Aims

Patients with femoral neck fractures (FNFs) treated with total hip arthroplasty (THA) have an almost ten-fold increased risk of dislocation compared to patients undergoing elective THA. The surgical approach influences the risk of dislocation. To date, the influence of differing head sizes and dual-mobility components (DMCs) on the risk of dislocation has not been well studied.

Dislocation after total hip arthroplasty in individuals treated for acute hip fracture is up to 10 times more frequent than in elective patients. Whilst approach plays a role, the effect of head sizes in conventional THA and dual mobility cups (DMC) is less studied in fracture cases.

The total dislocation rate at 1-year and 3-year revision rates were recorded in this observational study on 8,031 patients with acute hip fracture, treated with a THA 2005–2014. Swedish Arthroplasty Register data were linked with the National Patient Register. Cox multivariable regression models were fitted to calculate adjusted hazard ratios stratified by approach and head size.

The cumulative risk of dislocation during year 1 was 2.7% (95% CI 2.2–3.2) with lateral approach and 8.3% (7.3–9.3) with posterior approach (KM estimates).

In the posterior approach group DMC was associated with a lower risk of dislocation compared to cTHA=32mm (HR=0.21; 0.07–0.68), whilst a head size <32mm carried a higher risk (HR=1.47; 1.10–1.98). These differences were no longer visible when revision in general was used as outcome.

Neither of the implant designs influenced the dislocation risk when direct lateral approach was used. Male gender and severe comorbidity increased the risk. DMC with lateral approach was associated with a reduced risk of revision in general (HR=0.36; 0.13–0.99). Head size did not influence the revision risk.

When aiming to reduce the risk of any dislocation, lateral approach – regardless of cup/head design – is referable. If, for any reason, posterior approach is used, DMC is associated with the lowest risk of dislocation. This is not reflected in analysing revision in general as outcome. An interpretation could be that there are different thresholds for dislocation prompting revision.

Aims

Our aim was to examine the Elixhauser and Charlson comorbidity indices, based on administrative data available before surgery, and to establish their predictive value for mortality for patients who underwent hip arthroplasty in the management of a femoral neck fracture.

Smoking is negatively implicated in healing and may increase the risk of surgical complications in orthopaedic patients. Carbon monoxide (CO) breath testing provides a rapid way of measuring recent smoking activity, but so far, to our knowledge, this has not been studied in elective orthopaedic patients. We studied whether CO-testing can be performed preoperatively in elective orthopaedic patients and whether testing accurately correlates with self-reported smoking status?

CO breath testing was performed on and a brief smoking history was obtained from 154 elective orthopaedic patients on the day of surgery. All patients admitted over 6 weeks for elective orthopaedic intervention were enrolled.

16.2% patients admitted to smoking. The mean CO levels were 15.2 ppm for self-reported smokers and 3.1 ppm for self-reporting non-smokers. One self-reporting non-smoker admitted to smoking after testing. 5 non-smoking patients had a CO breath of >=7, 1 had a CO level of >= 10 ppm. Using a cutoff of 7 ppm gave a sensitivity of 65.4% and a specificity of 96.1%, whilst a cutoff of 10 ppm gave a sensitivity of 57.6% and specificity of 99.2%.

Whilst most patients are honest about smoking, CO testing can identify non-disclosing smokers undergoing elective orthopaedic procedures. Due to the high specificity, speed and cost-effectiveness, CO breath testing could be performed routinely to identify patients at risk from smoking-related complications in pre-assessment clinics. Smoking cessation services may reduce the risk of harm. CO testing on admission may demonstrate the efficacy of smoking cessation services.

The risk of dying following total hip replacement (THR) is low and has declined over the last decades. The influence of comorbidities and worse physical status on mortality leads to the idea that patient-reported health status may also be a predictor of mortality. Although this has not been demonstrated in THR surgery, some studies in other fields have reported an association. The aim of this study was to investigate the relationship between patient-reported health status before THR and the risk of dying up to 5 years post-operatively.

The Swedish Hip Arthroplasty Register runs a nationwide PROMs program including the EQ-5D questionnaire to routinely monitor patients undergoing THR in Sweden. For these analyses, we used register data on 42,862 patients with hip osteoarthritis operated with THR between 2008 and 2012. Relative survival ratio was calculated by dividing the observed survival in the patient group by age- and gender-adjusted expected survival of the general population. Multivariable modelling proceeded with time-transformed Cox proportional hazards. Pre-operative responses to the five EQ-5D dimensions along with age, gender, education status, year of surgery, and hospital type were used as independent variables.

As a group THR patients had a better survival than the general population. Broken down by the five EQ-5D dimensions we observed differentiated survival patters. For all dimensions, those reporting moderate problems (level 2) had higher mortality than those reporting no problems (level 1) and those reporting extreme problems (level 3) had higher mortality than those reporting level 1 or 2.

Worse health status according to the EQ-5D before THR is associated with higher mortality up to five years after surgery. The complexity of the interactions between different patient-factors associated with outcomes complicates accurate assessments of risks and expected benefits for individual patients. EQ-5D responses may be useful in a multifactorial individualized risk assessment before THR.

Prospectively collected data is an important source of information subjected to change over time. What surgeons were doing in 1999 might not be the case anymore in 2016 and this change in time also applies to a number of factors related to the performance and outcome of total hip replacement. We evaluated the evolution of factors related to the patient, the surgical procedure, socio-economy and various outcome parameters after merging the databases of the Swedish Hip Arthroplasty Register, Statistics Sweden and the National Board of Health and Welfare.

Data on 193,253 THRs (164,113 patients) operated between 1999 and 2012 were merged with databases including general information about the Swedish population and about hospital care. We studied the evolution of surgical volume, patient demographics, socio-economic factors, surgical factors, length of stay, mortality rate, adverse events, re-operation and revision rates and PROMs.

Most patients were operated because of primary osteoarthritis and this share increased further during the period at the expense of decreasing number of patients with inflammatory OA and hip fracture. Comorbidity and ASA scores increased for each year. The share of all cemented implants has dropped from 92% to 68% with a corresponding increase of all uncemented from 2% to 16%.

Length of stay decreased with about 50 percent to 4.5 days in 2012. The 30- and 90-day mortality rate dropped to 0.4% and 0.7%. Re-operation and revision rates at 2 years were lower in the more recent years. The postoperative PROMs are improving despite the preoperative pain scores getting worse.

Even in Sweden, always been considered as a very conservative country with regards to hip replacement surgery, the demographics of the patients, the comorbidities and the primary diagnosis for surgery are changing. Despite these changes the outcomes like mortality, re-operations, revisions and PROMs are improving.

Introduction

Stem revision with retention of the old cement mantle (cement-in-cement revision) in cases with an intact cement/bone interface is an appealing option. There has been an increasing use of this technique. In 2014 this cement-in- cement technique was used in 10% of all stem revisions reported to the Swedish Hip Arthroplasty Register (SHAR). We analysed the outcome of cement-in-cement stem revisions reported to the SHAR during years 2001–2014

Introduction

Dislocation as a primary cause of revision has been on the increase in Sweden (14% in 2014). The increasing use of Dual Mobility cups (DMC) could well be explained by the increased revision burden due to dislocation, patients undergoing revision having increased comorbidities and reports that dual articular cup designs reduce the risk of dislocation. The aim of this study was to analyze the change in utilization pattern of the dual articular designs used in acetabular revision surgery in Sweden. The short-term survival of DMC was compared to traditional designs.

Abstract: Between 1997 to 200, 230 patients underwent primary cemented total hip replacement using the ULTIMA Cobalt alloy, collarless femoral stem and UHMW Polyethylene Cup.184 Patients were available for review with an average follow up of 48 months. The average age at operation was 69 years. The majority of the patients were female (58%). Most of the surgeries were performed by a Consultant Surgeon(91%). Cementing technique was satisfactory in majority with a cement mantle of Grade B noted in 81% of the patients. The position of the femoral stem was noted to be in neutral position in the majority of the patients (76%) with varus and valgus positions in 21 % and 3 % respectively. There was radiological evidence of loosening in 39% of the patients at the follow up out of which a quarter of patients were symptomatic clinically. Subsidence of the femoral stem was noted in 30% of the patients out of which majority 71% had evidence of loosening. About 8 patients had undergone revision or waiting revision surgery. Revision surgeries were performed between 3 to 7 years following the primary surgery with a peak in the 5^th year