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PubMed1997

Total hip arthroplasty for avascular necrosis and degenerative osteoarthritis of the hip.

Although several studies of various treatment modalities have been reported during the past decade, osteonecrosis of the femoral head remains a difficult therapeutic problem. Total hip replacement which is reserved for patients showing collapse of the femoral head, usually shows poorer results in patients with osteonecrosis compared with those with osteoarthritis. Uncemented total hip arthroplasty was performed on 29 patients with avascular necrosis of the femoral head and 29 patients with degenerative osteoarthritis. After a mean followup of 7.6 years and 7.1 years for the two groups of patients, only one failure was observed in one patient with osteonecrosis. Clinical evaluation after cementless total hip arthroplasty in both groups of patients revealed improvement in all parameters. Postoperatively, pain improved from 1.4 to 5.1, walking ability from 3.4 to 5.3, and range of motion from 4.5 to 5.5 in patients with osteonecrosis, and pain improved from 1.2 to 5.3, walking ability from 3.2 to 5.4, and range of motion from 3.1 to 4.7 in patients with osteoarthritis. Thigh pain was observed postoperatively in only two and three patients treated for osteonecrosis and osteoarthritis, respectively. The present results using cementless arthroplasty seem to be somewhat better than those reported for cemented arthroplasty in patients suffering from osteonecrosis. The clinical and radiographic findings after noncemented arthroplasty in patients with osteonecrosis of the femoral head and in patients with degenerative arthritis of the hip were similar in the two groups.

Adult↗

PubMed1997

[Two stages reimplantation for infection after knee arthroplasty. Apropos of a series of 29 cases].

PURPOSE OF THE STUDY: The purpose of this work was to precise diagnosis and treatment of infected total knee arthroplasty with two stage reimplantation. MATERIAL: 29 infected total knee arthroplasties were operated between 1984 and 1994 and included in this study (mean F.U. 3.5 Y). There were 20 females and 9 males, mean age 70 (46-83). The original arthroplasty was done for OA in 28 patients, RA in one. The arthroplasties were: UHK 2, Bicompartmental 2, Tricompartmental 19. 20 TKA were cementless. 14 patients showed one or several risk factors. Infection was diagnosed in 1 of 2 ways: preoperative aspiration or culture of surgical specimen. There were 12 staphylococcus epidermidis, 8 staphylococcus aureus, streptococcus (n = 2) acinetobacter (n = 2), peptococcus (n = 1) pseudomonas (n = 1), gemella morbidellum (n = 1). 6 were non identified. METHOD: The protocol for two stage reimplantation began with components and cement removal. A synovectomy was performed. The knee cavity was filled with antibiotic cement spacer and the wound was closed. The leg was placed in a splint. All patients underwend a continued antibiotic therapy, specific in 20 cases with isolated organisms. A total knee arthroplasty was performed, using a total posterior cruciate substituting prosthesis, 6 to 8 weeks after components removal (2-24). All patients received parenteral antibiotics after reimplantation for not less than 2 months (2-6). RESULTS: Infection was eradicated in 24 cases, 22 in one time, 2 bad second debridement. At last follow-up the average Hungerford score was 75.6/100, the average Knee society knee score was 80 and the average functional score was 70. Mean range of flexion was 95 degrees. 6 patients had recurrent infection and poor result. They underwent arthrodesis. 5 of the 6 patients had solid mature fusion at last follow-up. DISCUSSION: The results of two stage reimplantation for infected total knee replacement showed that this is the method of choice for infection treatment and acceptable function restoration. As other authors, we get a good success rate (82 per cent). Functional result was better with identified microorganisms, but we did not find any correlation with organisms type or infection length. Punction and bone scanning are of great help for diagnosis in difficult chronical cases. Organism identification is fundamental for infection duration. Staphylococcus epidermidis was the most frequent identified organism. New procedures using articulated cement spacer may improve functional results.

Aged↗

PubMed2005

Prosthetic replacement in secondary Girdlestone arthroplasty has an unpredictable outcome.

The functional outcome of hip replacement following a Girdlestone arthroplasty may be difficult to predict. We reviewed 39 hips in 39 patients with a minimum follow-up of 12 (range 12-208) months from re-implantation total hip arthroplasty. The patients were treated in one institution between 1983 and 2000, and their mean age at conversion was 65 (32-85) years. The main indication for the Girdlestone arthroplasty was peri-prosthetic infection. A post-operative complication occurred in 26 cases and in 17, surgical revisions were performed. The average Harris hip score (HHS) following conversion was 62 (24-93), and only three hips were graded as very good whereas 23 were graded as poor. Microbiological culture, patient age, duration of Girdlestone arthroplasty and the number of preceding surgical procedures did not correlate with the functional outcome after conversion.

Adult↗

PubMed2005

Arthroplasty in the octogenarian: quantifying the risks.

The objective of this study was to determine the risk of complications after primary total hip and knee arthroplasties in octogenarians. Using administrative data, we compared the rate of complications for octogenarians vs patients aged 65 to 79 years who underwent total hip or knee arthroplasty in Ontario between 1993 and 1997. Octogenarians were 3.4 times more likely to die, 2.7 times more likely to sustain a myocardial infarction, and 3.5 times more likely to develop pneumonia. Postoperative confusion and urinary tract infections were also significantly more common in octogenarians. Octogenarians are at higher risk for death and serious complications after primary joint arthroplasty. However, the overall event rate remains low and total joint arthroplasty surgery should continue to be offered to these individuals provided that the complication rates are acceptable to the patients and their families.

Aged↗

PubMed2006

Perioperative autotransfusion in total hip and knee arthroplasty.

We assessed the OrthoPAT Orthopedic Perioperative Autotransfusion System (Zimmer Inc, Warsaw, Ind) in reducing the need for allogeneic blood in hip or knee arthroplasty. Patients (N = 398) were divided into 5 cohorts: unilateral primary hip (n = 131), unilateral revision hip (n = 38), unilateral primary knee (n = 179), unilateral revision knee (n = 26), and bilateral primary knee (n = 24). Primary or revision hip arthroplasties with no preoperative autologous blood donation, knee arthroplasties with no preoperative autologous blood donation, and unilateral primary hip arthroplasties were 2.7, 2.3, and 2 times less likely (P < .05), respectively, to use allogeneic blood with OrthoPAT. We conclude that OrthoPAT use significantly reduced the risk of receiving allogeneic blood transfusions in defined patient subsets.

Aged↗

PubMed2006

Postdischarge costs in arthroplasty surgery.

Postdischarge costs associated with primary arthroplasty surgeries have received limited attention in the literature. Our objective was to identify the costs incurred after discharge in primary arthroplasty and to estimate annual postdischarge expenditures in the United States. A cohort of 136 patients who underwent primary arthroplasty was studied. Comprehensive rehabilitation unit (CRU) and home care (HC) costs were obtained. The National Hospital Discharge Survey 2003 data were used to model the national discharge cost estimates. Local patient-oriented outcome was also compared in the patients discharged to CRU vs HC. Total costs were significantly lower in patients discharged directly to home vs those sent to the CRU and who subsequently received HC ($2405 vs $13435, P < .001); both patient groups experienced similar quality of life improvements. An estimated $3.2 billion is spent annually on postsurgical rehabilitation after arthroplasty. Postdischarge costs are significantly higher for patients going to a CRU vs those discharged home; yet, both groups had comparable short-term outcomes.

Aged↗

PubMed2005

Total joint arthroplasties: current concepts of patient outcomes after surgery.

Total hip and knee arthroplasties are effective surgical interventions for relieving pain and improving physical function caused by arthritis. Although the majority of patients substantially improve, not all reports gains or are satisfied after receiving a total joint arthroplasty. This article reviews the literature on patient outcomes after total hip and knee arthroplasties for osteoarthritis and the evidence pertaining to factors that affect these patient-centered outcomes. Mounting evidence suggests that no one patient-related or peri-operative factor clearly predicts the amount of pain relief or functional improvement that will occur following total hip or knee arthroplasty.

Arthroplasty, Replacement, Hip↗

PubMed2026

Comparison of analgesic efficacy of pericapsular group of nerve block versus anterior quadratus lumborum block in adult patients undergoing unilateral hip arthroplasty: A comparative randomized controlled trial.

BACKGROUND: Total hip arthroplasty is a painful surgical procedure; therefore, it is a challenge to manage effective pain control during the perioperative period. STUDY OBJECTIVES: We compared the analgesic efficacy of the pericapsular nerve group block and the anterior quadratus lumborum block in patients undergoing unilateral hip arthroplasty. DESIGN: Randomized controlled trial. SETTINGS: Operating room of a tertiary care center. PATIENTS: 92 adult patients of >18 years who underwent elective, unilateral total hip arthroplasty under spinal anesthesia were randomized to either Group P (USG guided PENG block with 30 ml 0.25% ropivacaine +4 mg dexamethasone) or Group Q (USG guided QL block with 30 ml 0.25% ropivacaine +4 mg dexamethasone) 20 min before surgery. MEASUREMENTS: We compared the total perioperative fentanyl consumption between the two groups in the first 24 h as the primary outcome. Other outcomes included time to first rescue analgesia in the postoperative period, NRS scores at rest and on movement at 0, 2, 4, 6, 12, and 24 h, incidence of intraoperative hemodynamic changes, and incidence of postoperative PONV. MAIN RESULTS: There was no significant difference in the total fentanyl consumption between the two groups: 237.5 (150-450) μg in the P group and 250 (125-400) μg in the Q group; p = 0.617. The time to first rescue analgesia was similar in both groups: the P group (198 [123-268] minutes) and the Q group (241 [180-318] minutes); p = 0.120. There was also no difference in pain scores, intraoperative hemodynamic changes, or PONV. CONCLUSION: There was no difference in the perioperative opioid consumption, pain scores, and adverse event rates between the pericapsular nerve group block and anterior quadratus lumborum block in adult patients undergoing unilateral hip arthroplasty. TRIAL REGISTRATION: Clinical Trials Registry of India (CTRI number: CTRI/2023/08/057157).

Humans↗

PubMed2006

Risk of conjunctival contamination in total joint arthroplasty.

This study arose from a concern about the transmission of infection through conjunctival contamination during total joint arthroplasty surgery. A prospective analysis of 110 sets of personal face and eye protective equipment (Sterishields) used for 29 total hip arthroplasties (THA) and 26 total knee arthroplasties (TKA) were examined for macroscopic contamination. In additition, a postal questionnaire regarding the perceived risk of eye contamination and current practice of eye protection used during TKA and THA surgery was sent to 1500 Fellows of the British Orthopaedic Association. All Sterishields demonstrated macroscopic contamination with an average of 203 blood and fat spots. The number of these was significantly higher in the lower half of the Sterishields. Of the 834 useable replies, 48% of respondents did not use adequate eye protection routinely. Twenty-eight percent felt that no eye protection was needed, while 45% felt that the eye protection available compromised their vision and so did not use it. One hundred and seven respondents (13%) reported being aware of eye contamination, while 21 (2.5%) respondents were aware of at least one case of conjunctival infection following contamination. This study demonstrates that there is a high risk of conjunctival contamination with fat and blood in major total joint arthroplasty. The reported use of appropriate eye and face protection in the UK has been shown to be low (52%).

Arthroplasty, Replacement, Hip↗

PubMed2026

Do wound protectors reduce contamination in total shoulder arthroplasty? A randomized controlled trial.

HYPOTHESIS: Cutibacterium acnes is the most frequent cause of shoulder prosthetic joint infection with skin edges as a source of wound contamination. The primary purpose of this study was to determine if the use of a wound protector device decreases the deep wound bacterial colonization in primary shoulder arthroplasty. The secondary purpose was to assess the effect of device usage on deltopectoral muscle and cephalic vein injury. METHODS: This was a prospective, randomized controlled trial. A total of 100 patients undergoing primary total shoulder arthroplasty were enrolled and randomized into 2 groups: a wound protector group and a control group. Five patients withdrew from the study, leaving 48 patients in the wound protector group and 47 controls. Three deep wound culture swabs were taken after final arthroplasty implantation. The surgeon also graded deltoid, pectoralis major, and cephalic vein injury on a 0-3 scale based on modification to the Tscherne classification of soft tissue injury. The primary outcome of this study was positive culture results for C acnes. Secondary outcomes included total bacterial culture positivity as well as soft tissue injury grades. A subanalysis removing likely contaminant positive cultures (growth >7 days and 1 colony only) was also performed. Comparisons between groups were made using Fisher exact test for categorical outcomes and t tests and Mann-Whitney U tests for continuous variables. RESULTS: The use of a wound protector did not result in any significant differences compared with controls in the rate of positive cultures for C acnes (15% vs. 21%, P = .593) or all bacteria (15% vs. 26%, P = .304). Removing likely contaminant positive cultures did not demonstrate any significant difference in culture positivity (9% vs. 17%, P = .355, for C acnes; 9% vs. 19%, P = .231, for all bacterial species). The wound protector group had better soft tissue injury scores for the deltoid muscle (P < .001) and pectoralis muscle (P < .001). No difference in cephalic vein injury was noted between the 2 groups (P > .05). No difference in surgical time was noted. CONCLUSION: The use of a surgical wound protector device in total shoulder arthroplasty did not significantly decrease bacterial colonization of the deep wound. However, soft tissue damage to the deltoid and pectoralis muscle was less severe in the wound protector group. These findings suggest that this device reduces iatrogenic soft tissue injury.

Humans↗

PubMed1983

Arthroplasty of the rheumatoid wrist by silicone implants. Experience with forty cases.

The authors report their first evaluation of 40 arthroplasties of the wrist with the Swanson implant. The indication for this procedure was principally severe damage to the wrist joint. The radiologic findings have been summarized. In regard to operative technic, there have been no major problems. In 20 cases also arthroplasty of the head of the ulnar was done. There were no significant early complications. The clinical results after 14 months, with a range of 6 to 45 months, was always satisfactory in regard to pain and the preservation useful flexion and extension. So far, tolerance to the implant seems to be satisfactory. The joint narrowing, regularily found in the new articulation, does not detract from the long-term results. Thus the authors retain a favorable impression of this arthroplasty which should find a place in the treatment of badly damaged rheumatoid wrists. In addition to relieving the pain, it preserves mobility that would be sacrificed with an arthrodesis. Among the associated procedures, the authors have been disappointed with arthroplasty of the head of the ulna and have given it up.

Adult↗

PubMed2000

Determining the necessity for routine pathologic examinations in uncomplicated total hip and total knee arthroplasties.

Total hip and total knee arthroplasties (n = 951) were retrospectively reviewed to determine the cost-effectiveness of routine pathologic examination of surgical specimens in primary total hip and total knee replacements. Discrepancies between the postoperative diagnosis and the final pathologic diagnoses were recorded. Of the 951 cases reviewed, 27 (2.8%) noted conflicting postoperative and pathologic diagnosis. In all cases, the discrepancy was between a postoperative diagnosis of osteoarthritis and pathologic diagnosis of avascular necrosis. No new cases of neoplasia or inflammatory arthropathy were noted based on the pathologic interpretation. Sixteen of these discrepancies (5.1%) and were noted in total hip arthroplasties, and 11 (1.7%) were noted in total knee arthroplasties. In no case was postoperative medical or surgical treatment altered. Based on this review, strong consideration should be given to the elimination of routine pathologic evaluation of surgical specimens during primary joint arthroplasty, leaving this pathologic evaluation optional, at the discretion of the orthopaedic surgeon, rather than mandatory.

Aged↗

PubMed2003

Evaluation of patient concerns before total knee and hip arthroplasty.

The preoperative concerns of patients undergoing total knee or hip arthroplasty were evaluated in a cross-sectional study of 370 patients. Patients completed a questionnaire on 29 concerns, each rated on a scale of 1 (not concerned) to 4 (very concerned). Short Form 12 and Oxford hip or knee scores were also calculated. The results showed that the greatest concern for patients was cancellation of the surgery. This was followed by failure of the surgery to reduce pain, loss of a limb, and joint infection. Concerns regarding scar problems, nursing care, and preoperative tests were the lowest. Women showed statistically significant greater concerns in 9 areas. Younger patients (age, <65) showed increased concerns in 8 areas. Patients who had previously undergone joint arthroplasty were less concerned than those who had not undergone previous lower limb joint arthroplasty for 6 responses. They showed increased concern in 2 areas, nursing care and hospital food. Those undergoing total hip arthroplasty were more concerned about dislocation, dressing, and returning to work (all, P<.05). This study provides useful information for the preoperative counseling of patients and the production of preoperative literature.

Adult↗

PubMed2001

Defining the relationship between obesity and total joint arthroplasty.

OBJECTIVE: The purpose of this study was to examine the relationship between obesity and patient-administered outcome measures after total joint arthroplasty. RESEARCH METHODS AND PROCEDURES: A voluntary questionnaire-based registry contained 592 primary total hip arthroplasty patients and 1011 primary total knee arthroplasty patients with preoperative and 1-year data. Using logistic regression, the relationships between body mass index and the several outcome measures, including Short Form-36 and Western Ontario and McMaster Universities Osteoarthritis Index, were examined. RESULTS: There was no difference between obese and non-obese patients regarding satisfaction, decision to repeat surgery, and Delta physical component summary, Delta mental component summary, and Delta Western Ontario and McMaster Universities Osteoarthritis Index scores (p > 0.05 for all). Body mass index was associated with an increased risk of having difficulty descending or ascending stairs at 1 year (odds ratio, 1.2 to 1.3). DISCUSSION: Obese patients enjoy as much improvement and satisfaction as other patients from total joint arthroplasty.

Adult↗

PubMed2005

Cancer following hip and knee arthroplasty: record linkage study.

Concerns have been raised that degradation of implants used in hip and knee arthroplasty may lead to an increased risk of some cancers, particularly those of the haematopoietic, lymphatic and urinary systems. We used linked statistical records of hospital admissions and deaths to compare cancer rates in cohorts of people who had undergone hip or knee arthroplasty with a comparison cohort. We did not find an elevated risk for cancer, overall, in either the hip or knee cohort or in both combined (rate ratio for both combined 0.99; 95% confidence intervals 0.95-1.02), or for haematopoietic, lymphatic or urinary system cancers. There was also no elevation in risk of cancer more than 10 years after arthroplasty. Our findings add to the evidence that arthroplasty is safe in respect of cancer risk.

Adult↗

PubMed2000

The impact of health status on waiting time for major joint arthroplasty.

This study was conducted to determine the impact of health status on waiting time for major joint arthroplasty in a universal publicly funded health system. Data were collected prospectively from a cohort of 553 patients waiting for total hip or total knee arthroplasty. The WOMAC and SF-36 health status instruments were administered at the time the patient was placed on the waiting list. The outcome measure was length of waiting time. Multivariate analyses found increased body mass index and decreased social function as the only determinants of waiting time. This model explained only 4% of the variance in waiting time. The association between health status and waiting time for arthroplasties appears to be small. These findings suggest that major joint arthroplasty is not prioritized on the basis of burden of illness.

Adult↗

PubMed2001

Change in pain and function while waiting for major joint arthroplasty.

The objective of this study was to examine the change in pain and physical function that occurs while waiting for major arthroplasty. Data were collected prospectively from a cohort of 313 patients who were waiting > 1 month for total hip arthroplasty or total knee arthroplasty. The WOMAC and the SF-36 health status instruments were administered at the time the patient was placed on the waiting list and again just before surgery. Minimal amounts of change in pain and physical and psychosocial function occurred for hip and knee arthroplasty patients while they waited. Overall, waiting time did not appear to have a negative impact on the amount of pain and dysfunction experienced.

Adult↗

PubMed2003

The impact of medicare reimbursement policies on simultaneous bilateral total hip and knee arthroplasty.

In October of 1992, Medicare reimbursement decreased by 50% for a second total hip or knee arthroplasty performed as part of a simultaneous bilateral procedure. The Medicare records of 67726 patients who underwent total hip and knee arthroplasty were reviewed using data from the New York State Department of Health in the period from October 1, 1989, to September 30, 1996. Simultaneous bilateral total hip arthroplasties represented 1.8% of the total number of total hip replacements performed in fiscal year 1991 (60 of 3418) compared with 1.7% (77 of 4547) performed in fiscal year 1994 (P=.902). Similarly, the number of simultaneous bilateral total knee arthroplasties did not change significantly, with simultaneous bilateral procedures representing 5.9% of the total number of total knee replacements performed in fiscal year 1991 (214 of 3620) compared with 6.2% (369 of 5,931) performed in fiscal year 1994 (P=.568).

Adult↗