a clinical case of a female patient with aseptic loosening of acetabular component of prosthesis in the right hip joint, with failed hip function of stage 2, right limb shortening of 2 cm. Treatment results confirm the efficiency and rationality of the proposed bone grafting option. The authors conclude bone allograft in combination with the PRF technology proves to be an alternative to the implantation of massive metal implants in the acetabulum while it reduces the risk of implant-associated infection, of metallosis in surrounding tissues and expands further revision options.

  20. Surfing for hip replacements: has the "internet tidal wave" led to better quality information.

    Science.gov (United States)

    Nassiri, Mujtaba; Bruce-Brand, Robert A; O'Neill, Francis; Chenouri, Shojaeddin; Curtin, Paul T

    2014-07-01

    This study aimed to determine the quality of information available on the internet regarding Total Hip Replacement (THR). The unique websites identified were categorised by type and assessed using the DISCERN score, the Journal of the American Medical Association (JAMA) benchmark criteria, and a novel (THR)-specific content score. The presence of the Health On the Net (HON) code, a reported quality assurance marker, was noted. Commercial websites predominate. Governmental & Non-Profit Organizations websites attained the highest DISCERN score. Sites that bore the HONcode seal obtained significantly higher DISCERN and THR content scores than those without the certification. Physicians should recommend the HONcode seal to their patients as a reliable indicator of website quality or, better yet, refer patients to sites they have personally reviewed. Copyright © 2014 Elsevier Inc. All rights reserved.

  1. Systemic distribution of wear debris after hip replacement. A cause for concern?

    Science.gov (United States)

    Langkamer, V G; Case, C P; Heap, P; Taylor, A; Collins, C; Pearse, M; Solomon, L

    1992-11-01

    The production of particulate wear debris is a recognised complication of joint arthroplasty, but interest has concentrated on local tissue reactions and a possible association with implant loosening. The fate of wear products in the body remains unknown, although some of the metals used in the construction of orthopaedic implants are known to have toxic and oncogenic properties. We report histological and electron-microscopic evidence from two cases which shows that metallic debris can be identified in the lymphoreticular tissues of the body distant from the hip some years after joint replacement. The increase in the use of total arthroplasty in younger patients, the development of new alloys and the use of porous coatings must raise concern for the long-term effects of the accumulation of wear debris in the body.

  2. A nationwide analysis of socioeconomic outcomes after hip and knee replacement

    DEFF Research Database (Denmark)

    Kjellberg, Jakob; Kehlet, Henrik

    2016-01-01

    INTRODUCTION: Total hip and knee replacement (THA and TKA) are successful operations based on patient-reported outcomes and short-term socioeconomic evaluations. However, other data have shown problems regarding persistent pain and function. No detailed large-scale, long-term socioeconomic data...... exist on income and total health expenses before and after THA and TKA compared with a matched reference population (RP). METHODS: From the unique nationwide Danish registers, a total of 128,109 patients undergoing primary THA and TKA were followed from up to 12 years before to up to 12 years after...... surgery. The economic analysis of the total costs before and after surgery were divided into annual healthcare costs (outpatient services, inpatient admissions, prescription drugs and physician office visits), home care and loss of income and compared with a matched RP. RESULTS: Healthcare costs increased...

  3. Allogeneic blood transfusion and prognosis following total hip replacement: a population-based follow up study

    DEFF Research Database (Denmark)

    Pedersen, Alma B; Mehnert, Frank; Overgaard, Søren

    2009-01-01

    BACKGROUND: Allogeneic red blood cell transfusion is frequently used in total hip replacement surgery (THR). However, data on the prognosis of transfused patients are sparse. In this study we compared the risk of complications following THR in transfused and non-transfused patients. METHODS......: A population-based follow-up study was performed using data from medical databases in Denmark. We identified 28,087 primary THR procedures performed from 1999 to 2007, from which we computed a propensity score for red blood cell transfusion based on detailed data on patient-, procedure-, and hospital......-related characteristics. We were able to match 2,254 transfused with 2,254 non-transfused THR patients using the propensity score. RESULTS: Of the 28,087 THR patients, 9,063 (32.3%) received at least one red blood cell transfusion within 8 days of surgery. Transfused patients had higher 90-day mortality compared...

  4. Quality-adjusted life years gained in patients aged over 65 years after total hip replacement

    DEFF Research Database (Denmark)

    Hørdam, Britta; Pedersen, P.U.; Søballe, Kjeld

    2011-01-01

    Background: Total hip replacement (THR) is an effective, but also cost-intensive health care procedure for the elderly. Because of demographic changes in Western Europe, THR-associated financial investment for health care has become a question of priorities in society. To provide a quantitative...... rationale for a discussion within Western European health care systems, we undertook a prospective assessment of the benefit of THR from the patients´ perspective and as measured by quality-adjusted life years (QALYs). Aim: To measure the difference in health related quality of life between an intervention...... treatment and telephone intervention. QALYs were calculated from measures of health-related quality of life using questionnaire SF-36. These scores were transformed to QALYs using a formula based on the method developed by Brazier (Brazier 1998). Results: Both the control and the intervention patients...

  5. Increased risk of revision for infection in rheumatoid arthritis patients with total hip replacements

    DEFF Research Database (Denmark)

    Schrama, Johannes Cornelis; Fenstad, Anne M; Dale, Håvard

    2015-01-01

    Background and purpose-Medical treatment of rheumatoid arthritis (RA) has changed dramatically over the last 15 years, including immune modulation. We investigated the risk of revision for infection after primary total hip replacement (THR) in patients with rheumatoid arthritis over a 16-year...... period, and compared it with that in THR patients with osteoarthritis (OA).Patients and methods-We identified 13,384 THRs in RA patients and 377,287 THRs in OA patients from 1995 through 2010 in a dataset from the Nordic Arthroplasty Register Association (NARA). Kaplan-Meier survival curves......, with revision for infection as the endpoint, were constructed. Cox regression analyses were performed to calculate the relative risk (RR) of revision for infection adjusted for age, sex, fixation technique, and year of primary surgery.Results-RA patients had a 1.3 times (95% CI 1.0-1.6) higher risk of revision...

  6. High patient satisfaction in 445 patients who underwent fast-track hip or knee replacement

    DEFF Research Database (Denmark)

    Specht, Kirsten; Kjaersgaard-Andersen, Per; Kehlet, Henrik

    2015-01-01

    BACKGROUND AND PURPOSE: Patient satisfaction is important in fast-track total hip and knee replacement (THR, TKR). We assessed: (1) how satisfied patients were with the treatment; (2) factors related to overall satisfaction; and (3) whether there was a difference between THR and TKR regarding...... length of stay (LOS) and patient satisfaction. PATIENTS AND METHODS: In this follow-up study, a consecutive series of 445 patients undergoing THR and TKR completed a questionnaire 2 weeks after discharge. LOS and short-term patient satisfaction with the fast-track management were measured. Patient...... satisfaction was measured using a numerical rating scale (NRS; 0-10). RESULTS: For THR, the median satisfaction score was 9-10 and for TKR it was 8.5-10 in all parameters. Older THR patients had higher overall satisfaction. No association was found between overall satisfaction following THR or TKR and sex...

  7. Is lumbosacral plexus blockade effective and safe for surgical anesthesia in total hip replacement?

    DEFF Research Database (Denmark)

    Nielsen, Niels Dalsgaard; Larsen, Jens Rolighed; Børglum, Jens

    Background and Aims Patients scheduled for total hip replacement often presents cardiovascular comorbidity, which increases perioperative risk of complications. This pilot study aimed to compare lumbosacral plexus blockade with continuous and single-dose spinal anesthesia for surgical anesthesia...... had lumbosacral plexus blockade (lumbar plexus block, sacral plexus block and fascia transversalis plane block) with ropivacaine. Group 2 had continuous spinal anesthesia with repeated bupivacaine-doses. Group 3 had single-dose spinal anesthesia with bupivacaine. Hemodynamic data were recorded during...... vascular resistance, and arterial and central venous pressures. (table 1) No patients in group 1 achieved complete surgical anesthesia due to lack of anesthesia of the cranial part of the surgical incision. Conclusions Neither lumbosacral plexus block nor continuous spinal anesthesia affected any...

  8. PMS49 – Empirical comparison of discrete choice experiment and best-worst scaling to estimate stakeholders' risk tolerance for hip replacement surgery

    NARCIS (Netherlands)

    van Dijk, J.D.; Groothuis-Oudshoorn, Karin; Marshall, D.; IJzerman, Maarten Joost

    2013-01-01

    Objectives Empirical comparison of two preference elicitation methods, discrete choice experiment (DCE) and profile case best-worst scaling (BWS), regarding the estimation of the risk tolerance for hip replacement surgery (total hip arthroplasty and total hip resurfacing arthroplasty). Methods An

  9. Perioperative plasmatic presepsin levels in patients undergoing total hip or knee replacement: a preliminary study.

    Science.gov (United States)

    Vicenti, G; Pesce, V; Bizzoca, D; Nappi, V; Palmiotto, F; Carrozzo, M; Moretti, B

    2017-01-01

    Presepsin (sCD14-ST) is an emerging biomarker in the diagnosis of sepsis. In the field of orthopaedics, it could be useful in the diagnosis and management of periprosthetic joint infections (PJI). The aim of this study is to define the normal perioperative plasmatic levels of presepsin in patients undergoing primary cementless total hip replacement (THR) or primary cemented total knee replacement (TKR). For this purpose, 50 patients (19 male, 31 female, mean age= 64.04±8.88) were recruited. The patients were divided into two groups: Group A patients underwent cementless THR, whereas Group B patients underwent cemented TKR. On recruitment, anthropometric data, smocking status, osteoarthritis stage according to Kellgren and Lawrence, Harris Hip Score (HHS) for Group A patients and Knee Society Score (KSS) for Group B patients, drugs assumption and comorbidities were recorded. All the patients underwent serial blood tests, including complete blood count, presepsin (PS), C-reactive protein (CRP) and procalcitonin (PCT) 24 hours before arthroplasty (T0) and at 24 (T1), 48 (T2), 72 (T3) and 96 (T4) hours postoperatively. Body temperature (θ) was recorded every six hours in the time lapse T0-T4. Presepsin plasmatic concentration was comparable at baseline in both groups. After surgery, however, a significant increase of presepsin was observed in Group A, whereas in Group B no significant changes of presepsin were recorded. A comparable trend of this biomarker was found in the two groups, i.e. presepsin increased from T0 to T3, when it reached its maximum value, and its decrease started at T4. Finally, presepsin resulted more accurate than CRP in the evaluation of perioperative inflammatory response in patients undergoing THR or TKR. These data will be helpful in defining a reference interval for presepsin in patients with prosthetic joint implants, and a cut-off of this biomarker for the diagnosis of PJI.

  10. Return to work and workplace activity limitations following total hip or knee replacement.

    Science.gov (United States)

    Sankar, A; Davis, A M; Palaganas, M P; Beaton, D E; Badley, E M; Gignac, M A

    2013-10-01

    Total hip (THR) and knee (TKR) replacements increasingly are performed on younger people making return to work a salient outcome. This research evaluates characteristics of individuals with early and later return to work following THR and TKR. Additionally, at work limitations pre-surgery and upon returning to work, and factors associated with work limitations were evaluated. 190 THR and 170 TKR of a total 931 cohort participants were eligible (i.e., working or on short-term disability pre-surgery). They completed questionnaires pre-surgery and 1, 3, 6 and 12 months post-surgery that included demographics, type of occupation, and the Workplace Activity Limitations Scale (WALS). 166 (87%) and 144 (85%) returned to work by 12 months following THR and TKR, respectively. Early (1 month) return to work was associated with, male gender, university education, working in business, finance or administration, and low physical demand work. People with THR returned to work earlier than those with TKR. For both groups, less pain and every day functional limitations were associated with less workplace activity limitations at the time return to work. The majority of individuals working prior to surgery return to work following hip or knee replacement for osteoarthritis (OA) and experience fewer limitations at work than pre-surgery. The changing workforce dynamics and trends toward surgery at younger ages mean that these are important outcomes for clinicians to assess. Additionally, this is important information for employers in understanding continued participation in employment for people with OA. Copyright © 2013 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  11. Contributions of human tissue analysis to understanding the mechanisms of loosening and osteolysis in total hip replacement

    DEFF Research Database (Denmark)

    Gallo, Jiri; Vaculova, Jana; Goodman, Stuart B

    2014-01-01

    /osteolysis development. Only studies analysing periprosthetic tissues retrieved from failed implants in humans were included. Data from 101 studies (5532 patients with failure of THA implants) published in English or German between 1974 and 2013 were included. "Control" samples were reported in 45 of the 101 studies...... of pathophysiological events that lead to prosthetic loosening and osteolysis. One possible solution is to examine tissues harvested from stable total hip arthroplasties that have been revised at various time periods due to dislocation or periprosthetic fracture in multicenter studies....

  12. A longitudinal study of quality of life and functional status in total hip and total knee replacement patients.

    Science.gov (United States)

    Mandzuk, Lynda L; McMillan, Diana E; Bohm, Eric R

    2015-05-01

    Primary total hip and primary total knee surgeries are commonly performed to improve patients' quality of life and functional status. This longitudinal retrospective study (N = 851) examined self-reported quality of life and functional status over the preoperative and postoperative periods: 12 months prior to surgery, one month prior to surgery and 12 months following surgery. A linear mixed effects model was used to analyze the changes in quality of life and functional status over the sampling period. Patients in the convenience sample reported improvements in quality of life and functional status utilizing the SF-12 and Oxford Hip and Oxford Knee, although differences were noted by procedure and gender. Total hip patients tended to demonstrate greater improvement than total knee patients and males reported higher levels of physical and mental quality of life as well as functional status when compared to females. Of particular note was that mental health scores were consistently lower in both total hip and total knee replacement patients across the perioperative period and up to one year postoperative. This study identifies an opportunity for health care providers to proactively address the mental health of total hip and total knee replacement patients throughout their joint replacement trajectory. Copyright © 2014 Elsevier Ltd. All rights reserved.

  13. The use of clinical analysis of movements in evaluation of motor functional status of patients after total hip replacement

    Directory of Open Access Journals (Sweden)

    Romakina N.A.

    2016-06-01

    Full Text Available Aim: to estimate functional status of coxarthrosis in patients requiring total hip replacement of the two hip joints. Material and methods. The biomechanical examination of 94 patients with bilateral primary coxarthrosis before and after total hip replacement was performed using clinical stabilometric software complex. The ability to perceive the mechanical load during standing and walking was evaluated at different stages of the treatment. The difference between the samples was estimated with the use of Mann — Whitney U-test. The rank correlation of biomechanical parameters was measured by Spearman coefficient. Results. It was revealed that the most responsive indicators are the transfer period, the first and second periods of double support and the deviation of the center of pressure relative to the average position in the frontal plane. Conclusion. After surgical treatment there was observed some improvement: the-left-and-right-step asymmetry decrease, rhythm rate increase, improved ability to maintain body balance, jog reactions increase.

  14. [Intra-prosthetic dislocation of the Bousquet dual mobility socket].

    Science.gov (United States)

    Lecuire, F; Benareau, I; Rubini, J; Basso, M

    2004-05-01

    The Bousquet system is a dual mobility head-polyethylene polyethylene-metal cup socket. The polyethylene insert retaining the femoral head moves in the noncemented metal cup, increasing both mobility and stability. Between 1989 and 1997, seven cases of intra-prosthetic dislocation (six patients) were observed. The femoral head escaped from the polyethylene insert due to wear. On the average, this complication occurred ten Years after implantation. Risk of dislocation was high in six of the seven hips. All patients had a large sized stem screwed into the femoral neck. There was a characteristic radiological aspect with loss of the concentric head metal cup configuration. The head was applied against the upper wall of the metal cup. Surgical replacement was undertaken early in six patients by simply changing the insert without modifying the other stable components. Outcome remained good at three to eight Years. One patient underwent late surgery. The insert and the cup were replaced with a classical implant. Functional outcome was good but recurrent dislocation occurred. At mid-term, intra-prosthetic dislocation of dual mobility sockets appears to be exceptional. Dislocation results from polyethylene wear leading to failure of the insert to retain the prosthetic head. Wear is favored by direct phenomena (direct contact between neck and insert which can occur early if there is a small difference in the head and neck diameters) or indirect phenomena (factors limiting polyethylene metal-cup mobility). Surgical treatment is necessary. If undertaken early, replacement with a modular head and insert can be sufficient if the prosthesis has not loosened but the metal cup may have to be replaced in the event of metal-metal contact between the head and the cup. Prosthesis loosening, wear of the metal cup, or an identified cause of dislocation imply replacing the failing implants. Implantation of the dual mobility system is particularly interesting for patients with a high risk

  15. Risk of low-energy hip, wrist, and upper arm fractures among current and previous users of hormone replacement therapy

    DEFF Research Database (Denmark)

    Hundrup, Yrsa Andersen; Høidrup, Susanne; Ekholm, Ola

    2004-01-01

    To examine the effect of oestrogen alone and in combination with progestin on the risk of low-energy, hip, wrist, and upper arm fractures. Additionally, to examine to what extent previous use, duration of use as well as recency of discontinuation of hormone replacement therapy (HRT) influences...

  16. Predictors of clinical outcome in total hip and knee replacement : a methodological appraisal of implants and patient factors

    NARCIS (Netherlands)

    Keurentjes, Johan Christiaan

    2014-01-01

    In this thesis, we studied both implants and patient and surgeon factors as predictors of clinical outcome after total hip and knee replacement. Additionally, we studied a number of methodological aspects of orthopaedic research, such as competing risks in estimating the probability of revision

  17. The influence of NSAIDs on coumarin sensitivity in patients with CYP2C9 polymorphism after total hip replacement surgery.

    NARCIS (Netherlands)

    Beinema, M.J.; Jong, P.H. de; Salden, H.J.; Wijnen, M.H.W.A.; Meer, J.W.M. van der; Brouwers, J.R.B.J.

    2007-01-01

    OBJECTIVE: To determine the influence of NSAIDs on the international normalized ratio (INR) in patients with cytochrome P450 (CYP)-2C9 enzyme variants starting acenocoumarol (an oral coumarin) therapy during the first 7 days after total hip replacement surgery. METHODS: In this prospective study, an

  18. The influence of NSAIDs on coumarin sensitivity in patients with CYP2C9 polymorphism after total hip replacement surgery

    NARCIS (Netherlands)

    Beinema, Maarten J.; de Jong, Petra H.; Salden, Har J. M.; van Wijnen, Merel; van der Meer, Jan; Brouwers, Jacobus R. B. J.

    2007-01-01

    Objective: To determine the influence of NSAIDs on the international normalized ratio (INR) in patients with cytochrome P450 (CYP)-2C9 enzyme variants starting acenocoumarol (an oral coumarin) therapy during the first 7 days after total hip replacement surgery. Methods: In this prospective study, an

  19. Characterization and tribology of PEG-like coatings on UHMWPE for total hip replacements.

    Science.gov (United States)

    Kane, Sheryl R; Ashby, Paul D; Pruitt, Lisa A

    2010-03-15

    A crosslinked hydrogel coating similar to poly(ethylene glycol) (PEG) was covalently bonded to the surface of ultrahigh molecular weight polyethylene (UHMWPE) to improve the lubricity and wear resistance of the UHWMPE for use in total joint replacements. The chemistry, hydrophilicity, and protein adsorption resistance of the coatings were determined, and the wear behavior of the PEG-like coating was examined by two methods: pin-on-disk tribometry to evaluate macroscale behavior, and atomic force microscopy (AFM) to simulate asperity wear. As expected, the coating was found to be highly PEG-like, with approximately 83% ether content by x-ray photoelectron spectroscopy and more hydrophilic and resistant to protein adsorption than uncoated UHMWPE. Pin-on-disk testing showed that the PEG-like coating could survive 3 MPa of contact pressure, comparable to that experienced by total hip replacements. AFM nanoscratching experiments uncovered three damage mechanisms for the coatings: adhesion/microfracture, pure adhesion, and delamination. The latter two mechanisms appear to correlate well with wear patterns induced by pin-on-disk testing and evaluated by attenuated total reflection Fourier transform infrared spectroscopy mapping. Understanding the mechanisms by which the PEG-like coatings wear is critical for improving the behavior of subsequent generations of wear-resistant hydrogel coatings. (c) 2009 Wiley Periodicals, Inc.

  20. Countrywise results of total hip replacement An analysis of 438,733 hips based on the Nordic Arthroplasty Register Association database

    DEFF Research Database (Denmark)

    Makela, K. T.; Matilainen, M.; Pulkkinen, P.

    2014-01-01

    Background and purpose An earlier Nordic Arthroplasty Register Association (NARA) report on 280,201 total hip replacements (THRs) based on data from 1995-2006, from Sweden, Norway, and Denmark, was published in 2009. The present study assessed THR survival according to country, based on the NARA.......36-0.98) year of follow-up. Interpretation The differences in THR survival rates were considerable, with inferior results in Finland. Brand-level comparison of THRs in Nordic countries will be required....

  1. A computational parametric study on edge loading in ceramic-on-ceramic total hip joint replacements.

    Science.gov (United States)

    Liu, Feng; Feng, Li; Wang, Junyuan

    2018-07-01

    Edge loading in ceramic-on-ceramic total hip joint replacement is an adverse condition that occurs as the result of a direct contact between the head and the cup rim. It has been associated with translational mismatch in the centres of rotation of the cup and head, and found to cause severe wear and early failure of the implants. Edge loading has been considered in particular in relation to dynamic separation of the cup and head centres during a gait cycle. Research has been carried out both experimentally and computationally to understand the mechanism including the influence of bearing component positioning on the occurrence and severity of edge loading. However, it is experimentally difficult to measure both the load magnitude and duration of edge loading as it occurs as a short impact within the tight space of hip joints. Computationally, a dynamic contact model, for example, developed using the MSC ADAMS software for a multi-body dynamics simulation can be particularly useful for calculating the loads and characterising the edge loading. The aim of the present study was to further develop the computational model, and improve the predictions of contact force and the understanding of mechanism in order to provide guidance on design and surgical factors to avoid or to reduce edge loading and wear. The results have shown that edge loading can be avoided for a low range of translational mismatch in the centres of rotation of the cup and head during gait at the level of approximately 1.0 mm for a cup at 45° inclination, keeping a correct cup inclination at 45° is important to reduce the edge loading severity, and edge loading can be avoided for a certain range of translational mismatch of the cup and head centres with an increased swing phase load. Copyright © 2018 Elsevier Ltd. All rights reserved.

  2. Oral nutrition or water loading before hip replacement surgery; a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Ljunggren Stefan

    2012-07-01

    Full Text Available Abstract Background Surgery induces insulin resistance that might be alleviated by a nutritional drink given preoperatively. The authors hypothesized that some of the beneficial effects of the drink could be attributed to the volume component (approximately 1 L rather than to the nutrients. Methods Sixty patients scheduled for elective total hip replacement under spinal anesthesia were recruited to a clinical trial, and randomly allocated to preoperative fasting, to oral ingestion of tap water, or to oral ingestion of a carbohydrate drink. An intravenous glucose tolerance test calculated glucose clearance and insulin sensitivity on the day before surgery, in the postoperative ward, and on the day after surgery. Other parameters were stress (cortisol in plasma and urine, muscle catabolism (urinary 3-methylhistidine, and wellbeing. Results Fifty-seven patients completed the study. In the postoperative ward, the glucose clearance and the insulin response had decreased from the previous day by 23% and 36%, respectively. Insulin sensitivity did not decrease until the next morning (−48% and was due to an increased insulin response (+51%. Cortisol excretion was highest on the day of surgery, while 3-methylhistidine increased 1 day later. Follow-up on the third postoperative day showed an average of 1.5 complications per patient. Wellbeing was better 2 weeks after than before the surgery. None of the measured parameters differed significantly between the study groups. Conclusions Preoperative ingestion of tap water or a nutritional drink had no statistically significant effect on glucose clearance, insulin sensitivity, postoperative complications, or wellbeing in patients undergoing elective hip surgery. Trial registration Registration number: NCT 01211184 (http://www.clinicaltrials.gov

  3. Oral nutrition or water loading before hip replacement surgery; a randomized clinical trial.

    Science.gov (United States)

    Ljunggren, Stefan; Hahn, Robert G

    2012-07-02

    Surgery induces insulin resistance that might be alleviated by a nutritional drink given preoperatively. The authors hypothesized that some of the beneficial effects of the drink could be attributed to the volume component (approximately 1 L) rather than to the nutrients. Sixty patients scheduled for elective total hip replacement under spinal anesthesia were recruited to a clinical trial, and randomly allocated to preoperative fasting, to oral ingestion of tap water, or to oral ingestion of a carbohydrate drink. An intravenous glucose tolerance test calculated glucose clearance and insulin sensitivity on the day before surgery, in the postoperative ward, and on the day after surgery. Other parameters were stress (cortisol in plasma and urine), muscle catabolism (urinary 3-methylhistidine), and wellbeing. Fifty-seven patients completed the study. In the postoperative ward, the glucose clearance and the insulin response had decreased from the previous day by 23% and 36%, respectively. Insulin sensitivity did not decrease until the next morning (-48%) and was due to an increased insulin response (+51%). Cortisol excretion was highest on the day of surgery, while 3-methylhistidine increased 1 day later. Follow-up on the third postoperative day showed an average of 1.5 complications per patient. Wellbeing was better 2 weeks after than before the surgery. None of the measured parameters differed significantly between the study groups. Preoperative ingestion of tap water or a nutritional drink had no statistically significant effect on glucose clearance, insulin sensitivity, postoperative complications, or wellbeing in patients undergoing elective hip surgery.

  4. Indications for MARS-MRI in Patients Treated With Articular Surface Replacement XL Total Hip Arthroplasty.

    Science.gov (United States)

    Connelly, James W; Galea, Vincent P; Laaksonen, Inari; Matuszak, Sean J; Madanat, Rami; Muratoglu, Orhun; Malchau, Henrik

    2018-04-19

    The purpose of this study was to identify which patient and clinical factors are predictive of adverse local tissue reaction (ALTR) and to use these factors to create a highly sensitive algorithm for indicating metal artifact reduction sequence magnetic resonance imaging (MARS-MRI) in Articular Surface Replacement (ASR) XL total hip arthroplasty patients. Our secondary aim was to compare our algorithm to existing national guidelines on when to take MARS-MRI in metal-on-metal total hip arthroplasty patients. The study consisted of 137 patients treated with unilateral ASR XL implants from a prospective, multicenter study. Patients underwent MARS-MRI regardless of clinical presentation at a mean of 6.2 (range, 3.3-10.4) years from surgery. Univariate and multivariate analyses were conducted to determine which variables were predictive of ALTR. Predictors were used to create an algorithm to indicate MARS-MRI. Finally, we compared our algorithm's ability to detect ALTR to existing guidelines. We found a visual analog scale pain score ≥2 (odds ratio [OR] = 2.53; P = .023), high blood cobalt (OR = 1.05; P = .023), and male gender (OR = 2.37; P = .034) to be significant predictors of ALTR presence in our cohort. The resultant algorithm achieved 86.4% sensitivity and 60.2% specificity in detecting ALTR within our cohort. Our algorithm had the highest area under the curve and was the only guideline that was significantly predictive of ALTR (P = .014). Our algorithm including patient-reported pain and sex-specific cutoffs for blood cobalt levels could predict ALTR and indicate MARS-MRI in our cohort of ASR XL metal-on-metal patients with high sensitivity. Level II, diagnostic study. Copyright © 2018 Elsevier Inc. All rights reserved.

  5. Gene therapy and cement injection for the treatment of hip prosthesis loosening in elderly patients

    NARCIS (Netherlands)

    Poorter, Jolanda de

    2010-01-01

    Approximately one million total hip replacement operations are performed worldwide annually, mostly for osteoarthritis and rheumatoid arthritis. A major complication in total hip arthroplasties is loosening of the prosthesis leading to pain and walking difficulties and a higher risk for dislocations

  6. Functional exercise after total hip replacement (FEATHER a randomised control trial

    Directory of Open Access Journals (Sweden)

    Monaghan Brenda

    2012-11-01

    Full Text Available Abstract Background Prolonged physical impairments in range of movement, postural stability and walking speed are commonly reported following total hip replacement (THR. It is unclear from the current body of evidence what kind of exercises should be performed to maximize patient function and quality of life. Methods/design This will be a single blind multi centre randomized control trial with two arms. Seventy subjects post primary total hip arthroplasty will be randomized into either an experimental group (n=35, or to a control group (n=35. The experimental group will attend a functional exercise class twice weekly for a six week period from week 12 to week 18 post surgery. The functional exercise group will follow a circuit based functional exercise class supervised by a chartered Physiotherapist. The control group will receive usual care. The principal investigator (BM will perform blinded outcome assessments on all patients using validated measures for pain, stiffness, and function using the Western Ontario and Mc Master Universities Osteoarthritis index (WOMAC. This is the primary outcome measurement tool. Secondary outcome measurements include Quality of life (SF-36, 6 min walk test, Visual Analogue Scale, and the Berg Balance score. The WOMAC score will be collated on day five post surgery and repeated at week twelve and week eighteen. All other measurements will be taken at week 12 and repeated at week eighteen. In addition a blinded radiologist will measure gluteus medius cross sectional area using real time ultrasound for all subjects at week 12 and at week 18 to determine if the functional exercise programme has any effect on muscle size. Discussion This randomised controlled trial will add to the body of evidence on the relationship between muscle size, functional ability, balance, quality of life and time post surgery in patients following total hip arthroplasty. The CONSORT guidelines will be followed to throughout. Ethical

  7. Choice of implant combinations in total hip replacement: systematic review and network meta-analysis.

    Science.gov (United States)

    López-López, José A; Humphriss, Rachel L; Beswick, Andrew D; Thom, Howard H Z; Hunt, Linda P; Burston, Amanda; Fawsitt, Christopher G; Hollingworth, William; Higgins, Julian P T; Welton, Nicky J; Blom, Ashley W; Marques, Elsa M R

    2017-11-02

    Objective  To compare the survival of different implant combinations for primary total hip replacement (THR). Design  Systematic review and network meta-analysis. Data sources  Medline, Embase, The Cochrane Library, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, and the EU Clinical Trials Register. Review methods  Published randomised controlled trials comparing different implant combinations. Implant combinations were defined by bearing surface materials (metal-on-polyethylene, ceramic-on-polyethylene, ceramic-on-ceramic, or metal-on-metal), head size (large ≥36 mm or small meta-analysis for revision. There was no evidence that the risk of revision surgery was reduced by other implant combinations compared with the reference implant combination. Although estimates are imprecise, metal-on-metal, small head, cemented implants (hazard ratio 4.4, 95% credible interval 1.6 to 16.6) and resurfacing (12.1, 2.1 to 120.3) increase the risk of revision at 0-2 years after primary THR compared with the reference implant combination. Similar results were observed for the 2-10 years period. 31 studies (2888 patients) were included in the analysis of Harris hip score. No implant combination had a better score than the reference implant combination. Conclusions  Newer implant combinations were not found to be better than the reference implant combination (metal-on-polyethylene (not highly cross linked), small head, cemented) in terms of risk of revision surgery or Harris hip score. Metal-on-metal, small head, cemented implants and resurfacing increased the risk of revision surgery compared with the reference implant combination. The results were consistent with observational evidence and were replicated in sensitivity analysis but were limited by poor reporting across studies. Systematic review registration  PROSPERO CRD42015019435. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence

  8. Total hip arthroplasty survival in femoral head avascular necrosis versus primary hip osteoarthritis: Case-control study with a mean 10-year follow-up after anatomical cementless metal-on-metal 28-mm replacement.

    Science.gov (United States)

    Ancelin, D; Reina, N; Cavaignac, E; Delclaux, S; Chiron, P

    2016-12-01

    Total hip arthroplasty is the most widely used procedure to treat avascular necrosis (AVN) of the femoral head. Few studies have compared the outcomes of THA in femoral head AVN and primary hip osteoarthritis. Therefore we performed a case-control study to compare THA for femoral head AVN vs. primary hip osteoarthritis in terms of: (1) prosthesis survival, (2) complication rates, (3) functional outcomes and radiographic outcomes, (4) and to determine whether specific risk factors for THA failure exist in femoral head AVN. THA survival is similar in femoral head AVN and primary hip osteoarthritis. We compared two prospective cohorts of patients who underwent THA before 65 years of age, one composed of cases with femoral head AVN and the other of controls with primary hip osteoarthritis. In both cohorts, a cementless metal-on-metal prosthesis with a 28-mm cup and an anatomical stem was used. Exclusion criteria were THA with other types of prosthesis, posttraumatic AVN, and secondary osteoarthritis. With α set at 5%, to obtain 80% power, 246 patients were required in all. Prosthesis survival was assessed based on time to major revision (defined as replacement of at least one implant fixed to bone) and time to aseptic loosening. The other evaluation criteria were complications, Postel-Merle d'Aubigné (PMA) score, and the Engh and Agora Radiographic Assessment (ARA) scores for implant osseointegration. The study included 282 patients, 149 with AVN and 133 with osteoarthritis. Mean age was 47.8±10.2 years (range, 18.5-65) and mean follow-up was 11.4±2.8 years (range, 4.5-18.3 years). The 10-year survival rates were similar in the two groups: for major revision, AVN group, 92.5% (95% confidence interval [95% CI], 90.2-94.8) and osteoarthritis group, 95.3% (95% CI, 92.9-97.7); for aseptic loosening, AVN group, 98.6% (95% CI, 97.6-98.6) and osteoarthritis, 99.2% (95% CI, 98.4-100). The AVN group had higher numbers of revision for any reason (19 vs. 6, P=0.018) and

  9. Posterosuperior Placement of a Standard-Sized Cup at the True Acetabulum in Acetabular Reconstruction of Developmental Dysplasia of the Hip With High Dislocation.

    Science.gov (United States)

    Xu, Jiawei; Xu, Chen; Mao, Yuanqing; Zhang, Jincheng; Li, Huiwu; Zhu, Zhenan

    2016-06-01

    We sought to evaluate posterosuperior placement of the acetabular component at the true acetabulum during acetabular reconstruction in patients with Crowe type-IV developmental dysplasia of the hip. Using pelvic computed tomography and image processing, we developed a two-dimensional mapping technique to demonstrate the distribution of preoperative three-dimensional cup coverage at the true acetabulum, determined the postoperative location of the acetabular cup, and calculated postoperative three-dimensional coverage for 16 Crowe type-IV dysplastic hips in 14 patients with a mean age of 52 years (33-78 years) who underwent total hip arthroplasty. Mean follow-up was 6.3 years (5.5-7.3 years). On preoperative mapping, the maximum three-dimensional coverage using a 44-mm cup was 87.31% (77.36%-98.14%). Mapping enabled the successful replacement of 16 hips using a mean cup size of 44.13 mm (42-46 mm) with posterosuperior placement of the cup. Early weight-bearing and no prosthesis revision or loosening during follow-up were achieved in all patients. The postoperative two-dimensional coverage on anteroposterior radiographs and three-dimensional coverage were 96.15% (89.49%-100%) and 83.42% (71.81%-98.50%), respectively. This technique may improve long-term implant survival in patients with Crowe-IV developmental dysplasia of the hip undergoing total hip arthroplasty by allowing the use of durable bearings, increasing host bone coverage, ensuring initial stability, and restoring the normal hip center. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Telerehabilitation Versus Traditional Care Following Total Hip Replacement: A Randomized Controlled Trial Protocol.

    Science.gov (United States)

    Nelson, Mark; Bourke, Michael; Crossley, Kay; Russell, Trevor

    2017-03-02

    Total hip replacement (THR) is the gold standard treatment for severe hip osteoarthritis. Effectiveness of physical rehabilitation for THR patients following discharge from hospital is supported by evidence; however, barriers such as geographical location and transport can limit access to appropriate health care. One solution to this issue is using an alternative model of care using telerehabilitation technology to deliver rehabilitation programs directly into patients' homes. A telerehabilitation model may also have potential health care cost savings for health care providers. This study aims to determine if a telerehabilitation model of care delivered remotely is as effective as face-to-face rehabilitation in the THR population and cost effective for health care providers and patients. A total of 70 people undergoing THR will be recruited to participate in a randomized, single-blind, controlled noninferiority clinical trial. The trial will compare a technology-based THR rehabilitation program to in-person care. On discharge from hospital, participants randomized to the in-person group will receive usual care, defined as a paper home exercise program (HEP) targeting strengthening exercises for quadriceps, hip abductors, extensors, and flexors; they will be advised to perform their HEP 3 times per day. At 2, 4, and 6 weeks postoperatively, they will receive a 30-minute in-person physiotherapy session with a focus on gait retraining and reviewing and progressing their HEP. The telerehabilitation protocol will involve a program similar in content to the in-person rehabilitation program, except delivery will be directly into the homes of the participants via telerehabilitation technology on an iPad. Outcomes will be evaluated preoperatively, day of discharge from in-patient physiotherapy, 6 weeks and 6 months postoperatively. The primary outcome will be the quality of life subscale of the hip disability and osteoarthritis outcome score, measured at 6 weeks. Both

  11. The principle of low frictional torque in the Charnley total hip replacement.

    Science.gov (United States)

    Wroblewski, B M; Siney, P D; Fleming, P A

    2009-07-01

    The design of the Charnley total hip replacement follows the principle of low frictional torque. It is based on the largest possible difference between the radius of the femoral head and that of the outer aspect of the acetabular component. The aim is to protect the bone-cement interface by movement taking place at the smaller radius, the articulation. This is achieved in clinical practice by a 22.225 mm diameter head articulating with a 40 mm or 43 mm diameter acetabular component of ultra-high molecular weight polyethylene. We compared the incidence of aseptic loosening of acetabular components with an outer diameter of 40 mm and 43 mm at comparable depths of penetration with a mean follow-up of 17 years (1 to 40). In cases with no measurable wear none of the acetabular components were loose. With increasing acetabular penetration there was an increased incidence of aseptic loosening which reflected the difference in the external radii, with 1.5% at 1 mm, 8.8% at 2 mm, 9.7% at 3 mm and 9.6% at 4 mm of penetration in favour of the larger 43 mm acetabular component. Our findings support the Charnley principle of low frictional torque. The level of the benefit is in keeping with the predicted values.

  12. Lean Six Sigma: a new approach to the management of patients undergoing prosthetic hip replacement surgery.

    Science.gov (United States)

    Improta, Giovanni; Balato, Giovanni; Romano, Maria; Carpentieri, Francesco; Bifulco, Paolo; Alessandro Russo, Mario; Rosa, Donato; Triassi, Maria; Cesarelli, Mario

    2015-08-01

    In 2012, health care spending in Italy reached €114.5 billion, accounting for 7.2% of the Gross Domestic Product (GDP) and 14.2% of total public spending. Therefore, reducing waste in health facilities could generate substantial cost savings. The objective of this study is to show that Lean Six Sigma represents an appropriate methodology for the development of a clinical pathway which allows to improve quality and to reduce costs in prosthetic hip replacement surgery. The methodology used for the development of a new clinical pathway was Lean Six Sigma. Problem solving in Lean Six Sigma is the DMAIC (Define, Measure, Analyse, Improve, Control) roadmap, characterized by five operational phases which make possible to reach fixed goals through a rigorous process of defining, measuring, analysing, improving and controlling business problems. The following project indicated several variables influencing the inappropriate prolongation of the length of stay for inpatient treatment and corrective actions were performed to improve the effectiveness and efficiency of the process of care. The average length of stay was reduced from 18.9 to 10.6 days (-44%). This article shows there is no trade-off between quality and costs: Lean Six Sigma improves quality and, at the same time, reduces costs. © 2015 John Wiley & Sons, Ltd.

  13. Blood management in total hip replacement: an analysis of factors associated with allogenic blood transfusion.

    Science.gov (United States)

    Wong, Samuel; Tang, Howard; de Steiger, Richard

    2015-06-01

    The aim of this study was to audit the blood transfusion practice throughout the Epworth Healthcare Hospitals for patients undergoing primary total hip replacement (THR). We determined if blood-saving techniques were having an impact on the risk of allogenic blood transfusion and which patients were at risk of receiving allogenic blood transfusion. This study uses a retrospective audit of 787 patients who had undergone primary THR surgery at three Melbourne hospitals: Epworth Richmond, Epworth Eastern and Epworth Freemasons in 2010. Patient demographics, transfusion requirements and blood-conserving techniques were recorded. One hundred and eighty (23%) patients received allogenic blood transfusion and 18 (2.3%) patients received autologous blood transfusion. On multivariate analysis, preoperative anaemia (odds ratio (OR) 4.7, P blood transfusion. Use of spinal anaesthetic was found to be associated with lower risk of transfusion (OR 0.6, P = 0.0180) compared with general anaesthetic alone. Cell saver, acute normovolaemic haemodilution and re-infusion drain tube usage did not have a significant impact on reducing the risk of allogenic blood transfusion. Identification of patients at risk of blood transfusion, correction of preoperative anaemia and a restrictive transfusion policy are important factors to consider in effective perioperative blood management. © 2015 Royal Australasian College of Surgeons.

  14. Instrumental and laboratory assessment of stressful remodelling processes in bone tissue at total hip replacement

    Directory of Open Access Journals (Sweden)

    E.V. Karjakina

    2010-06-01

    Full Text Available Research objective is to estimate stressful remodelling features of bone tissue according to the densitometry data and to the level of biochemical markers of bone resorption and formation in total hip replacement (THR. Bone tissue mineral density (BTMD, condition of calcium-phosphoric metabolism and biochemical markers of bone formation (osteocalcin and bone isoenzyme of alkaline phosphatase and resorption (С-terminal bodypeptide of the I type collagen have been determined in 52 patients with coxarthrosis of ll-lll stages with marked joint dysfunction before and after THR. The control group included 24 donors. The data were considered to be reliable when the probability index was р<0,05. The reliable (р<0,05 change of BTMD was determined only in 3-6 months after the operation, whereas the change of biochemical markers of remodeling had already been done after 1,5-3 months, allowing to define the group of patients with obvious negative bone balance: strong predominance of resorption processes without compensation of the subsequent adequate osteogenesis, that subsequently could lead to significant bone tissue deficiency in the area adjacent to the endoprosthesis. Changes of indices of calcium-phosphoric metabolism were not certain during the investigation term. ln conclusion it is to state that biochemical markers of remodeling in comparison with BTMD allow to estimate objectively features of adaptive bone tissue remodeling after THR in earlier periods and to define group of patients with sharp intensification of metabolism and obvious negative bone balance

  15. SYNDROME-PATHOGENETIC APPROACH TO MEDICAL REHABILITATION OF PATIENTS AFTER THE TOTAL HIP AND KNEE REPLACEMENT

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    Y. Y. Udartsev

    2011-01-01

    Full Text Available The results of treatment 103 patients in term of 4-6 months after total hip and knee replacement were examined. Established that in the operated limb disorders of regional blood flow in the form of chronic lympho-venous insufficiency and changes in the functional state of neuromuscular apparatus in the form of muscle dysfunction, autonomic dysfunction occured. According to detected characteristics the medical rehabilitation for patients of the 1st group (52 patients was based on the combination of therapeutic factors complex usage, each of which exerts a specific effect on pathogenesis of a certain syndrome or their different combinations, and developing therapeutic factors are summarized and potentiated. That is why balneo-radon-kinesiotherapy, intermittent pneumocompression, low-frequency magnetotherapy, transcranial electroanalgesia, electrical myostimulation, pelotherapy, taking of central myorelexanat tizanidine were included in the treatment program. Among the patients of the 2nd group medical rehabilitation was based exclusively on motion state and bodily exercises. The analysis of treatment showed the advantage of syndrome-pathogenetic approach, applied for the 1st group of patients: joint range of motions increased by 33,1%, venous drainage increased by 24,4%, neuromuscular apparatus duty improved by 51,8%, involuntary nervous system balance normalized, functional outcome of the medical rehabilitation improved by 73,1%.

  16. Use of Autoplasma in the Prevention of Venous Thromboses during Endoprosthetic Replacement of the Hip Joint

    Directory of Open Access Journals (Sweden)

    S. A. Kravtsov

    2009-01-01

    Full Text Available Hip joint endoprosthetic replacement (HJER leads to hemodynamic disorders and massive intraoperative hemorrhage and presents a high risk (30—55% of cases for postoperative deep vein thrombosis in the lower extremity, at the same time the possibility (12—22% of massive pulmonary thromboembolism (PTE is ruled out. So the choice of infusion-transfusion therapy is of paramount importance in these patients. The authors studied the efficiency of normovolemic hemodilution with the autoplasma (patented in the Russian Federation in treating massive perioperative hemorrhage in patients undergoing HJER and in reducing postoperative thrombotic events. It was compared with infusion therapy comprising hydroxyethyl starch (130/0.4. All the patients had spinal anesthesia and standard postoperative analgesia in an intensive care unit. The administration of autologous fresh frozen plasma resulted in a 15% reduction in intraoperative blood loss, by increasing the coagulation potential and platelet aggregability. Postoperatively, there was an overall increase in the hypercoagulation potential, both the plasma link and platelet aggregability, in both groups. The use of autologous plasma by elevating the concentration of natural anticoagulants (AT III by 9% could prevent 35 and 75% rises in soluble fibrin monomer complexes and D-dimer. In two patients from the comparative group, the postoperative period was complicated by the development of occlusive thrombosis of the femoral vein. Key words: intraoperative hemodilution, auto-plasma, vein thromboses.

  17. Sequential use of technetium 99m MDP and gallium 67 citrate imaging in the evaluation of painful total hip replacement

    International Nuclear Information System (INIS)

    Horoszowski, H.; Ganel, A.; Kamhin, M.; Zaltman, S.; Farine, I.

    1980-01-01

    Fourteen patients with 20 total hip joint replacements were studied for 14 painful prosthetic hips. Clinical examination, plain film radiographs and 99 Tcsup(m)-methylene diphosphonate bone scans failed to differentiate between infection and mechanical loosening of a prosthesis. Sequential use of 99 Tcsup(m)-methylene diphosphonate and 67 Ga-citrate bone scans were performed in an attempt to discover underlying infectious process. Increased focal uptake of both radiopharmaceuticals over the same hip indicated an infectious process responsible for prosthetic loosening. There were no false positive gallium examinations. Sequential use of 99 Tcsup(m)-phosphate compounds and 67 Ga-citrate is recommended for differentiation between mechanical loosening of a prosthesis and loosening of a prosthesis secondary to an infectious process. (U.K.)

  18. The effect of education and supervised exercise vs. education alone on the time to total hip replacement in patients with severe hip osteoarthritis. A randomized clinical trial protocol

    DEFF Research Database (Denmark)

    Jensen, Carsten; Roos, Ewa M.; Kjærsgaard-Andersen, Per

    2013-01-01

    Background: The age- and gender-specific incidence of total hip replacement surgery has increased over the last two decades in all age groups. Recent studies indicate that non-surgical interventions are effective in reducing pain and disability, even at later stages of the disease when joint...... will receive 3 months of supervised exercise consisting of 12 sessions of individualized, goal-based neuromuscular training, and 12 sessions of intensive resistance training plus patient education (3 sessions). The control group will receive only patient education (3 sessions). The primary end...... measures are the five subscales of the Hip disability and Osteoarthritis Outcome Score, physical activity (UCLA activity score), and patient’s global perceived effect. Other measures include pain after exercise, joint-specific adverse events, exercise adherence, general health status (EQ-5D-5L), mechanical...

  19. [Dislocated fracture of the lesser trochanter with malrotation of the stem after robot assisted implantation of a cementless hip prosthesis: a casuistic report].

    Science.gov (United States)

    Prymka, M; Hassenpflug, J

    2003-08-01

    This paper presents the case of a 63 year old female with a severe coxarthrosis. She got a robot assited implantation of a cementless hip prosthesis (Osteolock, Stryker-Howmedica, Mühlheim). As operation robot the CASPAR-System (Orto-Maquet, Rastatt) was used. Initially, the clinical progress of the patient was fine. She was nearly painfree within 14 days and showed an acceptable range of motion in the operated joint (flexion/ extension 90 degrees /05 degrees /00 degrees ). She was mobilized with crutches and 15 kg weight bearing at the operated leg. 3 weeks postoperative the patient complaint about increasing pain without trauma or intensification of the weight bearing. X-rays showed not only a dislocated fracture of the lesser trochanter, but also a sinking combined with a malrotation of the stem. A revision operation was necessary,where we implanted a cemented stem. Now clinical progress was completely satisfying.

  20. Fixation method does not affect restoration of rotation center in hip replacements: A single-site retrospective study

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    Wegner Alexander

    2012-06-01

    Full Text Available Abstract Background Aseptic loosening is one of the greatest problems in hip replacement surgery. The rotation center of the hip is believed to influence the longevity of fixation. The aim of this study was to compare the influence of cemented and cementless cup fixation techniques on the position of the center of rotation because cemented cup fixation requires the removal of more bone for solid fixation than the cementless technique. Methods We retrospectively compared pre- and post-operative positions of the hip rotation center in 25 and 68 patients who underwent artificial hip replacements in our department in 2007 using cemented or cementless cup fixation, respectively, with digital radiographic image analysis. Results The mean horizontal and vertical distances between the rotation center and the acetabular teardrop were compared in radiographic images taken pre- and post-operatively. The mean horizontal difference was −2.63 mm (range: -11.00 mm to 10.46 mm, standard deviation 4.23 mm for patients who underwent cementless fixation, and −2.84 mm (range: -10.87 to 5.30 mm, standard deviation 4.59 mm for patients who underwent cemented fixation. The mean vertical difference was 0.60 mm (range: -20.15 mm to 10.00 mm, standard deviation 3.93 mm and 0.41 mm (range: -9.26 mm to 6.54 mm, standard deviation 3.58 mm for the cementless and cemented fixation groups, respectively. The two fixation techniques had no significant difference on the position of the hip rotation center in the 93 patients in this study. Conclusions The hip rotation center was similarly restored using either the cemented or cementless fixation techniques in this patient cohort, indicating that the fixation technique itself does not interfere with the position of the center of rotation. To completely answer this question further studies with more patients are needed.

  1. Evaluation of a new methodology to simulate damage and wear of polyethylene hip replacements subjected to edge loading in hip simulator testing.

    Science.gov (United States)

    Partridge, Susan; Tipper, Joanne L; Al-Hajjar, Mazen; Isaac, Graham H; Fisher, John; Williams, Sophie

    2018-05-01

    Wear and fatigue of polyethylene acetabular cups have been reported to play a role in the failure of total hip replacements. Hip simulator testing under a wide range of clinically relevant loading conditions is important. Edge loading of hip replacements can occur following impingement under extreme activities and can also occur during normal gait, where there is an offset deficiency and/or joint laxity. This study evaluated a hip simulator method that assessed wear and damage in polyethylene acetabular liners that were subjected to edge loading. The liners tested to evaluate the method were a currently manufactured crosslinked polyethylene acetabular liner and an aged conventional polyethylene acetabular liner. The acetabular liners were tested for 5 million standard walking cycles and following this 5 million walking cycles with edge loading. Edge loading conditions represented a separation of the centers of rotation of the femoral head and the acetabular liner during the swing phase, leading to loading of the liner rim on heel strike. Rim damage and cracking was observed in the aged conventional polyethylene liner. Steady-state wear rates assessed gravimetrically were lower under edge loading compared to standard loading. This study supports previous clinical findings that edge loading may cause rim cracking in liners, where component positioning is suboptimal or where material degradation is present. The simulation method developed has the potential to be used in the future to test the effect of aging and different levels of severity of edge loading on a range of cross-linked polyethylene materials. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1456-1462, 2018. © 2017 Wiley Periodicals, Inc.

  2. Diagnostic value of bone scintigraphy with sup(99m)Tc-pyrophosphate for evaluation of complications after hip joint replacement

    International Nuclear Information System (INIS)

    Baumer, J.F.

    1979-01-01

    For 102 patients with complaints after total hip replacement, bone scintigraphies with sup(99m)Tc have been made in addition to the usual examinations. 95 of these patients had to be operated once more, whereas the infected endoprosteses detected in the remaining 7 patients have been treated for the time being by non-surgical measures. In 68 patients, the examination revealed an aseptic loosening of the total endoprosthesis, including fracture of the diaphysis in 19 cases. In one case, a replacement of the prosthesis had been necessary in spite of the alloarthroplasty being firmly fixed in the right place. The bacterioscopic and bacteriologic investigations clearly revealed an infection of the environment of the prosthesis, in 27 patients, whereas the findings obtained on 6 other patients have not been as unambiguons. 85% of the patients with septic complications showed an increased E.S.R., however only 26% of the patients with aseptic complications. In only 47% of the patients with infection of the hip joint, bacteria have been found in the hip joint puncture fluid, whereas the bacteriological examination of tissue taken from the environment of the artificial hip joint during the operation revealed no increase in bacteria in only one case (5%). In 4 patients (20%), the bacterioscopic findings showed no signs of an acute infection, although saprophytic germs had been isolated from the environment of the prosthesis. 78% of the cases with loosening of the prosthesis and 11% of the infections have been detected by X-ray examination. The nuclear medical examination showed normal radionuclide accumulation in 30% of the cases with loosened prosthesis and in 4% of the infections, for 6% each of the two complications the scintigrams yielded no unambiguous results. In 4 patients (40%) with total hip joint replacement on both sides, enhanced radionuclide accumulation has been abserved even on the symptom-free side. (orig./AJ) [de

  3. Variability of indication criteria in knee and hip replacement: an observational study

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    Sarasqueta Cristina

    2010-10-01

    Full Text Available Abstract Background Total knee (TKR and hip (THR replacement (arthroplasty are effective surgical procedures that relieve pain, improve patients' quality of life and increase functional capacity. Studies on variations in medical practice usually place the indications for performing these procedures to be highly variable, because surgeons appear to follow different criteria when recommending surgery in patients with different severity levels. We therefore proposed a study to evaluate inter-hospital variability in arthroplasty indication. Methods The pre-surgical condition of 1603 patients included was compared by their personal characteristics, clinical situation and self-perceived health status. Patients were asked to complete two health-related quality of life questionnaires: the generic SF-12 (Short Form and the specific WOMAC (Western Ontario and Mcmaster Universities scale. The type of patient undergoing primary arthroplasty was similar in the 15 different hospitals evaluated. The variability in baseline WOMAC score between hospitals in THR and TKR indication was described by range, mean and standard deviation (SD, mean and standard deviation weighted by the number of procedures at each hospital, high/low ratio or extremal quotient (EQ5-95, variation coefficient (CV5-95 and weighted variation coefficient (WCV5-95 for 5-95 percentile range. The variability in subjective and objective signs was evaluated using median, range and WCV5-95. The appropriateness of the procedures performed was calculated using a specific threshold proposed by Quintana et al for assessing pain and functional capacity. Results The variability expressed as WCV5-95 was very low, between 0.05 and 0.11 for all three dimensions on WOMAC scale for both types of procedure in all participating hospitals. The variability in the physical and mental SF-12 components was very low for both types of procedure (0.08 and 0.07 for hip and 0.03 and 0.07 for knee surgery patients

  4. Variability of indication criteria in knee and hip replacement: an observational study.

    Science.gov (United States)

    Cobos, Raquel; Latorre, Amaia; Aizpuru, Felipe; Guenaga, Jose I; Sarasqueta, Cristina; Escobar, Antonio; García, Lidia; Herrera-Espiñeira, Carmen

    2010-10-26

    Total knee (TKR) and hip (THR) replacement (arthroplasty) are effective surgical procedures that relieve pain, improve patients' quality of life and increase functional capacity. Studies on variations in medical practice usually place the indications for performing these procedures to be highly variable, because surgeons appear to follow different criteria when recommending surgery in patients with different severity levels. We therefore proposed a study to evaluate inter-hospital variability in arthroplasty indication. The pre-surgical condition of 1603 patients included was compared by their personal characteristics, clinical situation and self-perceived health status. Patients were asked to complete two health-related quality of life questionnaires: the generic SF-12 (Short Form) and the specific WOMAC (Western Ontario and Mcmaster Universities) scale. The type of patient undergoing primary arthroplasty was similar in the 15 different hospitals evaluated.The variability in baseline WOMAC score between hospitals in THR and TKR indication was described by range, mean and standard deviation (SD), mean and standard deviation weighted by the number of procedures at each hospital, high/low ratio or extremal quotient (EQ5-95), variation coefficient (CV5-95) and weighted variation coefficient (WCV5-95) for 5-95 percentile range. The variability in subjective and objective signs was evaluated using median, range and WCV5-95. The appropriateness of the procedures performed was calculated using a specific threshold proposed by Quintana et al for assessing pain and functional capacity. The variability expressed as WCV5-95 was very low, between 0.05 and 0.11 for all three dimensions on WOMAC scale for both types of procedure in all participating hospitals. The variability in the physical and mental SF-12 components was very low for both types of procedure (0.08 and 0.07 for hip and 0.03 and 0.07 for knee surgery patients). However, a moderate-high variability was detected in

  5. A Multicenter Approach Evaluating the Impact of Vitamin E-Blended Polyethylene in Cementless Total Hip Replacement

    Science.gov (United States)

    Jäger, Marcus; van Wasen, Andrea; Warwas, Sebastian; Landgraeber, Stefan; Haversath, Marcel; Group, VITAS

    2014-01-01

    Since polyethylene is one of the most frequently used biomaterials as a liner in total hip arthroplasty, strong efforts have been made to improve design and material properties over the last 50 years. Antioxidants seems to be a promising alternative to further increase durability and reduce polyethylene wear in long term. As of yet, only in vitro results are available. While they are promising, there is yet no clinical evidence that the new material shows these advantages in vivo. To answer the question if vitamin-E enhanced ultra-high molecular weight polyethylene (UHMWPE) is able to improve long-term survivorship of cementless total hip arthroplasty we initiated a randomized long-term multicenter trial. Designed as a superiority study, the oxidation index assessed in retrieval analyses of explanted liners was chosen as primary parameter. Radiographic results (wear rate, osteolysis, radiolucency) and functional outcome (Harris Hip Scores, University of California-Los Angeles, Hip Disability and Osteoarthritis Outcome Score, Visual Analogue Scale) will serve as secondary parameters. Patients with the indication for a cementless total hip arthroplasty will be asked to participate in the study and will be randomized to either receive a standard hip replacement with a highly cross-linked UHMWPE-X liner or a highly cross-linked vitamin-E supplemented UHMWPE-XE liner. The follow-up will be 15 years, with evaluation after 5, 10 and 15 years. The controlled randomized study has been designed to determine if Vitamin-E supplemented highly cross-linked polyethylene liners are superior to standard XLPE liners in cementless total hip arthroplasty. While several studies have been started to evaluate the influence of vitamin-E, most of them evaluate wear rates and functional results. The approach used for this multicenter study, to analyze the oxidation status of retrieved implants, should make it possible to directly evaluate the ageing process and development of the implant

  6. A multicenter approach evaluating the impact of vitamin E-blended polyethylene in cementless total hip replacement

    Directory of Open Access Journals (Sweden)

    Marcus Jäger

    2014-04-01

    Full Text Available Since polyethylene is one of the most frequently used biomaterials as a liner in total hip arthroplasty, strong efforts have been made to improve design and material properties over the last 50 years. Antioxidants seems to be a promising alternative to further increase durability and reduce polyethylene wear in long term. As of yet, only in vitro results are available. While they are promising, there is yet no clinical evidence that the new material shows these advantages in vivo. To answer the question if vitamin-E enhanced ultra-high molecular weight polyethylene (UHMWPE is able to improve long-term survivorship of cementless total hip arthroplasty we initiated a randomized long-term multicenter trial. Designed as a superiority study, the oxidation index assessed in retrieval analyses of explanted liners was chosen as primary parameter. Radiographic results (wear rate, osteolysis, radiolucency and functional outcome (Harris Hip Scores, University of California-Los Angeles, Hip Disability and Osteoarthritis Outcome Score, Visual Analogue Scale will serve as secondary parameters. Patients with the indication for a cementless total hip arthroplasty will be asked to participate in the study and will be randomized to either receive a standard hip replacement with a highly cross-linked UHMWPE-X liner or a highly cross-linked vitamin-E supplemented UHMWPE-XE liner. The follow-up will be 15 years, with evaluation after 5, 10 and 15 years. The controlled randomized study has been designed to determine if Vitamin-E supplemented highly cross-linked polyethylene liners are superior to standard XLPE liners in cementless total hip arthroplasty. While several studies have been started to evaluate the influence of vitamin-E, most of them evaluate wear rates and functional results. The approach used for this multicenter study, to analyze the oxidation status of retrieved implants, should make it possible to directly evaluate the ageing process and development

  7. Monitoring the quality of total hip replacement in a tertiary care department using a cumulative summation statistical method (CUSUM).

    Science.gov (United States)

    Biau, D J; Meziane, M; Bhumbra, R S; Dumaine, V; Babinet, A; Anract, P

    2011-09-01

    The purpose of this study was to define immediate post-operative 'quality' in total hip replacements and to study prospectively the occurrence of failure based on these definitions of quality. The evaluation and assessment of failure were based on ten radiological and clinical criteria. The cumulative summation (CUSUM) test was used to study 200 procedures over a one-year period. Technical criteria defined failure in 17 cases (8.5%), those related to the femoral component in nine (4.5%), the acetabular component in 32 (16%) and those relating to discharge from hospital in five (2.5%). Overall, the procedure was considered to have failed in 57 of the 200 total hip replacements (28.5%). The use of a new design of acetabular component was associated with more failures. For the CUSUM test, the level of adequate performance was set at a rate of failure of 20% and the level of inadequate performance set at a failure rate of 40%; no alarm was raised by the test, indicating that there was no evidence of inadequate performance. The use of a continuous monitoring statistical method is useful to ensure that the quality of total hip replacement is maintained, especially as newer implants are introduced.

  8. Hip Abductor Strengthening Improves Physical Function Following Total Knee Replacement: One-Year Follow-Up of a Randomized Pilot Study

    OpenAIRE

    Harikesavan, Karvannan; Chakravarty, Raj D.; Maiya, Arun G; Hegde, Sanjay P.; Y. Shivanna, Shivakumar

    2017-01-01

    Background: Total knee replacement (TKR) is the commonest surgical procedure for patients with severe pain and impaired physical function following end stage knee osteoarthritis. The hip abductors are well renowned in stabilization of the trunk and hip during walking, maintaining the lower limb position, and transferring the forces from the lower limbs to the pelvis. Objective: To assess the efficacy of hip abductor strengthening exercise on functional outcome using performance based outcome ...

  9. Tantalum-based multilayer coating on cobalt alloys in total hip and knee replacement

    Energy Technology Data Exchange (ETDEWEB)

    Balagna, C., E-mail: cristina.balagna@polito.it [Institute of Materials Engineering and Physics, Applied Science and Technology Department, Politecnico di Torino, Corso Duca degli Abruzzi 24,10129 Torino (Italy); Faga, M.G. [Istituto di Scienza e Tecnologia dei Materiali Ceramici, Consiglio Nazionale delle Ricerche, Strada delle Cacce 73, 10135 Torino (Italy); Spriano, S. [Institute of Materials Engineering and Physics, Applied Science and Technology Department, Politecnico di Torino, Corso Duca degli Abruzzi 24,10129 Torino (Italy)

    2012-05-01

    Cobalt-chromium-molybdenum (CoCrMo) alloys are widely used in total hip and knee joint replacement, due to high mechanical properties and resistance to wear and corrosion. They are able to form efficient artificial joints by means of coupling metal-on-polymer or metal-on-metal contacts. However, a high concentration of stress and direct friction between surfaces leads to the formation of polyethylene wear debris and the release of toxic metal ions into the human body, limiting, as a consequence, the lifetime of implants. The aim of this research is a surface modification of CoCrMo alloys in order to improve their biocompatibility and to decrease the release of metal ions and polyethylene debris. Thermal treatment in molten salts was the process employed for the deposition of tantalum-enriched coating. Tantalum and its compounds are considered biocompatible materials with low ion release and high corrosion resistance. Three different CoCrMo alloys were processed as substrates. An adherent coating of about 1 {mu}m of thickness, with a multilayer structure consisting of two tantalum carbides and metallic tantalum was deposited. The substrates and modified layers were characterized by means of structural, chemical and morphological analysis. Moreover nanoindentation, scratch and tribological tests were carried out in order to evaluate the mechanical behavior of the substrates and coating. The hardness of the coated samples increases more than double than the untreated alloys meanwhile the presence of the coating reduced the wear volume and rate of about one order of magnitude. - Highlights: Black-Right-Pointing-Pointer Thermal treatment in molten salts deposits a Ta-based coating on Co-based alloys. Black-Right-Pointing-Pointer Coating is composed by one or two tantalum carbides and/or metallic tantalum. Black-Right-Pointing-Pointer The coating structure depends on thermal temperature and substrates carbon content. Black-Right-Pointing-Pointer Coating is able to

  10. Allogeneic blood transfusion and prognosis following total hip replacement: a population-based follow up study

    Directory of Open Access Journals (Sweden)

    Overgaard Soren

    2009-12-01

    Full Text Available Abstract Background Allogeneic red blood cell transfusion is frequently used in total hip replacement surgery (THR. However, data on the prognosis of transfused patients are sparse. In this study we compared the risk of complications following THR in transfused and non-transfused patients. Methods A population-based follow-up study was performed using data from medical databases in Denmark. We identified 28,087 primary THR procedures performed from 1999 to 2007, from which we computed a propensity score for red blood cell transfusion based on detailed data on patient-, procedure-, and hospital-related characteristics. We were able to match 2,254 transfused with 2,254 non-transfused THR patients using the propensity score. Results Of the 28,087 THR patients, 9,063 (32.3% received at least one red blood cell transfusion within 8 days of surgery. Transfused patients had higher 90-day mortality compared with matched non-transfused patients: the adjusted OR was 2.2 (95% confidence interval (CI: 1.2-3.8. Blood transfusion was also associated with increased odds of pneumonia (OR 2.1; CI: 1.2-3.8, whereas the associations with cardiovascular or cerebrovascular events (OR 1.4; CI: 0.9-2.2 and venous thromboembolism (OR 1.2; CI: 0.7-2.1 did not reach statistical significance. The adjusted OR of reoperation due to infection was 0.6 (CI: 0.1-2.9. Conclusions Red blood cell transfusion was associated with an adverse prognosis following primary THR, in particular with increased odds of death and pneumonia. Although the odds estimates may partly reflect unmeasured bias due to blood loss, they indicate the need for careful assessment of the risk versus benefit of transfusion even in relation to routine THR procedures.

  11. Physician referral patterns and racial disparities in total hip replacement: A network analysis approach.

    Directory of Open Access Journals (Sweden)

    Hassan M K Ghomrawi

    Full Text Available Efforts to reduce racial disparities in total hip replacement (THR have focused mainly on patient behaviors. While these efforts are no doubt important, they ignore the potentially important role of provider- and system-level factors, which may be easier to modify. We aimed to determine whether the patterns of interaction among physicians around THR episodes differ in communities with low versus high concentrations of black residents.We analyzed national Medicare claims from 2008 to 2011, identifying all fee-for-service beneficiaries who underwent THR. Based on physician encounter data, we then mapped the physician referral networks at the hospitals where beneficiaries' procedures were performed. Next, we measured two structural properties of these networks that could affect care coordination and information sharing: clustering, and the number of external ties. Finally, we estimated multivariate regression models to determine the relationship between the concentration of black residents in the community [as measured by the hospital service area (HSA] served by a given network and each of these 2 network properties.Our sample included 336,506 beneficiaries (mean age 76.3 ± SD, 63.1% of whom were women. HSAs with higher concentrations of black residents tended to be more impoverished than those with lower concentrations. While HSAs with higher concentrations of black residents had, on average, more acute care beds and medical specialists, they had fewer surgeons per capita than those with lower concentrations. After adjusting for these differences, we found that HSAs with higher concentrations of black residents were served by physician referral networks that had significantly higher within-network clustering but fewer external ties.We observed differences in the patterns of interaction among physicians around THR episodes in communities with low versus high concentrations of black residents. Studies investigating the impact of these differences

  12. Total hip and knee replacement surgery results in changes in leukocyte and endothelial markers

    Directory of Open Access Journals (Sweden)

    Maclean Kirsty M

    2010-01-01

    Full Text Available Abstract Background It is estimated that over 8 million people in the United Kingdom suffer from osteoarthritis. These patients may require orthopaedic surgical intervention to help alleviate their clinical condition. Investigations presented here was to test the hypothesis that total hip replacement (THR and total knee replacement (TKR orthopaedic surgery result in changes to leukocyte and endothelial markers thus increasing inflammatory reactions postoperatively. Methods During this 'pilot study', ten test subjects were all scheduled for THR or TKR elective surgery due to osteoarthritis. Leukocyte concentrations were measured using an automated full blood count analyser. Leukocyte CD11b (Mac-1 and CD62L cell surface expression, intracellular production of H2O2 and elastase were measured as markers of leukocyte function. Von Willebrand factor (vWF and soluble intercellular adhesion molecule-1 (sICAM-1 were measured as markers of endothelial activation. Results The results obtained during this study demonstrate that THR and TKR orthopaedic surgery result in similar changes of leukocyte and endothelial markers, suggestive of increased inflammatory reactions postoperatively. Specifically, THR and TKR surgery resulted in a leukocytosis, this being demonstrated by an increase in the total leukocyte concentration following surgery. Evidence of leukocyte activation was demonstrated by a decrease in CD62L expression and an increase in CD11b expression by neutrophils and monocytes respectively. An increase in the intracellular H2O2 production by neutrophils and monocytes and in the leukocyte elastase concentrations was also evident of leukocyte activation following orthopaedic surgery. With respect to endothelial activation, increases in vWF and sICAM-1 concentrations were demonstrated following surgery. Conclusion In general it appeared that most of the leukocyte and endothelial markers measured during these studies peaked between days 1

  13. Factors influencing health-related quality of life after total hip replacement - a comparison of data from the Swedish and Danish hip arthroplasty registers

    DEFF Research Database (Denmark)

    Gordon, Max; Paulsen, Aksel; Overgaard, Søren

    2013-01-01

    of PROs may present difficulties due to cultural differences and differences in the provision of health care. However, in order to understand how these differences affect PROs, common predictors for poor and good outcomes need to be investigated. This cross-sectional study investigates factors influencing......There is an increasing focus on measuring patient-reported outcomes (PROs) as part of routine medical practice, particularly in fields such as joint replacement surgery where pain relief and improvement in health-related quality of life (HRQoL) are primary outcomes. Between-country comparisons...... health-related quality of life (HRQoL) one year after total hip replacement (THR) surgery in Sweden and in Denmark....

  14. Can shared care deliver better outcomes for patients undergoing total hip replacement? A prospective assessment of patient outcomes and associated service use

    NARCIS (Netherlands)

    Rosendal, H.; Beekum, W.T. van; Nijhof, P.; Witte, L.P. de; Schrijvers, A.J.P.

    2000-01-01

    Objectives: To assess whether shared care for patients undergoing total hip replacement delivers better outcomes compared to care as usual. Design: Prospective, observational cohort study. Setting: Two regions in the Netherlands where different organisational health care models have been

  15. Depression and the Overall Burden of Painful Joints: An Examination among Individuals Undergoing Hip and Knee Replacement for Osteoarthritis

    Directory of Open Access Journals (Sweden)

    Rajiv Gandhi

    2015-01-01

    Full Text Available The majority of patients with hip or knee osteoarthritis (OA report one or more symptomatic joints apart from the one targeted for surgical care. Therefore, the purpose of the present study was to investigate the association between the burden of multiple symptomatic joints and self-reported depression in patients awaiting joint replacement for OA. Four hundred and seventy-five patients at a single centre were evaluated. Patients self-reported joints that were painful and/or symptomatic most days of the previous month on a homunculus, with nearly one-third of the sample reporting 6 or more painful joints. The prevalence of depression was 12.2% (58/475. When adjusted for age, sex, education level, hip or knee OA, body mass index, chronic condition count, and joint-specific WOMAC scores, each additional symptomatic joint was associated with a 19% increased odds (odds ratio: 1.19 (95% CI: 1.08, 1.31, P<0.01 of self-reported depression. Individuals reporting 6 or more painful joints had 2.5-fold or greater odds of depression when compared to those patients whose symptoms were limited to the surgical joint. A focus on the surgical joint alone is likely to miss a potentially important determinant of postsurgical patient-reported outcomes in patients undergoing hip or knee replacement.

  16. Effects of balance and proprioceptive training on total hip and knee replacement rehabilitation: A systematic review and meta-analysis.

    Science.gov (United States)

    Domínguez-Navarro, Fernando; Igual-Camacho, Celedonia; Silvestre-Muñoz, Antonio; Roig-Casasús, Sergio; Blasco, José María

    2018-05-01

    Balance and proprioceptive deficits are frequently persistent after total joint replacement, limiting functionality and involving altered movement patterns and difficulties in walking and maintaining postural control among patients. The goal of this systematic review was to evaluate the short- and mid-term effects of proprioceptive and balance training for patients undergoing total knee and hip replacement. This is a systematic review of literature. MEDLINE, Embase, Cochrane Library, PEDro, and Scopus were the databases searched. The review included randomized clinical trials in which the experimental groups underwent a training aimed at improving balance and proprioception, in addition to conventional care. The studies had to assess at least one of the following outcomes: self-reported functionality or balance (primary outcomes), knee function, pain, falls, or quality of life. Eight trials were included, involving 567 participants. The quantitative synthesis found a moderate to high significant effect of balance and proprioceptive trainings on self-reported functionality and balance after total knee replacement. The effects were maintained at mid-term in terms of balance alone. Conversely, preoperative training did not enhance outcomes after total hip arthroplasty. The synthesis showed that, in clinical terms, balance trainings are a convenient complement to conventional physiotherapy care to produce an impact on balance and functionality after knee replacement. If outcomes such as improvement in pain, knee range of movement, or patient quality of life are to be promoted, it would be advisable to explore alternative proposals specifically targeting these goals. Further research is needed to confirm or discard the current evidence ultimately, predominantly in terms of the effects on the hips and those yielded by preoperative interventions. Copyright © 2018 Elsevier B.V. All rights reserved.

  17. Corrosion and Tribology of Materials Used in a Novel Reverse Hip Replacement.

    Science.gov (United States)

    Braddon, Linda; Termanini, Zafer; MacDonald, Steven; Parvizi, Jay; Lieberman, Jay; Frankel, Victor; Zuckerman, Joseph

    2017-07-05

    Total hip arthroplasty has been utilized for the past 50 years as an effective treatment for degenerative, inflammatory and traumatic disorders of the hip. The design of these implants has generally followed the anatomy of the hip as a ball and socket joint with the femoral head representing the ball and the acetabulum representing the socket. We describe a novel hip arthroplasty design in which the "ball" is located on the acetabular side and the "socket" is located on the femoral side. The results of extensive biomechanical testing are described and document wear and corrosion characteristics that are at least equivalent to standard designs. These results support clinical assessment as the next step of the evaluation.

  18. Psychiatric disease as a risk factor in fast-track hip and knee replacement

    DEFF Research Database (Denmark)

    Gylvin, Silas Hinsch; Jørgensen, Christoffer Calov; Fink-Jensen, Anders

    2016-01-01

    Recent studies suggest that patients with psychiatric disorders tend to do worse than patients without a psychiatric diagnosis when undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA). Whether this is due to their psychiatric condition, pharmacological treatment, a combination...... role of psychotropic drugs in the perioperative course. This will be useful when planning future strategies for improvement of surgical outcome following hip and knee arthroplasty....

  19. Preoperative radiotherapy (RT) for prevention of heterotopic ossification (HO) after total hip replacement

    International Nuclear Information System (INIS)

    Heyd, R.; Schopohl, B.; Boettcher, H.D.; Kirchner, J.

    1997-01-01

    Preliminary results of a prospective study which investigates the efficacy of preoperative radiotherapy (RT) for prevention of heterotopic ossification (HO) after total hip arthroplasty are summarized. A total number of 20 hip joints (18 patients) were irradiated with a single dose of 6.0 Gy Brooker grade II). The functional outcome quantified with the Harris score was improved by an average of 37.9 points. The authors conclude that preoperative RT is an effective alternative for postoperative irradiation. (orig.) [de

  20. Taking care of your new hip joint

    Science.gov (United States)

    Hip arthroplasty - precautions; Hip replacement - precautions; Osteoarthritis - hip; Osteoarthritis - knee ... After you have hip replacement surgery, you will need to be careful how you move your hip, especially for the first few months ...

  1. Pre- and postoperative ventilation-perfusion scan findings in patients undergoing total hip replacement or knee arthroplasty

    International Nuclear Information System (INIS)

    Kim, S.M.; Park, C.H.; Intenzo, C.M.

    1988-01-01

    Venous thrombolembolism is one of the major postoperative complications in patients undergoing total hip replacement (THR) or knee anthroplasty (TKA). The reported incidence of pulmonary embolism in this group is as high as 20%. The purpose of this report was to evaluate the value of preoperative and 7th-day postpoperative ventilation-perfusion (V/Q) lung scans in the management of patients undergoing elective reconstructive surgery of the hips or knees. Routine preoperative and 7th-day postoperative V/Q lung scans were obtained in 34 patients who underwent THR (17 patients) or TKA (17 patients). There were 15 male and 19 female patients, with an age distribution ranging from 56 to 80 years. Chest radiographs were obtained within 1 day of the pre- or postoperative lungs scan. Lung scans were interpreted by two experienced nuclear physicians

  2. Fulfilment of knowledge expectations and emotional state among people undergoing hip replacement: a multi-national survey.

    Science.gov (United States)

    Johansson Stark, Asa; Ingadottir, Brynja; Salanterä, Sanna; Sigurdardottir, Arun; Valkeapää, Kirsi; Bachrach-Lindström, Margareta; Unosson, Mitra

    2014-11-01

    Patient education in connection with hip replacement is intended to prepare patients for surgery, discharge and postoperative recovery. Patients experience symptoms and emotions due to disease or upcoming surgery which can affect how their knowledge expectations are fulfilled. To describe the differences between received and expected knowledge in patients undergoing elective hip replacement in three Nordic countries, and to analyse how these differences are related to patients' characteristics, preoperative symptoms and emotions. A descriptive, prospective survey with two data collection points; before admission and at hospital discharge after surgery. Two Finnish, three Icelandic and two Swedish hospitals. The population consisted of patients on a waiting list for hip replacement. Of the consecutively included patients, 320 answered questionnaires both before admission and at discharge and were included in the study. The mean age of the patients was 64 years, and 55% were women. Structured questionnaires were used; the knowledge expectations of hospital patients scale and self-reported scales for symptoms and emotions before admission and received knowledge of hospital patients scale at discharge. Fulfilment of knowledge expectation was assessed by calculating the difference between received and expected knowledge with a paired sample t-test. A multiple stepwise regression model was used to explain the variance of fulfilled knowledge expectations. Patients expected more knowledge than they received (p<0.001) and 77% of them had unfulfilled knowledge expectations. Patients with a higher level of education were more likely to have unfulfilled knowledge expectations. A higher level of education was also related to a greater difference between received and expected knowledge. The difference was more correlated with patients' emotions than their symptoms. A depressive state was the major predictor of the variance in the difference between received and expected

  3. Factors associated with health related quality of life after a hip or knee total replacement, according to a gender approach

    Directory of Open Access Journals (Sweden)

    Sergio R. López Alonso

    2010-07-01

    Full Text Available Objective: To identify the factors associated with Health Related Quality of Life (HRQL, and Symptoms and Physical Functional Disability (S&PFD after a Hip or Knee Total Replacement, according to a gender approach. A longitudinal cohort study design is performed at “La Merced” (Osuna. Sevilla and “Torrecárdenas” (Almería Hospitals, via telephone interview since October 2004 to November 2006. The study included all people who underwent a hip or knee total replacement. The dependent variables were HRQL and S&PFD, both measured via short versions of the COOP/WONCA and WOMAC questionnaires.Results: 311 people were included, who were mostly women (82,63% and 70 years old (average. The hip and knee replacement obtained an statistically significant improvement on HRQL (20,5% and S&PFD (28,2%, with no gender difference. Five variables were associated to HRQL for Women: HRQL previous to surgery, hospital, local infection as a complication, autonomy for daily living, and marital status. All of them were associated to men, except the last two ones. About S&PFD, six variables were associated for women: HRQL and S&PFD previous to surgery, hospital, local infection as a complication, body mass index and marital status. All of them were associated to men, except the last two ones.Factors associated to improve on HRQL and S&PFD in male population are few, though they find a great explanation of the improvement. Different situation arise on female population because more factors obtained a substantially inferior explanation.

  4. Primary Total Hip Replacement for a Femoral Neck Fracture in a Below-Knee Amputee

    OpenAIRE

    Masmoudi, Karim; Rbai, H?di; Fradj, Ayman Ben; Sa?dena, Jecem; Boughattas, Anouar

    2016-01-01

    Introduction: Femoral neck fracture on amputated limb is an uncommon lesion and challenging to manage. Case Report: We report a case of a displaced neck fracture of the left femur in a 57-year-old female. She underwent at the age of the three a below-knee amputation of the ipsilateral limb for post traumatic ischemia. The fracture was managed by a total hip arthroplasty (THA), as a primary procedure. In this article we describe our experience of this unusual entity. Conclusion: Total hip arth...

  5. [Social and professional effects of hip prosthetic replacment on people under 50 years of age].

    Science.gov (United States)

    Xenard, J

    1996-12-01

    Although total hip prosthetic replacement is a common surgical procedure, it is not without social and professional consequences. In a certain number of cases, return to occupational activities is not possible. In others, it is difficult. Long-term work break repercussions can be major as they often go together with financial difficulties. The medical counsultant and the occupational doctor will have an important role to play at the time of the return to occupational activities or to determine the conditions of workplace adaptation or a vocational training program.Functional recovery after insertion of total hip prosthesis observes precise rules of articular mobilization, weight bearing and muscular strengthening.In the young patient, before 50 years old, objectives will be more accurate and progress not only will concern recovery of daily living, walking and do-it-yourself activities but also return to sports, play and occupational activities. Not only will reactivation be physical, muscular and articular but also behavioral and psychological.Disease and its consequences, surgery in particular, cause a psychological and a physical aggression which modifies the patient's self-concept. • Vulnerability and plastic wrong (limping, modifications of gesture and sports performanee as well as modifications of the living conditions). The patient unconsciously translates this physical affection into: * loneliness (taking away or exclusion from the usual surroundings of those who are in good health) * "blues" * lack of dynamism * uselessness, feeling of being incompetent "in those conditions, what's the use of fighting?" ٜ At the same time - loss of social status: "Colleagues get up to go to work, children go to school, all the others are productive, I'm good at nothing." - impression of uselessness, dependence; reinforcement of turning in on the self. •The undertaking by a surgeon and his team (anaesthetist, nurse, physiotherapist) which implies constraints, orders

  6. Dual X-ray absortiometry(DXA) in the detection of loosening in the total hip replacement arthroplasty: preliminary study

    International Nuclear Information System (INIS)

    Yoon, Hye Kyung; Kang, Heung Sik; Han, Man Chung; Kim, Hee Joong; Kim, Young Min

    1994-01-01

    Algorithms to get cross-sectional bone density pattern(transverse histogram) to predict the loosening of hip prosthesis using DXA(Dual X-ray Absorptiometry) have been developed. We performed this study to analyze the correlation between radiologic findings and densitometric pattern of the THRA(Total Hip Replacement Arthroplasty) patients. Thirty-six hips of 32 THRA patients were evaluated. The duration between THRA and DXA was from 1 year 7 months to 15 years. On transverse histogram, the periprosthetic bone density patterns were classified as 3 types; type I , rigid fixation in 17, type II definite loosening in 8, and type III, partial loosening in 11 cases. Surgical findings, plain X-ray findings and transverse histogram using DXA were correlated. Among 14 cases performing revision for acetabular prosthesis loosening, 5 cases revealed loosening of femoral stems while 9 cases revealed rigid fixation of femoral stems. Sensitivity was 100% for either plain X-ray or DXA. Specificity was 88%, 77% for plain X-ray and DXA respectively. This preliminary study reveals that periprosthetic bone density pattern on transverse histogram on DXA may be useful in the evaluation of the loosening. However, further study will be needed for clinical application

  7. Stair climbing is more detrimental to the cement in hip replacement than walking

    NARCIS (Netherlands)

    Stolk, J.; Verdonschot, N.J.J.; Huiskes, H.W.J.

    2002-01-01

    Stair climbing may be detrimental to cemented total hip arthroplasties, because it subjects the reconstruction to high torsional loads. The current study investigated how stair climbing contributes to damage accumulation in the cement around a femoral stem compared with walking, taking into account

  8. Measurement of installation deformation of the acetabulum during prosthetic replacement of a hip joint using digital image correlation

    Science.gov (United States)

    Lei, Dong; Bai, Pengxiang; Zhu, Feipeng

    2018-01-01

    Nowadays, acetabulum prosthesis replacement is widely used in clinical medicine. However, there is no efficient way to evaluate the implantation effect of the prosthesis. Based on a modern photomechanics technique called digital image correlation (DIC), the evaluation method of the installation effect of the acetabulum was established during a prosthetic replacement of a hip joint. The DIC method determines strain field by comparing the speckle images between the undeformed sample and the deformed counterpart. Three groups of experiments were carried out to verify the feasibility of the DIC method on the acetabulum installation deformation test. Experimental results indicate that the installation deformation of acetabulum generally includes elastic deformation (corresponding to the principal strain of about 1.2%) and plastic deformation. When the installation angle is ideal, the plastic deformation can be effectively reduced, which could prolong the service life of acetabulum prostheses.

  9. A custom-made guide-wire positioning device for Hip Surface Replacement Arthroplasty: description and first results

    Directory of Open Access Journals (Sweden)

    Clijmans Tim

    2010-07-01

    Full Text Available Abstract Background Hip surface replacement arthroplasty (SRA can be an alternative for total hip arthroplasty. The short and long-term outcome of hip surface replacement arthroplasty mainly relies on the optimal size and position of the femoral component. This can be defined before surgery with pre-operative templating. Reproducing the optimal, templated femoral implant position during surgery relies on guide wire positioning devices in combination with visual inspection and experience of the surgeon. Another method of transferring the templated position into surgery is by navigation or Computer Assisted Surgery (CAS. Though CAS is documented to increase accurate placement particularly in case of normal hip anatomy, it requires bulky equipment that is not readily available in each centre. Methods A custom made neck jig device is presented as well as the results of a pilot study. The device is produced based on data pre-operatively acquired with CT-scan. The position of the guide wire is chosen as the anatomical axis of the femoral neck. Adjustments to the design of the jig are made based on the orthopedic surgeon's recommendations for the drill direction. The SRA jig is designed as a slightly more-than-hemispherical cage to fit the anterior part of the femoral head. The cage is connected to an anterior neck support. Four knifes are attached on the central arch of the cage. A drill guide cylinder is attached to the cage, thus allowing guide wire positioning as pre-operatively planned. Custom made devices were tested in 5 patients scheduled for total hip arthroplasty. The orthopedic surgeons reported the practical aspects of the use of the neck-jig device. The retrieved femoral heads were analyzed to assess the achieved drill place in mm deviation from the predefined location and orientation compared to the predefined orientation. Results The orthopedic surgeons rated the passive stability, full contact with neck portion of the jig and knife

  10. The effect of cup outer sizes on the contact mechanics and cement fixation of cemented total hip replacements.

    Science.gov (United States)

    Hua, Xijin; Li, Junyan; Wang, Ling; Wilcox, Ruth; Fisher, John; Jin, Zhongmin

    2015-10-01

    One important loosening mechanism of the cemented total hip arthroplasty is the mechanical overload at the bone-cement interface and consequent failure of the cement fixation. Clinical studies have revealed that the outer diameter of the acetabular component is a key factor in influencing aseptic loosening of the hip arthroplasty. The aim of the present study was to investigate the influence of the cup outer diameter on the contact mechanics and cement fixation of a cemented total hip replacement (THR) with different wear penetration depths and under different cup inclination angles using finite element (FE) method. A three-dimensional FE model was developed based on a typical Charnley hip prosthesis. Two acetabular cup designs with outer diameters of 40 and 43 mm were modelled and the effect of cup outer diameter, penetration depth and cup inclination angle on the contact mechanics and cement fixation stresses in the cemented THR were studied. The results showed that for all penetration depths and cup inclination angles considered, the contact mechanics in terms of peak von Mises stress in the acetabular cup and peak contact pressure at the bearing surface for the two cup designs were similar (within 5%). However, the peak von Mises stress, the peak maximum principal stress and peak shear stress in the cement mantle at the bone-cement interface for the 43 mm diameter cup design were predicted to be lower compared to those for the 40 mm diameter cup design. The differences were predicted to be 15-19%, 15-22% and 18-20% respectively for different cup penetration depths and inclination angles, which compares to the clinical difference of aseptic loosening incidence of about 20% between the two cup designs. Copyright © 2015 IPEM. Published by Elsevier Ltd. All rights reserved.

  11. Patient Recall of Informed Consent at 4 Weeks After Total Hip Replacement With Standardized Versus Procedure-Specific Consent Forms.

    Science.gov (United States)

    Pomeroy, Eoghan; Shaarani, Shahril; Kenyon, Robert; Cashman, James

    2017-08-25

    Informed consent plays a pivotal role in the operative process, and surgeons have an ethical and legal obligation to provide patients with information to allow for shared decision-making. Unfortunately, patient recall after the consent process is frequently poor. This study aims to evaluate the effect of procedure-specific consent forms on patient's recall four weeks after total hip replacement (THR). This is a prospective study using a posttest-only control group design. Sixty adult patients undergoing total hip replacement were allocated to be consented using either the generic or the surgery-specific consent form. Four weeks after surgery, a phone interview was conducted to assess patient's recall of risk of surgical complications. Patient demographic characteristics and educational attainment were similar in both groups. There was a statistically significant increase in the mean number of risks recalled in the study group at 1.43 compared with 0.67 in the control group (P = 0.0131). Consent is a complex process, and obtaining informed consent is far from straightforward. A statistically significant improvement in patient's recall with the use of procedure-specific consent forms was identified, and based on this, we would advocate their use. However, overall patient recall in both groups was poor. We believe that improving the quality of informed consent may require the sum of small gains, and the use of procedure-specific consent forms may aid in this regard.

  12. The contact mechanics and occurrence of edge loading in modular metal-on-polyethylene total hip replacement during daily activities.

    Science.gov (United States)

    Hua, Xijin; Li, Junyan; Jin, Zhongmin; Fisher, John

    2016-06-01

    The occurrence of edge loading in hip joint replacement has been associated with many factors such as prosthetic design, component malposition and activities of daily living. The present study aimed to quantify the occurrence of edge loading/contact at the articulating surface and to evaluate the effect of cup angles and edge loading on the contact mechanics of a modular metal-on-polyethylene (MoP) total hip replacement (THR) during different daily activities. A three-dimensional finite element model was developed based on a modular MoP bearing system. Different cup inclination and anteversion angles were modelled and six daily activities were considered. The results showed that edge loading was predicted during normal walking, ascending and descending stairs activities under steep cup inclination conditions (≥55°) while no edge loading was observed during standing up, sitting down and knee bending activities. The duration of edge loading increased with increased cup inclination angles and was affected by the cup anteversion angles. Edge loading caused elevated contact pressure at the articulating surface and substantially increased equivalent plastic strain of the polyethylene liner. The present study suggested that correct positioning the component to avoid edge loading that may occur during daily activities is important for MoP THR in clinical practice. Copyright © 2016. Published by Elsevier Ltd.

  13. Accuracy of templating the acetabular cup size in Total Hip Replacement using conventional acetate templates on digital radiographs.

    Science.gov (United States)

    Krishnamoorthy, Vignesh P; Perumal, Rajamani; Daniel, Alfred J; Poonnoose, Pradeep M

    2015-12-01

    Templating of the acetabular cup size in Total Hip Replacement (THR) is normally done using conventional radiographs. As these are being replaced by digital radiographs, it has become essential to create a technique of templating using digital films. We describe a technique that involves templating the digital films using the universally available acetate templates for THR without the use of special software. Preoperative digital radiographs of the pelvis were taken with a 30 mm diameter spherical metal ball strapped over the greater trochanter. Using standard acetate templates provided by the implant company on magnified digital radiographs, the size of the metal ball (X mm) and acetabular cup (Y mm) were determined. The size of the acetabular cup to be implanted was estimated using the formula 30*Y/X. The estimated size was compared with the actual size of the cup used at surgery. Using this technique, it was possible to accurately predict the acetabular cup size in 28/40 (70%) of the hips. When the accuracy to within one size was considered, templating was correct in 90% (36/40). When assessed by two independent observers, there was good intra-observer and inter-observer reliability with intra-class correlation coefficient values greater than 0.8. It was possible to accurately and reliably predict the size of the acetabular cup, using acetate templates on digital films, without any digital templates.

  14. Cross-sectional analysis of association between socioeconomic status and utilization of primary total hip joint replacements 2006–7: Australian Orthopaedic Association National Joint Replacement Registry

    Directory of Open Access Journals (Sweden)

    Brennan Sharon L

    2012-04-01

    Full Text Available Abstract Background The utilization of total hip replacement (THR surgery is rapidly increasing, however few data examine whether these procedures are associated with socioeconomic status (SES within Australia. This study examined primary THR across SES for both genders for the Barwon Statistical Division (BSD of Victoria, Australia. Methods Using the Australian Orthopaedic Association National Joint Replacement Registry data for 2006–7, primary THR with a diagnosis of osteoarthritis (OA among residents of the BSD was ascertained. The Index of Relative Socioeconomic Disadvantage was used to measure SES; determined by matching residential addresses with Australian Bureau of Statistics census data. The data were categorised into quintiles; quintile 1 indicating the most disadvantaged. Age- and sex-specific rates of primary THR per 1,000 person years were reported for 10-year age bands using the total population at risk. Results Females accounted for 46.9% of the 642 primary THR performed during 2006–7. THR utilization per 1,000 person years was 1.9 for males and 1.5 for females. The highest utilization of primary THR was observed in those aged 70–79 years (males 6.1, and females 5.4 per 1,000 person years. Overall, the U-shaped pattern of THR across SES gave the appearance of bimodality for both males and females, whereby rates were greater for both the most disadvantaged and least disadvantaged groups. Conclusions Further work on a larger scale is required to determine whether relationships between SES and THR utilization for the diagnosis of OA is attributable to lifestyle factors related to SES, or alternatively reflects geographic and health system biases. Identifying contributing factors associated with SES may enhance resource planning and enable more effective and focussed preventive strategies for hip OA.

  15. Cross-sectional analysis of association between socioeconomic status and utilization of primary total hip joint replacements 2006-7: Australian Orthopaedic Association National Joint Replacement Registry.

    Science.gov (United States)

    Brennan, Sharon L; Stanford, Tyman; Wluka, Anita E; Henry, Margaret J; Page, Richard S; Graves, Stephen E; Kotowicz, Mark A; Nicholson, Geoffrey C; Pasco, Julie A

    2012-04-30

    The utilization of total hip replacement (THR) surgery is rapidly increasing, however few data examine whether these procedures are associated with socioeconomic status (SES) within Australia. This study examined primary THR across SES for both genders for the Barwon Statistical Division (BSD) of Victoria, Australia. Using the Australian Orthopaedic Association National Joint Replacement Registry data for 2006-7, primary THR with a diagnosis of osteoarthritis (OA) among residents of the BSD was ascertained. The Index of Relative Socioeconomic Disadvantage was used to measure SES; determined by matching residential addresses with Australian Bureau of Statistics census data. The data were categorised into quintiles; quintile 1 indicating the most disadvantaged. Age- and sex-specific rates of primary THR per 1,000 person years were reported for 10-year age bands using the total population at risk. Females accounted for 46.9% of the 642 primary THR performed during 2006-7. THR utilization per 1,000 person years was 1.9 for males and 1.5 for females. The highest utilization of primary THR was observed in those aged 70-79 years (males 6.1, and females 5.4 per 1,000 person years). Overall, the U-shaped pattern of THR across SES gave the appearance of bimodality for both males and females, whereby rates were greater for both the most disadvantaged and least disadvantaged groups. Further work on a larger scale is required to determine whether relationships between SES and THR utilization for the diagnosis of OA is attributable to lifestyle factors related to SES, or alternatively reflects geographic and health system biases. Identifying contributing factors associated with SES may enhance resource planning and enable more effective and focussed preventive strategies for hip OA.

  16. The effect of posterior and lateral approach on patient-reported outcome measures and physical function in patients with osteoarthritis, undergoing total hip replacement

    DEFF Research Database (Denmark)

    Rosenlund, Signe; Broeng, Leif; Jensen, Carsten

    2014-01-01

    BACKGROUND: Total hip replacement provides pain relief and improves physical function and quality of life in patients with end-stage hip osteoarthritis. The incidence of hip replacement operations is expected to increase due to the growing elderly population. Overall, the posterior approach...... Outcome Score, subscale of "Physical function Short form" (HOOS-PS) Secondary outcome measures include two other subscales of HOOS ("Pain" and "Hip related Quality of Life"), physical activity level (UCLA activity score), limping (HHS) and general health status (EQ-5D-3L). Explorative outcomes include...... physical function and pain; however, this has not been investigated in a randomised controlled trial with a twelve-month follow-up. We hypothesized that the lateral approach has an inferior outcome in patient-reported outcome compared with the posterior approach after one year. METHODS/DESIGN: The trial...

  17. Social profile and cost analysis of deep infection following total hip replacement surgery

    Directory of Open Access Journals (Sweden)

    Vera Lucia Frazão

    Full Text Available ABSTRACT OBJECTIVE: To characterize the socio-economic and demographic profile of patients undergoing surgery for revision total hip arthroplasty regarding the diagnosis of deep prosthetic infection. METHODS: Twenty patients were retrospectively studied, admitted in the period between 2009 and 2010 by the Hip Surgery Group with the diagnosis of deep prosthetic infection, whose proposed treatment was surgical. This study was carried out in the presence of the patient by completing two forms applied by the social worker of the Group. RESULTS: In a 20-patient sample, 40% were male, 45% were working age, 50% of patients originated from the capital, 85% depended on benefits, 70% were retired, 60% of patients were from this hospital, and 40% were from other services. The average cost of patients to the public system was R$ 55,821.62 per patient and the total spent on treatment of patients in the study exceeded one million Brazilian reals, totalling R$ 1,116,432.40. CONCLUSION: Infection from total hip arthroplasty generates a major expense to the social security system and to the public healthcare system. Physicians must always be alert to the possible risk factors and perioperative care, striving to minimize this complication.

  18. Personality, function and satisfaction in patients undergoing total hip or knee replacement.

    Science.gov (United States)

    Ramaesh, Rishikesan; Jenkins, Paul; Lane, Judith V; Knight, Sara; Macdonald, Deborah; Howie, Colin

    2014-03-01

    The aim of this study was to investigate the relationships between personality and joint-specific function, general physical and general mental health in patients undergoing total hip (THA) and knee arthroplasty (TKA). One hundred and eighty-four patients undergoing THA and 205 undergoing TKA were assessed using the Eysneck Personality Questionnaire, brief version (EPQ-BV). General physical and mental health was measured using the Short-Form 12 (SF-12) questionnaire and the EuroQol (EQ-5D). Joint-specific function was measured using the Oxford hip or knee score. The "unstable introvert" personality type was associated with poorer pre-operative function and health in patients with hip arthrosis. In patients with knee arthrosis, there was poorer general health in those with "stable extrovert" and "unstable introvert" types. Personality was not an independent predictor of outcome following TKA or THA. The main predictor was pre-operative function and health. Comorbidity was an important covariate of both pre-operative and postoperative function. Personality may play a role in the interaction of these disease processes with function and health perception. It may also affect the response and interpretation of psychometric and patient-reported outcome measures. It may be important to characterise and identify these traits in potential arthroplasty patients as it may help deliver targeted education and management to improve outcomes in certain groups.

  19. Lessons learned from study of congenital hip disease in adults.

    Science.gov (United States)

    Hartofilakidis, George; Lampropoulou-Adamidou, Kalliopi

    2016-12-18

    Orthopaedic surgeons specialising in adult hip reconstruction surgery often face the problem of osteoarthritis secondary to congenital hip disease (CHD). To achieve better communication among physicians, better treatment planning and evaluation of the results of various treatment options, an agreed terminology is needed to describe the entire pathology. Furthermore, a generally accepted classification of the deformities is necessary. Herein, the authors propose the use of the term "congenital hip disease" and its classification as dysplasia, low dislocation and high dislocation. Knowledge of the CHD natural history facilitates comprehension of the potential development and progression of the disease, which differs among the aforementioned types. This can lead to better understanding of the anatomical abnormalities found in the different CHD types and thus facilitate preoperative planning and choice of the most appropriate management for adult patients. The basic principles for improved results of total hip replacement in patients with CHD, especially those with low and high dislocation, are: Wide exposure, restoration of the normal centre of rotation and the use of special techniques and implants for the reconstruction of the acetabulum and femur. Application of these principles during total hip replacement in young female patients born with severe deformities of the hip joint has led to radical improvement of their quality of life.

  20. The importance of patient expectations as a determinant of satisfaction with waiting times for hip and knee replacement surgery.

    Science.gov (United States)

    Conner-Spady, Barbara L; Sanmartin, Claudia; Johnston, Geoffrey H; McGurran, John J; Kehler, Melissa; Noseworthy, Tom W

    2011-08-01

    The disconfirmation model hypothesizes that satisfaction is a function of a perceived discrepancy from an initial expectation. Our objectives were: (1) to test the disconfirmation model as it applies to patient satisfaction with waiting time (WT) and (2) to build an explanatory model of the determinants of satisfaction with WT for hip and knee replacement. We mailed 1000 questionnaires to 2 random samples: patients waiting or those who had received a joint replacement within the preceding 3-12 months. We used ordinal logistic regression analysis to build an explanatory model of the determinants of satisfaction. Of the 1330 returned surveys, 1240 contained patient satisfaction data. The sample was 57% female; mean age was 70 years (SD 11). Consistent with the disconfirmation model, when their WTs were longer than expected, both waiting (OR 5.77, 95% CI 3.57-9.32) and post-surgery patients (OR 6.57, 95% CI 4.21-10.26) had greater odds of dissatisfaction, adjusting for the other variables in the model. Compared to those who waited 3 months or less, post-surgery patients who waited 6 to 12 months (OR 2.59, 95% CI 1.27-5.27) and over 12 months (OR 3.30, 95% CI 1.65-6.58) had greater odds of being dissatisfied with their waiting time. Patients who felt they were treated unfairly had greater odds of being dissatisfied (OR 4.74, 95% CI 2.60-8.62). In patients on waiting lists and post-surgery for hip and knee replacement, satisfaction with waiting times is related to fulfillment of expectations about waiting, as well as a perception of fairness. Measures to modify expectations and increase perceived fairness, such as informing patients of a realistic WT and communication during the waiting period, may increase satisfaction with WTs. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  1. Body mass index and risk of perioperative cardiovascular adverse events and mortality in 34,744 Danish patients undergoing hip or knee replacement

    DEFF Research Database (Denmark)

    Thornqvist, Catharina; Gislason, Gunnar H; Køber, Lars

    2014-01-01

    underwent elective primary hip or knee replacement surgery between 2005 and 2011. We used multivariable Cox regression models to calculate the 30-day risks of MACE and mortality associated with 5 BMI groups (underweight (BMI ...BACKGROUND AND PURPOSE: Obesity is a risk factor for osteoarthritis in the lower limb, yet the cardiovascular risks associated with obesity in hip or knee replacement surgery are unknown. We examined associations between body mass index (BMI) and the risk of a major adverse cardiovascular event...... (MACE: ischemic stroke, acute myocardial infarction, or cardiovascular death) or the risk of all-cause mortality in a nationwide Danish cohort of patients who underwent primary hip or knee replacement surgery. METHODS: Using Danish nationwide registries, we identified 34,744 patients aged ≥ 20 years who...

  2. Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients

    DEFF Research Database (Denmark)

    Husted, Henrik; Holm, Gitte; Jacobsen, Steffen

    2008-01-01

    BACKGROUND AND PURPOSE: Very few studies have focused on patient characteristics that influence length of stay (LOS) in fast-track total hip (THR) and knee arthroplasty (TKR). The aim of this prospective study was to identify patient characteristics associated with LOS and patient satisfaction...... after total hip and knee replacement surgery. PATIENTS AND METHODS: Between September 2003 and December 2005, 712 consecutive, unselected patients (440 women) with a mean age of 69 (31-91) years were admitted for hip and knee replacement surgery at our specialized fast-track joint replacement unit....... Epidemiological, physical, and perioperative parameters were registered and correlated to LOS and patient satisfaction. RESULTS: 92% of the patients were discharged directly to their homes within 5 days, and 41% were discharged within 3 days. Age, sex, marital status, co-morbidity, preoperative use of walking...

  3. Resource use and costs associated with opioid-induced constipation following total hip or total knee replacement surgery

    Directory of Open Access Journals (Sweden)

    Wittbrodt ET

    2018-05-01

    Full Text Available Eric T Wittbrodt,1 Tong J Gan,2 Catherine Datto,1 Charles McLeskey,1 Meenal Sinha3 1US Medical Affairs, AstraZeneca, Wilmington, DE, USA; 2Department of Anesthesiology, Stony Brook Medicine, Stony Brook, NY, USA; 3Premier Applied Sciences, Premier, Inc., Charlotte, NC, USA Purpose: Constipation is a well-known complication of surgery that can be exacerbated by opioid analgesics. This study evaluated resource utilization and costs associated with opioid-induced constipation (OIC. Patients and methods: This retrospective, observational, and propensity-matched cohort study utilized the Premier Healthcare Database. The study included adults ≥18 years of age undergoing total hip or total knee replacement as inpatients who received an opioid analgesic and were discharged between January 1, 2012, and June 30, 2015. Diagnosis codes identified patients with OIC who were then matched 1:1 to patients without OIC. Generalized linear and logistic regression models were used to compare inpatient resource utilization, total hospital costs, inpatient mortality, and 30-day all-cause readmissions and emergency department visits. Results: Of 788,448 eligible patients, 40,891 (5.2% had OIC. Covariates were well balanced between matched patients with and without OIC (n=40,890 each. In adjusted analyses, patients with OIC had longer hospital lengths of stay (3.6 versus 3.3 days; p<0.001, higher total hospital costs (US$17,479 versus US$16,265; p<0.001, greater risk of intensive care unit admission (odds ratio [OR]=1.12, 95% CI: 1.01–1.24, and increased likelihood of 30-day hospital readmissions (OR=1.16, 95% CI: 1.11–1.22 and emergency department visits (OR=1.38, 95% CI: 1.07–1.79 than patients without OIC. No statistically significant difference was found with inpatient mortality (OR=0.89, 95% CI: 0.59–1.35. Conclusion: OIC was associated with greater resource utilization and hospital costs for patients undergoing primarily elective total hip or total knee

  4. The migration of femoral components after total hip replacement surgery: accuracy and precision of software-aided measurements

    International Nuclear Information System (INIS)

    Decking, J.; Schuetz, U.; Decking, R.; Puhl, W.

    2003-01-01

    Objective: To assess the accuracy and precision of a software-aided system to measure migration of femoral components after total hip replacement (THR) on digitised radiographs. Design and patients: Subsidence and varus-valgus tilt of THR stems within the femur were measured on digitised anteroposterior pelvic radiographs. The measuring software (UMA, GEMED, Germany) relies on bony landmarks and comparability parameters of two consecutive radiographs. Its accuracy and precision were calculated by comparing it with the gold standard in migration measurements, radiostereometric analysis (RSA). Radiographs and corresponding RSA measurements were performed in 60 patients (38-69 years) following cementless THR surgery. Results and conclusions: The UMA software measured the subsidence of the stems with an accuracy of ±2.5 mm and varus-valgus tilt with an accuracy of ±1.8 (95% confidence interval). A good interobserver and intraobserver reliability was calculated with Cronbach's alpha ranging from 0.86 to 0.97. Measuring the subsidence of THR stems within the femur is an important parameter in the diagnosis of implant loosening. Software systems such as UMA improve the accuracy of migration measurements and are easy to use on routinely performed radiographs of operated hip joints. (orig.)

  5. Incidence of hip and knee replacement in patients with rheumatoid arthritis following the introduction of biological DMARDs

    DEFF Research Database (Denmark)

    Cordtz, René Lindholm; Hawley, Samuel; Prieto-Alhambra, Daniel

    2018-01-01

    person-years were calculated for patients with RA and GPCs in 6-month periods. Levels and trends in the pre-bDMARD (1996-2001) were compared with the bDMARD era (2003-2016) using segmented linear regression interrupted by a 1-year lag period (2002). RESULTS: We identified 30 404 patients with incident RA......OBJECTIVES: To study the impact of the introduction of biological disease-modifying anti-rheumatic drugs (bDMARDs) and associated rheumatoid arthritis (RA) management guidelines on the incidence of total hip (THR) and knee replacements (TKR) in Denmark. METHODS: Nationwide register-based cohort...... in 1996. In patients with RA, introduction of bDMARDs was associated with a decreasing incidence rate of TKR, whereas the incidence of THR had started to decrease before bDMARD introduction....

  6. Relatives in older patients' fast-track treatment programme during total hip or knee replacement. A grounded theory study

    DEFF Research Database (Denmark)

    Berthelsen, Connie Bøttcher

    and considerate support in concern for the patients; Substituting mode, with practical and cognitive support; and Adapting mode, by trying to fit in with the patients’ and health professionals’ requirements. Study II: 16 patients aged 70 to 94 were included and data was collected through 15 non......The aim of this Ph.D.-dissertation was to generate grounded theories of relatives, patients, and health professionals’ pattern of behaviour, respectively, in relation to the relatives of older patients’ fast-track treatment programmes during total hip or knee replacement. The dissertation includes...... to the older patients’ self-determination of being autonomous and how they adapt and are perceived in the health professionals’ environment. This may be useful to the health professionals in orthopaedic fast-track treatment programmes and their future collaboration with older patients and their relatives....

  7. The effect of tranexamic acid on blood coagulation in total hip replacement arthroplasty: rotational thromboelastographic (ROTEM®) analysis.

    Science.gov (United States)

    Na, H S; Shin, H J; Lee, Y J; Kim, J H; Koo, K H; Do, S H

    2016-01-01

    We evaluated changes in rotational thromboelastometry (ROTEM(®) ) parameters and clinical outcomes in patients undergoing total hip replacement arthroplasty, with concomitant infusions of tranexamic acid and of 6% hydroxyethyl starch 130/0.4. Fifty-five patients were randomly assigned to either the tranexamic acid (n = 29) or the control (n = 26) group. Hydroxyethyl starch was administered in the range of 10-15 ml.kg(-1) during the operation in both groups. In the control group, the clot formation time and maximum clot firmness of APTEM showed significant differences when compared with those of EXTEM at one hour postoperatively, suggestive of fibrinolysis. In the tranexamic acid group, there was no significant difference between each postoperative EXTEM and APTEM parameter. In the tranexamic acid and control group, postoperative blood loss was 308 ml (210-420 [106-745]) and 488 ml (375-620 [170-910], p = 0.002), respectively, and total blood loss was 1168 ml (922-1470 [663-2107]) and 1563 ml (1276-1708 [887-1494], p = 0.003). Haemoglobin concentration was higher in the tranexamic acid group on the second postoperative day (10.5 (9.4-12.1 [7.9-14.0]) vs. 9.6 (8.9-10.5[7.3-16.0]) g.dl(-1) , p = 0.027). In patients undergoing total hip replacement arthroplasty, postoperative fibrinolysis aggravated by hydroxyethyl starch was attenuated by co-administration of 10 mg.kg(-1) tranexamic acid, which may have led to less postoperative blood loss. © 2015 The Association of Anaesthetists of Great Britain and Ireland.

  8. Support for total hip replacement surgery: Structures modeling, Gait Data Analysis and Report system

    Directory of Open Access Journals (Sweden)

    Gianluca Mario Izzo

    2012-03-01

    Full Text Available For the treatment of advanced damages of hip joints, Total Hip Arthroplasty is well proven. Due to the different mechanical properties of the prosthesis material and the bone tissue, a partial unloading of the periprosthetic bone occurs. The bone cement causes reduction in bone density as a result of removal of normal stress from the bone, leading to weakening of the bone in that area and the fracture risk increases. Bone loss is identified as one of the main reasons for loosening of the stem. Otherwise, thanks to the press-fit of the non-cemented stem achieved by surgery, the bone layers immediately adjacent to the stem are preloaded, thus encouraged growing, and the bone getting stronger. The non-cemented stem would be the better choice for every patient, but the question remains if the femur can handle the press- fitting surgery. This studies aim to develop a monitoring techniques based on Gait analysis and bone density changes to assess patient recovery after Total Hip Arthroplasty. Furthermore, to validate computational processes based on 3D modeling and Finite Element Methods for optimizing decision making in the operation process and selecting the suited surgical procedure. A vision could be minimizing risk of periprosthetic fracture during and after surgery. Patients: The sample presents 11 patients receiving cemented implant and 13 for the uncemented. Patients are grouped by type of implant. Three checkpoints were considered: before, after operation and one year later. CT scans, gaitrite and kinepro measurements have been realized. Main outcome measures: Fracture risk probability is higher in bone with low bone mineral density; therefore bones are more fragile in elderly people. BMD is indeed one parameter considered among all the observations. Periprosthetic fracture of the femur is a rare but complex complication of THA, and requires demanding surgery. As such, they result in considerable morbidity and dysfunction. Thus, tests of

  9. Regional or general anesthesia for fast-track hip and knee replacement - what is the evidence?

    DEFF Research Database (Denmark)

    Kehlet, Henrik; Aasvang, Eske Kvanner

    2015-01-01

    Regional anesthesia for knee and hip arthroplasty may have favorable outcome effects compared with general anesthesia by effectively blocking afferent input, providing initial postoperative analgesia, reducing endocrine metabolic responses, and providing sympathetic blockade with reduced bleeding...... and less risk of thromboembolic complications but with undesirable effects on lower limb motor and urinary bladder function. Old randomized studies supported the use of regional anesthesia with fewer postoperative pulmonary and thromboembolic complications, and this has been supported by recent large non......-randomized epidemiological database cohort studies. In contrast, the data from newer randomized trials are conflicting, and recent studies using modern general anesthetic techniques may potentially support the use of general versus spinal anesthesia. In summary, the lack of properly designed large randomized controlled...

  10. Variations in the pre-operative status of patients coming to primary hip replacement for osteoarthritis in European orthopaedic centres

    Directory of Open Access Journals (Sweden)

    Puhl Wofhart

    2009-02-01

    Full Text Available Abstract Background Total hip joint replacement (THR is a high volume, effective intervention for hip osteoarthritis (OA. However, indications and determinants of outcome remain unclear. The 'EUROHIP consortium' has undertaken a cohort study to investigate these questions. This paper describes the variations in disease severity in this cohort and the relationships between clinical and radiographic severity, and explores some of the determinants of variation. Methods A minimum of 50 consecutive, consenting patients coming to primary THR for primary hip OA in each of the 20 participating orthopaedic centres entered the study. Pre-operative data included demographics, employment and educational attainment, drug utilisation, and involvement of other joints. Each subject completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC – Likert version 3.1. Other data collected at the time of surgery included the prosthesis used and American Society of Anaesthesiologists (ASA status. Pre-operative radiographs were read by the same three readers for Kellgren and Lawrence (K&L grading and Osteoarthritis Research Society International (OARSI atlas features. Regression analyses were carried out. Results Data from 1327 subjects has been analysed. The mean age of the group was 65.7 years, and there were more women (53.4% than men. Most (79% were ASA status 1 or 2. Reported disease duration was 5 years or less in 69.2%. Disease in other joint sites was common. Radiographs were available in 1051 subjects and the K&L grade was 3 or 4 in 95.8%. There was much more variation in clinical severity (WOMAC score; the mean total WOMAC score was 59.2 (SD 16.1. The radiographic severity showed no correlation with WOMAC scores. Significantly higher WOMAC scores (worse disease were seen in older people, women, those with obesity, those with worse general health, and those with lower educational attainment. Conclusion 1. Clinical disease severity

  11. The Morse taper junction in modular revision hip replacement--a biomechanical and retrieval analysis.

    Science.gov (United States)

    Schramm, M; Wirtz, D C; Holzwarth, U; Pitto, R P

    2000-04-01

    All biomaterials used for total joint surgery are subjected to wear mechanisms. Morse taper junctions of modular hip revision implants are predilection sites for both fretting and crevice corrosion, dissociation and breakage of the components. The aim of this study is to quantify wear and study metallurgical changes of Morse taper junctions of in-vitro and in-vivo loaded modular revision stems. Three modular revision stems (MRP-Titan, Peter Brehm GmbH, Germany) were loaded by a servohydraulic testing machine. The loads and conditions used exceeded by far the values required by ISO-standard 7206. The tests were performed with maximum axial loads of 3,500 N to 4,000 N over 10-12 x 10(6) cycles at 2 Hz. Additionally, the female part of the taper junctions were coated with blood and bone debris. The free length of the implant was set to 200 mm. One other MRP stem was investigated after retrieval following 5.5 years of in-vivo use. All contact surfaces of the modular elements were assessed by visual inspection, optical microscopy and scanning electron microscopy (SEM). The degree of plastic deformation of the male part of the morse taper junction was determined by contouroscopy. None of the morse taper junctions broke or failed mechanically. Corrosion and wear affected all tapers, especially at the medial side. The retrieved implant showed no cracks and the amount of debris measured only one third of that for the stems tested in-vitro. The present retrieval and laboratory investigations have proven, that the morse taper junctions of the MRP-titanium stem are stable and resistant to relevant wear mechanisms. The longevity of the junctions for clinical use is given. If an optimal taper design is selected, the advantages of modular femoral components in total hip revision arthroplasty will outweigh the possible risks.

  12. Distribution of polyethylene wear particles and bone fragments in periprosthetic tissue around total hip joint replacements

    Czech Academy of Sciences Publication Activity Database

    Zolotarevova, E.; Entlicher, G.; Pavlova, Ewa; Šlouf, Miroslav; Pokorný, D.; Veselý, F.; Gallo, J.; Sosna, A.

    2010-01-01

    Roč. 6, č. 9 (2010), s. 3595-3600 ISSN 1742-7061 R&D Projects: GA MŠk 2B06096 Institutional research plan: CEZ:AV0Z40500505 Keywords : joint replacement * polyethylene * wear particles distribution Subject RIV: CD - Macromolecular Chemistry Impact factor: 4.824, year: 2010

  13. Role of self-efficacy and social support in short-term recovery after total hip replacement: a prospective cohort study.

    NARCIS (Netherlands)

    Brembo, E.A.; Kapstad, H.; Dulmen, S. van; Eide, H.

    2017-01-01

    Background: Despite the overall success of total hip replacement (THR) in patients with symptomatic osteoarthritis (OA), up to one-quarter of patients report suboptimal recovery. The aim of this study was to determine whether social support and general self-efficacy predict variability in short-term

  14. A new system of computer-assisted navigation leading to reduction in operating time in uncemented total hip replacement in a matched population.

    Science.gov (United States)

    Chaudhry, Fouad A; Ismail, Sanaa Z; Davis, Edward T

    2018-05-01

    Computer-assisted navigation techniques are used to optimise component placement and alignment in total hip replacement. It has developed in the last 10 years but despite its advantages only 0.3% of all total hip replacements in England and Wales are done using computer navigation. One of the reasons for this is that computer-assisted technology increases operative time. A new method of pelvic registration has been developed without the need to register the anterior pelvic plane (BrainLab hip 6.0) which has shown to improve the accuracy of THR. The purpose of this study was to find out if the new method reduces the operating time. This was a retrospective analysis of comparing operating time in computer navigated primary uncemented total hip replacement using two methods of registration. Group 1 included 128 cases that were performed using BrainLab versions 2.1-5.1. This version relied on the acquisition of the anterior pelvic plane for registration. Group 2 included 128 cases that were performed using the newest navigation software, BrainLab hip 6.0 (registration possible with the patient in the lateral decubitus position). The operating time was 65.79 (40-98) minutes using the old method of registration and was 50.87 (33-74) minutes using the new method of registration. This difference was statistically significant. The body mass index (BMI) was comparable in both groups. The study supports the use of new method of registration in improving the operating time in computer navigated primary uncemented total hip replacements.

  15. [Quality of Outcome after Primary Total Hip Replacement at a Maximum Care Hospital in Relation to Preoperative Influencing Factors].

    Science.gov (United States)

    Osmanski-Zenk, K; Steinig, N S; Glass, Ä; Mittelmeier, W; Bader, R

    2015-12-01

    As the need for joint replacements will continue to rise, the outcome of primary total hip replacement (THR) must be improved and stabilised at a high level. In this study, we investigated whether pre-operative risk factors, such as gender, age and body weight at the time of the surgery or a restricted physical status (ASA-Status > 2 or Kellgren and Lawrence grade > 2) have a negative influence on the post-operative results or on patient satisfaction. Retrospective data collection and a prospective interview were performed with 486 patients who underwent primary total hip replacement between January 2007 and December 2010 in our hospital. The patients' satisfaction and quality of life were surveyed with the WOMAC-Score, SF-36 and EuroQol-5. Differences between more than two independent spot tests were tested with the non-parametric Kruskal-Wallis test. Differences between two independent spot tests were tested with the non-parametric Mann-Whitney U test. The frequencies were reported and odds ratios calculated. The confidence interval was set at 95 %. The level of significance was p total score of the SF-36 was 66.9 points. The patients declared an average EuroQol Index of 0.81. Our data show that the patients' gender did not influence the duration of surgery or the scores. However, female patients tended to exhibit more postoperative complications. However, increased patient age at the time of surgery was associated with an increased OR for duration of surgery, length of stay and risk of complications. Patients who had a normal body weight at time of the surgery showed better peri- and post-operative results. We showed that the preoperative estimated Kellgren and Lawrence grade had a significant influence on the duration of surgery. The ASA classification influenced the duration of surgery as well the length of stay and the rate of complications. The quality of results after primary THR depends on preoperative factors. Existing comorbidities have a

  16. Primary Care Physician and Patient Perceptions of Reimbursement for Total Knee and Hip Replacement.

    Science.gov (United States)

    Wiznia, Daniel H; Kim, Chang-Yeon; Wang, Yuexin; Swami, Nishwant; Pelker, Richard R

    2016-07-01

    The opinions of nonspecialists and patients will be important to determining reimbursements for specialists such as orthopedic surgeons. In addition, primary care physician (PCP) perceptions of reimbursements may affect utilization of orthopedic services. We distributed a web-based survey to PCPs, asking how much they believed orthopedic surgeons were reimbursed for total hip arthroplasty (THA) and total knee arthroplasty (TKA). We also proctored a paper-based survey to postoperative patients, asking how much orthopedic surgeons should be reimbursed. There was a significant difference between perceived and actual reimbursement values for THA and TKA. Hospital-affiliated PCPs estimated higher reimbursements for both THA ($1657 vs $838, P < .0001 for Medicaid and $2246 vs $1515, P = .018 for Medicare) and TKA ($1260 vs $903, P = .052 for Medicaid and $2022 vs $1514, P = .049 for Medicare). Similarly, larger practices estimated higher reimbursements for both THA ($1861 vs $838, P < .0001 for Medicaid and $2635 vs $1515, P = .004 for Medicare) and TKA ($1583 vs $903, P = .005 for Medicaid and $2380 vs $1514, P = .011 for Medicare). Compared to PCPs, patients estimated that orthopedic surgeons should be paid 4 times higher for both THA ($9787 vs $2235, P < .0001) and TKA ($9088 vs $2134, P < .0001). PCPs believe that reimbursements for orthopedic procedures are higher than actual values. The effect that these perceptions will have on efforts at cost reform and utilization of orthopedic services requires further study. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Incidence, risk factors and the healthcare cost of falls postdischarge after elective total hip and total knee replacement surgery: protocol for a prospective observational cohort study

    Science.gov (United States)

    Hill, Anne-Marie; Ross-Adjie, Gail; McPhail, Steven M; Monterosso, Leanne; Bulsara, Max; Etherton-Beer, Christopher; Powell, Sarah-Jayne; Hardisty, Gerard

    2016-01-01

    Introduction The number of major joint replacement procedures continues to increase in Australia. The primary aim of this study is to determine the incidence of falls in the first 12 months after discharge from hospital in a cohort of older patients who undergo elective total hip or total knee replacement. Methods and analyses A prospective longitudinal observational cohort study starting in July 2015, enrolling patients aged ≥60 years who are admitted for elective major joint replacement (n=267 total hip replacement, n=267 total knee replacement) and are to be discharged to the community. Participants are followed up for 12 months after hospital discharge. The primary outcome measure is the rate of falls per thousand patient-days. Falls data will be collected by 2 methods: issuing a falls diary to each participant and telephoning participants monthly after discharge. Secondary outcomes include the rate of injurious falls and health-related quality of life. Patient-rated outcomes will be measured using the Oxford Hip or Oxford Knee score. Generalised linear mixed modelling will be used to examine the falls outcomes in the 12 months after discharge and to examine patient and clinical characteristics predictive of falls. An economic evaluation will be conducted to describe the nature of healthcare costs in the first 12 months after elective joint replacement and estimate costs directly attributable to fall events. Ethics and dissemination The results will be disseminated through local site networks and will inform future services to support older people undergoing hip or knee joint replacement and also through peer-reviewed publications and medical conferences. This study has been approved by The University of Notre Dame Australia and local hospital human research ethics committees. Trial registration number ACTRN12615000653561; Pre-results. PMID:27412102

  18. Emergency Department Visits Following Elective Total Hip and Knee Replacement Surgery: Identifying Gaps in Continuity of Care.

    Science.gov (United States)

    Finnegan, Micaela A; Shaffer, Robyn; Remington, Austin; Kwong, Jereen; Curtin, Catherine; Hernandez-Boussard, Tina

    2017-06-21

    Major joint replacement surgical procedures are common, elective procedures with a care episode that includes both inpatient readmissions and postoperative emergency department (ED) visits. Inpatient readmissions are well studied; however, to our knowledge, little is known about ED visits following these procedures. We sought to characterize 30-day ED visits following a major joint replacement surgical procedure. We used administrative records from California, Florida, and New York, from 2010 through 2012, to identify adults undergoing total knee and hip arthroplasty. Factors associated with increased risk of an ED visit were estimated using hierarchical regression models controlling for patient variables with a fixed hospital effect. The main outcome was an ED visit within 30 days of discharge. Among the 152,783 patients who underwent major joint replacement, 5,229 (3.42%) returned to the inpatient setting and 8,883 (5.81%) presented to the ED for care within 30 days. Among ED visits, 17.94% had a primary diagnosis of pain and 25.75% had both a primary and/or a secondary diagnosis of pain. Patients presenting to the ED for subsequent care had more comorbidities and were more frequently non-white with public insurance relative to those not returning to the ED (p care insurance coverage expansions are uncertain; however, there are ongoing attempts to improve quality across the continuum of care. It is therefore essential to ensure that all patients, particularly vulnerable populations, receive appropriate postoperative care, including pain management. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  19. Local Infiltration Analgesia Compared With Epidural and Intravenous PCA After Surgical Hip Dislocation for the Treatment of Femoroacetabular Impingement in Adolescents.

    Science.gov (United States)

    Novais, Eduardo N; Kestel, Lauryn; Carry, Patrick M; Sink, Ernest; Strupp, Kim

    2018-01-01

    Open treatment of femoroacetabular impingement (FAI) through a surgical hip dislocation (SHD) approach has been reported to allow for improvement in pain and function. However, the approach require a trochanteric osteotomy and may be associated with high level of pain after surgery. Currently, there is no systematic approach for pain management after SHD for treatment of FAI. A retrospective chart review was used to collect data from 121 subjects (12 to 21 y and below) who received periarticular local infiltration analgesia (LIA, n=20), epidural analgesia (n=72), or intravenous patient-controlled analgesia (PCA, n=29) after SHD from January 2003 to June 2014. Verbal pain scores, opioid consumption, incidence of side effects/complications, and length of hospital stay (LOS) were recorded. All nonopioid medications with analgesic potential were included in the statistical models as potential confounding variables RESULTS:: Twelve hours after surgery, the odds of moderate/severe pain were higher in the PCA group (odds ratio, 20.5; 95% confidence interval (CI), 1.7-243.8; P=0.0166] and epidural group (odds ratio, 5.2; 95% CI, 0.7-92.0; P=0.3218) compared with the LIA group. There was no difference in pain scores across all groups 1 hour (P=0.0675) or 24 hours (P=0.3473) postoperatively. Total opioid consumption in the LIA group was 59.8% (95% CI, 15.0%-81.0%; P=0.0175) lower than the total opioid consumption in the epidural group and 60.7% (95% CI, 17.3-81.3; P=0.0144) lower than the total opioid consumption in the PCA group. LOS was increased in the epidural (mean difference, 22.1; 95% CI, 6.8-37.4 h; P=0.0051) and PCA (mean difference, 16 h; 95% CI, 1-31.5 h; P=0.0367) groups relative to the LIA group. There was 0 (0%) complication in the LIA group compared with 11 (15.3%) in the epidural group. LIA was more effective at controlling pain 12 hours after surgery in comparison with PCA with similar pain control to epidural. LIA was associated with significantly lower

  20. Bearing surfaces in total hip replacements: state of the art and future developments.

    Science.gov (United States)

    McKellop, H A

    2001-01-01

    Because the UHMWPE components fabricated by the historic process of gamma-sterilization in air are no longer marketed, a surgeon who wishes to continue performing joint replacement surgery must choose among the new polyethylenes, or he or she may choose a modern metal-metal or ceramic-ceramic bearing, each of which has its potential advantages and disadvantages (Table 4). Ultimately, it is the responsibility of the surgeon to assess the risk-benefit ratios of each of the new bearing combinations and make an informed and wise choice among them.

  1. Assessment of the Swedish EQ-5D experience-based value sets in a total hip replacement population.

    Science.gov (United States)

    Nemes, Szilárd; Burström, Kristina; Zethraeus, Niklas; Eneqvist, Ted; Garellick, Göran; Rolfson, Ola

    2015-12-01

    All patients undergoing elective total hip replacement (THR) in Sweden are asked to complete a survey, including the EQ-5D. Thus far, EQ-5D values have been presented using the UK TTO value set based on hypothetical values. Shift to the use of the recently introduced Swedish experience-based value set, derived from a representative Swedish population, is an appealing alternative. To investigate how accurate the Swedish experience-based VAS value set predicts observed EQ VAS values and to compare correlations between Swedish and UK value sets including two provisional value sets derived from the THR population. Pre- and one-year postoperative data from 56,062 THR patients from the Swedish Hip Arthroplasty Register were used. Agreement between the observed and the predicted EQ VAS values was assessed with correlation. Based on pre- and postoperative data, we constructed two provisional VAS value sets. Correlations between observed and calculated values using the Swedish VAS value set were moderate (r = 0.46) in preoperative data and high (r = 0.72) in postoperative data. Correlations between UK and register-based value sets were constantly lower compared to Swedish value sets. Register-based values and Swedish values were highly correlated. The Swedish value sets are more accurate in terms of representation of the Swedish THR patients than the currently used UK TTO value set. We find it feasible to use the experience-based Swedish value sets for further presentation of EQ-5D values in the Swedish THR population.

  2. Expect the best, prepare for the worst: surgeon and patient expectation of the outcome of primary total hip and knee replacement.

    Science.gov (United States)

    Moran, M.; Khan, A.; Sochart, D. H.; Andrew, G.

    2003-01-01

    A cross-sectional study of 100 surgeons and 370 patients awaiting primary total hip or knee replacement was carried out. Oxford hip or knee score questionnaires were sent to the surgeons and patients. They were asked to predict the level of symptoms expected 6 months following surgery. The Oxford scores derive a value of 12-60, with a greater score indicating worsening symptoms. The mean pre-operative score was 45.12 for the hip patients and 42.96 for the knee patients, and the patients expected this to drop to 23.70 and 25.66, respectively, 6 months' postoperatively. This was a significant difference for both groups. The surgeons expected the patients to have a mean postoperative score of 20.91 for the hip group and 22.19 for the knee group. The surgeons' scores were significantly lower than those from the patients. There was a significant difference between the patients' and surgeons' expectations of the results of total knee and hip replacement surgery. The surgeons expected better results than the patients. We believe that this is the first study that directly compares surgeon and patient expectations of lower limb arthroplasty. PMID:12831497

  3. Ranking hospitals for outcomes in total hip replacement - administrative data with or without additional patient surveys? - Part 1: Administrative data

    Directory of Open Access Journals (Sweden)

    Dörning, Hans

    2007-03-01

    Full Text Available Background: Many hospital rankings rely on the frequency of adverse outcomes and are based on administrative data. In the study presented here, we tried to find out, to what extent available administrative data of German Sickness Funds allow for an adequate hospital ranking and compared this with rankings based on additional information derived from a patient survey. Total hip replacement was chosen as an example procedure. In part I of the publication, we present the results of the approach based on administrative data. Methods: We used administrative data from the AOK-Lower Saxony of the years 2000, 2001 and 2002. The study population comprised all beneficiaries, who received total hip replacement in the years 2000 or 2001. Performance indicators used where “critical incident (Mortality or revision” and “number of revisions” within the first year. Hospitals were ranked if they performed at least 20 procedures on AOK-beneficiaries in each of the two years. Multivariate modelling (logistic and poisson regression was used to estimate the performance indicators by case-mix variables (age, sex, co-diagnoses and hospital characteristics (hospital size, surgical volume. The actual ranking was based on these multivariate models, excluding hospital variables and adding dummy-variables for each hospital. Hospitals were ranked by their case-mix adjusted odds ratio or SMR respectively with respect to a pre-selected reference hospital. The resulting rankings were compared with each other, with regard to temporal stability, and the impact of case-mix variables.Results: About 4500 beneficiaries received total hip replacement in each year (n2000: 4482; n2001: 4579. The ranking included 65 hospitals. Comparing the years 2000 and 2001, the temporal stability of the rankings based on a single performance indicator was low (Spearman rang correlation coefficients 0.158 and 0.191. The agreement of rankings based on different performance indicators in the

  4. PERIPROSTHETIC INFECTION AFTER ENDOPROSTHETIC REPLACEMENT OF THE HIP JOINT IN PATIENTS WITH RHEUMATOID DISEASES

    Directory of Open Access Journals (Sweden)

    Vadim Petrovich Pavlov

    2013-01-01

    Full Text Available Periprosthetic infection (PI in patients with rheumatoid diseases (RD after total hip joint endoprosthesis (THJE is a relevant problem of rheumoorphopedics that has not been solved yet. The relative assessment of PI incidence rate after THJE and treatment outcomes in patients with this complication is expected to be carried out. A total of 1201 THJE performed in 1069 patients with RD are considered. The female : male ratio was 3.6 : 1; the mean age was 49.6 years (range: 16 to 83 years. 323 patients had rheumatoid arthritis (RA; 124 patients had juvenile rheumatoid arthritis (JRA; 80 patients had ankylosing spondylitis (AS; 79 patients had systemic lupus erythematosus (SLE; 11 patients had systemic sclerodermatitis (SSD; 18 patients had psoriatic arthropathy (PsA; and 353 patients had osteoarthritis (OA. Other RD were revealed in 81 patients. PI were detected in 9 (0.84% of 1069 patients with RD, including 7 (2.17% of 323 patients with RA; 1 (0.8% of 124 patients with JRA; and 1 (0.28% of 353 patients with OA. No PI were detected in 81 patients who had other RD. An eightfold (in patients with RA and a threefold (in patients with JRA increase in PI compared to that in patients with OA attests to the high risk of this complication in patients with inflammatory as compared to the patients with degenerative RD. After integrated treatment (revision surgery, sanation, continuous irrigation with antibiotics/lavasept, the graft was preserved in OA patients; the complication was prevented in RA patients. Six patients will be subjected to repeated revision surgery; one patient died of diabetes complications after the graft had been removed. A significant increase in PI incidence rate after THJE in patients with RA and JRA as compared to that in OA patients allows one to regard inflammatory RD as risk factors of this complication. The low effectiveness of the procedure for integrated therapy for PI in RD patients indicates that it needs to

  5. Implant Optimisation for Primary Hip Replacement in Patients over 60 Years with Osteoarthritis: A Cohort Study of Clinical Outcomes and Implant Costs Using Data from England and Wales.

    Directory of Open Access Journals (Sweden)

    Simon S Jameson

    Full Text Available Hip replacement is one of the most commonly performed surgical procedures worldwide; hundreds of implant configurations provide options for femoral head size, joint surface material and fixation method with dramatically varying costs. Robust comparative evidence to inform the choice of implant is needed. This retrospective cohort study uses linked national databases from England and Wales to determine the optimal type of replacement for patients over 60 years undergoing hip replacement for osteoarthritis.Implants included were the commonest brand from each of the four types of replacement (cemented, cementless, hybrid and resurfacing; the reference prosthesis was the cemented hip procedure. Patient reported outcome scores (PROMs, costs and risk of repeat (revision surgery were examined. Multivariable analyses included analysis of covariance to assess improvement in PROMs (Oxford hip score, OHS, and EQ5D index (9159 linked episodes and competing risks modelling of implant survival (79,775 procedures. Cost of implants and ancillary equipment were obtained from National Health Service procurement data.EQ5D score improvements (at 6 months were similar for all hip replacement types. In females, revision risk was significantly higher in cementless hip prostheses (hazard ratio, HR = 2.22, p<0.001, when compared to the reference hip. Although improvement in OHS was statistically higher (22.1 versus 20.5, p<0.001 for cementless implants, this small difference is unlikely to be clinically important. In males, revision risk was significantly higher in cementless (HR = 1.95, p = 0.003 and resurfacing implants, HR = 3.46, p<0.001, with no differences in OHS. Material costs were lowest with the reference implant (cemented, range £1103 to £1524 and highest with cementless implants (£1928 to £4285. Limitations include the design of the study, which is intrinsically vulnerable to omitted variables, a paucity of long-term implant survival data (reflecting the

  6. The stress response and anesthetic potency of unilateral spinal anesthesia for total Hip Replacement in geriatric patients.

    Science.gov (United States)

    Zhu, Li; Tian, Chun; Li, Min; Peng, Ming-Qing; Ma, Kun-Long; Wang, Zhong-Lin; Ding, Jia-Hui; Cai, Yi

    2014-11-01

    Recently, some scholars suggested that it is important to keep a stablehemodynamic state and prevent the stress responses in geriatric patients undergoing total hip replacement (THR). We conducted this randomized prospective study to observe anesthetic potency of unilateral spinal anesthesia and stress response to it in geriatric patients during THR. We compared the effect of unilateral spinal and bilateral spinal on inhibition of stress response through measuring Norepinephrine (NE), epinephrine (E) and cortisol (CORT). Plasma concentrations of NE, E and CORT were determined in blood samples using ELISA (enzyme-linked immunosorbent assays) at three time points: To (prior to anesthesia) T1 (at the time point of skin closure), T2 (twenty-four hours after the operation). Sixty patients were randomly divided into two groups: group A (unilateral spinal anesthesia) and group B (conventional bilateral spinal anesthesia). 7.5tymg of hypobaric bupivacaine were injected into subarachnoid cavity at group A and 12mg hypobaric bupivacaine were given at group B. The onset time of sensory and motor block, loss of pinprick sensation, degree of motor block, regression of sensory and motor blocks and hemodynamic changes were also recorded. These data were used to evaluate anesthetic potency of spinal anesthesia. The results of this experiment show that unilateral spinal anesthesia can provide restriction of sensory and motor block, minimize the incidence of hypotension and prevent the stress responses undergoing THR. It is optimal anesthesia procedure for geriatric patients by rapid subarachnoid injection of small doses of bupivacaine.

  7. Regional variation in acute care length of stay after orthopaedic surgery total joint replacement surgery and hip fracture surgery.

    Science.gov (United States)

    Fitzgerald, John D; Weng, Haoling H; Soohoo, Nelson F; Ettner, Susan L

    2013-01-01

    To examine change in regional variations in acute care length of stay (LOS) after orthopedic surgery following expiration of the New York (NY) State exemption to the Prospective Payment System and implementation of the Medicare Short Stay Transfer Policy. Time series analyses were conducted to evaluate change in LOS across regions after policy implementations. Small area analyses were conducted to examine residual variation in LOS. The dataset included A 100% sample of fee-for-service Medicare patients undergoing surgical repair for hip fracture or elective joint replacement surgery between 1996 and 2001. Data files from Centers for Medicare and Medicaid Services 1996-2001 Medicare Provider Analysis and Review file, 1999 Provider of Service file, and data from the 2000 United States Census were used for analysis. In 1996, LOS in NY after orthopedic procedures was much longer than the remainder of the country. After policy changes, LOS fell. However, significant residual variation in LOS persisted. This residual variation was likely partly explained by differences variation in regional managed care market penetration, patient management practices and unmeasured characteristics associated with the hospital location. NY hospitals responded to changes in reimbursement policy, reducing variation in LOS. However, even after 5 years of financial pressure to constrain costs, other factors still have a strong impact on delivery of patient care.

  8. Audit on the Efficient Use of Cross-Matched Blood in Elective Total Hip and Total Knee Replacement

    Science.gov (United States)

    Rogers, BA; Johnstone, DJ

    2006-01-01

    INTRODUCTION This prospective audit studies the use of cross-matched blood in 301 patients over a 1-year period undergoing total knee (TKR) and total hip replacement (THR) surgery in an orthopaedic unit. PATIENTS AND METHODS Analysis over the first 6 months revealed a high level of unnecessary cross-matched blood. The following interventions were introduced: (i) to cease routine cross-matching for THR; (ii) all patients to have a check full blood count on day 2 after surgery; and (iii) Hb < 8 g/dl to be considered as the trigger for transfusion in patients over 65 years and free from significant co-morbidity. These changes are in accordance with published national guidelines [Anon. Guidelines for the clinical use of red cell transfusions. Br J Haematol 2001; 113: 24–31]. RESULTS In the next 6 months, the number of units cross-matched but not transfused fell by 96% for THR, and the cross-match transfusion (C:T) ratio reduced from 3.21 to 1.62. Reductions were also observed for the TKR cohort. These results provide evidence of a substantial risk and cost benefit in the use of this limited resource. A telephone survey of 44 hospitals revealed that 20 hospitals routinely cross-matched blood for THR and 11 do so for TKR. CONCLUSIONS Changes can be made to the Maximum Surgical Blood Ordering Schedules (MSBOS) in other orthopaedic units according to national guidelines. PMID:16551419

  9. Validity of a simple Internet-based outcome-prediction tool in patients with total hip replacement: a pilot study.

    Science.gov (United States)

    Stöckli, Cornel; Theiler, Robert; Sidelnikov, Eduard; Balsiger, Maria; Ferrari, Stephen M; Buchzig, Beatus; Uehlinger, Kurt; Riniker, Christoph; Bischoff-Ferrari, Heike A

    2014-04-01

    We developed a user-friendly Internet-based tool for patients undergoing total hip replacement (THR) due to osteoarthritis to predict their pain and function after surgery. In the first step, the key questions were identified by statistical modelling in a data set of 375 patients undergoing THR. Based on multiple regression, we identified the two most predictive WOMAC questions for pain and the three most predictive WOMAC questions for functional outcome, while controlling for comorbidity, body mass index, age, gender and specific comorbidities relevant to the outcome. In the second step, a pilot study was performed to validate the resulting tool against the full WOMAC questionnaire among 108 patients undergoing THR. The mean difference between observed (WOMAC) and model-predicted value was -1.1 points (95% confidence interval, CI -3.8, 1.5) for pain and -2.5 points (95% CI -5.3, 0.3) for function. The model-predicted value was within 20% of the observed value in 48% of cases for pain and in 57% of cases for function. The tool demonstrated moderate validity, but performed weakly for patients with extreme levels of pain and extreme functional limitations at 3 months post surgery. This may have been partly due to early complications after surgery. However, the outcome-prediction tool may be useful in helping patients to become better informed about the realistic outcome of their THR.

  10. Cemented versus uncemented fixation in total hip replacement: a systematic review and meta-analysis of randomized controlled trials.

    LENUS (Irish Health Repository)

    Abdulkarim, Ali

    2013-02-22

    The optimal method of fixation for primary total hip replacements (THR), particularly fixation with or without the use of cement is still controversial. In a systematic review and metaanalysis of all randomized controlled trials comparing cemented versus uncemented THRS available in the published literature, we found that there is no significant difference between cemented and uncemented THRs in terms of implant survival as measured by the revision rate. Better short-term clinical outcome, particularly an improved pain score can be obtained with cemented fixation. However, the results are unclear for the long-term clinical and functional outcome between the two groups. No difference was evident in the mortality and the post operative complication rate. On the other hand, the radiographic findings were variable and do not seem to correlate with clinical findings as differences in the surgical technique and prosthesis design might be associated with the incidence of osteolysis. We concluded in our review that cemented THR is similar if not superior to uncemented THR, and provides better short term clinical outcomes. Further research, improved methodology and longer follow up are necessary to better define specific subgroups of patients in whom the relative benefits of cemented and uncemented implant fixation can be clearly demonstrated.

  11. Cemented versus uncemented fixation in total hip replacement: a systematic review and meta-analysis of randomized controlled trials

    Directory of Open Access Journals (Sweden)

    Ali Abdulkarim

    2013-03-01

    Full Text Available The optimal method of fixation for primary total hip replacements (THR, particularly fixation with or without the use of cement is still controversial. In a systematic review and metaanalysis of all randomized controlled trials comparing cemented versus uncemented THRS available in the published literature, we found that there is no significant difference between cemented and uncemented THRs in terms of implant survival as measured by the revision rate. Better short-term clinical outcome, particularly an improved pain score can be obtained with cemented fixation. However, the results are unclear for the long-term clinical and functional outcome between the two groups. No difference was evident in the mortality and the post operative complication rate. On the other hand, the radiographic findings were variable and do not seem to correlate with clinical findings as differences in the surgical technique and prosthesis design might be associated with the incidence of osteolysis. We concluded in our review that cemented THR is similar if not superior to uncemented THR, and provides better short term clinical outcomes. Further research, improved methodology and longer follow up are necessary to better define specific subgroups of patients in whom the relative benefits of cemented and uncemented implant fixation can be clearly demonstrated.

  12. IMU-based Real-time Pose Measurement system for Anterior Pelvic Plane in Total Hip Replacement Surgeries.

    Science.gov (United States)

    Zhe Cao; Shaojie Su; Hao Tang; Yixin Zhou; Zhihua Wang; Hong Chen

    2017-07-01

    With the aging of population, the number of Total Hip Replacement Surgeries (THR) increased year by year. In THR, inaccurate position of the implanted prosthesis may lead to the failure of the operation. In order to reduce the failure rate and acquire the real-time pose of Anterior Pelvic Plane (APP), we propose a measurement system in this paper. The measurement system includes two parts: Initial Pose Measurement Instrument (IPMI) and Real-time Pose Measurement Instrument (RPMI). IPMI is used to acquire the initial pose of the APP, and RPMI is used to estimate the real-time pose of the APP. Both are composed of an Inertial Measurement Unit (IMU) and magnetometer sensors. To estimate the attitude of the measurement system, the Extended Kalman Filter (EKF) is adopted in this paper. The real-time pose of the APP could be acquired together with the algorithm designed in the paper. The experiment results show that the Root Mean Square Error (RMSE) is within 1.6 degrees, which meets the requirement of THR operations.

  13. Ultrasound in Total Hip Replacement: Value of Anterior Acetabular Cup Visibility and Contact With the Iliopsoas Tendon.

    Science.gov (United States)

    Guillin, Raphaël; Bertaud, Valérie; Garetier, Marc; Fantino, Olivier; Polard, Jean-Louis; Lambotte, Jean-Christophe

    2018-06-01

    To assess visibility of the acetabular cup in total hip replacement and to determine the value of direct and indirect signs of iliopsoas impingement syndrome with ultrasound. Ultrasound examinations were performed by a single operator in 17 patients with iliopsoas impingement syndrome and 48 control patients. Cup visibility, contact between the cup and psoas tendon, and the presence of indirect signs of iliopsoas impingement syndrome were investigated in all patients. When the acetabular cup was visible, its size and position in relation to the psoas tendon were recorded. Anterior cup visibility (P = .03), contact with the psoas tendon (P cup shift of 3 mm or greater yielded respective sensitivities of 82% and 59% and specificities of 81% and 100%. When iliopsoas impingement syndrome is clinically suspected, the presence of iliopsoas bursitis or a posteroanterior cup shift of greater than 3 mm under the psoas tendon serve to confirm the diagnosis. In the absence of these conditions, a therapeutic test may be necessary because of the incomplete, albeit high, specificity of other signs. © 2017 by the American Institute of Ultrasound in Medicine.

  14. The Influence of Oral Carbohydrate Solution Intake on Stress Response before Total Hip Replacement Surgery during Epidural and General Anaesthesia.

    Science.gov (United States)

    Çeliksular, M Cem; Saraçoğlu, Ayten; Yentür, Ercüment

    2016-06-01

    The effects of oral carbohydrate solutions, ingested 2 h prior to operation, on stress response were studied in patients undergoing general or epidural anaesthesia. The study was performed on 80 ASA I-II adult patients undergoing elective total hip replacement, which were randomized to four groups (n=20). Group G patients undergoing general anaesthesia fasted for 8 h preoperatively; Group GN patients undergoing general anaesthesia drank oral carbohydrate solutions preoperatively; Group E patients undergoing epidural anaesthesia fasted for 8 h and Group EN patients undergoing epidural anaesthesia drank oral carbohydrate solutions preoperatively. Groups GN and EN drank 800 mL of 12.5% oral carbohydrate solution at 24:00 preoperatively and 400 mL 2 h before the operation. Blood samples were taken for measurements of glucose, insulin, cortisol and IL-6 levels. The effect of preoperative oral carbohydrate ingestion on blood glucose levels was not significant. Insulin levels 24 h prior to surgery were similar; however, insulin levels measured just before surgery were 2-3 times higher in groups GN and EN than in groups G and E. Insulin levels at the 24(th) postoperative hour in epidural groups were increased compared to those at basal levels, although general anaesthesia groups showed a decrease. From these measurements, only the change in Group EN was statistically significant (poral carbohydrate nutrition did not reveal a significant effect on surgical stress response.

  15. The design of the acetabular component and size of the femoral head influence the risk of revision following 34 721 single-brand cemented hip replacements: a retrospective cohort study of medium-term data from a National Joint Registry.

    Science.gov (United States)

    Jameson, S S; Baker, P N; Mason, J; Gregg, P J; Brewster, N; Deehan, D J; Reed, M R

    2012-12-01

    Despite excellent results, the use of cemented total hip replacement (THR) is declining. This retrospective cohort study records survival time to revision following primary cemented THR using the most common combination of components that accounted for almost a quarter of all cemented THRs, exploring risk factors independently associated with failure. All patients with osteoarthritis who had an Exeter V40/Contemporary THR (Stryker) implanted before 31 December 2010 and recorded in the National Joint Registry for England and Wales were included in the analysis. Cox's proportional hazard models were used to analyse the extent to which risk of revision was related to patient, surgeon and implant covariates, with a significance threshold of p brand of cement/presence of antibiotic, femoral head material (stainless steel/alumina) and stem taper size/offset. However, the risk of revision for dislocation was significantly higher with a 'plus' offset head (HR 2.05, p = 0.003) and a hooded acetabular component (HR 2.34, p designs of acetabular component and sizes of femoral head after adjustment for a range of covariates.

  16. Ranking hospitals for outcomes in total hip replacement - administrative data with or without patient surveys? - Part 2: Patient survey and administrative data

    Directory of Open Access Journals (Sweden)

    Schäfer, Thomas

    2007-03-01

    Full Text Available Background: Many hospital rankings rely on the frequency of adverse outcomes and are based on administrative data. In the study presented here, we tried to find out, to what extent available administrative data of German Sickness Funds allow for an adequate hospital ranking and compared this with rankings based on additional information derived from a patient survey. Total hip replacement was chosen as an example procedure. In part II of the publication, we present the results of the approach based on administrative and patient-derived data. Methods: We used administrative data from a large health insurance (AOK-Lower Saxony of the year 2002 and from a patient survey. The study population comprised mainly beneficiaries, who received primary total hip replacement in the year 2002, were mailed a survey 6 month post-operatively and participated in the survey. Performance indicators used where “Revision”, “Complications” and “Change of functional impairment”. Hospitals were ranked if they performed at least 20 procedures on AOK-beneficiaries. Multivariate modelling (logistic regression and generalized linear models was used to estimate the performance indicators by case-mix variables (a.o. age, sex, co-morbidity, medical history and hospital characteristics (hospital size, surgical volume. The actual ranking was based on these multivariate models, excluding hospital variables and adding dummy-variables for each hospital. Hospitals were ranked by their case-mix adjusted odds ratio or Standardized Difference (SDR with respect to a pre-selected reference hospital. The resulting rankings were compared with each other and with regard to the impact of case-mix variables. Results: 4089 beneficiaries received primary total hip replacement in 2002. 3293 patients participated in the survey (80.5%. The ranking included 60 hospitals. The agreement of rankings based on different performance indicators in the same year was low to high (a correlation

  17. Replacement

    Directory of Open Access Journals (Sweden)

    S. Radhakrishnan

    2014-03-01

    Full Text Available The fishmeal replaced with Spirulina platensis, Chlorella vulgaris and Azolla pinnata and the formulated diet fed to Macrobrachium rosenbergii postlarvae to assess the enhancement ability of non-enzymatic antioxidants (vitamin C and E, enzymatic antioxidants (superoxide dismutase (SOD and catalase (CAT and lipid peroxidation (LPx were analysed. In the present study, the S. platensis, C. vulgaris and A. pinnata inclusion diet fed groups had significant (P < 0.05 improvement in the levels of vitamins C and E in the hepatopancreas and muscle tissue. Among all the diets, the replacement materials in 50% incorporated feed fed groups showed better performance when compared with the control group in non-enzymatic antioxidant activity. The 50% fishmeal replacement (best performance diet fed groups taken for enzymatic antioxidant study, in SOD, CAT and LPx showed no significant increases when compared with the control group. Hence, the present results revealed that the formulated feed enhanced the vitamins C and E, the result of decreased level of enzymatic antioxidants (SOD, CAT and LPx revealed that these feeds are non-toxic and do not produce any stress to postlarvae. These ingredients can be used as an alternative protein source for sustainable Macrobrachium culture.

  18. Usability Test of Exercise Games Designed for Rehabilitation of Elderly Patients After Hip Replacement Surgery: Pilot Study

    Science.gov (United States)

    Ter Meer, Louis P; Yumak, Zerrin; Veltkamp, Remco C

    2017-01-01

    Background Patients who receive rehabilitation after hip replacement surgery are shown to have increased muscle strength and better functional performance. However, traditional physiotherapy is often tedious and leads to poor adherence. Exercise games, provide ways for increasing the engagement of elderly patients and increase the uptake of rehabilitation exercises. Objective The objective of this study was to evaluate Fietsgame (Dutch for cycling game), which translates existing rehabilitation exercises into fun exercise games. The system connects exercise games with a patient’s personal record and a therapist interface by an Internet of Things server. Thus, both the patient and physiotherapist can monitor the patient’s medical status. Methods This paper describes a pilot study that evaluates the usability of the Fietsgame. The study was conducted in a rehabilitation center with 9 participants, including 2 physiotherapists and 7 patients. The patients were asked to play 6 exercise games, each lasting about 5 min, under the guidance of a physiotherapist. The mean age of the patients was 74.57 years (standard deviation [SD] 8.28); all the patients were in the recovery process after hip surgery. Surveys were developed to quantitatively measure the usability factors, including presence, enjoyment, pain, exertion, and technology acceptance. Comments on advantages and suggested improvements of our game system provided by the physiotherapists and patients were summarized and their implications were discussed. Results The results showed that after successfully playing the games, 75% to 100% of the patients experienced high levels of enjoyment in all the games except the squats game. Patients reported the highest level of exertion in squats when compared with other exercise games. Lunges resulted in the highest dropout rate (43%) due to interference with the Kinect v2 from support chairs. All the patients (100%) found the game system useful and easy to use, felt that

  19. Usability Test of Exercise Games Designed for Rehabilitation of Elderly Patients After Hip Replacement Surgery: Pilot Study.

    Science.gov (United States)

    Ling, Yun; Ter Meer, Louis P; Yumak, Zerrin; Veltkamp, Remco C

    2017-10-12

    Patients who receive rehabilitation after hip replacement surgery are shown to have increased muscle strength and better functional performance. However, traditional physiotherapy is often tedious and leads to poor adherence. Exercise games, provide ways for increasing the engagement of elderly patients and increase the uptake of rehabilitation exercises. The objective of this study was to evaluate Fietsgame (Dutch for cycling game), which translates existing rehabilitation exercises into fun exercise games. The system connects exercise games with a patient's personal record and a therapist interface by an Internet of Things server. Thus, both the patient and physiotherapist can monitor the patient's medical status. This paper describes a pilot study that evaluates the usability of the Fietsgame. The study was conducted in a rehabilitation center with 9 participants, including 2 physiotherapists and 7 patients. The patients were asked to play 6 exercise games, each lasting about 5 min, under the guidance of a physiotherapist. The mean age of the patients was 74.57 years (standard deviation [SD] 8.28); all the patients were in the recovery process after hip surgery. Surveys were developed to quantitatively measure the usability factors, including presence, enjoyment, pain, exertion, and technology acceptance. Comments on advantages and suggested improvements of our game system provided by the physiotherapists and patients were summarized and their implications were discussed. The results showed that after successfully playing the games, 75% to 100% of the patients experienced high levels of enjoyment in all the games except the squats game. Patients reported the highest level of exertion in squats when compared with other exercise games. Lunges resulted in the highest dropout rate (43%) due to interference with the Kinect v2 from support chairs. All the patients (100%) found the game system useful and easy to use, felt that it would be a useful tool in their further

  20. Association between NICE guidance on biologic therapies with rates of hip and knee replacement among rheumatoid arthritis patients in England and Wales

    DEFF Research Database (Denmark)

    Hawley, Samuel; Cordtz, René; Dreyer, Lene

    2018-01-01

    OBJECTIVE: To estimate the impact of NICE approval of tumor necrosis factor inhibitor (TNFi) therapies on the incidence of total hip replacement (THR) and total knee replacement (TKR) among rheumatoid arthritis (RA) patients in England and Wales. METHODS: Primary care data [Clinical Practice.......92 PYs, respectively. NICE guidance was associated with a significant average decrease in TKR incidence of -4.41/1000 PYs (95% C.I. -6.88 to -1.94), equating to a relative 34% reduction. Overall, no effect was seen on THR rates. CONCLUSIONS: Among incident RA patients in England and Wales, NICE guidance...

  1. [Evaluation of selected parameters of blood coagulation and fibrinolysis system in patients undergoing total hip replacement surgery with normovolemic hemodilution procedure and standard enoxaparine prophylaxis].

    Science.gov (United States)

    Piecuch, Wiesław; Sokołowska, Bozena; Dmoszyńska, Anna; Furmanik, Franciszek

    2003-01-01

    The aim of the study was to evaluate selected blood coagulation and fibrinolysis parameters in patients undergoing total hip replacement surgery with normovolemic hemodilution and standard enoksaparine profilaxis. The study included 66 patients undergoing hip replacement surgery. The group consisted of 51 women and 15 men, within the age range of 47-78, the mean age was 64. In 32 (subgroup II) patients the surgery was performed with the use of normovolemic hemodilution, in 34 (subgroup I) the hemodilution procedure was not applied. The enoksaparine as prophylaxis started 12 hours prior to surgery and continued during hospitalisation. The examination of the coagulation system was performed: on the day of the operation in the morning, on the day of the operation in the evening and on the first day after operation. We determined the concentrations of TAT and PAP complexes, prothrombin fragments 1 + 2 (F1 + 2) and d-dimers (DD). 1) during total hip replacement surgery and particularly in the period of the first 12 hours after the procedure marked activation of coagulation and fibrinolysis occurRed; 2) the application of the hemodilution procedure does not influence significantly the degree of coagulation and fibrinolysis disorders in the perioperative period, but could reduced incidence of thromboembolic complications in the postoperative period.

  2. Modular titanium alloy neck adapter failures in hip replacement - failure mode analysis and influence of implant material

    Directory of Open Access Journals (Sweden)

    Bloemer Wilhelm

    2010-01-01

    Full Text Available Abstract Background Modular neck adapters for hip arthroplasty stems allow the surgeon to modify CCD angle, offset and femoral anteversion intraoperatively. Fretting or crevice corrosion may lead to failure of such a modular device due to high loads or surface contamination inside the modular coupling. Unfortunately we have experienced such a failure of implants and now report our clinical experience with the failures in order to advance orthopaedic material research and joint replacement surgery. The failed neck adapters were implanted between August 2004 and November 2006 a total of about 5000 devices. After this period, the titanium neck adapters were replaced by adapters out of cobalt-chromium. Until the end of 2008 in total 1.4% (n = 68 of the implanted titanium alloy neck adapters failed with an average time of 2.0 years (0.7 to 4.0 years postoperatively. All, but one, patients were male, their average age being 57.4 years (36 to 75 years and the average weight 102.3 kg (75 to 130 kg. The failures of neck adapters were divided into 66% with small CCD of 130° and 60% with head lengths of L or larger. Assuming an average time to failure of 2.8 years, the cumulative failure rate was calculated with 2.4%. Methods A series of adapter failures of titanium alloy modular neck adapters in combination with a titanium alloy modular short hip stem was investigated. For patients having received this particular implant combination risk factors were identified which were associated with the occurence of implant failure. A Kaplan-Meier survival-failure-analysis was conducted. The retrieved implants were analysed using microscopic and chemical methods. Modes of failure were simulated in biomechanical tests. Comparative tests included modular neck adapters made of titanium alloy and cobalt chrome alloy material. Results Retrieval examinations and biomechanical simulation revealed that primary micromotions initiated fretting within the modular tapered neck

  3. Rationale for one stage exchange of infected hip replacement using uncemented implants and antibiotic impregnated bone graft.

    Science.gov (United States)

    Winkler, Heinz

    2009-09-04

    Infection of a total hip replacement (THR) is considered a devastating complication, necessitating its complete removal and thorough debridement of the site. It is undoubted that one stage exchange, if successful, would provide the best benefit both for the patient and the society. Still the fear of re-infection dominates the surgeons decisions and in the majority of cases directs them to multiple stage protocols. However, there is no scientifically based argument for that practice. Successful eradication of infection with two stage procedures is reported to average 80% to 98%. On the other hand a literature review of Jackson and Schmalzried (CORR 2000) summarizing the results of 1,299 infected hip replacements treated with direct exchange (almost exclusively using antibiotic loaded cement), reports of 1,077 (83%) having been successful. The comparable results suggest, that the major factor for a successful outcome with traditional approaches may be found in the quality of surgical debridement and dead space management. Failures in all protocols seem to be caused by small fragments of bacterial colonies remaining after debridement, whereas neither systemic antibiotics nor antibiotic loaded bone cement (PMMA) have been able to improve the situation significantly. Reasons for failure may be found in the limited sensitivity of traditional bacterial culturing and reduced antibiotic susceptibility of involved pathogens, especially considering biofilm formation. Whenever a new prosthesis is implanted into a previously infected site the surgeon must be aware of increased risk of failure, both in single or two stage revisions. Eventual removal therefore should be easy with low risk of additional damage to the bony substance. On the other hand it should also have potential of a good long term result in case of success. Cemented revisions generally show inferior long term results compared to uncemented techniques; the addition of antibiotics to cement reduces its

  4. [The hardware techniques for the restoration of the gait stereotype in the patients following total hip replacement: the personalized approach].

    Science.gov (United States)

    Koneva, E S; Lyadov, K V; Shapovalenko, T V; Zhukova, E V; Polushkin, V G

    2018-04-09

    total hip replacement has long ago become the «golden standard» for the treatment of dysplastic coxarthrosis in thousands of the patients receiving it every year. In the meantime, the analysis of the specialized literature gives evidence of the lack of a systematic and personified approach to the rehabilitation treatment. The objective of the present study was to improve medical rehabilitation of the patients following the total hip replacement and to develop the personalized programs for walking modality reconstruction taking into consideration the age and the body weight of the patients. A total of 240 patients were available for the observation including 184 women and 56 men. They were divided into three study groups and one control group, with the differentiation into the following three subgroups: one comprised of the patients of moderate acerage age and body weight, the other containing the obese patients (BMI>35), and the third one involving the elderly patients (age >70 years); each subgroup consisted of 20 patients. All the patients received the early basic rehabilitation treatment, those in the study groups had to perform in addition the robotic training based on the use of hardware techniques supplemented by passive mechanotherapy and electromyostimulation designed to restore the walking stereotype with three types of devices: body weight unloading, video-reconstruction associated with biological feedback and robototherapy. The comparative analysis of the effectiveness of various methods of gait reconstruction has demonstrated the high effectiveness of the application of the hardware technique in the patients of moderate acerage age and body weight. At the same time, the elderly patients had a significantly higher rate of successful walking reconstruction efficiency under the influence of the video-associated training with biological feedback (3 times that achieved with training using the device for unloading the body weight and 4 times compared with

  5. Determinants of patient satisfaction and their willingness to return after primary total hip replacement: a cross-sectional study.

    Science.gov (United States)

    Schaal, Tom; Schoenfelder, Tonio; Klewer, Joerg; Kugler, Joachim

    2016-08-08

    Surveys of patient satisfaction and their willingness to return can be used for the optimization of processes, improving their quality, and increasing the satisfaction and loyalty in customers. This study looked at the factors significantly associated with patient satisfaction after primary total hip replacement (THR), and which affect the patients' willingness to return to the same hospital for future treatment, even when unrelated to their THR. Data for the study was collected by written survey from 810 patients of 43 hospitals following their THR. Satisfaction and willingness to return were measured using a validated, multidimensional questionnaire, primarily based on six-point scales, which were then evaluated together with routine hospital data, according to bivariate and multivariate analyses. The bivariate analysis showed a strong correlation between satisfaction or willingness to return and the health condition before hospitalization as well as the perceived length of stay. In contrast, the patient's gender and the number of inpatient cases in a hospital with THR had no influence. The binary logistic regression analyses identified three predictors associated with overall satisfaction and seven predictors associated with willingness to return. The strongest factor for both dependent variables was the perceived length of stay, and the weakest factor for satisfaction was the treatment outcome. Overall, with all of the medical and service-related issues considered, high levels of satisfaction were reached. Despite the high satisfaction scores, probable causes for declining the willingness to return were identified. The results provide incentives for hospitals and medical professionals to attain a high satisfaction levels in their THR patients.

  6. Prediction of contact mechanics in metal-on-metal Total Hip Replacement for parametrically comprehensive designs and loads.

    Science.gov (United States)

    Donaldson, Finn E; Nyman, Edward; Coburn, James C

    2015-07-16

    Manufacturers and investigators of Total Hip Replacement (THR) bearings require tools to predict the contact mechanics resulting from diverse design and loading parameters. This study provides contact mechanics solutions for metal-on-metal (MoM) bearings that encompass the current design space and could aid pre-clinical design optimization and evaluation. Stochastic finite element (FE) simulation was used to calculate the head-on-cup contact mechanics for five thousand combinations of design and loading parameters. FE results were used to train a Random Forest (RF) surrogate model to rapidly predict the contact patch dimensions, contact area, pressures and plastic deformations for arbitrary designs and loading. In addition to widely observed polar and edge contact, FE results included ring-polar, asymmetric-polar, and transitional categories which have previously received limited attention. Combinations of design and load parameters associated with each contact category were identified. Polar contact pressures were predicted in the range of 0-200 MPa with no permanent deformation. Edge loading (with subluxation) was associated with pressures greater than 500 MPa and induced permanent deformation in 83% of cases. Transitional-edge contact (with little subluxation) was associated with intermediate pressures and permanent deformation in most cases, indicating that, even with ideal anatomical alignment, bearings may face extreme wear challenges. Surrogate models were able to accurately predict contact mechanics 18,000 times faster than FE analyses. The developed surrogate models enable rapid prediction of MoM bearing contact mechanics across the most comprehensive range of loading and designs to date, and may be useful to those performing bearing design optimization or evaluation. Published by Elsevier Ltd.

  7. Lymphoid Aggregates That Resemble Tertiary Lymphoid Organs Define a Specific Pathological Subset in Metal-on-Metal Hip Replacements

    Science.gov (United States)

    Barone, Francesca; Hardie, Debbie L.; Matharu, Gulraj S.; Davenport, Alison J.; Martin, Richard A.; Grant, Melissa; Mosselmans, Frederick; Pynsent, Paul; Sumathi, Vaiyapuri P.; Addison, Owen; Revell, Peter A.; Buckley, Christopher D.

    2013-01-01

    Aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL) has been used to describe the histological lesion associated with metal-on-metal (M-M) bearings. We tested the hypothesis that the lymphoid aggregates, associated with ALVAL lesions resemble tertiary lymphoid organs (TLOs). Histopathological changes were examined in the periprosthetic tissue of 62 M-M hip replacements requiring revision surgery, with particular emphasis on the characteristics and pattern of the lymphocytic infiltrate. Immunofluorescence and immunohistochemistry were used to study the classical features of TLOs in cases where large organized lymphoid follicles were present. Synchrotron X-ray fluorescence (XRF) measurements were undertaken to detect localisation of implant derived ions/particles within the samples. Based on type of lymphocytic infiltrates, three different categories were recognised; diffuse aggregates (51%), T cell aggregates (20%), and organised lymphoid aggregates (29%). Further investigation of tissues with organised lymphoid aggregates showed that these tissues recapitulate many of the features of TLOs with T cells and B cells organised into discrete areas, the presence of follicular dendritic cells, acquisition of high endothelial venule like phenotype by blood vessels, expression of lymphoid chemokines and the presence of plasma cells. Co-localisation of implant-derived metals with lymphoid aggregates was observed. These findings suggest that in addition to the well described general foreign body reaction mediated by macrophages and a T cell mediated type IV hypersensitivity response, an under-recognized immunological reaction to metal wear debris involving B cells and the formation of tertiary lymphoid organs occurs in a distinct subset of patients with M-M implants. PMID:23723985

  8. Association between Apoptotis and CD4+/CD8+ T-Lymphocyte Ratio in Aseptic Loosening after Total Hip Replacement

    Science.gov (United States)

    Landgraeber, Stefan; von Knoch, Marius; Löer, Franz; Brankamp, Jochen; Tsokos, Michael; Grabellus, Florian; Schmid, Kurt Werner; Totsch, Martin

    2009-01-01

    Particle-induced osteolysis is a major cause of aseptic loosening after total joint replacement. While the osteolytic cascade initiated by cytokine release from macrophages has been studied extensively, the involvement of T-lymphocytes in this context is controversial and has been addressed by only a few authors. In a former study we detected that the quantity of T-lymphocytes may be influenced by apoptosis in patients with aseptic loosening. In this study we intended to find out more details about the apoptosis-induced shifting of the T-cell number. We focused our interest on the CD4+ and CD8+ T-cells and their relative ratio. Caspase-3 cleaved was evaluated immunohistochemically to detect apoptotic T-cells in capsules and interface membranes from patients with aseptic hip implant loosening and a varying degree of caspase-3 cleaved expression in CD4+ and CD8+ T-lymphocytes was detected. Moreover, a relationship between the intensity of the apoptotic reactions and the radiological extent of osteolysis was observed. The number of CD4+ cells was decreased in the presence of strong apoptotic reactions, respectively extensive osteolysis, while CD8+ cells were affected to a much lower degree. Thus, the CD4+/CD8+ ratio changed from 1.0 in cases with only small areas of periprosthetic osteolysis and minimally intense apoptosis to 0.33 in cases with large areas of osteolysis. This may suggest a causal relationship between the apoptosis-induced shift in the CD4+/CD8+ ratio and the osteolysis respectively aseptic loosening. It is possible that these findings may lead to a new understanding of particle-induced osteolysis. PMID:19214244

  9. Hospital Discharge Information After Elective Total hip or knee Joint Replacement Surgery: A clinical Audit of preferences among general practitioners

    Directory of Open Access Journals (Sweden)

    Andrew M Briggs

    2012-05-01

    Full Text Available AbstractThe demand for elective joint replacement (EJR surgery for degenerative joint disease continues to rise in Australia, and relative to earlier practices, patients are discharged back to the care of their general practitioner (GP and other community-based providers after a shorter hospital stay and potentially greater post-operative acuity. In order to coordinate safe and effective post-operative care, GPs rely on accurate, timely and clinically-informative information from hospitals when their patients are discharged. The aim of this project was to undertake an audit with GPs regarding their preferences about the components of information provided in discharge summaries for patients undergoing EJR surgery for the hip or knee. GPs in a defined catchment area were invited to respond to an online audit instrument, developed by an interdisciplinary group of clinicians with knowledge of orthopaedic surgery practices. The 15-item instrument required respondents to rank the importance of components of discharge information developed by the clinician working group, using a three-point rating scale. Fifty-three GPs and nine GP registrars responded to the audit invitation (11.0% response rate. All discharge information options were ranked as ‘essential’ by a proportion of respondents, ranging from 14.8–88.5%. Essential information requested by the respondents included early post-operative actions required by the GP, medications prescribed, post-operative complications encountered and noting of any allergies. Non-essential information related to the prosthesis used. The provision of clinical guidelines was largely rated as ‘useful’ information (47.5–56.7%. GPs require a range of clinical information to safely and effectively care for their patients after discharge from hospital for EJR surgery. Implementation of changes to processes used to create discharge summaries will require engagement and collaboration between clinical staff

  10. [Elbow dislocation].

    Science.gov (United States)

    de Pablo Márquez, B; Castillón Bernal, P; Bernaus Johnson, M C; Ibañez Aparicio, N M

    Elbow dislocation is the most frequent dislocation in the upper limb after shoulder dislocation. Closed reduction is feasible in outpatient care when there is no associated fracture. A review is presented of the different reduction procedures. Copyright © 2017 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  11. Subtalar dislocation

    International Nuclear Information System (INIS)

    El-Khoury, G.Y.; Yousefzadeh, D.K.; Mulligan, G.M.; Moore, T.E.

    1982-01-01

    Over a period of three years we have seen nine patients with subtalar dislocation, all of whom sustained violent trauma to the region of the ankle and hind foot. All but one patient were males. Clinically a subtalar dislocation resembles a complicated fracture dislocation of the ankle but a definitive diagnosis can only be made radiographically. The mechanism of injury and radiographic features of this injury are discussed. (orig.)

  12. Hip replacement - discharge

    Science.gov (United States)

    ... such as downhill skiing or contact sports like football and soccer. But you should be able to ... herein should not be used during any medical emergency or for the diagnosis or treatment of any ...

  13. Imaging of hip arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Miller, Theodore T., E-mail: millertt@hss.edu [Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 (United States)

    2012-12-15

    The imaging evaluation of the prosthetic hip begins with radiography, but arthrography, aspiration, scintigraphy, sonography, CT and MR imaging all have roles in the evaluation of the painful prosthesis. This article will review the appearance of normal hip arthroplasty including hemiarthroplasty, total arthroplasty, and hip resurfacing, as well as the appearances of potential complications such as aseptic loosening and osteolysis, dislocation, infection, periprosthetic fracture, hardware failure, and soft tissue abnormalities.

  14. Computed tomography in abnormalities of the hip

    Energy Technology Data Exchange (ETDEWEB)

    Visser, J.D.; Jonkers, A.; Klasen, H.J. (Rijksuniversiteit Groningen (Netherlands). Academisch Ziekenhuis); Hillen, B. (Rijksuniversiteit Groningen (Netherlands). Lab. voor Anatomie en Embryologie)

    1982-06-26

    The value of computed tomography in the assessment of abnormalities of the hip is demonstrated with the aid of an anatomical preparation and in patients with, respectively, congenital dislocation of a hip, dislocation of the hip in spina bifida, an acetabular fracture and a Ewing tumour. The anteversion of the acetabulum and femur and the instability index of the hip joint can be measured by means of computed tomography.

  15. Digital correction of magnification in pelvic x rays for preoperative planning of hip joint replacements: Theoretical development and clinical results of a new protocol

    International Nuclear Information System (INIS)

    The, B.; Diercks, R.L.; Stewart, R.E.; Ooijen, P.M.A. van; Horn, J.R. van

    2005-01-01

    The introduction of digital radiological facilities leads to the necessity of digital preoperative planning, which is an essential part of joint replacement surgery. To avoid errors in the preparation and execution of hip surgery, reliable correction of the magnification of the projected hip is a prerequisite. So far, no validated method exists to accomplish this. We present validated geometrical models of the x-ray projection of spheres, relevant for the calibration procedure to correct for the radiographic magnification. With help of these models a new calibration protocol was developed. The validity and precision of this procedure was determined in clinical practice. Magnification factors could be predicted with a maximal margin of error of 1.5%. The new calibration protocol is valid and reliable. The clinical tests revealed that correction of magnification has a 95% margin of error of -3% to +3%. Future research might clarify if a strict calibration protocol, as presented in this study, results in more accurate preoperative planning of hip joint replacements

  16. A prospective randomised study comparing the jubilee dressing method to a standard adhesive dressing for total hip and knee replacements.

    LENUS (Irish Health Repository)

    Burke, Neil G

    2012-08-01

    It is important to reduce potential wound complications in total hip and total knee arthroplasty procedures. The purpose of this study was to compare the jubilee dressing method to a standard adhesive dressing.

  17. Stereotactic ultrasound for target volume definition in a patient with prostate cancer and bilateral total hip replacement.

    Science.gov (United States)

    Boda-Heggemann, Judit; Haneder, Stefan; Ehmann, Michael; Sihono, Dwi Seno Kuncoro; Wertz, Hansjörg; Mai, Sabine; Kegel, Stefan; Heitmann, Sigrun; von Swietochowski, Sandra; Lohr, Frank; Wenz, Frederik

    2015-01-01

    Target-volume definition for prostate cancer in patients with bilateral metal total hip replacements (THRs) is a challenge because of metal artifacts in the planning computed tomography (CT) scans. Magnetic resonance imaging (MRI) can be used for matching and prostate delineation; however, at a spatial and temporal distance from the planning CT, identical rectal and vesical filling is difficult to achieve. In addition, MRI may also be impaired by metal artifacts, even resulting in spatial image distortion. Here, we present a method to define prostate target volumes based on ultrasound images acquired during CT simulation and online-matched to the CT data set directly at the planning CT. A 78-year-old patient with cT2cNxM0 prostate cancer with bilateral metal THRs was referred to external beam radiation therapy. T2-weighted MRI was performed on the day of the planning CT with preparation according to a protocol for reproducible bladder and rectal filling. The planning CT was obtained with the immediate acquisition of a 3-dimensional ultrasound data set with a dedicated stereotactic ultrasound system for online intermodality image matching referenced to the isocenter by ceiling-mounted infrared cameras. MRI (offline) and ultrasound images (online) were thus both matched to the CT images for planning. Daily image guided radiation therapy (IGRT) was performed with transabdominal ultrasound and compared with cone beam CT. Because of variations in bladder and rectal filling and metal-induced image distortion in MRI, soft-tissue-based matching of the MRI to CT was not sufficient for unequivocal prostate target definition. Ultrasound-based images could be matched, and prostate, seminal vesicles, and target volumes were reliably defined. Daily IGRT could be successfully completed with transabdominal ultrasound with good accordance between cone beam CT and ultrasound. For prostate cancer patients with bilateral THRs causing artifacts in planning CTs, ultrasound referenced to

  18. NeurimmiRs and Postoperative Delirium in Elderly Patients Undergoing Total Hip/Knee Replacement: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Rui Dong

    2017-06-01

    Full Text Available Objective: Postoperative delirium (POD is a frequent complication after surgery and its occurrence is associated with poor outcomes. The pathophysiology of this complication is not clear, but identification of risk factors is important for positive postoperative outcomes. The purpose of this study was to investigate the associations between the preoperative expression levels of microRNA (miR-146a, miR-125b, and miR-181c in cerebrospinal fluid (CSF and serum and the development and severity of POD.Methods: Forty elderly patients aged 65 years old and older admitted for elective total hip/knee replacement under spinal anesthesia. Preoperatively, baseline cognitive function was assessed using the Mini-Mental State Examination. Each patient was interviewed daily on the first and second postoperative days. Delirium was diagnosed using the Confusion Assessment Method, and delirium severity was measured using the Memorial Delirium Assessment Scale (MDAS. Preoperative serum and CSF miR levels were determined by quantitative real-time PCR (qRT-PCR.Results: POD was detected in 27.5% (11/40 of patients. Up-regulation of miR-146a and miR-181c in CSF and down-regulation of miR-146a in serum were observed preoperatively in patients who developed POD, while patients with and without POD did not differ in serum or CSF levels of miR-125b. Delirious patients had higher CSF/serum ratios of miR-146a and miR-181c levels than non-delirious patients. The lower CSF miR-146a and CSF/serum miR-146a ratios were significantly associated with milder POD severity, represented by a lower MDAS score.Conclusion: The dysregulation of preoperative miR-146a and miR-181c in CSF and serum was associated with the development and severity of POD. These NeurimmiRs might participate in the neuropathogenesis of POD, pending further investigations.Clinical trial registration: this study was registered at ClinicalTrials.gov (NCT02817386.

  19. Large diameter metal on metal total hip replacement for femoral neck fractures with neurological conditions A retrospective assessment

    Directory of Open Access Journals (Sweden)

    Jia Li

    2014-01-01

    Conclusion: We believe the use of L-MoM can diminish the rate of instability or dislocation, after operation. The L-MoM is an option for patients with Parkinson′s disease and poliomyelitis with femoral neck fracture.

  20. A influência da via de acesso na luxação das artroplastias totais do quadril The influence of the surgical approach concerning dislocation in total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    José Ricardo Negreiros Vicente

    2009-01-01

    Full Text Available OBJETIVO: Avaliar a ocorrência de luxação nas artroplastias totais do quadril não cimentadas, comparando-se os acessos posterior e lateral direto. Métodos: Estudo retrospectivo comparativo com 232 pacientes submetidos à artroplastia total do quadril não cimentada, por diagnóstico de osteoartrose primária e secundária, sendo 105 submetidos ao acesso posterior e 127 ao acesso lateral. O modelo protético utilizado foi único, assim como o protocolo de reabilitação e cuidados pós-operatórios. Foram verificados ocorrência de luxação, posicionamento acetabular e componentes utilizados. RESULTADOS: Ocorreu um caso isolado de luxação no grupo do acesso lateral direto (0,8% contra 0% no grupo de pacientes submetidos ao acesso posterior, sem diferença significativa (p = 1. A luxação ocorreu em uma paciente de 47 anos de idade, que foi tratada com redução incruenta sem recidiva da luxação após três anos e um mês de seguimento. O tempo de seguimento dos dois grupos variou entre seis e 42 meses, com média de 23,7 meses. CONCLUSÃO: Os autores concluem que a prevalência de luxação nas artroplastias totais do quadril é similar nos dois acessos estudados e que medidas educativas, técnica cirúrgica adequada e utilização de próteses com offsets maiores podem diminuir o risco dessa complicação.OBJECTIVES: Our primary aim was to evaluate the occurrence of dislocation of non-cemented total hip arthroplasty, when using the posterior and the direct lateral approaches. METHODS: We performed a comparative retrospective study with 232 patients submitted to non-cemented total hip arthroplasty, due to the diagnosis of primary or secondary osteoarthritis. The posterior approach was used in 105 patients while direct lateral approach was used in 127 patients. There was only one prosthesis model and the same rehabilitation program and post-operative care was used for all patients. We checked the occurrence of dislocation, the

  1. Transitioning to the direct anterior approach in total hip arthroplasty. Is it a true muscle sparing approach when performed by a low volume hip replacement surgeon?

    Science.gov (United States)

    Nistor, Dan-Viorel; Caterev, Sergiu; Bolboacă, Sorana-Daniela; Cosma, Dan; Lucaciu, Dan Osvald Gheorghe; Todor, Adrian

    2017-11-01

    We conducted this study to establish if the transition from a lateral approach (LA) to the direct anterior approach (DAA) for a low volume hip arthroplasty surgeon during the steep learning curve can be performed maintaining the muscle sparing approach of the DAA without increasing the complication rates. In this controlled, prospective, randomized clinical study we investigated 70 patients (35 DAA, 35 LA) with similar demographics that underwent a total hip arthroplasty. Assessment of the two approaches consisted of determining the invasiveness through serum markers for muscle damage (i.e. myoglobin, creatine kinase and lactate dehydrogenase), the operative parameters such as post-operative pain and rescue medication consumption, the component positioning and complication rates. Post-operative myoglobin levels were higher (p < 0.001) in the LA group (326.42 ± 84.91 ng/mL) as compared to the DAA group (242.80 ± 71.03 ng/mL), but with no differences regarding other biomarkers for muscle damage. Pain levels were overall lower in the DAA group, with a statistical and clinical difference during surgery day (p < 0.001) associated with lower (p < 0.001) rescue medication consumption (median 1 (1; 3) mg morphine vs. 3 (2; 4) mg morphine). Most patients in the LA group reported chronic post-operative pain throughout all three evaluated months, while the majority of patients in the DAA group reported no pain after week six. Component positioning did not differ significantly between groups and neither did complication rates. The DAA can be transitioned from the LA safely, without higher complication rates while maintaining its muscle spearing advantages when performed by a low volume hip arthroplasty surgeon.

  2. An Empirical Comparison of Discrete Choice Experiment and Best-Worst Scaling to Estimate Stakeholders' Risk Tolerance for Hip Replacement Surgery.

    Science.gov (United States)

    van Dijk, Joris D; Groothuis-Oudshoorn, Catharina G M; Marshall, Deborah A; IJzerman, Maarten J

    2016-06-01

    Previous studies have been inconclusive regarding the validity and reliability of preference elicitation methods. The aim of this study was to compare the metrics obtained from a discrete choice experiment (DCE) and profile-case best-worst scaling (BWS) with respect to hip replacement. We surveyed the general US population of men aged 45 to 65 years, and potentially eligible for hip replacement surgery. The survey included sociodemographic questions, eight DCE questions, and twelve BWS questions. Attributes were the probability of a first and second revision, pain relief, ability to participate in sports and perform daily activities, and length of hospital stay. Conditional logit analysis was used to estimate attribute weights, level preferences, and the maximum acceptable risk (MAR) for undergoing revision surgery in six hypothetical treatment scenarios with different attribute levels. A total of 429 (96%) respondents were included. Comparable attribute weights and level preferences were found for both BWS and DCE. Preferences were greatest for hip replacement surgery with high pain relief and the ability to participate in sports and perform daily activities. Although the estimated MARs for revision surgery followed the same trend, the MARs were systematically higher in five of the six scenarios using DCE. This study confirms previous findings that BWS or DCEs are comparable in estimating attribute weights and level preferences. However, the risk tolerance threshold based on the estimation of MAR differs between these methods, possibly leading to inconsistency in comparing treatment scenarios. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  3. Nursing intervention by telephone interviews of patients aged over 65 years after total hip replacement improves health status: a randomised clinical trial Nursing intervention by telephone interviews of patients aged over 65 years after total hip replacement improves health status: a randomised

    DEFF Research Database (Denmark)

    Hørdam, Britta

    2010-01-01

    and over by using telephone support and counselling 2 and 10 weeks after surgery compared with a control group receiving conventional care and treatment. Design: A randomised clinical trial focusing on patients' health status by using short-form 36 at 4 weeks preoperatively and 3 and 9 months...... postoperatively was carried out. Sample: 180 patients aged 65 years and over were randomised 4 weeks preoperatively to either control or intervention groups. Measurements: both groups received conventional surgical treatment, but the intervention group was interviewed by telephone 2 and 10 weeks after surgery......Nursing intervention by telephone interviews of patients aged over 65 years after total hip replacement improves health status: a randomised clinical trial Objective: We hypothesised that all areas of health status after total hip replacement could be improved in patients aged over 65 years...

  4. Are digital images good enough? A comparative study of conventional film-screen vs digital radiographs on printed images of total hip replacement

    International Nuclear Information System (INIS)

    Eklund, K.; Jonsson, K.; Lindblom, G.; Lundin, B.; Sanfridsson, J.; Sloth, M.; Sivberg, B.

    2004-01-01

    The aim of this study was to evaluate the inter- and intra-observer variability and to find differences in diagnostic safety between digital and analog technique in diagnostic zones around hip prostheses. In 80 patients who had had a total hip replacement (THR) for more than 2 years, a conventional image and a digital image were taken. Gruen's model of seven distinct regions of interest was used for evaluations. Five experienced radiologists observed the seven regions and noted in a protocol the following distances: stem-cement; cement-bone; and stem-bone. All images were printed on hard copies and were read twice. Weighted kappa, κ w , analyses were used. The two most frequently loosening regions, stem-cement region 1 and cement-bone region 7, were closely analyzed. In region 1 the five observers had an agreement of 86.75-97.92% between analog and digital images in stem-cement, which is a varied κ w 0.29-0.71. For cement-bone region 7 an agreement of 87.21-90.45% was found, which is a varied κ w of 0.48-0.58. All the kappa values differ significantly from nil. The result shows that digital technique is as good as analog radiographs for diagnosing possible loosening of hip prostheses. (orig.)

  5. Are digital images good enough? A comparative study of conventional film-screen vs digital radiographs on printed images of total hip replacement

    Energy Technology Data Exchange (ETDEWEB)

    Eklund, K.; Jonsson, K.; Lindblom, G.; Lundin, B.; Sanfridsson, J.; Sloth, M. [Department of Radiology, Center for Medical Imaging and Physiology, Lund University Hospital, 22185, Lund (Sweden); Sivberg, B. [Department of Nursing, Faculty of Medicine, Lund University, P.O. Box 157, 22100, Lund (Sweden)

    2004-05-01

    The aim of this study was to evaluate the inter- and intra-observer variability and to find differences in diagnostic safety between digital and analog technique in diagnostic zones around hip prostheses. In 80 patients who had had a total hip replacement (THR) for more than 2 years, a conventional image and a digital image were taken. Gruen's model of seven distinct regions of interest was used for evaluations. Five experienced radiologists observed the seven regions and noted in a protocol the following distances: stem-cement; cement-bone; and stem-bone. All images were printed on hard copies and were read twice. Weighted kappa, {kappa}{sub w}, analyses were used. The two most frequently loosening regions, stem-cement region 1 and cement-bone region 7, were closely analyzed. In region 1 the five observers had an agreement of 86.75-97.92% between analog and digital images in stem-cement, which is a varied {kappa}{sub w} 0.29-0.71. For cement-bone region 7 an agreement of 87.21-90.45% was found, which is a varied {kappa}{sub w} of 0.48-0.58. All the kappa values differ significantly from nil. The result shows that digital technique is as good as analog radiographs for diagnosing possible loosening of hip prostheses. (orig.)

  6. Associations between preoperative Oxford hip and knee scores and costs and quality of life of patients undergoing primary total joint replacement in the NHS England: an observational study.

    Science.gov (United States)

    Eibich, Peter; Dakin, Helen A; Price, Andrew James; Beard, David; Arden, Nigel K; Gray, Alastair M

    2018-04-10

    To assess how costs and quality of life (measured by EuroQoL-5 Dimensions (EQ-5D)) before and after total hip replacement (THR) and total knee replacement (TKR) vary with age, gender and preoperative Oxford hip score (OHS) and Oxford knee score (OKS). Regression analyses using prospectively collected data from clinical trials, cohort studies and administrative data bases. UK secondary care. Men and women undergoing primary THR or TKR. The Hospital Episode Statistics data linked to patient-reported outcome measures included 602 176 patients undergoing hip or knee replacement who were followed up for up to 6 years. The Knee Arthroplasty Trial included 2217 patients undergoing TKR who were followed up for 12 years. The Clinical Outcomes in Arthroplasty Study cohort included 806 patients undergoing THR and 484 patients undergoing TKR who were observed for 1 year. EQ-5D-3L quality of life before and after surgery, costs of primary arthroplasty, costs of revision arthroplasty and the costs of hospital readmissions and ambulatory costs in the year before and up to 12 years after joint replacement. Average postoperative utility for patients at the 5th percentile of the OHS/OKS distribution was 0.61/0.5 for THR/TKR and 0.89/0.85 for patients at the 95th percentile. The difference between postoperative and preoperative EQ-5D utility was highest for patients with preoperative OHS/OKS lower than 10. However, postoperative EQ-5D utility was higher than preoperative utility for all patients with OHS≤46 and those with OKS≤44. In contrast, costs were generally higher for patients with low preoperative OHS/OKS than those with high OHS/OKS. For example, costs of hospital readmissions within 12 months after primary THR/TKR were £740/£888 for patients at the 5th percentile compared with £314/£404 at the 95th percentile of the OHS/OKS distribution. Our findings suggest that costs and quality of life associated with total joint replacement vary systematically with

  7. Ipsilateral Fracture Shaft Femur with Neglected Dislocation of Prosthesis: A Case Report

    Directory of Open Access Journals (Sweden)

    Mantu Jain

    2013-10-01

    Full Text Available Introduction: Neglected hip dislocation is rare in today’s world and after prosthesis replacement even rarer finding. However such patients may not report to surgeons until they develop secondary complications. Management of such patient’s is a challenge to the treating surgeon and need to be tailored suiting to patient’s demands, expectations and constraints of financial resources. We did not find a similar case in the electronic and print media and therefore report this case which was innovatively managed. Case Report: A 60 year farmer presented with fracture shaft femur and ipsilateral dislocation prosthesis of right hip. He had a hemiarthroplasty done for fracture neck of femur in the past but used to walk with a lurch since he started to ambulate after discharge. However he was satisfied despite “some problems” which had caused shortening of his limb. The patient was informed of the various treatment options and their possible complications. He expressed his inability to afford a Total Hip Arthroplasty (THA at any stage and consented for other options discussed with him. The patient was positioned supine and adductor tenotomy done. Next he was positioned laterally and the fracture was fixed with heavy duty broad dynamic compression plate and screws. The wound was temporarily closed. Now through the previous scar via posterior approach the hip was exposed. The prosthesis was found to be firmly fixed to the proximal femur. The acetabulum was cleared with fibrous tissue. All attempts the prosthesis to relocate the prosthesis failed after several attempts and it was best decided to leave alone. Post operatively period was uneventful. At follow up he refused for any further manoeuvre in future inform of heavy traction and attempts to reduce the same. At one year when he was walking unaided and his X-rays showed that fracture had well united his SF-36 score was PCS – 49.6 and MCS – 51.9. Conclusion: Ipsilateral shaft femur fracture

  8. Perilunate Dislocation

    Directory of Open Access Journals (Sweden)

    John Jiao

    2016-09-01

    Full Text Available History of present illness: A 25-year-old female presented to the emergency department with left wrist pain following a fall off a skateboard. The patient fell on her outstretched left wrist with the wrist dorsiflexed and reported immediate sharp pain to her left wrist that was worse with movement. She denied other trauma. Significant findings: In the left lateral wrist x-ray, the lunate (outlined in blue is dislocated from the rest of the wrist bones (yellow line but still articulates with the radius (red line. The capitate (yellow line does not sit within the distal articulation of the lunate and is displaced dorsally. Additionally, a line drawn through the radius and lunate (green line fails to intersect with the capitate. This is consistent with a perilunate dislocation. This is compared to a lunate dislocation, where the lunate itself is displaced and turned ventrally (spilled teacup and the proximal aspect does not articulate with the radius. Discussion: A perilunate dislocation is a significant closed wrist injury that is easily missed on standard anterior-posterior imaging. These dislocations are relatively rare, involving only 7% of all carpal injuries and are associated with high-energy trauma onto a hyperextended wrist, such as falls from a height, motor vehicle accidents, and sports injuries.1 An untreated perilunate dislocation is associated with high risk of chronic carpal instability and post-traumatic arthritis. If the mechanism of injury is sufficient to suspect perilunate dislocation, multiple radiographic views of the wrist should be ordered. Patients should receive prompt orthopedic consultation for open reduction and ligamentous repair. Even after successful identification and subsequent surgical repair, median nerve neuropathy and post-traumatic arthritis are frequent.2-3

  9. Luxação traumática posterior do quadril em crianças: relato de cinco casos Traumatic posterior dislocation of the hip in children: report of five cases

    Directory of Open Access Journals (Sweden)

    Gilberto Francisco Brandão

    2010-01-01

    Full Text Available OBJETIVO: Avaliar uma série de casos de luxação traumática posterior em crianças, o tratamento e os resultados, e revisar os aspectos relacionados à sua epidemiologia, diagnóstico clínico e radiográfico, tratamento, complicações e prognóstico. MÉTODOS: Foram avaliados retrospectivamente cinco pacientes com luxação traumática do quadril com média idade de 4,6 ± 0,9 anos e tempo de seguimento de 19,8 ± 7,0 meses. Foram avaliados o tempo entre a luxação e a redução, o tipo de tratamento, as lesões associadas e as complicações tardias. RESULTADOS: O tratamento inicial foi a redução incruenta com tempo médio de 5,2 ± 3,6 horas após o trauma inicial, sendo que todos foram submetidos à redução sob anestesia. O tratamento complementar incluiu imobilização gessada e tração. Não foi observada necessidade de cirurgias adicionais ou sequelas a longo prazo. CONCLUSÃO: A luxação traumática do quadril deve ser tratada com redução incruenta rápida, controle adequado da redução e observação rigorosa para diagnóstico e tratamento de complicações tardias.OBJECTIVE: To evaluate a series of cases of traumatic posterior dislocations in children, the treatment and the results, and to revise aspects such as the epidemiology, clinical and radiographic diagnosis, treatment, complications and prognosis. METHODS: Five patients with traumatic hip dislocation, with an average age of 4.6 ± 0.9 years, and an ongoing follow-up period of 19.8 ± 7.0 months, were evaluated retrospectively. The time between dislocation and reduction, the type of treatment, associated injuries, and subsequent complications were also evaluated. RESULTS: The initial treatment was closed reduction, in an average time of 5.2 ± 3.6 hours after the initial trauma, in which the patients were subjected to the reduction under anesthesia. Complementary treatment included immobilization with casts and traction. No needs for additional surgeries or long

  10. Volume Replacement Therapy during Hip Arthroplasty using Hydroxyethyl Starch (130/0.4 Compared to Lactated Ringer Decreases Allogeneic Blood Transfusion and Postoperative Infection

    Directory of Open Access Journals (Sweden)

    Adilson Hamaji

    2013-01-01

    Ringer. Keywords: Arthroplasty, Replacement, Hip, Anesthesia, Spinal, Blood Transfusion, Hetastarch, Hemodilution

  11. Toilet Grab-Bar Preference and Center of Pressure Deviation During Toilet Transfers in Healthy Seniors, Seniors With Hip Replacements, and Seniors Having Suffered a Stroke.

    Science.gov (United States)

    Kennedy, Matthew Joel; Arcelus, Amaya; Guitard, Paulette; Goubran, R A; Sveistrup, Heidi

    2015-01-01

    Multiple toilet grab-bar configurations are required by people with a diverse spectrum of disability. The study purpose was to determine toilet grab-bar preference of healthy seniors, seniors with a hip replacement, and seniors post-stroke, and to determine the effect of each configuration on centre of pressure (COP) displacement during toilet transfers. 14 healthy seniors, 7 ambulatory seniors with a hip replacement, and 8 ambulatory seniors post-stroke participated in the study. Toilet transfers were performed with no bars (NB), commode (C), two vertical bars (2VB), one vertical bar (1VB), a horizontal bar (H), two swing-away bars (S) and a diagonal bar (D). COP was measured using pressure sensitive floor mats. Participants rated the safety, ease of use, helpfulness, comfort and preference for instalment. 2VB was most preferred and had the smallest COP deviation. Least preferred was H and NB. C caused largest COP displacement but had favourable ratings. The preference and safety of the 2VB should be considered in the design of accessible toilets and in accessibility construction guidelines. However these results need to be verified in non-ambulatory populations. C is frequently prescribed, but generates large COP deviation, suggesting it may present an increased risk of falls.

  12. Spouses’ involvement in older patients’ fast-track programmes during total hip replacement using case management intervention. A study protocol of the SICAM-trial

    DEFF Research Database (Denmark)

    Berthelsen, Connie Bøttcher; Kristensson, Jimmie

    2015-01-01

    Aim To present the protocol of a two-group quasi-experimental study of spouses’ involvement through case management (The SICAM-trial) in older patients’ fast-track programmes during total hip replacement. Background Patients in fast-track programmes are required to take an active part in their tr......Aim To present the protocol of a two-group quasi-experimental study of spouses’ involvement through case management (The SICAM-trial) in older patients’ fast-track programmes during total hip replacement. Background Patients in fast-track programmes are required to take an active part...... in their treatment and rehabilitation. Spouses of older patients can often provide valued practical and emotional support, reducing stress, pain and length of stay – yet they are seldom invited to participate in a supporting role. Design A two-group quasi-experimental design with pre-test and repeated post...... and subsequently include the intervention group to avoid contamination of the control group. A case manager will be recruited to perform the case management intervention. Data will be collected from both groups at baseline, 2 weeks and 3 months after surgery. Outcome measures for patients include: functional...

  13. Clinical usage of indium-111 labeled leukocyte scintigraphy and technetium-99m methylene diphosphonate scintigraphy in patients with total hip replacement

    International Nuclear Information System (INIS)

    Terauchi, Takashi; Uno, Kimiichi; Yuyama, Takuo; Seto, Kazuhiko; Arimizu, Noboru; Suguro, Tohru; Moriya, Hideshige; Uematsu, Sadao.

    1988-01-01

    Tc-99m methylene diphosphonate (MDP) scintigraphy and In-111 labeled leukocyte scintigraphy were done in 13 patients with total hip replacement in order to determine the presence of prosthetic infection. Tc-99m MDP scintigraphy was done in 11 patients (12 studies). In-111 labeled leukocyte scintigraphy was done in 13 patients (14 studies). Tc-99m MDP imaging showed diffuse accumulation of the radionuclide in all of the 3 infected lesions, but focal one in 5 of the 7 noninfected lesions with a specificity of 33.3 %, sensitivity of 100 %, overall accuracy of 50 %. In-111 labeled leukocyte normally accumulates in the spleen, the liver, and the bone marrow. Before insertion of a stemmed prosthesis, the local bone marrows were reamed out in all of our cases. Thus, no radioactive accumulation would be expected in the lesions with prosthesis unless infected. However, if the prosthesis is infected, increased uptake of In-111 would be seen as a result of the accumulation of leukocyte. In-111 labeled leukocyte imaging showed abnormal accumulation of In-111 in all of the 4 infected lesions and no accumulation in all of the 10 noninfected lesions with a specificity of 100 %, sensitivity of 100 %, overall accuracy of 100 %. We conclude that In-111 labeled leukocyte scintigraphy might be useful in evaluating prosthetic infection in a patient with total hip replacement. (author)

  14. SU-E-T-504: Usefulness of CT-MR Fusion in Radiotherapy Planning for Prostate Cancer Patient with Bilateral Hip Replacements

    Energy Technology Data Exchange (ETDEWEB)

    He, R.; Giri, Shankar [University of Mississippi Med. Center, Jackson, MS (United States); VA Medical Center at Jackson, Mississippi (United States); Kumar, P. [VA Medical Center at Jackson, Mississippi (United States); Hu, Y.; Suggs, J.; Yang, C. [University of Mississippi Med. Center, Jackson, MS (United States)

    2014-06-01

    Purpose: Target localization of prostate for Intensity Modulated Radiation Therapy (IMRT) in patients with bilateral hip replacements is difficult due to artifacts in Computed Tomography (CT) images generated from the prostheses high Z materials. In this study, Magnetic Resonance (MR) images fused with CT images are tested as a solution. Methods: CT images of 2.5 mm slice thickness were acquired on a GE Lightspeed scanner with a flat-topped couch for a prostate cancer patient with bilateral hip replacements. T2 weighted images of 5 mm separation were acquired on a MR Scanner. After the MR-CT registration on a radiotherapy treatment planning system (Eclipse, Varian), the target volumes were defined by the radiation oncologists on MR images and then transferred to CT images for planning and dose calculation. The CT Hounsfield Units (HU) was reassigned to zero (as water) for artifacts. The Varian flat panel treatment couch was modeled for dose calculation accuracy with heterogeneity correction. A Volume Matrix Arc Therapy (VMAT) and a seven-field IMRT plans were generated, each avoiding any beam transversing the prostheses; the two plans were compared. The superior VMAT plan was used for treating the patient. In-vivo dosimetry was performed using MOSFET (Best Canada) placed in a surgical tube inserted into the patient rectum during therapy. The measured dose was compared with planned dose for MOSFET location. Results: The registration of MR-CT images and the agreement of target volumes were confirmed by three physicians. VMAT plan was deemed superior to IMRT based on dose to critical nearby structures and overall conformality of target dosing. In-vivo measured dose compared with calculated dose was -4.5% which was likely due to attenuation of the surgical tube surrounding MOSFET. Conclusion: When artifacts are present on planning CT due to bilateral hip prostheses, MR-CT image fusion is a feasible solution for target delineation.

  15. SU-E-T-504: Usefulness of CT-MR Fusion in Radiotherapy Planning for Prostate Cancer Patient with Bilateral Hip Replacements

    International Nuclear Information System (INIS)

    He, R.; Giri, Shankar; Kumar, P.; Hu, Y.; Suggs, J.; Yang, C.

    2014-01-01

    Purpose: Target localization of prostate for Intensity Modulated Radiation Therapy (IMRT) in patients with bilateral hip replacements is difficult due to artifacts in Computed Tomography (CT) images generated from the prostheses high Z materials. In this study, Magnetic Resonance (MR) images fused with CT images are tested as a solution. Methods: CT images of 2.5 mm slice thickness were acquired on a GE Lightspeed scanner with a flat-topped couch for a prostate cancer patient with bilateral hip replacements. T2 weighted images of 5 mm separation were acquired on a MR Scanner. After the MR-CT registration on a radiotherapy treatment planning system (Eclipse, Varian), the target volumes were defined by the radiation oncologists on MR images and then transferred to CT images for planning and dose calculation. The CT Hounsfield Units (HU) was reassigned to zero (as water) for artifacts. The Varian flat panel treatment couch was modeled for dose calculation accuracy with heterogeneity correction. A Volume Matrix Arc Therapy (VMAT) and a seven-field IMRT plans were generated, each avoiding any beam transversing the prostheses; the two plans were compared. The superior VMAT plan was used for treating the patient. In-vivo dosimetry was performed using MOSFET (Best Canada) placed in a surgical tube inserted into the patient rectum during therapy. The measured dose was compared with planned dose for MOSFET location. Results: The registration of MR-CT images and the agreement of target volumes were confirmed by three physicians. VMAT plan was deemed superior to IMRT based on dose to critical nearby structures and overall conformality of target dosing. In-vivo measured dose compared with calculated dose was -4.5% which was likely due to attenuation of the surgical tube surrounding MOSFET. Conclusion: When artifacts are present on planning CT due to bilateral hip prostheses, MR-CT image fusion is a feasible solution for target delineation

  16. Difference between received and expected knowledge of patients undergoing knee or hip replacement in seven European countries.

    Science.gov (United States)

    Klemetti, Seija; Leino-Kilpi, Helena; Cabrera, Esther; Copanitsanou, Panagiota; Ingadottir, Brynja; Istomina, Natalja; Katajisto, Jouko; Papastavrou, Evridiki; Unosson, Mitra; Valkeapää, Kirsi

    2015-12-01

    The purpose of the study was to examine received and expected knowledge of patients with knee/hip arthroplasty in seven European countries. The goal was to obtain information for developing empowering patient education. The data were collected (during 2009-2012) from patients (n = 943) with hip/knee arthroplasty prior to scheduled preoperative education and before discharge with the Received Knowledge of hospital patient scale (RKhp) and Expected Knowledge of hospital patient scale (EKhp). Patients' knowledge expectations were high but the level of received knowledge did not correspond to expectations. The difference between received and expected knowledge was higher in Greece and Sweden compared with Finland (p European countries. © The Author(s) 2014.

  17. A multicenter approach evaluating the impact of vitamin E-blended polyethylene in cementless total hip replacement

    OpenAIRE

    Marcus Jäger; Andrea van Wasen; Sebastian Warwas; Stefan Landgraeber; Marcel Haversath; VITAS Group

    2014-01-01

    Since polyethylene is one of the most frequently used biomaterials as a liner in total hip arthroplasty, strong efforts have been made to improve design and material properties over the last 50 years. Antioxidants seems to be a promising alternative to further increase durability and reduce polyethylene wear in long term. As of yet, only in vitro results are available. While they are promising, there is yet no clinical evidence that the new material shows these advantages in vivo. To answer t...

  18. Highly Cross-Linked Polyethylene in Total Hip and Knee Replacement: Spatial Distribution of Molecular Orientation and Shape Recovery Behavior

    Directory of Open Access Journals (Sweden)

    Yasuhito Takahashi

    2014-01-01

    Full Text Available The present study investigated effects of processing procedures on morphology of highly cross-linked and re-melted UHMWPE (XLPE in total hip and knee arthroplasty (THA, TKA. The shape recovery behavior was also monitored via uniaxial compression test at room temperature after non-destructive characterizations of the in-depth microstructure by confocal/polarized Raman spectroscopy. The goal of this study was to relate the manufacturing-induced morphology to the in vivo micromechanical performance, and ultimately to explore an optimal structure in each alternative joint bearing. It was clearly confirmed that the investigated XLPE hip and knee implants, which were produced from different orthopaedic grade resins (GUR 1050 and GUR 1020, consisted of two structural regions in the as-received states: the near-surface transitional anisotropic layer (≈100 μm thickness and the bulk isotropic structural region. These XLPEs exhibited a different crystalline anisotropy and molecular texture within the near-surface layers. In addition, the knee insert showed a slightly higher efficiency of shape recovery against the applied strain over the hip liner owing to a markedly higher percentage of the bulk amorphous phase with intermolecular cross-linking. The quantitative data presented in this study might contribute to construct manufacturing strategies for further rationalized structures as alternative bearings in THA and TKA.

  19. Hip supporting device

    DEFF Research Database (Denmark)

    2011-01-01

    The present invention relates to a device for limiting movements in one or more anatomical joints, such as a device for limiting movement in the human hip joint after hip replacement surgery. This is provided by a device for limiting movement in the human hip joint, said device comprising: at least...

  20. [Three-dimensional finite element analysis on mechanical behavior of the bone remodeling and bone integration between the bone-implant interface after hip replacement].

    Science.gov (United States)

    Li, Yong-Jiang; Zhang, Li-Cheng; Zhang, Mei-Chao; Yang, Guo-Jing; Lin, Rui-Xin; Cai, Chun-Yuan; Zhong, Shi-Zhen

    2014-04-01

    To discuss the primary stability of the fixed interface between the cementless prosthesis and femur, and its influence on bone ingrowth and secondary stability under the roughened surface and press fit of different prostheses by finite element analysis. :A three-dimensional finite element module of total hip arthroplasty (THA) was developed with Mimics software. There was a collection of data when simulating hip arthroplasty. The frictional coefficient between the fixed interface was 0,0.15,0.40 and 1.00 representing the roughness of prosthesis surface. The press fit was 0, 0.01,0.05 and 0.10 mm according to the operation. The Vion Mises stress distribution and the contact pressure,friction stress and relative sliding displacement between the interface were analysed and compared when simulating the maneuver of climbing stairs. At a fixed press fit of 0.05 mm,the contact pressure between the interface was 230 , 231, 222 and 275 MN under four different frictional coefficient (0,0. 15,0.40 and 1.00) with little change; the relative sliding displacement was 0.529, 0.129, 0.107 and 0.087 mm with a consistent and obvious decline. As the fixed frictional coefficient was 0.40,the contact pressure between the interface were 56.0,67.7 ,60.4 and 49.6 MN under four different press fit (0, 0.01, 0.05 and 0.10 mm) with a reduction; the relative sliding displacement was 0.064,0.062,0.043 and 0.042 mm with an obvious decline, and there was a maximal friction stress when press fit of 0.01 mm. There is a dynamic process of the bone remodeling and bone integration between the interface after hip replacement, determining the long-term outcome. The interface clearance and the frictional coefficient are the key factors of the bone integration.

  1. Effect of head contact on the rim of the cup on the offset loading and torque in hip joint replacement.

    Science.gov (United States)

    Liu, Feng; Williams, Sophie; Jin, Zhongmin; Fisher, John

    2013-11-01

    Head contact on the rim of the cup causes stress concentration and consequently increased wear. The head contact on the rim of the cup may in addition cause an offset load and torque on the cup. The head-rim contact resulting from microseparation or subluxation has been investigated. An analytical model has been developed to calculate the offset loading and resultant torque on the cup as a function of the translational displacement of the head under simplified loading condition of the hip joint at heel strike during a walking cycle. The magnitude of the torque on the cup was found to increase with the increasing translational displacement, larger diameter heads, eccentric cups, and the coefficient of friction of the contact. The effects of cup inclination, cup rim radius, and cup coverage angle on the magnitude of the torque were found to be relatively small with a maximum variation in the torque magnitude being lower than 20%. This study has shown an increased torque due to the head loading on the rim of the cup, and this may contribute to the incidence of cup loosening. Particularly, metal-on-metal hip joints with larger head diameters may produce the highest offset loading torque.

  2. Cerebral blood flow and metabolism during controlled hypotension with sodium-nitroprusside and general anaesthesia for total hip replacement a.m. Charnley

    International Nuclear Information System (INIS)

    Buenemann, L.; Jensen, K.; Thomsen, L.; Riisager, S.

    1987-01-01

    Cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMRo 2 ) were studied during hypotension induced with sodium nitroprusside (SNP) in 10 patients undergoing total hip replacement a.m. Charnley. Cerebral blood flow was measured using an injection of xenon-133 into an arm vein. The decay curve was detected by five scintillation counters placed over each hemisphere and analysed with the Novo 10a cerebrograph. Blood samples were drawn from the radial artery and the jugular venous bulb to calculate the CMRo 2 . In the gropu as a whole, there were significant decreases in mean arterial pressure and in cerebrovascular resistance. There were no significant changes, in either CBF or CMRo 2 in the gropu as a whole, but there were substantial individual differences. In conclusion, the use of SNP-induced hypotension for extracranial surgery should be used only in patients monitored closely. (author)

  3. Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients

    DEFF Research Database (Denmark)

    Husted, Henrik; Holm, Gitte; Jacobsen, Steffen

    2008-01-01

    BACKGROUND AND PURPOSE: Very few studies have focused on patient characteristics that influence length of stay (LOS) in fast-track total hip (THR) and knee arthroplasty (TKR). The aim of this prospective study was to identify patient characteristics associated with LOS and patient satisfaction...... aids, pre- and postoperative hemoglobin levels, the need for blood transfusion, ASA score, and time between surgery and mobilization, were all found to influence postoperative outcome in general, and LOS and patient satisfaction in particular. INTERPRETATION: We identified several patient...... characteristics that influence postoperative outcome, LOS, and patient satisfaction in our series of consecutive fast-track joint replacement patients, enabling further attention to be paid to certain aspects of surgery and rehabilitation....

  4. Effect of early supervised progressive resistance training compared to unsupervised home-based exercise after fast-track total hip replacement applied to patients with preoperative functional limitations

    DEFF Research Database (Denmark)

    Mikkelsen, L R; Mechlenburg, I; Søballe, K

    2014-01-01

    OBJECTIVE: To examine if 2 weekly sessions of supervised progressive resistance training (PRT) in combination with 5 weekly sessions of unsupervised home-based exercise is more effective than 7 weekly sessions of unsupervised home-based exercise in improving leg-extension power of the operated leg...... 10 weeks after total hip replacement (THR) in patients with lower pre-operative function. METHOD: A total of 73 patients scheduled for THR were randomised (1:1) to intervention group (IG, home based exercise 5 days/week and PRT 2 days/week) or control group (CG, home based exercise 7 days...... of the operated leg, at the primary endpoint 10 weeks after surgery in THR patients with lower pre-operative function. TRIAL REGISTRATION: NCT01214954....

  5. Treatment of tuberculosis of the hip.

    African Journals Online (AJOL)

    The common presentation was a swollen hip, a limp, decreased range of hip movements, fixed flexion deformity and pain. Three patients had protrusio acetabuli and three had subluxed or dislocated hips. Twenty-three patients were anaemic and the erythrocyte sedimentation rate (ESR) was raised in all (mean. 6 5 d h r ...

  6. The Infection Rate of Metal-on-Metal Total Hip Replacement Is Higher When Compared to Other Bearing Surfaces as Documented by the Australian Orthopaedic Association National Joint Replacement Registry.

    Science.gov (United States)

    Huang, Phil; Lyons, Matt; O'Sullivan, Michael

    2018-02-01

    Despite the well-documented decline in the use of metal-on-metal (MoM) implants over the last decade, there are still controversies regarding whether all MoM implants are created equally. Complications such as elevated serum metal ion levels, aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL) and pseudotumours have all been well documented, but recent studies suggest increased risk of infection with MoM bearing surfaces. Most of these studies however have small patient numbers. The purpose of this study was to examine the cumulative incidence of revision for infection of MoM bearing surfaces in primary hip arthroplasty at a national and single-surgeon level. Data was collected from the Australian Orthopaedic Association National Joint Replacement Registry, which contains over 98% of all arthroplasties performed in Australia since 2001. The cumulative incidence of revision for infection was extracted at a national level and single-surgeon level. Two hundred seventy-six thousand eight hundred seventy-eight subjects were documented in the Australian registry. The 10-year cumulative percent revision for infection of MoM bearing surfaces in primary total hip replacement (THR) was 2.5% at a national level, compared to 0.8% for other bearing surfaces. The senior author contributed 1755 subjects with 7-year follow-up and a cumulative percent revision for infection of MoM bearing surfaces in primary THR of 36.9%, compared to 2.0% for other bearing surfaces. The cumulative percent of revision of MoM bearing surfaces is higher compared to other bearing surfaces; this is especially pronounced in cumulative percent of revision for infection. There was a higher cumulative percent of revision for infection in MoM bearings surfaces (in particular, large-head MoM) compared to other bearing surfaces at both the national and individual-surgeon level.

  7. Experimental assessment of precision and accuracy of radiostereometric analysis for the determination of polyethylene wear in a total hip replacement model.

    Science.gov (United States)

    Bragdon, Charles R; Malchau, Henrik; Yuan, Xunhua; Perinchief, Rebecca; Kärrholm, Johan; Börlin, Niclas; Estok, Daniel M; Harris, William H

    2002-07-01

    The purpose of this study was to develop and test a phantom model based on actual total hip replacement (THR) components to simulate the true penetration of the femoral head resulting from polyethylene wear. This model was used to study both the accuracy and the precision of radiostereometric analysis, RSA, in measuring wear. We also used this model to evaluate optimum tantalum bead configuration for this particular cup design when used in a clinical setting. A physical model of a total hip replacement (a phantom) was constructed which could simulate progressive, three-dimensional (3-D) penetration of the femoral head into the polyethylene component of a THR. Using a coordinate measuring machine (CMM) the positioning of the femoral head using the phantom was measured to be accurate to within 7 microm. The accuracy and precision of an RSA analysis system was determined from five repeat examinations of the phantom using various experimental set-ups of the phantom. The accuracy of the radiostereometric analysis, in this optimal experimental set-up studied was 33 microm for the medial direction, 22 microm for the superior direction, 86 microm for the posterior direction and 55 microm for the resultant 3-D vector length. The corresponding precision at the 95% confidence interval of the test results for repositioning the phantom five times, measured 8.4 microm for the medial direction, 5.5 microm for the superior direction, 16.0 microm for the posterior direction, and 13.5 microm for the resultant 3-D vector length. This in vitro model is proposed as a useful tool for developing a standard for the evaluation of radiostereometric and other radiographic methods used to measure in vivo wear.

  8. Insulin sensitivity and beta-cell function after carbohydrate oral loading in hip replacement surgery: a double-blind, randomised controlled clinical trial.

    Science.gov (United States)

    Ljunggren, Stefan; Hahn, Robert G; Nyström, Thomas

    2014-06-01

    Surgery initiates a series of physiological stress processes in the body, inducing transient insulin resistance. Preoperative carbohydrate treatment can reduce the latter phenomenon. We investigated the effects of carbohydrate loading on insulin sensitivity and beta-cell function after elective hip replacement. Twenty-three nondiabetic patients (mean age of 68 years) who underwent elective hip replacement surgery participated in this double-blind controlled study. The patients were randomised to a nutrition group, which ingested a carbohydrate-rich fluid (50 kcal/100 ml) (Preop(®)), or a control group (tap water flavoured with lemon) 800 ml + 400 ml before the surgery. The insulin response (beta-cell function) and the insulin sensitivity were measured with an intravenous glucose tolerance test (IVGTT) and a hyperinsulinaemic euglycaemic glucose clamp, respectively, one day before and two days after the surgery. Insulin sensitivity decreased by 51% (median; 25-75th percentiles 35-61) after ingesting Preop(®) and by 39% (21-51) after ingesting in the control group (n.s.). The postoperative IVGTT in the nutrition group was followed by a significantly larger area under the curve (AUC) for plasma insulin (+54% versus the preoperative IVGTT) compared to the control group (+7%). This difference was already apparent during the first phase (0-10 min) of insulin secretion (+20 and -21%, respectively; P water prior to the surgery demonstrated a significant but similar decrease in insulin sensitivity. The carbohydrates increased the beta-cell function as a compensatory response to the disposition index, resulting in a smaller reduction in surgery-induced insulin resistance compared to the tap water. The study was registered at http://www.clinicaltrials.gov (NCT01774084). Copyright © 2013 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  9. A feasibility randomised controlled trial of pre-operative occupational therapy to optimise recovery for patients undergoing primary total hip replacement for osteoarthritis (PROOF-THR).

    Science.gov (United States)

    Jepson, Paul; Sands, Gina; Beswick, Andrew D; Davis, Edward T; Blom, Ashley W; Sackley, Catherine M

    2016-02-01

    To assess the feasibility of a pre-operative occupational therapy intervention for patients undergoing primary total hip replacement. Single blinded feasibility randomised controlled trial, with data collection prior to the intervention, and at 4, 12, and 26 weeks following surgery. Recruitment from two NHS orthopaedic outpatient centres in the West Midlands, UK. Patients awaiting primary total hip replacement due to osteoarthritis were recruited. Following pre-operative assessment, patients were individually randomised to intervention or control by a computer-generated block randomisation algorithm stratified by age and centre. The intervention group received a pre-surgery home visit by an occupational therapist who discussed expectations, assessed home safety, and provided appropriate adaptive equipment. The control group received treatment as usual. The study assessed the feasibility of recruitment procedures, delivery of the intervention, appropriateness of outcome measures and data collection methods. Health related quality of life and resource use were recorded at 4, 12 and 26 weeks. Forty-four participants were recruited, 21 were randomised to the occupational therapy intervention and 23 to usual care. Analysis of 26 week data included 18 participants in the intervention group and 21 in the control. The intervention was delivered successfully with no withdrawals or crossovers; 5/44 were lost to follow-up with further missing data for participation and resource use. The feasibility study provided the information required to conduct a definitive trial. Burden of assessment would need to be addressed. A total of 219 patients would be required in an efficacy trial. © The Author(s) 2015.

  10. Total hip replacement infected with Mycobacterium tuberculosis complicated by Addison disease and psoas muscle abscess: a case report

    Directory of Open Access Journals (Sweden)

    De Nardo Pasquale

    2012-01-01

    Full Text Available Abstract Introduction Prosthetic joint infection due to Mycobacterium tuberculosis is occasionally encountered in clinical practice. To the best of our knowledge, this is the first report of a prosthetic joint infection due to Mycobacterium tuberculosis complicated by psoas abscesses and secondary Addison disease. Case presentation A 67-year-old immunocompetent Caucasian woman underwent total left hip arthroplasty because of osteoarthritis. After 18 months, she underwent arthroplasty revision for a possible prosthetic infection. Periprosthetic tissue specimens for bacteria were negative, and empirical antibiotic therapy was unsuccessful. She was then admitted to our department because of complications arising 22 months after arthroplasty. A physical examination revealed a sinus tract overlying her left hip and skin and mucosal pigmentation. Her levels of C-reactive protein, basal cortisol, adrenocorticotropic hormone, and sodium were out of normal range. Results of the tuberculin skin test and QuantiFERON-TB Gold test were positive. Computed tomography revealed a periprosthetic abscess and the inclusion of the left psoas muscle. Results of microbiological tests were negative, but polymerase chain reaction of a specimen taken from the hip fistula was positive for Mycobacterium tuberculosis. Our patient's condition was diagnosed as prosthetic joint infection and muscle psoas abscess due to Mycobacterium tuberculosis and secondary Addison disease. She underwent standard treatment with rifampicin, ethambutol, isoniazid, and pyrazinamide associated with hydrocortisone and fludrocortisone. At 15 months from the beginning of therapy, she was in good clinical condition and free of symptoms. Conclusions Prosthetic joint infection with Mycobacterium tuberculosis is uncommon. A differential diagnosis of tuberculosis should be considered when dealing with prosthetic joint infection, especially when repeated smears and histology examination from infected

  11. Interventions for Hip Pain in the Maturing Athlete

    Science.gov (United States)

    Gomberawalla, M. Mustafa; Kelly, Bryan T.; Bedi, Asheesh

    2014-01-01

    Context: Femoroacetabular impingement (FAI) alters hip mechanics, results in hip pain, and may lead to secondary osteoarthritis (OA) in the maturing athlete. Hip impingement can be caused by osseous abnormalities in the proximal femur or acetabulum. These impingement lesions may cause altered loads within the hip joint, which result in repetitive collision damage or sheer forces to the chondral surfaces and acetabular labrum. These anatomic lesions and resultant abnormal mechanics may lead to early osteoarthritic changes. Evidence Acquisition: Relevant articles from the years 1995 to 2013 were identified using MEDLINE, EMBASE, and the bibliographies of reviewed publications. Level of Evidence: Level 4. Results: Improvements in hip arthroscopy have allowed FAI to be addressed utilizing the arthroscope. Adequately resecting the underlying osseous abnormalities is essential to improving hip symptomatology and preventing further chondral damage. Additionally, preserving the labrum by repairing the damaged tissue and restoring the suction seal may theoretically help normalize hip mechanics and prevent further arthritic changes. The outcomes of joint-preserving treatment options may be varied in the maturing athlete due to the degree of underlying OA. Irreversible damage to the hip joint may have already occurred in patients with moderate to advanced OA. In the presence of preexisting arthritis, these patients may only experience fair or even poor results after hip arthroscopy, with early conversion to hip replacement. For patients with advanced hip arthritis, total hip arthroplasty remains a treatment option to reliably improve symptoms with good to excellent outcomes and return to low-impact activities. Conclusion: Advances in the knowledge base and treatment techniques of intra-articular hip pain have allowed surgeons to address this complex clinical problem with promising outcomes. Traditionally, open surgical dislocations for hip preservation surgery have shown good

  12. Does reduced movement restrictions and use of assistive devices affect rehabilitation outcome after total hip replacement? A non-randomized, controlled study in 365 patients with six week follow up

    DEFF Research Database (Denmark)

    Mikkelsen, Lone Ramer; Petersen, Annemette Krintel; Søballe, Kjeld

    (primary outcome, HOOS), anxiety (HADS), working status and patient satisfaction were administered before THR, 3 and 6 weeks after. Findings / Results HOOS function score at the 3 measurement times were (mean ± SD); UG: 46±17 - 76±9 - 83±14 compared to RG: 43±16 – 81±14 - 83±13, (difference between groups...... over time, p=0.004). For return to work 6 weeks post THR, UG compared to RG: 53% versus 32% (p=0.045). No significant differences between groups in anxiety, hip dislocations and patient satisfaction. Conclusions No clinically relevant difference between UG and RG on patient evaluated function was found...

  13. Metal Ion Concentrations in Body Fluids after Implantation of Hip Replacements with Metal-on-Metal Bearing – Systematic Review of Clinical and Epidemiological Studies

    Science.gov (United States)

    Hartmann, Albrecht; Hannemann, Franziska; Lützner, Jörg; Seidler, Andreas; Drexler, Hans; Günther, Klaus-Peter; Schmitt, Jochen

    2013-01-01

    Introduction The use of metal-on-metal (MoM) total hip arthroplasty (THA) increased in the last decades. A release of metal products (i.e. particles, ions, metallo-organic compounds) in these implants may cause local and/or systemic adverse reactions. Metal ion concentrations in body fluids are surrogate measures of metal exposure. Objective To systematically summarize and critically appraise published studies concerning metal ion concentrations after MoM THA. Methods Systematic review of clinical trials (RCTs) and epidemiological studies with assessment of metal ion levels (cobalt, chromium, titanium, nickel, molybdenum) in body fluids after implantation of metalliferous hip replacements. Systematic search in PubMed and Embase in January 2012 supplemented by hand search. Standardized abstraction of pre- and postoperative metal ion concentrations stratified by type of bearing (primary explanatory factor), patient characteristics as well as study quality characteristics (secondary explanatory factors). Results Overall, 104 studies (11 RCTs, 93 epidemiological studies) totaling 9.957 patients with measurement of metal ions in body fluids were identified and analyzed. Consistently, median metal ion concentrations were persistently elevated after implantation of MoM-bearings in all investigated mediums (whole blood, serum, plasma, erythrocytes, urine) irrespective of patient characteristics and study characteristics. In several studies very high serum cobalt concentrations above 50 µg/L were measured (detection limit typically 0.3 µg/L). Highest metal ion concentrations were observed after treatment with stemmed large-head MoM-implants and hip resurfacing arthroplasty. Discussion Due to the risk of local and systemic accumulation of metallic products after treatment with MoM-bearing, risk and benefits should be carefully balanced preoperatively. The authors support a proposed „time out“ for stemmed large-head MoM-THA and recommend a restricted indication for hip

  14. Metal ion concentrations in body fluids after implantation of hip replacements with metal-on-metal bearing--systematic review of clinical and epidemiological studies.

    Directory of Open Access Journals (Sweden)

    Albrecht Hartmann

    Full Text Available INTRODUCTION: The use of metal-on-metal (MoM total hip arthroplasty (THA increased in the last decades. A release of metal products (i.e. particles, ions, metallo-organic compounds in these implants may cause local and/or systemic adverse reactions. Metal ion concentrations in body fluids are surrogate measures of metal exposure. OBJECTIVE: To systematically summarize and critically appraise published studies concerning metal ion concentrations after MoM THA. METHODS: Systematic review of clinical trials (RCTs and epidemiological studies with assessment of metal ion levels (cobalt, chromium, titanium, nickel, molybdenum in body fluids after implantation of metalliferous hip replacements. Systematic search in PubMed and Embase in January 2012 supplemented by hand search. Standardized abstraction of pre- and postoperative metal ion concentrations stratified by type of bearing (primary explanatory factor, patient characteristics as well as study quality characteristics (secondary explanatory factors. RESULTS: Overall, 104 studies (11 RCTs, 93 epidemiological studies totaling 9.957 patients with measurement of metal ions in body fluids were identified and analyzed. Consistently, median metal ion concentrations were persistently elevated after implantation of MoM-bearings in all investigated mediums (whole blood, serum, plasma, erythrocytes, urine irrespective of patient characteristics and study characteristics. In several studies very high serum cobalt concentrations above 50 µg/L were measured (detection limit typically 0.3 µg/L. Highest metal ion concentrations were observed after treatment with stemmed large-head MoM-implants and hip resurfacing arthroplasty. DISCUSSION: Due to the risk of local and systemic accumulation of metallic products after treatment with MoM-bearing, risk and benefits should be carefully balanced preoperatively. The authors support a proposed "time out" for stemmed large-head MoM-THA and recommend a restricted

  15. OMERACT/OARSI initiative to define states of severity and indication for joint replacement in hip and knee osteoarthritis

    DEFF Research Database (Denmark)

    Gossec, Laure; Hawker, Gillian; Davis, Aileen M

    2007-01-01

    OBJECTIVE: Time to theoretical indication of joint replacement surgery has been proposed as a primary outcome for potential structure-modifying interventions for osteoarthritis (OA). The objectives of this OMERACT/OARSI Working Group were to identify pain, physical function, and structure states ...

  16. Functional outcome, revision rates and mortality after primary total hip replacement--a national comparison of nine prosthesis brands in England.

    Directory of Open Access Journals (Sweden)

    Mark Pennington

    Full Text Available The number of prosthesis brands used for hip replacement has increased rapidly, but there is little evidence on their effectiveness. We compared patient-reported outcomes, revision rates, and mortality for the three most frequently used brands within each prosthesis type: cemented (Exeter V40 Contemporary, Exeter V40 Duration and Exeter V40 Elite Plus Ogee, cementless (Corail Pinnacle, Accolade Trident, and Taperloc Exceed, and hybrid (Exeter V40 Trilogy, Exeter V40 Trilogy, and CPT Trilogy.We used three national databases of patients who had hip replacements between 2008 and 2011 in the English NHS to compare functional outcome (Oxford Hip Score (OHS ranging from 0 (worst to 48 (best in 43,524 patients at six months. We analysed revisions and mortality in 187,201 patients. We used multiple regression to adjust for pre-operative differences. Prosthesis type had an impact on post-operative OHS and revision rates (both p<0.001. Patients with hybrid prostheses had the best functional outcome (mean OHS 39.4, 95%CI 39.1 to 39.7 and those with cemented prostheses the worst (37.7, 37.3 to 38.1. Patients with cemented prostheses had the lowest reported 5-year revision rates (1.3%, 1.2% to 1.4% and those with cementless prostheses the highest (2.2%, 2.1% to 2.4%. Differences in mortality according to prosthesis type were small and not significant (p = 0.06. Functional outcome varied according to brand among cemented (p = 0.05, with Exeter V40 Duration having the best and cementless prostheses (p = 0.01, with Corail Pinnacle having the best. Revision rates varied according to brand among hybrids (p = 0.05, with Exeter V40 Trident having the lowest.Functional outcomes were better with cementless cups and revision rates were lower with cemented stems, which underlies the good overall performance of hybrids. The hybrid Exeter V40 Trident seemed to produce the best overall results. This brand should be considered as a benchmark in randomised trials.

  17. HIP JOINT AND HIP ENDOPROSTHESIS BIOMECHANICS

    OpenAIRE

    Jakub Gryka

    2017-01-01

    This article contains a description of the basic issues related to anatomy, loading of hip joint and its endoprosthesis research methods. The methods of testing and simulating hip joint loads, factors that influence the selection of parameters during the design of prostheses, typical solutions to engineering problems related to this topic are presented. The article concludes with short summary of the finite element method for the design of hip replacements.

  18. Dynamic behavior of tripolar hip endoprostheses under physiological conditions and their effect on stability.

    Science.gov (United States)

    Fabry, Christian; Kaehler, Michael; Herrmann, Sven; Woernle, Christoph; Bader, Rainer

    2014-01-01

    Tripolar systems have been implanted to reduce the risk of recurrent dislocation. However, there is little known about the dynamic behavior of tripolar hip endoprostheses under daily life conditions and achieved joint stability. Hence, the objective of this biomechanical study was to examine the in vivo dynamics and dislocation behavior of two types of tripolar systems compared to a standard total hip replacement (THR) with the same outer head diameter. Several load cases of daily life activities were applied to an eccentric and a concentric tripolar system by an industrial robot. During testing, the motion of the intermediate component was measured using a stereo camera system. Additionally, their behavior under different dislocation scenarios was investigated in comparison to a standard THR. For the eccentric tripolar system, the intermediate component demonstrated the shifting into moderate valgus-positions, regardless of the type of movement. This implant showed the highest resisting torque against dislocation in combination with a large range of motion. In contrast, the concentric tripolar system tended to remain in varus-positions and was primarily moved after stem contact. According to the results, eccentric tripolar systems can work well under in vivo conditions and increase hip joint stability in comparison to standard THRs. Copyright © 2013 IPEM. Published by Elsevier Ltd. All rights reserved.

  19. Patterns of pharmacotherapy and health care utilization and costs prior to total hip or total knee replacement in patients with osteoarthritis.

    Science.gov (United States)

    Berger, Ariel; Bozic, Kevin; Stacey, Brett; Edelsberg, John; Sadosky, Alesia; Oster, Gerry

    2011-08-01

    To examine patterns of pharmacotherapy and health care utilization and costs prior to total knee replacement (TKR) or total hip replacement (THR) in patients with osteoarthritis (OA). Using a large US health insurance claims database, we identified all patients with OA who were ages ≥40 years and had undergone TKR or THR between January 1, 2006 and December 31, 2007. Patients with care utilization and costs over the 2-year period preceding surgery. A total of 16,527 patients met all study entry criteria. Their mean ± SD age was 56.6 ± 6.1 years, and 56% of them were women. In the 2 years preceding surgery, 55% of patients received prescription nonsteroidal antiinflammatory drugs, 58% received opioids, and 50% received injections of corticosteroids. The numbers of patients receiving these drugs increased steadily during the presurgery period. The mean ± SD total health care costs in the 2 years preceding surgery were $19,466 ± 29,869, of which outpatient care, inpatient care, and pharmacotherapy represented 45%, 20%, and 20%, respectively. Costs increased from $2,094 in the eighth calendar quarter prior to surgery to $3,100 in the final quarter. Patients with OA who undergo THR or TKR have relatively high levels of use of pain-related pharmacotherapy and high total health care costs in the 2-year period preceding surgery. Levels of utilization and cost increase as the date of surgery approaches. Copyright © 2011 by the American College of Rheumatology.

  20. Leisure time physical activity and the risk of hip or knee replacement due to primary osteoarthritis: a population based cohort study (The HUNT Study).

    Science.gov (United States)

    Johnsen, Marianne Bakke; Hellevik, Alf Inge; Baste, Valborg; Furnes, Ove; Langhammer, Arnulf; Flugsrud, Gunnar; Nordsletten, Lars; Zwart, John Anker; Storheim, Kjersti

    2016-02-16

    The relationship between leisure time physical activity (LPA) and hip and knee OA and subsequent joint replacement has not yet been clearly defined. Some studies have found the risk of knee replacement (TKR) to increase with high levels of LPA, while others have found no overall relationship to either TKR or hip replacement (THR). The aim was to investigate the association between LPA and the risk of severe end-stage OA, defined as THR or TKR due to primary OA, in a large population-based cohort. Participants in the Nord-Trøndelag Health Study (HUNT) were followed prospectively to identify THR and TKR using the Norwegian Arthroplasty Register. Self-reported LPA was classified as inactive, low, moderate or high. The Cox proportional hazards model was used to calculate hazard ratios (HRs) according to levels of LPA with adjustments for confounding variables. Analyses were performed by age (<45, 45-59 and ≥60 years) and sex. A total of 66 964 participants (mean age 46.8 years (SD 16.3) were included in the analyses. We identified 1636 THRs and 1016 TKRs due to primary OA during 17.0 years (median) of follow-up. High LPA was significantly associated with THR for women <45 years (HR 1.78, 95 % CI 1.08-2.94) and men between 45-59 years (HR 1.53, 95 % CI 1.10-2.13) at baseline. A significant trend was found only among women < 45 years at baseline (p = 0.02). We found that LPA was significantly associated with TKR for women only (HR 1.45, 95 % CI 1.03-2.04). No measures of LPA were associated with TKR for men. In this population-based study, high level of LPA was associated with increased risk of THR where a significant trend of LPA was seen among women <45 years at baseline. For TKR, high LPA was associated with increased risk only in women. In contrast to previous studies, this study shows a possible association between high LPA and the risk of THR.

  1. 99mTc-HMPAO labeled leucocyte, 99mTc-labeled antigranulocyte antibody and 67Ga scintigraphy in the evaluation of painful hip and knee prosthetic replacements

    International Nuclear Information System (INIS)

    Oliveira, S.; Pereira, L.; Joao, F.; Lima, J.

    2003-01-01

    Full text: Objective: To evaluate the utility of 99mTc-HMPAO labeled leucocyte, 99mTc-labeled anti-granulocyte antibody and 67Ga scintigraphy in patients suspected to have infected hip and knee replacements, from March/1998 to March/ 2002. Methods: Retrospective study of 33 patients (12 male, 21 female) with an average age of 61,1 ± 7,3 years. Nineteen had hip replacements and 14 were submitted to knee replacements. 99mTc-HMPAO labeled leucocyte scintigraphy was performed in 17 patients, 99mTc-labeled anti-granulocyte antibody scintigraphy in 13 patients and 67Ga scintigraphy in 3 patients. Twenty-six patients were also submitted to 3-phase 99mTc-MDP bone scintigraphy. Results were compared to those from studies with infection/inflammation agents. Concordant positive studies were considered to be a positive result for infection. A second study using 67Ga was also performed in 3 patients. Results: Diagnosis was based on surgical findings in 14 patients, pathologic study of biopsy specimen in 1 case and clinical/ imaging follow-up in 18 patients. Infection was detected in 22 cases and absent in 11. The conjoined evaluation of scintigraphic studies considered infection to be present in 20 cases and absent in 13. With infection/inflammation agents, 20 cases were positive (+) and 13 cases were negative (-). Using 99mTc-HMPAO labeled leucocytes, 12 cases were (+) and 5 cases were (-). With 99mTc-labeled anti-granulocyte antibodies, 8 cases were (+) and 5 were (-). With 67Ga, all 3 cases were (-). In patients with (+) studies using infection/ inflammation agents, a false positive case with 99mTc-HMPAO labeled leucocytes was reported. Two false negative cases were detected, both with 99mTc-labeled antigranulocyte antibodies, in patients with (-) studies. Regarding the studies with 99mTc-MDP, 24 were (+) and 2 were (-). Eighteen of these (+) cases were also (+) in studies with infection/inflammation agents, but 6 were (-) with these agents. Negative cases were also (-) in

  2. Machine learning techniques for the optimization of joint replacements: Application to a short-stem hip implant.

    Science.gov (United States)

    Cilla, Myriam; Borgiani, Edoardo; Martínez, Javier; Duda, Georg N; Checa, Sara

    2017-01-01

    Today, different implant designs exist in the market; however, there is not a clear understanding of which are the best implant design parameters to achieve mechanical optimal conditions. Therefore, the aim of this project was to investigate if the geometry of a commercial short stem hip prosthesis can be further optimized to reduce stress shielding effects and achieve better short-stemmed implant performance. To reach this aim, the potential of machine learning techniques combined with parametric Finite Element analysis was used. The selected implant geometrical parameters were: total stem length (L), thickness in the lateral (R1) and medial (R2) and the distance between the implant neck and the central stem surface (D). The results show that the total stem length was not the only parameter playing a role in stress shielding. An optimized implant should aim for a decreased stem length and a reduced length of the surface in contact with the bone. The two radiuses that characterize the stem width at the distal cross-section in contact with the bone were less influential in the reduction of stress shielding compared with the other two parameters; but they also play a role where thinner stems present better results.

  3. Dual energy X-ray absorptiometry analysis of peri-prosthetic stress shielding in the Birmingham resurfacing hip replacement.

    LENUS (Irish Health Repository)

    Harty, J A

    2012-02-03

    INTRODUCTION: Numerous reports in the literature refer to the femoral neck fracture rate in hip resurfacing. The aim of this study was to determine the bone mineral density and evidence of stress shielding around the femoral component of the Birmingham resurfacing prosthesis. MATERIAL AND METHODS: Twenty-eight patients with primary unilateral osteoarthritis had a Birmingham resurfacing prosthesis. DEXA analysis of the proximal femur and femoral neck was performed and compared with the opposite unaffected side. RESULTS: Total periprosthetic bone mineral density was 0.49% greater than the control, but this did not achieve statistical significance. Although the BMD of the femoral neck was slightly increased on the prosthetic side (1.002 g\\/cm2) as opposed to the control side, this difference did not reach statistical significance. CONCLUSION: The Birmingham resurfacing prosthesis does not appear to reduce femoral neck bone mineral density in comparison to the normal femoral neck bone density. We conclude that femoral neck fractures are unlikely to be due to stress shielding related to the prosthesis.

  4. Numerical analysis of the biomechanical complications accompanying the total hip replacement with NANOS-Prosthetic: bone remodelling and prosthesis migration

    Directory of Open Access Journals (Sweden)

    Almohallami A.

    2015-09-01

    Full Text Available Aseptic loosening of the prosthesis is still a problem in artificial joint implants. The ýloosening can be caused by the resorption of the bone surrounding ýthe prosthesis according to stress shielding. A numerical model was developed and validated by means of DEXA-studies in order to ýanalyse the bone remodelling process in the periprosthetic bone. A total loss of about 3.7% of the bone density in the periprosthetic Femur with NANOS is computed. The bone remodelling calculation was validated by means of a DEXA-study with a 3-years-follow-up. The model was further developed in order to be able to calculate and consider the migration of the implants. This method was applied on the ýNANOS-implant with a computed total migration of about 0.43 mm. These calculations showed good results in comparison with a 2-year-follow-up clinical study, whereby a RSA-method was used to determine the stem migration in the bone. In order to ýstudy the mutual influence between the implant migration and the hip contact forces ý, a software is developed by our scientific group to couple a multi body simulation (MBS of human lower limps with the FEA of the periprosthetic Femur.

  5. Comparison of anatomic vs. straight femoral stem design in total hip replacement - femoral canal fill in vivo.

    Science.gov (United States)

    de Boer, Friso A; Sariali, Elhadi

    2017-05-12

    The femoral canal fill between an anatomic and a straight prosthesis design in cementless total hip arthroplasty (THA) was compared. We hypothesised that the anatomic SPS stem has higher proximal fill and lesser distal fill than the straight stem. The femoral canal fill was measured on 3 months routine postoperative x-rays at 5 levels of the stem in 50 consecutive patients, aged 35-83 years, who underwent 56 THA procedures by a single surgeon in this hospital. 22 patients received a straight design Ceramconcept Global stem, 34 patients received an anatomic design Symbios SPS stem. Both anteroposterior (AP) and lateral x-rays were combined to suggest a 3-D measurement. On the AP x-rays, the canal fill was significantly higher using the anatomic design stem at the proximal measurement levels, and was significantly higher at the distal levels using the straight stem. With the AP and lateral x-rays combined, the canal fill at the proximal levels was also significantly higher in the anatomic groups, nonsignificantly lower at the central level and significantly lower at the distal levels. In THA surgery, achieving high fill at the metaphysis of the femur and less fill at the diaphysis has been suggested to result in satisfactory outcome and high stability of the prosthesis. This study demonstrated that, compared to straight stem design, an anatomically designed stem has a significantly higher metaphyseal femoral canal fill.

  6. An in vitro simulation model to assess the severity of edge loading and wear, due to variations in component positioning in hip joint replacements.

    Science.gov (United States)

    O'Dwyer Lancaster-Jones, O; Williams, S; Jennings, L M; Thompson, J; Isaac, G H; Fisher, J; Al-Hajjar, M

    2017-09-23

    The aim of this study was to develop a preclinical in vitro method to predict the occurrence and severity of edge loading condition associated with the dynamic separation of the centres of the head and cup (in the absence of impingement) for variations in surgical positioning of the cup. Specifically, this study investigated the effect of both the variations in the medial-lateral translational mismatch between the centres of the femoral head and acetabular cup and the variations in the cup inclination angles on the occurrence and magnitude of the dynamic separation, the severity of edge loading, and the wear rate of ceramic-on-ceramic hip replacement bearings in a multi-station hip joint simulator during a walking gait cycle. An increased mismatch between the centres of rotation of the femoral head and acetabular cup resulted in an increased level of dynamic separation and an increase in the severity of edge loading condition which led to increased wear rate in ceramic-on-ceramic bearings. Additionally for a given translational mismatch, an increase in the cup inclination angle gave rise to increased dynamic separation, worst edge loading conditions, and increased wear. To reduce the occurrence and severity of edge loading, the relative positions (the mismatch) of the centres of rotation of the head and the cup should be considered alongside the rotational position of the acetabular cup. This study has considered the combination of mechanical and tribological factors for the first time in the medial-lateral axis only, involving one rotational angle (inclination) and one translational mismatch. © 2017 The Authors Journal of Biomedical Materials Research Part B: Applied Biomaterials Published by Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2017. © 2017 The Authors Journal of Biomedical Materials Research Part B: Applied Biomaterials Published by Wiley Periodicals, Inc.

  7. Increased pain sensitivity but normal function of exercise induced analgesia in hip and knee osteoarthritis--treatment effects of neuromuscular exercise and total joint replacement.

    Science.gov (United States)

    Kosek, E; Roos, E M; Ageberg, E; Nilsdotter, A

    2013-09-01

    To assess exercise induced analgesia (EIA) and pain sensitivity in hip and knee osteoarthritis (OA) and to study the effects of neuromuscular exercise and surgery on these parameters. The dataset consisted of knee (n = 66) and hip (n = 47) OA patients assigned for total joint replacement at Lund University Hospital undergoing pre-operative neuromuscular exercise and 43 matched controls. Sensitivity to pressure pain was assessed by pressure algometry at 10 sites. Subjects were then instructed to perform a standardized static knee extension. Pressure pain thresholds (PPTs) were assessed at the contracting quadriceps muscle (Q) and at the resting deltoid muscle (D) before and during contraction. The relative increase in PPTs during contraction was taken as a measure of localized (Q) or generalized (D) EIA. Patients were assessed at baseline, following on average 12 weeks of neuromuscular exercise and 3 months following surgery. We found a normal function of EIA in OA patients at baseline. Previous studies have reported beneficial effects of physical exercise on pain modulation in healthy subjects. However, no treatment effects on EIA were seen in OA patients despite the increase in muscle strength following neuromuscular exercise and reduced pain following surgery. Compared to controls, OA patients had increased pain sensitivity and no beneficial effects on pain sensitivity were seen following treatment. To our knowledge, this is the first study of EIA in OA patients. Despite increased pain sensitivity, OA patients had a normal function of EIA. Copyright © 2013 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  8. Prospective associations of C-reactive protein (CRP) levels and CRP genetic risk scores with risk of total knee and hip replacement for osteoarthritis in a diverse cohort.

    Science.gov (United States)

    Shadyab, A H; Terkeltaub, R; Kooperberg, C; Reiner, A; Eaton, C B; Jackson, R D; Krok-Schoen, J L; Salem, R M; LaCroix, A Z

    2018-05-22

    To examine associations of high-sensitivity C-reactive protein (CRP) levels and polygenic CRP genetic risk scores (GRS) with risk of end-stage hip or knee osteoarthritis (OA), defined as incident total hip (THR) or knee replacement (TKR) for OA. This study included a cohort of postmenopausal white, African American, and Hispanic women from the Women's Health Initiative. Women were followed from baseline to date of THR or TKR, death, or December 31, 2014. Medicare claims data identified THR and TKR. Hs-CRP and genotyping data were collected at baseline. Three CRP GRS were constructed: 1) a 4-SNP GRS comprised of genetic variants representing variation in the CRP gene among European populations; 2) a multilocus 18-SNP GRS of genetic variants significantly associated with CRP levels in a meta-analysis of genome-wide association studies; and 3) a 5-SNP GRS of genetic variants significantly associated with CRP levels among African American women. In analyses conducted separately among each race and ethnic group, there were no significant associations of ln hs-CRP with risk of THR or TKR, after adjusting for age, body mass index, lifestyle characteristics, chronic diseases, hormone therapy use, and non-steroidal anti-inflammatory drug use. CRP GRS were not associated with risk of THR or TKR in any ethnic group. Serum levels of ln hs-CRP and genetically-predicted CRP levels were not associated with risk of THR or TKR for OA among a diverse cohort of women. Copyright © 2018 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  9. Development and validation of a shared decision-making instrument for health-related quality of life one year after total hip replacement based on quality registries data.

    Science.gov (United States)

    Nemes, Szilard; Rolfson, Ola; Garellick, Göran

    2018-02-01

    Clinicians considering improvements in health-related quality of life (HRQoL) after total hip replacement (THR) must account for multiple pieces of information. Evidence-based decisions are important to best assess the effect of THR on HRQoL. This work aims at constructing a shared decision-making tool that helps clinicians assessing the future benefits of THR by offering predictions of 1-year postoperative HRQoL of THR patients. We used data from the Swedish Hip Arthroplasty Register. Data from 2008 were used as training set and data from 2009 to 2012 as validation set. We adopted two approaches. First, we assumed a continuous distribution for the EQ-5D index and modelled the postoperative EQ-5D index with regression models. Second, we modelled the five dimensions of the EQ-5D and weighted together the predictions using the UK Time Trade-Off value set. As predictors, we used preoperative EQ-5D dimensions and the EQ-5D index, EQ visual analogue scale, visual analogue scale pain, Charnley classification, age, gender, body mass index, American Society of Anesthesiologists, surgical approach and prosthesis type. Additionally, the tested algorithms were combined in a single predictive tool by stacking. Best predictive power was obtained by the multivariate adaptive regression splines (R 2  = 0.158). However, this was not significantly better than the predictive power of linear regressions (R 2  = 0.157). The stacked model had a predictive power of 17%. Successful implementation of a shared decision-making tool that can aid clinicians and patients in understanding expected improvement in HRQoL following THR would require higher predictive power than we achieved. For a shared decision-making tool to succeed, further variables, such as socioeconomics, need to be considered. © 2016 John Wiley & Sons, Ltd.

  10. Quantitative analysis of orthopedic metal artefact reduction in 64-slice computed tomography scans in large head metal-on-metal total hip replacement, a phantom study

    NARCIS (Netherlands)

    Boomsma, Martijn F.; Warringa, Niek; Edens, Mireille A.; Mueller, Dirk; Ettema, Harmen B.; Verheyen, Cees C. P. M.; Maas, Mario

    2016-01-01

    Purpose: Quantification of the effect of O-MAR on decreasing metal artefacts caused by large head metal on metal total hip arthroplasty (MoM THA) in a dedicated phantom setup of the hip. Background: Pathological reactions of the hip capsule on Computed tomography (CT) can be difficult to diagnose

  11. Geographic region, socioeconomic position and the utilisation of primary total joint replacement for hip or knee osteoarthritis across western Victoria: a cross-sectional multilevel study of the Australian Orthopaedic Association National Joint Replacement Registry.

    Science.gov (United States)

    Brennan-Olsen, Sharon; Vogrin, Sara; Holloway, Kara L; Page, Richard S; Sajjad, Muhammad A; Kotowicz, Mark A; Livingston, Patricia M; Khasraw, Mustafa; Hakkennes, Sharon; Dunning, Trish L; Brumby, Susan; Pedler, Daryl; Sutherland, Alasdair; Venkatesh, Svetha; Williams, Lana J; Duque, Gustavo; Pasco, Julie A

    2017-11-06

    Compared to urban residents, those in rural/regional areas often experience inequitable healthcare from specialist service providers. Independent of small between-area differences in utilisation, socially advantaged groups had the greatest uptake of joint replacement. These data suggest low correlation between 'need' vs. 'uptake' of surgery in rural/regional areas. Compared to urban residents, those in rural and regional areas often experience inequitable healthcare from specialist service providers, often due to geographical issues. We investigated associations between socioeconomic position (SEP), region of residence and utilisation of primary total knee replacement (TKR) and/or total hip replacement (THR) for osteoarthritis. As part of the Ageing, Chronic Disease and Injury study, we extracted data from the Australian Orthopaedic Association National Joint Replacement Registry (2011-2013) for adults that utilised primary TKR (n = 4179; 56% female) and/or THR (n = 3120; 54% female). Residential addresses were matched with the Australian Bureau of Statistics (ABS) 2011 census data: region of residence was defined according to local government areas (LGAs), and area-level SEP (quintiles) defined using an ABS-derived composite index. The ABS-determined control population (n = 591,265; 51% female) excluded individuals identified as cases. We performed multilevel logistic regression modelling using a stratified two-stage cluster design. TKR was higher for those aged 70-79 years (AOR 1.4 95%CI 1.3-1.5; referent = 60-69 years) and in the most advantaged SEP quintile (AOR 2.1, 95%CI 1.8-2.3; referent = SEP quintile 3); results were similar for THR (70-79 years = AOR 1.7, 95%CI 1.5-1.8; SEP quintile 5 = AOR 2.5, 95%CI 2.2-2.8). Total variances contributed by the variance in LGAs were 2% (SD random effects ± 0.28) and 3% (SD ± 0.32), respectively. Independent of small between-LGA differences in utilisation, and in contrast to the expected greater

  12. Intravenous versus topical tranexamic acid in primary total hip replacement: A systemic review and meta-analysis.

    Science.gov (United States)

    Sun, Xiang; Dong, Qiang; Zhang, Yin-Guang

    2016-08-01

    Total hip arthroplasty (THA) is associated with substantial blood loss. Tranexamic acid (TXA) could reduce perioperative blood loss. The optimal administration routine of TXA remains controversial. The objective of the present systemic review and meta-analysis was to compare the effectiveness and safety of various application methods of tranexamic acid in primary THA. Potential relevant literature was identified from electronic databases including Medline, PubMed, Embase, ScienceDirect, web of science and Cochrane Library. Grey academic studies were also identified from the references of the included literature. There was no language restriction. The pooling of data was carried out by using RevMan 5.1. Three randomized controlled trials (RCTs) and two non-RCTs involving 1614 patients met the inclusion criteria. Current meta-analysis indicated that there were no significant differences in terms of total blood loss (MD = -30.04, 95% CI: -114.67 to 54.59, P = 0.49), postoperative hemoglobin level (MD = -0.29, 95% CI: -0.68 to 0.10, P = 0.14), transfusion rate (RD = -0.02, 95% CI: -0.5 to -0.00, P = 0.09), length of stay ((MD = -0.14, 95% CI: -0.30 to 0.01, P = 0.07) or operation time ((MD = 1.00, 95% CI: -0.31 to 2.31, P = 0.14) between treatment groups. No significant differences were found regarding the incidence of adverse effects such as wound infection (RD = -0.01, 95% CI: -0.06 to 0.04, P = 0.66), myocardial infarction (MI) (RD = -0.01, 95% CI: -0.04 to 0.02, P = 0.61), deep venous thrombosis (DVT) (RD = 0.00, 95% CI: -0.01 to 0.01, P = 0.51) or pulmonary embolism (PE) (RD = RD = 0.00, 95% CI: -0.01 to 0.01, P = 0.63) between groups. The topical administration of TXA in THA carried similar hemostasis effects compared with intravenous use without an increased risk of thrombotic complications. No other adverse effect was identified. Topical TXA application was a simple, safe, effective and cost-effective adjunct for

  13. Metabolic syndrome as a risk factor for total hip or knee replacement due to primary osteoarthritis: a prospective cohort study (the HUNT study and the Norwegian Arthroplasty Register

    Directory of Open Access Journals (Sweden)

    Hellevik AI

    2018-01-01

    Full Text Available Alf Inge Hellevik,1,2 Marianne Bakke Johnsen,3,4 Arnulf Langhammer,1 Valborg Baste,5 Ove Furnes,6,7 Kjersti Storheim,3,4 John Anker Zwart,3,4 Gunnar Birkeland Flugsrud,2 Lars Nordsletten2,4 1The HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Levanger, 2Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, 3Research and Communication Unit for Musculoskeletal Health, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, 4Faculty of Medicine, University of Oslo, Oslo, 5Uni Research Health, Bergen, 6The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, 7Department of Clinical Medicine, Institute of Medicine and Dentistry, University of Bergen, Bergen, Norway Objective: Biochemical changes associated with obesity may accelerate osteoarthritis beyond the effect of mechanical factors. This study investigated whether metabolic syndrome and its components (visceral obesity, hypertension, dyslipidemia and insulin resistance were risk factors for subsequent total hip replacement (THR or total knee replacement (TKR due to primary osteoarthritis.Design: In this prospective cohort study, data from the second survey of the Nord-Trøndelag Health Study 2 (HUNT2 were linked to the Norwegian Arthroplasty Register for identification of the outcome of THR or TKR. The analyses were stratified by age (<50, 50–69.9 and ≥70 years and adjusted for gender, body mass index, smoking, physical activity and education.Results: Of the 62,661 participants, 12,593 (20.1% were identified as having metabolic syndrome, and we recorded 1,840 (2.9% THRs and 1,111 (1.8% TKRs during a mean follow-up time of 15.4 years. Cox regression analyses did not show any association between full metabolic syndrome and THR or TKR, except in persons <50 years with metabolic syndrome who had a decreased risk

  14. Good results in postoperative and hematogenous deep infections of 89 stable total hip and knee replacements with retention of prosthesis and local antibiotics.

    Science.gov (United States)

    Geurts, Jan A P; Janssen, Daniël M C; Kessels, Alfons G H; Walenkamp, Geert H I M

    2013-12-01

    Deep postoperative and hematogenous prosthesis infections may be treated with retention of the prosthesis, if the prosthesis is stable. How long the infection may be present to preclude a good result is unclear. We retrospectively studied 89 deep-infected stable prostheses from 69 total hip replacements and 20 total knee replacements. There were 83 early or delayed postoperative infections and 6 hematogenous. In the postoperative infections, treatment had started 12 days to 2 years after implantation. In the hematogenous infections, symptoms had been present for 6 to 9 days. The patients had been treated with debridement, prosthesis retention, systemic antibiotics, and local antibiotics: gentamicin-PMMA beads or gentamicin collagen fleeces. The minimum follow-up time was 1.5 years. We investigated how the result of the treatment had been influenced by the length of the period the infection was present, and by other variables such as host characteristics, infection stage, and type of bacteria. In postoperative infections, the risk of failure increased with a longer postoperative interval: from 0.2 (95% CI: 0.1-0.3) if the treatment had started ≥ 4 weeks postoperatively to 0.5 (CI: 0.2-0.8) if it had started at ≥ 8 weeks. The relative risk for success was 0.6 (CI: 0.3-0.95) if the treatment had started ≥ 8 weeks. In the hematogenous group, 5 of 6 infections had been treated successfully. A longer delay before the start of the treatment caused an increased failure rate, but this must be weighed against the advantage of keeping the prosthesis. We consider a failure rate of < 50% to be acceptable, and we therefore advocate keeping the prosthesis for up to 8 weeks postoperatively, and in hematogenous infections with a short duration of symptoms.

  15. Web-Based, Pictograph-Formatted Discharge Instructions for Low-Literacy Older Adults After Hip Replacement Surgery: Findings of End-User Evaluation of the Website.

    Science.gov (United States)

    Choi, Jeungok; Jacelon, Cynthia S; Kalmakis, Karen A

    The purpose of this study was to develop web-based, pictograph-formatted discharge instructions and evaluate the website with intended users to maximize the relevance and clarity of the website. A descriptive study. Low-literacy text and 45 sets of pictographs were implemented in web-based instructions. The content, design, function, and navigation of the website were reviewed by 15 low-literate older adults following hip replacement surgery. Participants observed that the simple line drawings with clear background were well suited to web pages and helped to convey the points made. They also suggested changes such as adding an additional alphabetical index menu to enhance easy navigation and removing hypertext links to avoid distraction. Web-based, pictograph-formatted discharge instructions were well received by low-literate older adults, who perceived the website easy to use and understand. A pictograph-formatted approach may provide effective strategies to promote understanding of lengthy, complex action-based discharge instructions in rehabilitation facilities.

  16. Do diagnosis-related groups appropriately explain variations in costs and length of stay of hip replacement? A comparative assessment of DRG systems across 10 European countries.

    Science.gov (United States)

    Geissler, Alexander; Scheller-Kreinsen, David; Quentin, Wilm

    2012-08-01

    This paper assesses the variations in costs and length of stay for hip replacement cases in Austria, England, Estonia, Finland, France, Germany, Ireland, Poland, Spain and Sweden and examines the ability of national diagnosis-related group (DRG) systems to explain the variation in resource use against a set of patient characteristic and treatment specific variables. In total, 195,810 cases clustered in 712 hospitals were analyzed using OLS fixed effects models for cost data (n=125,698) and negative binominal models for length-of-stay data (n=70,112). The number of DRGs differs widely across the 10 European countries (range: 2-14). Underlying this wide range is a different use of classification variables, especially secondary diagnoses and treatment options are considered to a different extent. In six countries, a standard set of patient characteristics and treatment variables explain the variation in costs or length of stay better than the DRG variables. This raises questions about the adequacy of the countries' DRG system or the lack of specific criteria, which could be used as classification variables. Copyright © 2012 John Wiley & Sons, Ltd.

  17. The utility of the Philips SRI-100 real time portal imaging device in a case of postoperative irradiation for prevention of heterotopic bone formation following total hip replacement

    International Nuclear Information System (INIS)

    Kiffer, J.D.; Quong, G.; Lawlor, M.; Schumer, W.; Aitken, L.; Wallace, A.

    1994-01-01

    The new Radiation Oncology Department at the Heidelberg Repatriation Hospital in Melbourne, Australia commenced operation in June 1992. As part of quality control the Philips SL-15 linear accelerator was fitted with the Philips SRI-100 Real Time Portal Imaging Device (RTPID), the first such apparatus in Australia. One of its major advantages over older systems is its ability to provide a permanent hard copy of the image of the field treated. The computer image can be immediately manipulated and enhanced on the screen (with respect to such qualities as brightness and contrast) prior to the printing of the hard copy. This is a significant improvement over the more cumbersome older port films that required developing time, without any pre-assessment of the image quality. The utility of the Philips SRI-100 RTPID is demonstrated in the case of a patient irradiated soon after total hip replacement, as prophylaxis against heterotopic bone formation (HBF). The rapidity and quality of image production is a major advantage in these patients where post operative pain may result in positional change between film exposure and image production. Extremely accurate shielding block position is essential to shield the prosthesis(and allow bone ingrowth for fixation) whilst avoiding inadvertent shielding of the areas at risk for HBF. A review of the literature on this topic is provided. 14 refs., 4 figs

  18. What is the optimal time point to assess patient-reported recovery after hip and knee replacement? A systematic review and analysis of routinely reported outcome data from the English patient-reported outcome measures programme.

    Science.gov (United States)

    Browne, John Patrick; Bastaki, Hamad; Dawson, Jill

    2013-07-30

    It is unclear if there is a clinically important improvement in the six to 12-month recovery period after hip and knee replacement. This is an obvious gap in the evidence required by patients undergoing these procedures. It is also an issue for the English PROMs (Patient-Reported Outcome Measures) Programme which uses 6-month outcome data to compare the results of hospitals that perform hip and knee replacements. A systematic review of studies reporting the Oxford Hip Score (OHS) or Oxford Knee Score (OKS) at 12 months after surgery was performed. This was compared with six-month outcome data collected for 60, 160 patients within the English PROMs programme. A minimally important difference of one standard error of the measurement, equivalent to 2.7 for the OHS and 2.1 for the OKS, was adopted. Six studies reported OHS data for 10 different groups containing 8,308 patients in total. In eight groups the change scores reported were at least 2.7 points higher than the six-month change observed in the PROMs programme (20.2 points). Nine studies reported OKS data for 13 different groups containing 4,369 patients in total. In eight groups the change scores reported were at least 2.1 points higher than the six-month change observed in the PROMs programme (15.0 points). There is some evidence from this systematic review that clinically important improvement in the Oxford hip and knee scores occurs in the six to 12 month recovery period. This trend is more apparent for hip than knee replacement. Therefore we recommend that the English Department of Health study the impact on hospital comparisons of using 12- rather than six-month outcome data.

  19. Short-term clinical experience with hip resurfacing arthroplasty.

    Science.gov (United States)

    Cieliński, Łukasz; Kusz, Damian; Wojciechowski, Piotr; Dziuba, Anna

    2007-01-01

    This paper discusses the authors' experience with hip resurfacing arthroplasty. Although introduced many years ago, the method did not gain wide popularity because of poor long-term outcomes. At present, owing to the introduction of metal-on-metal bearings and hybrid fixation techniques, short- and mid-term results are very good and encourage wider use of this technique, especially in the younger and more active patients whose results with standard total hip replacements would be unsatisfactory. We performed 13 hip resurfacing arthroplasties at our institution between August 1, 2005, and May 1, 2006. Twelve patients reported for the scheduled follow-up and were included in the study. Treatment outcomes were assessed according to the Harris Hip Score. The short-term outcomes of hip resurfacing arthroplasties are encouraging. In the study group there were no intraoperative complications, infections, peripheral nerve palsy, hip dislocations or clinically overt vein thrombosis. All of the patients reported complete or major pain relief. Clinical assessment according to the Harris Hip Score revealed improvement from an average of 57.7 (20.1) points preoperatively to an average of 87.7 (12) points after the surgery. Crutches were used for a maximum of 6 weeks postoperatively. All of the patients are currently able to walk without crutches with full weight-bearing. 1) Hip resurfacing arthroplasty seems to be an advisable method of operative management of younger, active patients, in whom standard THR would be associated with a high risk of failure; it allows THR to be postponed and carried out as a revision surgery with the acetabular component already in place. 2) Despite the good short- and mid-term results, the utility of this method should be evaluated with caution due to the lack of adequate long-term follow-up data.

  20. A Multi-centre Study to Assess the Long-term Performance of the Pinnacle™ Cup With a Polyethylene-on-metal Bearing in Primary Total Hip Replacement

    Science.gov (United States)

    2017-06-27

    Rheumatoid Arthritis; Osteoarthritis; Post-traumatic Arthritis; Collagen Disorders; Avascular Necrosis; Traumatic Femoral Fractures; Nonunion of Femoral Fractures; Congenital Hip Dysplasia; Slipped Capital Femoral Epiphysis