Increased collection of patient-reported outcome measures (PROM) in registries enables international comparison of patient-centered outcomes after knee and hip replacement. We aimed to investigate 1) variations in PROM improvement, 2) the possible confounding factor of BMI, and 3) differences in comorbidity distributions between registries. Registries affiliated with the International Society of Arthroplasty Registries (ISAR) or OECD membership countries were invited to report aggregate EQ-5D, OKS, OHS, HOOS-PS and KOOS-PS values. Eligible patients underwent primary total, unilateral knee or hip replacement for osteoarthritis within three years and had completed PROMs preoperatively and either 6 or 12 months postoperatively, excluding patients with subsequent revisions. For each PROM cohort, Chi-square tests were performed for BMI distributions across registries and 12 predefined PROM strata (male/female, age 20-64/65-74/>75, high or low preoperative PROM scores). Comorbidity distributions were reported for available comorbidity indexes. Thirteen registries from 9 countries contributed data, n~130000 knee (range 140 to 79848) and n~113000 hip (range 137 to 85281). Mean EQ-5D index values (10 registries) ranged from 0.53 to 0.71 (knee) and 0.50 to 0.70 (hips) preoperatively and 0.78 to 0.85 (knee) and 0.83 to 0.87 (hip) postoperatively. Mean OKS (6 registries) ranged from 19.3 to 23.6 preoperatively and 36.2 to 41.2 postoperatively. Mean OHS (7 registries) ranged from 18.0 to 23.2 preoperatively and 39.8 to 44.2 postoperatively. Four registries reported KOOS-PS and three reported HOOS-PS. Proportions of patients with BMI >30 ranged from 35 to 62% (10 knee registries) and 16 to 43% (11 hip registries). For both knee and hip registries, distributions of patients across six BMI categories differed significantly among registries (p30 were for patients in the youngest age groups (20 to 64 and 65 to 74 years) with the lowest baseline scores. Additionally, females with lowest preoperative PROM scores had highest BMI. These findings were echoed for the OHS and OKS cohorts. Proportions of patients with ASA scores ≥3 ranged from 7 to 42% (9 knee registries) and 6 to 35% (8 hip registries). PROM-score improvement varies between international registries, which may be partially explained by differences in age, sex and preoperative scores. BMI and comorbidity may be relevant to adjust for

Obesity is a known risk factor for hip osteoarthritis. The aim of this study was to compare the incidence of obesity in Australians undergoing hip replacements (HR) for osteoarthritis to the general population. A cohort study was conducted comparing data from the Australian Bureau of Statistics and the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) from 2017-18. Body mass index (BMI) data for patients undergoing primary total hip replacement and resurfacing for osteoarthritis were obtained from the AOANJRR. The distribution of HR patients by BMI category was compared to the general population, in age and sex sub-groups. During the study period, 32,495 primary HR were performed for osteoarthritis in Australia. Compared to the general population, there was a higher incidence of Class I, II, and III obesity in patients undergoing HR in both sexes aged 35 to 74 years old. Class III obese females and males undergoing HR were on average 6 to 7 years younger than their normal weight counterparts. Class III obese females and males aged 55-64 years old were 2.9 and 1.7 times more likely to undergo HR, respectively (p<0.001). There is a strong association between increased BMI and relative risk of undergoing HR. Similar findings have been noted in the United States of America, Canada, United Kingdom, Sweden and Spain. A New Zealand Registry study and recent meta-analysis have also found a concerning trend of Class III obese patients undergoing HR at a younger age. Obese Australians are at increased risk of undergoing HR at a younger age. A national approach to address the prevalence of obesity is needed

Introduction. Total knee and hip arthroplasty were the main arthroplasty surgery performed in Brazil. In Brazil, around 50% of arthroplasty surgeries are performed by the public health system, knowing as SUS . 1. SUS is the biggest public and universal health system in the world, attending 100% of the Brazilian population (220 million), with 2020's expected budget of US$ 31 billion . 2,3. . The National Institute of Clinical Excellence utilizes the QALY system (Quality adjustment year life)to calculate the best cost-benefit between medical interventions . 4. In compliance with the study, an operated person has a QALY index of £5000 while a non-operated person has an index of £7182. In March 2020, due to the COVID-19 pandemics, the Brazilian Health Ministry oriented for the postponing of elective surgery, to prioritize combating the virus . 5. This postponing, it was important but will cause an impact in the economy at the public health system from Brazil this year and in the next years. Therefore, this study aims to present the economic impact caused by COVID-19 pandemics in the public heal system, SUS, of Brazil. Methods. Data about total hip arthroplasty (THA) and total knee arthroplasty (TKA) in Brazil were collected from the TABNET portal of the Brazilian Health Ministry/Datasus . 6. It was collected information per month about hospitalization authorization (AIH), and total cost per AIH. The information regards the period of January to June from years 2015 to 2020. Results and Discussion. After the orientation in march 2020 to postpone elective surgery, there was a reduction of up to 91% in total knee arthroplasty (TKA) and 76% in total hip arthroplasty (THA), compared to the same period in the previous years (see Figure 1). This represents a reduction of more than 5000 surgeries in the first semester. According to Brazilian doctors, the retention of surgeries will result in excessive demand for the sector in the upcoming months . 7. . Due to the reduction of the AIH, which occurs a reduction US$3,881,494 of the budget destined for arthroplasty surgeries in the first semester of 2020 (see Figure 2), being used to the combat of COVID-19. Consequently, the purchase of new hip and knee prostheses decreases, harming the implant sales sector in Brazil. Furthermore, by the QALY system, the cost of a non-operated patient is up to 43% bigger than that of an operated patient. Thus, this will generate an increase in the expenses of the SUS in the upcoming months or years. Conclusion. The COVID-19 pandemics generate the need of postponing elective surgery of the SUS, such as total hip and knee arthroplasty. Because of this, there was a reduction of 67% of the number and expense of knee and hip arthroplasties in the first semester of 2020. This generates an economic loss for the implants companies and it will increase overly the demand for new surgeries in the upcoming months or years. For any figures or tables, please contact the authors directly

Total knee and hip arthroplasty (TKA and THA) are two of the highest volume and resource intensive surgical procedures. Key drivers of the cost of surgical care are duration of surgery (DOS) and postoperative inpatient length of stay (LOS). The ability to predict TKA and THA DOS and LOS has substantial implications for hospital finances, scheduling and resource allocation. The goal of this study was to predict DOS and LOS for elective unilateral TKAs and THAs using machine learning models (MLMs) constructed on preoperative patient factors using a large North American database. The American College of Surgeons (ACS) National Surgical and Quality Improvement (NSQIP) database was queried for elective unilateral TKA and THA procedures from 2014-2019. The dataset was split into training, validation and testing based on year. Multiple conventional and deep MLMs such as linear, tree-based and multilayer perceptrons (MLPs) were constructed. The models with best performance on the validation set were evaluated on the testing set. Models were evaluated according to 1) mean squared error (MSE), 2) buffer accuracy (the number of times the predicted target was within a predesignated buffer of the actual target), and 3) classification accuracy (the number of times the correct class was predicted by the models). To ensure useful predictions, the results of the models were compared to a mean regressor. A total of 499,432 patients (TKA 302,490; THA 196,942) were included. The MLP models had the best MSEs and accuracy across both TKA and THA patients. During testing, the TKA MSEs for DOS and LOS were 0.893 and 0.688 while the THA MSEs for DOS and LOS were 0.895 and 0.691. The TKA DOS 30-minute buffer accuracy and ≤120 min, >120 min classification accuracy were 78.8% and 88.3%, while the TKA LOS 1-day buffer accuracy and ≤2 days, >2 days classification accuracy were 75.2% and 76.1%. The THA DOS 30-minute buffer accuracy and ≤120 min, >120 min classification accuracy were 81.6% and 91.4%, while the THA LOS 1-day buffer accuracy and ≤2 days, >2 days classification accuracy were 78.3% and 80.4%. All models across both TKA and THA patients were more accurate than the mean regressors for both DOS and LOS predictions across both buffer and classification accuracies. Conventional and deep MLMs have been effectively implemented to predict the DOS and LOS of elective unilateral TKA and THA patients based on preoperative patient factors using a large North American database with a high level of accuracy. Future work should include using operational factors to further refine these models and improve predictive accuracy. Results of this work will allow institutions to optimize their resource allocation, reduce costs and improve surgical scheduling. Acknowledgements:. The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors

Introduction and Aims. There are many surgical, implant design and patient factors that should be considered in preclinical testing of hip replacement which are not being considered in current standards. The aim of this study was to develop a preclinical testing method that consider surgical positioning, implant design and patient factors and predict the occurrence and severity of edge loading under the combination of such conditions. Then, assess the safety and reliability of the implant by predicting the wear, deformation and damage of the implant bearings under worst case conditions. Methods. Ceramic-on-ceramic (CoC, 36mm, BIOLOX. ®. delta, Pinnacle. ®. , DePuy Synthes, UK) and metal-on polyethylene (MoP, 36mm, Marathon®, Pinnacle. ®. , DePuy Synthes, UK) bearings were used for this study on multi-station multi-axis hip joint simulators. Two factors were varied, cup inclination angles (45° and 65°) and translational mismatch between the femoral head and acetabular cup (0, 2, 3 and 4 (mm)). Under each condition for both CoC and MoP bearings, three million cycles of gait cycle testing were completed with wear, deformation and/or damage measurements completed at one million cycle intervals. Other outputs of the study were the level of dynamic separation between the femoral head and acetabular cup during gait, the maximum force at the rim during edge loading when the head was sliding back to the cup confinement. Means and 95% confidence limits were determined and statistical analysis were done using one way ANOVA with significance taken at p<0.05. Results. As the level of mismatch and the cup inclination angle increased, the magnitude of dynamic separation and the force at the rim increased. The level of dynamic separation and the force on the rim correlated with the wear of CoC bearings (R= 0.96). For polyethylene, steeper inclination angle did not significantly increase the wear (p>0.05) however, edge loading under 4mm translational mismatch and steep cup inclination angle did (p<0.01). The combined wear and deformation of the polyethylene liners at the rim increased under larger levels of dynamic separation. Conclusions. The magnitude of dynamic separation and force at the rim were predictive of the severity of edge loading. These parameters can be measured using short term testing (500 cycles). This will determine the effect of variations in surgical positioning, implant design and patient factors on the occurrence and severity of edge loading. Then, the wear, deformation and/or damage on hip replacement bearings can be determined using longer term simulator testing under selected conditions. The short term tests do not only help identify worst case scenarios but may identify the boundary of surgical position under which the implants performance may be considered acceptable. A new approach for preclinical testing of hip replacement was developed:. Stage 1: Short biomechanical tests. : assess the occurrence and severity of edge loading conditions where the outputs are:. Magnitude of medial-lateral dynamic separation. Maximum force under edge loading. Stage 2: Wear assessment. : assess the tribological performance of hip replacement under selected conditions where the outputs are:. Wear rates. Deformation and/or damage on the bearing surface

Aims. Joint arthroplasties may be associated with a blood loss, which necessitates transfusion. Especially, hip arthroplasties are highly associate with transfusion to compensate perioperative bleeding. Orthopaedic surgeons and patients have increasing concerns regarding complications of blood transfusions. Although various methods to reduce transfusions have been attempted in TJA, a high percentage of patients require a transfusion during and after the procedures. The purposes of this study were to evaluate the trends of the transfusion(transfusion rates, transfusion amounts, economic burden) in hip arthroplasties, using nationwide data from the National Health Insurance Service (NHIS). Patients and methods. We used data from nationwide claims database of Health Insurance Review Assessment Service (HIRA). The data managed by the NHIS were used to identify the 161,934 hip arthroplasties by 3 categories including bipolar hemiarthroplasty(BH), total hip arthroplasty(THA), and revision arthroplasty(RA) from 2007 to 2015. These 3 categories were classified using the operation code recorded in the requisition data of NHIS. The transfusion rates, transfusion amounts, proportion of transfusion, cost of each type of operation was investigated and stratified by age, gender, hospital type, and area in hip arthroplasties. The proportion of transfusion about whole blood, red blood cell, fresh frozen plasma, platelet, was also evaluated in hip arthroplasties. Results. The patients of hip arthroplasties who receive transfusion was observed 11,224/13,584 in 2007, 12,823/15,325 in 2008, 13,447/16.144 in 2009, 14,915/17,702 in 2010, 15,623/18,648 in 2011, 16,374/19,878 in 2012, 16,961/20,423 in 2013, 16,367/20,060 in 2014 and 16,116/20,170 in 2015. Total transfusion rate was 81.1% in 9 years data.(82.6% in 2007, 83.7% in 2008, 83.3% in 2009, 84.3% in 2010, 83.8% in 2011, 82.4% in 2012, 83% in 2013, 81.6% in 2014, 79.9% in 2015. The overall proportion of transfusion was 7% fresh frozen plasma, 12% platelet, and 77% RBC. The total amount of transfusion was 47,351 in 2007, 56.387 in 2008, 58,320 in 2009, 66,604 in 2010, 68,472 in 2011, 74,735 in 2012, 73,370 in 2013, 67,736 in 2014, and 62,749 in 2015. The average dose of transfusion is 4.1 times in bipolar hemiarthroplasty(343,815/ 83,729), 8.7 times in revision arthroplasty(35,044/4,024), 4.3 times in total hip arthroplasty from 2007 to 2015. Conclusion. In this nationally representative study of patterns of transfusion use in hip arthroplasty, we observed relatively high rates in the use of blood transfusion among patients undergoing hip arthroplasties regardless of many factors including patient, hospital, characteristics, compared with researches in other countries. The total amount of transfusion shows decreasing trends recently, however, it does not seem a big difference in transfusion rate

Introduction. Patients with osteonecrosis of the femoral head are typically younger, more active, and often require high rates of revision following primary total hip arthroplasty. However, outcomes of revision hip arthroplasty in this patient population have been rarely reported in the literature. The purpose of this study was to report the intermediate-term clinical and radiographic outcomes of revision hip arthroplasty in patients with osteonecrosis of the femoral head. Materials & Methods. Between November 1994 and December 2009, 187 revision hip arthoplasty were performed in 137 patients who had a diagnosis of osteonecrosis of the femoral head. Exclusion criteria included infection, recurrent instability, isolated polyethylene liner exchange, and inadequate follow-up (less than 3 years). The final study cohort of this retrospective review consisted of 72 patients (75 hips) with a mean age of 53.3 years (range, 34 to 76). Components used for the acetabular revision included a cementless porous-coated cup in 58 hips and an acetabular cage in 2 hips. Components used for the femoral revision included a fully grit-blasted tapered stem in 30 hips and a proximally porous-coated modular stem in 9 hips. The mean duration of follow-up was 7 years (range, 3 to 17). Results. Mean Harris hip score improved 49 points preoperatively to 90 points. At the time of final follow-up, 11 hips (14.7%) patients required additional reoperation procedure. Of these, six for aseptic loosening of acetabular cup and/or femoral stem, two for deep infection, one for recurrent dislocation, one for periprosthetic femoral fracture, and one for ceramic head fracture. Kaplan-Meier survivorship with an end point for cup revision for aseptic loosening was 98.4% at 5 years, 93.4% at 10 years, and with an end point for stem revision for aseptic loosening was 100% at 5 years, 97.4% at 10 years (Fig. 1). Conclusions. Unlike the previous report, our study showed lower failure rate of femoral stem after revision hip arthroplasty using modern cementless femoral components in patients with osteonecrosis of the femoral head. Aseptic cup loosening or osteolysis is the most common mechanism of failure at the medium-term follow-up following revision hip arthroplasty in these patients group

Introduction. Short-stem hip arthroplasty is gaining popularity as a method of treating hip arthritis in biologically younger patients. The potential benefit of using a short-stem is preservation of bone in the proximal femur for a future revision. We have compared the early clinical and radiological results of a short-stem hip arthroplasty versus a conventional total hip arthroplasty (THA) using a standard length femoral prosthesis with particular focus on functional outcome. Methods. We evaluated a prospectively collected data on consecutive series of 249 patients, who underwent uncemented total hip arthroplasty at our institution. They were distributed into 2 groups: Group I, 125 patients received an uncemented short femoral stem (Mini Hip Arthroplasty (MHA), Corin, Cirencester) and Group II, 124 patients received a conventional uncemented femoral stem (Accolade, Stryker, Michigan) with mean follow up of 3.2 years (2–4). The characteristics of the two groups have been presented in Table I. Evaluation was based on plain radiographs performed at 6 months, 1 year and 2 years postoperatively, while their clinical status was assessed using the modified Harris hip score (mHHS) preoperatively and postoperatively at 6 weeks, 6 months, 1-year, 2-years and annually thereafter. Results. The outcome measures and complications in the two groups are presented in Table II. The mHHS was split into their two components (pain and function) to evaluate any differences between the groups. The postoperative results for pain were similar in both groups (p > 0.05), but the functional element of mHHS was significantly better (p < 0.05)* in Group I compared to Group II. This difference however did not reach the level of the minimum clinically important difference. All femoral stems showed radiographic evidence of bony ingrowth. No evidence of stem subsidence was found in any of the patients. One femoral implant was revised for infection in Group II. Conclusion. Our study suggests that the results of short-stem hip arthroplasty are comparable to conventional uncemented THA in the short-term. The functional outcome scores appear to be better in the short-stem group compared to the conventional group, but the difference is not clinically relevant. Short-stem hip arthroplasty can be an optimal choice for use in younger patients with good bone quality, who are expected to require revision in the future

Introduction. Hip arthroplasty is one of the most common procedures performed every year however complications do occur. Prior studies have examined the impact of insurance status on complications after TJA in small or focused cohorts. The purpose of our study was to utilize a large all-payer inpatient healthcare database to evaluate the effect of patient insurance status on complications following hip arthroplasty. Methods. Data was obtained from the Nationwide Inpatient Sample between 2004 and 2011. Analysis included patients undergoing hip arthroplasty procedures determined by ICD-9 procedure codes. Patient demographics and comorbidities were analyzed and stratified by insurance type. The primary outcome was medical complications, surgical complications and mortality during the same hospitalization. A secondary analysis was performed using a matched cohort comparing patients with Medicare vs private insurance using the coarsened exact matching algorithm. Pearson's chi-squared test and multivariate regression were performed. Results. Overall, 1,011,184 (64.8% Medicare, 29.3% private insurance, 3.7% Medicaid or uninsured, 2.0% Other) patients fulfilled criteria for inclusion into the study. Most were primary total hip arthroplasties (64.2%) and primary hip hemiarthroplasty (29.8%), with 6% revision hip arthroplasties. Multivariate regression analysis showed that patients with private insurance had fewer complications (OR 0.8, p=<0.001) and those with Medicaid or no insurance had more medical complications (OR 1.06, p=0.005) compared to Medicare patients. Similar trends were found for surgical complications and mortality. The matched cohort showed Medicare and private insurance patients had similar complication rates. The most common complication was postoperative anemia, occurring in 22.6% of Medicare patients and 21.1% of patients with private insurance (RR=1.06, p<0.001). Discussion and. Conclusion. This data reveals that patients with Medicare, Medicaid or no insurance have higher risk of medical complications, surgical complications and mortality following hip arthroplasty. Using a matched cohort to directly compare Medicare and private insurance patients, the risk of postoperative complications are similar and generally low with the notable exception of the most common complication, postoperative anemia, which occurs more frequently in patients with Medicare

Background and aim. Arthroplasty registries and consecutive series indicate significantly worse results of conventional metal-on-polyethylene total hip arthroplasty (THA) in patients younger than 50 years compared to older patients, with inferior clinical outcomes and 10-year survivorship ranging between 70 and 90%. At our institution, patients under 50 needing a THA receive either a metal-on-metal hip resurfacing (MoMHRA) or a ceramic-on-ceramic (CoC)THA. In order to evaluate the outcome of these options at minimum 10 years, we conducted a retrospective review of all MoMHRA and CoCTHA with more than 10 years follow-up implanted in patients under 50. Methods. From a single surgeon patients’ prospective database, we identified all consecutive THA performed before May 2005 in patients under 50. All patients are contacted by phone and asked to present for a clinical exam and patient reported outcome questionnaires, standard radiographs and metal ion measurements unless the hip arthroplasty has been revised. Complications and reasons for revision are noted. Kaplan-Meier survivorship is analysed for the whole cohort and sub-analysis is performed by type hip arthroplasty, gender, diagnosis and component size. Results. We identified 773 hip arthroplasties in 684 patients under 50 years performed by a single surgeon between 1997 and May 2005. There are 626 MoMHRA, all Birmingham Hip Resurfacings (BHR) in 561 patients (65 bilateral BHR), 135 CoCTHA in 111 patients (24 bilateral CoC) and 12 Metasul MoMTHA in 12 patients. In the BHR group, there are 392 males (70%) (42 bilateral) and 169 females (30%) (23 bilateral). Mean age at surgery was 40.8 years (median 42 years; range 16–50 years). In 33 cases, a BHR dysplasia cup was used (23 in females). Mean follow-up is 11.5 years (median 11 years; range 10–17 years). In the Metasul MoMTHA, there are 8 males and 4 females. Mean age at surgery was 40.4 years (range 20–50 years). All THA were non-cemented and head size was 28mm in all cases. Mean follow-up is 16.8 years (median 17.5 years; range 12–19 years). In the CoCTHA group, there are 71 males (64%) (17 bilateral) and 40 females (36%) (7 bilateral). Mean age at surgery was 38.2 years (median 39 years; range 16–50 years). In 21 cases, the CoCTHA was a revision of a former hip replacement: 15 THA revisions and 6 hip resurfacing revisions. Three types non-cemented acetabular components were used and 7 types femoral stems (5 non-cemented; 2 cemented). Ceramic heads and inlays were Biolox forte in 128 cases and Biolox delta in 7. Head size was 28mm in 125, 32mm in 7 and 36mm in 3. Mean follow-up is 14.9 years (median 15 years; range 10–18 years). Discussion. Patients under 50 needing a hip arthroplasty often present with more complex anatomic abnormalities or bone damage as in congenital dysplasia, avascular necrosis, traumatic osteoarthritis or rheumatic diseases. Besides, the worse results with conventional THA in young patients may be related to a higher activity level. We present the outcome and survivorship of MoMHRA and CoCTHA in patients under 50 at more than 10 years postop

Purpose. To analyze the effectiveness of a vancomycin impregnated calcium sulfate cement bead insertion after debridement (of) an acute-immediate stage infected hip arthroplasty. Materials and Methods. Between 2002 and 2008, 13 patients with documented acute-immediate stage infection of hip arthroplasty were reviewed and followed for at least two years postoperatively(average 4.3 years). The preoperative and postoperative clinical and radiologic findings and blood laboratory work were checked. All cases were performed through retention of the implant and massive debridement and saline irrigation. After that a vancomycin impregnated calcium sulfate cement beads was inserted. Results. After the first operation, the average interval for second operation was 27.7 days (17–37). At the second operation, the erythrocyte sediment rate and C-reactive protein were 150.97 mm/hr (34.6 ∼339.7 mm/hr) and 76.4 mg/L (41∼132 mg/L) respectively. Infectious organism were cultured and isolated. There were 5 cases of Methicillin resistant staphylococcus aureus (MRSA). In addition, results of an antibiotics sensitivity test were 8 cases of Vancomycin, and 5 cases of 3rd generation Cephalosporin. Radiologic results showed 10 cases with stable fixation on last follow-up (femoral stem) and 1 case of hip joint space narrowing, acetabular erosion. Conclusion. Vancomycin impregnated, calcium sulfate, cement bead insertion for an acute immediate infection of hip arthroplasty proved to be a useful method

Introduction. Robotic-assisted hip arthroplasty helps acetabular preparation and implantation with the assistance of a robotic arm. A computed tomography (CT)-based navigation system is also helpful for acetabular preparation and implantation, however, there is no report to compare these methods. The purpose of this study is to compare the acetabular cup position between the assistance of the robotic arm and the CT-based navigation system in total hip arthroplasty for patients with osteoarthritis secondary to developmental dysplasia of the hip. Methods. We studied 31 hips of 28 patients who underwent the robotic-assisted hip arthroplasty (MAKO group) between August 2018 and March 2019 and 119 hips of 112 patients who received THA under CT-based navigation (CT-navi group) between September 2015 and November 2018. The preoperative diagnosis of all patients was osteoarthritis secondary to developmental dysplasia of the hip. They received the same cementless cup (Trident, Stryker). Robotic-assisted hip arthroplasty were performed by four surgeons while THA under CT-based navigation were performed by single senior surgeon. Target angle was 40 degree of radiological cup inclination (RI) and 15 degree of radiological cup anteversion (RA) in all patients. Propensity score matching was used to match the patients by gender, age, weight, height, BMI, and surgical approach in the two groups and 30 patients in each group were included in this study. Postoperative cup position was assessed using postoperative anterior-posterior pelvic radiograph by the Lewinnek's methods. The differences between target and postoperative cup position were investigated. Results. The acetabular cup position of all cases in both Mako and CT-navi group within Lewinnek's safe zone (RI: 40±10 degree; RA: 15±10 degree) in group were within this zone. Three was no significant difference of RI between Mako and CT-navi group (40.0 ± 2.1 degree vs 39.7± 3.6 degree). RA was 15.0 ± 1.2 degree and 17.0 ± 1.9 degree in MAKO group and in CT-navi group, respectively, with significant difference (p<0.001). The differences of RA between target and postoperative angle were smaller in MAKO group than CT-navi group (0.60± 1.05 degree vs 2.34± 1.40 degree, p<0.001). The difference or RI in MAKO group was smaller than in CT-navi, however, there was no significance between them (1.67± 1.27 degree vs 2.39± 2.68 degree, p=0.197). Conclusions. Both the assistance of the robotic arm and the CT-based navigation system were helpful to achieve the acetabular cup implantation, however, MAKO system achieved more accurate acetabular cup implantation than CT-based navigation system in total hip arthroplasty for the patients with OA secondary to DDH. Longer follow-up is necessary to investigate the clinical outcome

Purpose. The purpose of this study was to assess the efficacy of newly designed topical administration of tranexamic acid (TXA) in reducing postoperative bleeding in total hip arthroplasty (THA) and bipolar hip hemiarthroplasty (BHA). Method. Consecutive series of 160 hip arthroplasty were enrolled for this study. Topical administration of TXA was done in group 1(40 hips of THA and 40 hips of BHA). We compared the amount of blood loss and rates of postoperative transfusion with group 2 (40 cases of THA and 40 cases of BHA) in which TXA solution was not applied. Results. The total amount of blood loss of THA group 1 and THA group 2 was 793±50 mL and 1086±73 mL respectively (p = 0.001). The transfusion rates of THA group 1 and THA group 2 was 27.5% and 50%, respectively (p= 0.039). The transfusion rates of BHA group 1 and BHA 2 group was 45% and 60%, respectively (p= 0.179). The amounts of blood loss through the drainage tube were 186±22 mL and 257±24 mL in THA group 1 and THA group 2, respectively, and 101±11 mL and 147±16 mL in BHA group 1 and BHA group 2, respectively, showing statistical significance. No complications such as infection, deep vein thrombosis, cardiovasular disease were observed during the hospital stay and last follow-up. Conclusion. Topical administration of TXA is an effective and safe method to reduce postoperative bleeding and transfusion rates in hip arthroplasty

INTRODUCTION. The Woodpecker pneumatic broaching system facilitates femoral preparation to achieve optimal primary fixation of the stem in direct anterior hip replacement using a standard operating table. The high-frequency axial impulses of the device reduce excess bone tension, intraoperative femoral fractures and overall operating time. The Woodpecker device provides uniformity and enhanced control while broaching, optimizing cortical contact between the femur and implant and thereby maximizing prosthetic axial stability and longevity. This study aims to describe a single surgeon's experience using the Woodpecker pneumatic broaching system in 649 cases of direct anterior approach (DAA) total hip arthroplasties to determine the device's safety and efficacy. METHODOLOGY. All consecutive patients undergoing elective anterior bikini total hip arthroplasties (THA) performed by a single surgeon between July 2013 and June 2018 were included. Patients undergoing a THA with the use of the Woodpecker device through a different surgical approach, revision THA or arthroplasties for a fractured neck of femur were excluded (n=219). The pneumatic device was used for broaching the femoral canal in all cases. Pre-operative and post-operative Harris Hip Scores (HHS) and post-operative radiographs were analyzed to identify femoral fractures and femoral component positioning at 6 weeks, 6 months and 12 months post-operative. Any intra-operative or post-operative surgical complications and component survivorship until most recent follow up were recorded in the clinical notes. RESULTS. A total of 649 patients (L THA=317, R THA=328 and bilateral=2) with a mean age of 69 (range 46–91yrs) and mean BMI of 28.3 (range = 18.4–44.0) underwent a DAA THA using a Woodpecker device were included in the study. Of these patients, 521 (80%) underwent uncemented and 128 (20%) underwent cemented femoral components. The time taken to broach the femur using Woodpecker broaching this system averaged 2.8 minutes (1.4 to 7.5 minutes) in both cemented and uncemented cases. In 91% of cases the templated broach size was achieved with the remaining 9% within +/− 1 size of the planned template. Radiographic analysis revealed 67.3% of the stems placed in 0–1.82 degrees of varus and 32.7% placed in 0–1.4 degrees of valgus. Average HHS were 24.4 pre-operatively, with drastic improvements shown at 6 weeks (80.95), 6 months (91.91) and 12 months (94.18) after surgery. Intraoperative femoral fractures occurred in three patients (0.4%) during trial reduction, a further three patients had periprosthetic post-operative fractures (0.4%) from falls, two patients had stem subsidence (0.3%) and a further two patients had wound infections (0.3%). At the most recent follow up, the survivorship of the acetabular component was 99.7% and the femoral component was 99.1%, with mean follow up of 2.9 years (0.5 to 5 years). No intraoperative or post-operative complications could be directly attributed to the Woodpecker broaching system. CONCLUSION. The pneumatic Woodpecker device is a safe and effective alternative tool in minimally invasive direct anterior hip replacement surgery for femoral broaching performed on a standard operating table. The skill and experience of the surgeon must be taken into consideration when utilizing new surgical devices

Aim

The duration of systemic antibiotic therapy following first-stage surgery is contentious. Our Institution's philosophy is to perform an aggressive debridement, use high concentration targeted antibiotics through cement beads and systemic prophylactic antibiotics alone. In the presence of significant soft tissue infection or microbiological diagnostic uncertainty; systemic antibiotics may be prescribed for 5 days whilst awaiting tissue culture results. The aim of this study was to assess the success of our philosophy in the management of PJI of the hip using our two-stage protocol.

The objective of this study was to evaluate the short term clinical and radiological results of a new short stem hip implant. In 29 consecutive patients suffering from osteoarthritis with 33 affected hip joints, the clinical and radiological results of 33 cementless hip arthroplasties using a cementless implanted short stem prosthesis type Aida and a cementless cup type Ecofit were evaluated prospectively between October 2009 and June 2015 in two hospitals. The median age of patients at time of surgery was 55 years (range, 30–71 years), 23 male and 10 female patients were included in the study. The median clinical follow up was 24 months (range, 1.5–51 months), and the median radiological follow up was 12 months (range, 1–51 months). Two patients were lost to follow up and two patients had only one immediate postoperative x- ray. The Harris Hip Score improved from a median preoperative value of 53 to a median postoperative value of 93 at follow up. Radiological analysis showed that 19 stems (58%) showed stable bony ingrowth, five cases (15%) showed stable fibrous ingrowth. Four cases need further follow up for proper evaluation of stem fixation. The short term survival of this new short stem is very promising, and achieving the goals of standard hip arthroplasty

Background

Data regarding the diagnostic value of ultrasound (US)-determined fluid film and joint aspiration prior to revision total hip arthroplasty (THA) for suspected periprosthetic joint infections (PJIs) is limited. This study aimed to analyse (1) the value of US-determined fluid film, (2) characterisation of the pre- and intraoperative microbiological spectrum and resistance patterns and (3) the concordance between preoperative synovial fluid and intraoperative culture results.

BACKGROUND. Hip arthroplasty is an ultimate treatment for individuals with severe hip osteoarthritis. There are several available approaches when performing this type of surgery, however there is a growing interest in using the least invasive procedures. These less invasive procedures aid in healthy bone preservation which may be particularly important for younger populations undergoing hip arthoplasy (Rajakulendran & Field, 2012). Accurate and reliable measurement techniques are needed to better study and monitor the outcome of different implantation techniques during the postop recovery. OBJECTIVES. To develop a better understanding of spatiotemporal aspects of gait pre- and post- hip arthroplasty through the anterior approach. METHODS. Six subjects treated with an anterior approach hip-arthroplasty were instructed to walk over a 30 foot walkway while wearing a lumbar gait sensor that is equipped with an accelerometer and gyroscope used to track changes in body position and hip angles. Subjects were tested before surgery, 3 and 6 weeks post-surgery, and 3 and 6 months post-surgery. The subjects were compared to healthy, age-matched controls. RESULTS. The use of this device enabled the measurement of consistent gait temporal characteristics throughout the different time points. It was found that spatiotemporal parameters improved as time progressed post-surgery. Furthermore, it is noted that the most substantial improvements were observed after the six week mark with a possible plateauing observed after the three month mark. The following figures illustrate the changes over time experienced by a subject. Their data is also compared to that of a healthy control. Figure 1 summarizes the 6-month follow up results of a female subject with anterior approach THA. CONCLUSIONS. The greatest improvements in performance were observed as early as 6 weeks post-surgery in some of the subjects. The data also suggests that improvements may plateau after 3 months post-surgery. These biomechanical findings may help with post-surgical physical activity and therapeutic recommendations as well as providing clinicians with a better prognosis time frame for the anterior approach hip arthroplasty

Background. Hip resurfacing arthroplasty (HRA) and total hip arthroplasty (THA) are treatments of end-stage hip disease. Gait analysis studies comparing HRA and THA have demonstrated that HRA results in a more normal gait than THA. The reasons may include the larger, more anatomic head diameter or the preservation of the neck of the femur with restoration of the anatomical position of the hip centre and normal proprioception. This study investigated (1) whether femoral head size diameter affects gait; (2) whether gait still differs between THA and HRA patients even with comparable head diameters. Methods. We retrospectively analysed the gait of 33 controls and 50 patients with a unilateral hip replacement, operated by the same surgeon. Follow-up ranged from 9–68 months. In 27 hips a small femoral head size was used (≤ 36mm); in 23 hips a large head size (>36mm). The small size group consisted of 11 long femoral stem THA and 16 short-stem THA and the large group of 5 long-stem THA, 8 short-stem THA and 10 HRA patients. There were 14 females/19 males in the control group; 22 females/5 males in the small size group; 13 females/10 males in the large size group. Results. (1) We found a significant difference in the step-length between the small head size group and the controls (p<0.01) at speeds ranging from 4.0 to 5.5 km/h but no difference between the larger head size and the controls. There was no significant difference in maximum speed, weight acceptance, push-off, mid-stance, impulse and cadence between the groups. (2) Analysis between THA and HRA in the large head size group revealed that there was a significant difference in the maximum speed (p=0.021) between the long-stem THA (6.338 km/h± 1.542) and HRA (7.756km/h± 0.7604) patients. At 5.5 km/h there was a significantly better weight acceptance (p=0.009) and mid-stance (p=0.041) of the HRA compared to short-stems. Impulse was significantly higher for HRA compared to long-stem THA (p<0.05) at all speeds ranging 4 to 5.5 km/h. (3) Males (7.1972 km/h ± .9700) had significantly higher maximum speeds compared to females (6.6524km/h± 1.019) (p=0.017) and lower gait impulse (p<0.01) at speeds ranging from 4 to 5.5km/h. (4) There was no significant difference in the Oxford Hip Score (OHS) and EQ-5D of patients in the small compared to the large head size group. Conclusions. Gait analysis demonstrated a significant difference in step length between THA patients with head size ≤ 36mm and normal controls. There was no difference in step length between normal controls and THA patients with larger head sizes. Compared to larger head size THA, the HRA still revealed higher maximum speeds and better weight acceptance. Males had significantly higher maximum speeds compared to females (controls and hip replacement patients). We could not demonstrate a correlation between better gait and Oxford scores or EQ-5D scores but these scores are known to have a ceiling effect. In a former study, better gait parameters such as longer step length and higher maximum speed have been associated with higher patient satisfaction

Revision of the femoral component during revision hip arthroplasty may pose significant technical challenges, most notably femoral fracture and bone perforation. The in-cementing technique allows use of the original bone-cement interface which has been proven to be biomechanically stronger than recementing after complete removal of the original cement mantle. This study reviews a series of 54 consecutive revision hip arthroplasty procedures carried out by the senior author using the in-cementing technique from November 1999 to March 2003. Patients were followed up clinically and radiologically with serial outpatient reviews and their functional outcome was assessed using the Harris hip scoring system, the Oxford hip scoring system and the University of California at Los Angeles (UCLA) activity profile. Their physical and mental well-being was also assessed using the SF-36 self-questionnaire. Fifty-four procedures were performed on 51 patients. There were 31 males and 20 females. The average age was 70.3+/-8.1 years (range: 45-83 years). The average time to revision from the original procedure was 132.8+/-59.0 months (range: 26-286 months). The average length of follow-up was 29.2+/-13.4 months (range: 6-51 months) post revision arthroplasty. Two patients suffered dislocations, one of which was recurrent and was revised with a Girdlestone's procedure. No patient displayed any evidence of radiographical loosening. The average Harris hip score of the study group was 85.2+/-11.6 (range: 51.9-98.5). The average Oxford hip score recorded was 19.6+/-7.7 (range: 12-41) and the average UCLA activity profile score was 5.9+/-1.6 (range: 3-8). The SF-36 questionnaire had an average value of 78.0+/-18.3 (range: 31.6-100). In conclusion, the results of this study show excellent clinical and radiological results of the in-cementing technique with high patient satisfaction in terms of functional outcome. This technique merits consideration where possible in revision hip arthroplasty