Aims. Due to the opioid epidemic in the USA, our service progressively decreased the number of opioid tablets prescribed at discharge after primary hip (THA) and knee (TKA) arthroplasty. The goal of this study was to analyze the effect on total morphine milligram equivalents (MMEs) prescribed and post-discharge opioid repeat
Aims. This study was designed to develop a model for predicting bone mineral density (BMD) loss of the femur after total hip arthroplasty (THA) using artificial intelligence (AI), and to identify factors that influence the prediction. Additionally, we virtually examined the efficacy of administration of bisphosphonate for cases with severe BMD loss based on the predictive model. Methods. The study included 538 joints that underwent primary THA. The patients were divided into groups using unsupervised time series clustering for five-year BMD loss of Gruen zone 7 postoperatively, and a machine-learning model to predict the BMD loss was developed. Additionally, the predictor for BMD loss was extracted using SHapley Additive exPlanations (SHAP). The patient-specific efficacy of bisphosphonate, which is the most important categorical predictor for BMD loss, was examined by calculating the change in predictive probability when hypothetically switching between the inclusion and exclusion of bisphosphonate. Results. Time series clustering allowed us to divide the patients into two groups, and the predictive factors were identified including patient- and operation-related factors. The area under the receiver operating characteristic (ROC) curve (AUC) for the BMD loss prediction averaged 0.734. Virtual administration of bisphosphonate showed on average 14% efficacy in preventing BMD loss of zone 7. Additionally, stem types and preoperative triglyceride (TG), creatinine (Cr), estimated glomerular filtration rate (eGFR), and creatine kinase (CK) showed significant association with the estimated patient-specific efficacy of bisphosphonate. Conclusion. Periprosthetic BMD loss after THA is predictable based on patient- and operation-related factors, and optimal
Introduction. Despite evidence-based recommendations opioids and benzodiazepines are commonly prescribed to treat osteoarthritis. This study aims to quantify the prevalence of opioid and benzodiazepine
Background. Postoperative recovery after routine total hip arthroplasty (THA) can lead to the development of prolonged opioid use but there are few tools for predicting this adverse outcome. The purpose of this study was to develop machine learning algorithms for preoperative prediction of prolonged post-operative opioid use after THA. Methods. A retrospective review of electronic health records was conducted at two academic medical centers and three community hospitals to identify adult patients who underwent THA for osteoarthritis between January 1. st. , 2000 and August 1. st. , 2018. Prolonged postoperative opioid
Proponents of the direct anterior approach (DAA) for hip arthroplasty (THA) claim lower postoperative pain compared to the posterolateral approach (PA); however, whether that theoretical advantage results in lower opioid consumption is unclear. We sought to investigate the relationship between the DAA and PA on total 90-day predicted opioid consumption in a large cohort. Retrospective analysis identified 2,304 DAA and 6,288 PA primary THAs in patients >18 years old from February 2019 to April 2022. Ninety-day postoperative total morphine milligram equivalent (MME); in-hospital administration, discharge
Introduction. Due to the opioid epidemic, our service developed a cultural change highlighted by decreasing discharge opioids after lower extremity arthroplasty. However, concern of potentially increasing refill requests exists. As such, the goal of this study was to analyze whether decreased discharge opioids led to increased postoperative opioid refills. Methods. We retrospectively reviewed 19,428 patients undergoing a primary hip or knee arthroplasty at a single institution from 2016–2019. Patients that underwent secondary procedures within that timeframe were excluded. Two-thousand two-hundred and forty-one patients (12%) were on narcotics preoperatively or had chronic pain syndrome. Two reductions in routine discharge narcotics were performed over this timeframe. First, 8,898 patients routinely received 750 morphine milligram equivalents (MMEs). After the first reduction, 4,842 patients routinely received 520 MMEs. After a second reduction, 5,688 patients routinely received 320 MMEs. We analyzed refill rates, refill MMEs, and whether discharge MMEs were associated with refill MMEs in a multivariate model. Results. Opioid refill rates were 28%, 32%, and 33% in each timeframe (p=0.001). Significantly fewer patients received narcotic refills after 6 weeks in the 320 MME group (8%) compared to the 750 MME group (6%, p=0.02). Total refill MMEs reduced significantly from a mean of 282 in the first to 227 in the last timeframe (p<0.001). After controlling for age, sex, BMI, history of anxiety/depression, and procedure type, opioid discharge of <400 MMEs was not a risk factor for increased refill MMEs in opioid-naïve patients (p=0.23). Conclusion. While decrease in MMEs prescribed at discharge after arthroplasty led to a slight increase in the number of opioid refills (5%), there was a reduction in total refill MMEs. Furthermore, less patients received refills beyond 6 weeks postoperatively. This institutional cultural change led to a reduction in opioid
We have evaluated the extent to which diabetes affects the revision rate following total hip replacement (THR). Through the Danish Hip Arthroplasty Registry we identified all patients undergoing a primary THR (n = 57 575) between 1 January 1996 and 31 December 2005, of whom 3278 had diabetes. The presence of diabetes among these patients was identified through the Danish National Registry of Patients and the Danish National Drug
Background. Orthopedic surgeons have relied heavily on opiates after total hip replacement (THR) despite no clear evidence of benefit and a rapidly growing abuse epidemic. Multimodal analgesia may reduce or even obviate the need for opiates after elective surgery. Methods. In a cluster-randomized, crossover trial, 235 patients undergoing THR were assigned to receive multimodal analgesia with minimal opiates (Group A-10 tablets), multimodal analgesia with a full opiate supply (Group B-60 tablets), or a traditional opiate regimen without multimodal analgesia (Group C-60 tablets). The multimodal regimen comprised scheduled-dose acetaminophen, meloxicam, and gabapentin. Primary outcomes were daily pain and opiate utilization for the first 30-days. Secondary outcomes included assessments of satisfaction, sleep-quality, opiate-related symptoms, hip function, and adverse events. Results. Daily pain was significantly lower in both multimodal groups, Group A (Coeff −0.81, p=0.003) and Group B (Coeff −0.61, p=0.021). While daily utilization and duration of opiate use was lower for both Group A (Coeff −0.77, p<0.001) and Group B (Coeff −0.30, p=0.04) compared with Group C, opiate use was also lower for Group A than Group B (Coeff −0.46, p=0.002). There were significantly fewer opiate-related symptoms in Group A compared to Group C (p=0.005), but Group B and C didn't differ (p=0.13). Additionally, both multimodal regimens improved satisfaction and sleep, and there was no difference in hip function or adverse events. Conclusion. A multimodal analgesic regimen with minimal opiates improved pain control while significantly decreasing opiate utilization and opiate-related adverse effects. It's time to rethink traditional opiate
Introduction. Opioids are an important component of multimodal analgesia, but improper utilization places patients at risk for overdose and addiction. The purpose of this randomized controlled trial is to determine whether the quantity of opioid pills prescribed at discharge is associated with the total amount of opioids consumed or unused by patients after total hip (THA) and knee (TKA) arthroplasty. Methods. 304 Opioid naïve patients undergoing THA or TKA were randomized to receive a
The aim of this study was to estimate the clinical and economic burden of dislocation following primary total hip arthroplasty (THA) in England. This retrospective evaluation used data from the UK Clinical Practice Research Datalink database. Patients were eligible if they underwent a primary THA (index date) and had medical records available 90 days pre-index and 180 days post-index. Bilateral THAs were excluded. Healthcare costs and resource use were evaluated over two years. Changes (pre- vs post-THA) in generic quality of life (QoL) and joint-specific disability were evaluated. Propensity score matching controlled for baseline differences between patients with and without THA dislocation.Aims
Methods
Introduction. Many pharmacologic agents have been used for venous thromboembolism (VTE) prophylaxis after elective total hip arthroplasty (THA). Rivaroxaban was the first novel oral anticoagulant approved for THA patients, but its actual efficacy and safety in clinical practice, beyond randomized trials, is unknown. Materials and Methods. This is a retrospective study, using the Truven Health MarketScan database, of anticoagulation medication
After total hip and knee replacement arthoplasty, patients may become anaemic and may be prescribed oral iron. There is, however, no published evidence that this is of benefit when used postoperatively. We treated 72 patients who were anaemic after primary total hip and knee arthroplasty by randomly allocating them to receive six weeks of either oral ferrous sulphate (35 patients) or a placebo (37 patients). Both groups of patients were similar in all aspects except for the treatment given. There was no statistically significant difference in the change of haemoglobin levels between the two groups. We therefore believe that the
We present the development of a day-case total hip arthroplasty (THA) pathway in a UK National Health Service institution in conjunction with an extensive evidence-based summary of the interventions used to achieve successful day-case THA to which the protocol is founded upon. We performed a prospective audit of day-case THA in our institution as we reinitiate our full capacity elective services. In parallel, we performed a review of the literature reporting complication or readmission rates at ≥ 30-day postoperative following day-case THA. Electronic searches were performed using four databases from the date of inception to November 2020. Relevant studies were identified, data extracted, and qualitative synthesis performed.Aims
Methods
The purpose of this exploratory study was to investigate if the 24-hour activity profile (i.e. waking activities and sleep) objectively measured using wrist-worn accelerometry of patients scheduled for total hip arthroplasty (THA) improves postoperatively. A total of 51 THA patients with a mean age of 64 years (24 to 87) were recruited from a single public hospital. All patients underwent THA using the same surgical approach with the same prosthesis type. The 24-hour activity profiles were captured using wrist-worn accelerometers preoperatively and at 2, 6, 12, and 26 weeks postoperatively. Patient-reported outcomes (Hip Disability and Osteoarthritis Outcome Score (HOOS)) were collected at all timepoints except two weeks postoperatively. Accelerometry data were used to quantify the intensity (sedentary, light, moderate, and vigorous activities) and frequency (bouts) of activity during the day and sleep efficiency. The analysis investigated changes with time and differences between Charnley class.Aims
Patients and Methods
The aim of this study was to identify modifiable risk factors associated with mortality in patients requiring revision total hip arthroplasty (THA) for periprosthetic hip fracture. The electronic records of consecutive patients undergoing revision THA for periprosthetic hip fracture between December 2011 and October 2018 were reviewed. The data which were collected included age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, the preoperative serum level of haemoglobin, time to surgery, operating time, blood transfusion, length of hospital stay, and postoperative surgical and medical complications. Univariate and multivariate logistic regression analyses were used to determine independent modifiable factors associated with mortality at 90 days and one year postoperatively.Aims
Methods
The purpose of this study was to examine whether leg-length discrepancy (LLD) following unilateral total hip arthroplasty (THA) affects the incidence of contralateral head collapse and subsequent THA in patients with bilateral osteonecrosis, and to determine factors associated with subsequent collapse. We identified 121 patients with bilateral non-traumatic osteonecrosis who underwent THA between 2003 and 2011 to treat a symptomatic hip, and who also exhibited medium-to-large lesions (necrotic area ≥ 30%) in an otherwise asymptomatic non-operated hip. Of the 121 patients, 71 were male (59%) and 50 were female (41%), with a mean age of 51 years (19 to 71) at the time of initial THA. All patients were followed for at least five years and were assessed according to the presence of a LLD (non-LLD Aims
Patients and Methods
The purpose of this study was to validate the diagnosis of periprosthetic
joint infection (PJI) in the Danish Hip Arthroplasty Register (DHR). We identified a cohort of patients from the DHR who had undergone
primary total hip arthroplasty (THA) since 1 January 2005 and followed
them until first-time revision, death, emigration or until 31 December
2012. Revision for PJI, as registered in the DHR, was validated against
a benchmark which included information from microbiology databases,
prescription registers, clinical biochemistry registers and clinical
records. We estimated the sensitivity, specificity, positive predictive
value (PPV) and negative predictive value (NPV) for PJI in the DHR
alone and in the DHR when combined with microbiology databases.Aims
Patients and Methods
An atypical femoral fracture (AFF), with a transverse
fracture radiologically through the lateral cortex is a rare but serious
condition. In order to improve our ability to identify patients
with this condition, we retrospectively surveyed all subtrochanteric,
peri-implant and diaphyseal femoral fractures in patients aged ≥ 65
years who underwent surgical treatment at our hospital between 2004
and 2011. We describe the incidence of atypical fractures and their characteristics,
with observational data including a review of the hospital and general
practitioner records. Clinical outcomes were evaluated using the
Harris hip score (HHS) and the timed up-and-go (TUG) test. Atypical fractures only occurred in women with an incidence of
9.8 per 100 000 person-years. The incidence in those who were treated
with bisphosphonates was 79.0 per 100 000 person-years; eight of
17 fractures occurred around metal implants. There was a high incidence
of delayed union and revision surgery. A total of nine patients (ten
AFFs) were available for review at a mean follow-up of 36.5 months
(10 to 104). The clinical outcome was poor with a mean HHS of 58.9
(95% CI 47.4 to 70.4) and a mean TUG test of 25.7 s (95% CI 12.7
to 38.8). The delay in diagnosis and treatment of AFF may result from a
lack of knowledge of this condition. Cite this article:
We examined whether a selective cyclooxygenase-2 (COX-2) inhibitor (celecoxib) was as effective as a non-selective inhibitor (ibuprofen) for the prevention of heterotopic ossification following total hip replacement. A total of 250 patients were randomised to receive celecoxib (200 mg b/d) or ibuprofen (400 mg t.d.s) for ten days after surgery. Anteroposterior radiographs of the pelvis were examined for heterotopic ossification three months after surgery. Of the 250 patients, 240 were available for assessment. Heterotopic ossification was more common in the ibuprofen group (none 40.7% (50), Brooker class I 46.3% (57), classes II and III 13.0% (16)) than in the celecoxib group (none 59.0% (69), Brooker class I 35.9% (42), classes II and III 5.1% (6), p = 0.002). Celecoxib was more effective than ibuprofen in preventing heterotopic bone formation after total hip replacement.