Introduction:. Intraoperative cell salvage involves the collection of blood directly from the operative field. The purpose of this study was to determine if its use reduces the need for postoperative allogenic blood transfusion, assess any adverse events and its effect on duration of postoperative stay in primary hip arthroplasty. Patients and Methods:. We prospectively examined the effect of intraoperative cell salvage on the need for postoperative allogenic blood transfusion. Between February 2009 and August 2010, a total of 77 patients who underwent primary total hip arthroplasty were included in the study, under the care of the senior author (KB). All patients had a diagnosis of osteoarthritis. Intraoperative cell salvage was used in 38 patients and not used in 39 patients. We prospectively collected data on patient demographics, ASA grade, preoperative and postoperative haematological features, number of units of packed red cells transfused and the volume of intraoperative reinfused cell salvaged blood. Total inpatient stay and any postoperative adverse events were recorded. Results:. No patients in the cell salvage group required postoperative allogenic blood transfusion compared to three patients (7.7%) in the conventional group. Postoperative decrease in haemoglobin was less in the cell salvage group (2.57 vs. 3.3 g/dL). The mean length of postoperative inpatient stay was shorter in the cell salvage group (5.1 vs. 6.41 days). Three patients in the cell salvage group had adverse events (1 UTI, 1 hyponatraemia, 1 colonic pseudo-obstruction). Three patients in the conventional group experienced adverse events (2 superficial wound infections, 1 DVT). An average of 361 mls of cell salvaged blood was reinfused (110–900 mls). Conclusions:. We have found that the use of intraoperative cell salvage in patients undergoing primary total hip arthroplasty reduces the need for post operative allogenic blood transfusion with no increase in adverse events when compared to conventional measures of blood preserving techniques

With an increasing ageing population and a rise in the number of primary hip arthroplasty, peri-prosthetic fracture (PPF) reconstructive surgery is becoming more commonplace. The Swedish National Hip Registry reported that, in 2002, 5.1% of primary total hip replacements required revision due to PPF. Laboratory studies have indicated that age, bone quality and BMI all contribute to an increased risk of PPF. Osteolysis and aseptic loosening contribute to the formation of loosening zones as described by Gruen, with subsequent increased risk of fracture. The aim of the study was to identify significant risk factors for PPF in patients who have undergone primary total hip replacement (THR). Logbooks of three Consultant hip surgeons were filtered for patients who had THR-PPF fixation subsequent to trauma. Risk factors evaluated included sex, age, bone density (Singhs index), loosening zones, Vancouver classification, prosthesis stem angle relative to the axis of the femur, and length of time from THR to fracture. A control group of uncomplicated primary THR patients was also scrutinised. Forty-six PPF were identified representing 2.59% of THR workload. The male: female ratios in both groups were not significantly different (1:1.27 and 1:1.14 respectively). Average age of PPF was 72.1, which was significantly older than the control group (54.7, p>0.05). The commonest type of PPF was Vancouver type B. Whilst stem position in the AP plane was similar in both groups, in lateral views the PPF stem angle demonstrated significant antero-grade leg position compared to the non-PPF group (p.0.05). The PPF group demonstrated a greater number of loosening zones in pre-fracture radiographs compared to the control group (2.59 and 1.39 respectively, p>0.05). Our workload from PPF reflects that seen in Europe. Age, stem position and the degree of stem loosening appear to contribute to the risk of a peri-prosthetic fracture

Structural bulk autografts restore the severe bone loss at primary hip arthroplasty in dysplastic hips and have shown to have good long term outcomes. There are only a few reports of revision arthroplasty for these sockets that fail eventually. We report on a series of such primary hips which underwent cemented revision of the socket for aseptic loosening and their outcomes. A retrospective review was performed from our database to identify fifteen acetabular revisions after previous bulk autograft. The mean age at revision was 53.9 years (range 31–72.1). The mean duration between the primary and revision arthroplasty was 12.4 years (range 6.6 – 20.3). All procedures were done using trochanteric osteotomy and three hips also needed the femoral component revision. All fifteen hips needed re-bone grafting at the revision surgery to restore the new socket to the level of the true acetabulum. Of these ten hips had morsellised impaction allograft, and the remaining five also needing a structural bulk allograft. Two sockets underwent re-revision at mean 7.5 years for aseptic loosening. One patient had a dislocation that was reduced closed. At a mean follow up of 5.7 years, one socket showed superior migration, but was stable and did not need further intervention. Two other sockets also showed radiological evidence of loosening, and are being closely monitored. The medium term results of cemented acetabular revision in this younger age group are satisfactory, with repeat bone grafting being required to restore the true acetabular position. Though the primary arthroplasty with bulk bone graft recreates the acetabular bone stock, significant bone loss due to the mechanical loosening of the socket needs to be anticipated in revision surgery

Introduction. This is a retrospective review of the incidence of deep venous thrombosis (DVT) in 679 consecutive unilateral primary hip arthroplasty procedures performed between January 2007 and December 2010 managed with no anticoagulants. Mean age at operation was 58 years. Mean BMI was 26. The prophylaxis regimen included hypotensive epidural anesthesia, compression stockings, intermittent calf compression, early mobilization and an antiplatelet agent. Methods. 562 hybrid hip resurfacing procedures and 117 uncemented THRs, all performed through a posterior incision were included. Doppler ultrasound screening for DVT was performed in all patients between the fourth and sixth post-operative days. Patients were reviewed clinicoradiologically 6 to 10 weeks after operation and with a postal questionnaire at the end of 12 weeks to detect symptomatic VTE incidence following discharge. 14 patients with pre-existent VTE, coagulation disorders or cardiac problems requiring anticoagulant usage were excluded. Results. There were no symptomatic DVTs. Ten cases (1.5%) of asymptomatic below-knee DVT and 1 above-knee asymptomatic DVT (0.15%) were detected on USG. One patient had non-fatal pulmonary embolism but no evidence of lower limb DVT on repeated USG examinations. On investigation he was found to have Prothrombin 20210A mutation. The incidence of DVT was 1.6% (9 of 562) in the resurfacing group and 1.7% (2 of 117) in the THA group, an overall incidence of 1.6% (11/679) in the whole group. Fourteen patients (2.1%) needed a blood transfusion including 9 resurfacings (1.6%) and 5 THAs (4.3%). Discussion and Conclusion. This combination regimen which offers the prospect of low incidence of venous thromboembolism, without subjecting patients to the higher risks of bleeding associated with anticoagulant usage

We report the clinical and radiological outcome of consecutive primary hip arthroplasties using the JRI-Furlong Hydroxyapatite ceramic (HAC) coated acetabular components. We reviewed 412 consecutive cementless primary THA using fully coated acetabular shell in 392 patients—with a minimum 12 to 18 year follow-up—performed at two institutions between 1986 and 1994. Twenty (22 THA) were lost prior to 12-year follow-up, leaving 372 patients (390 THA) available for study. Fully HAC coated stems were used in all patients. The clinical outcome was measured using Harris, Charnley and Oxford hip scores and the quality of life using EuroQol EQ-5D. Radiographs were systematically analysed for implant position, loosening, migration, osteolysis. Polythene wear was digitally measured. The radiographic stability of the acetabular component was determined by Enghs criteria. The mean age was 74.4 years. The mean Harris and Oxford scores were 87 (78– 97) and 19.1 (12–33) respectively. The Charnley score was 5.6 (5-6) for pain, 5.2 (4–6) for movement and 5.3 (4–6) for mobility. Migration of acetabular component was seen in four hips. Acetabular radiolucencies were present in 54 hips (9.7%). The mean linear polythene wear was 0.06mm/year. Mean inclination was 48.4° (38–65). Radiolucencies were present around 37 (6.6%) stems. Dislocation occurred in 10 patients (three recurrent). Re-operations were performed in nine patients (1.9%). Four acetabular revisions were performed for aseptic loosening. Other re-operations were for infection (three), periprosthetic fractures (one), cup malposition (one) and revision of worn liner (three). Mean EQ-5D description scores and health thermometer scores were 0.81 (0.71–0.89) and 86 (64–95). With an end point of definite or probable loosening, the probability of survival at 12 years was 97.1% for acetabular component. Overall survival at 12 years with removal or repeat revision of either component for any reason as the end point was 96.2%. The results of this study support the continued use of a fully coated prosthesis and documents the durability of the HAC coated components. In our clinical experience, the Furlong prosthesis revealed encouraging radiographic stability over a long-term period

This session will be practically oriented, focusing on important surgical decisions and on technical tips to avoid complications. The panel will be polled concerning individual preferences as regards the following issues in primary total hip arthroplasty: 1. Perioperative antibiotics; 2. Blood management and tranexamic acid protocols; 3. Surgical indications: high BMI patients; 4. Surgical approach for primary total hip arthroplasty: indications or preferences for direct anterior, anterolateral, posterior; 5. Acetabular fixation; 6. Tips for optimizing acetabular component orientation; 7. Femoral fixation: (a) Indications for cemented and uncemented implants. Case examples will be used.; (b) Is there still a role for hip resurfacing?; 8. Femoral material and size: (a) Preferred head sizes and materials in different situations.; (b) Is there a role for dual mobility implants in primary THA?; 9. Bearing surface: present role of different bearings. Case examples will be used. 10. Tips for optimizing intraoperative hip stability; 11. Tips for optimizing leg length; 12. Postoperative venous thromboembolism prophylaxis; 13. Heterotopic bone prophylaxis; 14. Postoperative pain management; 15. Hospital discharge: is there a role for outpatient surgery?; 16. Postoperative rehabilitation protocol: weight bearing, role of physical therapy; 17. Postoperative activity restrictions; hip dislocation precautions; 18. Is there value to physical therapy as outpatient after THA?; 19. Long-term antibiotic prophylaxis for procedures.

This session will be practically oriented, focusing on important surgical decisions and on technical tips to avoid complications. The panel will be polled concerning individual preferences as regards the following issues in primary total hip arthroplasty: 1.) Peri-operative antibiotics; 2.) Blood management and tranexamic acid protocols; 3.) Surgical indications: High BMI patients; 4.) Surgical approach for primary total hip arthroplasty: indications or preferences for direct anterior, anterolateral, posterior; 5.) Acetabular fixation; 6.) Tips for optimizing acetabular component orientation; 7.) Femoral fixation: Indications for cemented and uncemented implants. Is there still a role for hip resurfacing?; 8.) Femoral material and size: Preferred head sizes and materials in different situations. Is there a role for dual mobility implants in primary THA?; 9.) Bearing surface: Present role of different bearings; 10.) Tips for optimizing intra-operative hip stability; 11.) Tips for optimizing leg length; 12.) Post-operative venous thromboembolism prophylaxis; 13.) Heterotopic bone prophylaxis; 14.) Post-operative pain management; 15.) Hospital discharge: Is there a role for outpatient surgery?; 16.) Post-operative rehabilitation protocol: weight bearing, role of physical therapy; 17.) Post-operative activity restrictions; hip dislocation precautions; 18.) Is there value to physical therapy as outpatient after THA?; 19.) Long-term antibiotic prophylaxis for procedures.

This session will be practically oriented, focusing on important surgical decisions and on technical tips to avoid complications. The panel will be polled concerning individual preferences as regards the following issues in primary total hip arthroplasty: 1.) Peri-operative antibiotics; 2.) Blood management and tranexamic acid protocols; 3.) Surgical indications: High BMI patients; 4.) Surgical approach for primary total hip arthroplasty: indications or preferences for direct anterior, anterolateral, posterior; 5.) Acetabular fixation; 6.) Tips for optimizing acetabular component orientation; 7.) Femoral fixation: (a) Indications for cemented and uncemented implants. (b) Is there still a role for hip resurfacing?; 8.) Femoral material and size: (a) Preferred head sizes and materials in different situations. (b) Is there a role for dual mobility implants in primary THA?; 9.) Bearing surface: Present role of different bearings. 10.) Tips for optimizing intra-operative hip stability; 11.) Tips for optimizing leg length; 12.) Post-operative venous thromboembolism prophylaxis; 13.) Heterotopic bone prophylaxis; 14.) Post-operative pain management; 15.) Hospital discharge: Is there a role for outpatient surgery?; 16.) Post-operative rehabilitation protocol: weight bearing, role of physical therapy; 17.) Post-operative activity restrictions; hip dislocation precautions; 18.) Is there value to physical therapy as outpatient after THA?; and 19.) Long-term antibiotic prophylaxis for procedures.

This session will be practically oriented, focusing on important surgical decisions and on technical tips to avoid complications. The panel will be polled concerning individual preferences as regards the following issues in primary total hip arthroplasty: Perioperative antibiotics/blood management/preferred anesthetics, Surgical approach for primary total hip arthroplasty, Acetabular fixation, Tips for optimizing acetabular component orientation, Femoral fixation, Femoral head size, Bearing surface, Tips for optimizing intraoperative hip stability, Tips for optimizing leg length, Postoperative venous thromboembolism prophylaxis, Heterotopic bone prophylaxis, Postoperative pain management, Postoperative rehabilitation protocol, Postoperative activity restrictions, and Postoperative antibiotic prophylaxis for procedures.

This session will be practically oriented, focusing on important surgical decisions and on technical tips to avoid complications. The panel will be polled concerning individual preferences as regards the following issues in primary total hip arthroplasty: Perioperative antibiotics/blood management/preferred anesthetics; Surgical approach for primary total hip arthroplasty: indications or preferences for direct anterior, anterolateral, posterior; Acetabular fixation; Tips for optimizing acetabular component orientation; Femoral fixation: Indications for cemented and uncemented implants. Case examples will be used. Is there still a role for hip resurfacing?; Femoral head size: Preferred head sizes and materials in different situations. Is there a role for dual mobility implants in primary THA?; Bearing surface: Present role of different bearings. Case examples will be used.; Tips for optimizing intra-operative hip stability; Tips for optimizing leg length; Post-operative venous thromboembolism prophylaxis; Heterotopic bone prophylaxis; Post-operative pain management; Post-operative rehabilitation protocol: weight bearing, role of physical therapy; Post-operative activity restrictions; Post-operative antibiotic prophylaxis for procedures.

This session will be practically oriented, focusing on important surgical decisions and on technical tips to avoid complications. The panel will be polled concerning individual preferences as regards the following issues in primary total hip arthroplasty: 1. Peri-operative antibiotics/blood management/preferred anesthetics; 2. Surgical approach for primary total hip arthroplasty: indications or preferences for direct anterior, anterolateral, posterior; 3. Acetabular fixation; 4. Tips for optimizing acetabular component orientation; 5. Femoral fixation: (a) Indications for cemented and uncemented implants. (b) Role of hip resurfacing; 6. Femoral head size: Preferred head sizes in different situations; 7. Bearing surface: Present role of different bearings; 8. Tips for optimizing intra-operative hip stability; 9. Tips for optimizing leg length; 10. Post-operative venous thromboembolism prophylaxis; 11. Heterotopic bone prophylaxis; 12. Post-operative pain management; 13. Post-operative rehabilitation protocol: weight bearing, role of physical therapy; 14. Post-operative activity restrictions; and 15. Post-operative antibiotic prophylaxis for procedures.

This session will be practically oriented, focusing on important surgical decisions and on technical tips to avoid complications. The panel will be polled concerning individual preferences as regards the following issues in primary total hip arthroplasty.

Perioperative antibiotics/blood management/preferred anesthetics; Surgical approach for primary total hip arthroplasty: indications or preferences for direct anterior, anterolateral, posterior; Acetabular fixation; Tips for optimising acetabular component orientation; Femoral fixation: indications for cemented and uncemented implants, role of hip resurfacing; Femoral head size: preferred head sizes in different situations; Bearing surface: present role of different bearings; Tips for optimising intraoperative hip stability; Tips for optimising leg length; Postoperative venous thromboembolism prophylaxis; Heterotopic bone prophylaxis; Postoperative pain management; Postoperative rehabilitation protocol: weight bearing, role of physical therapy; Postoperative activity restrictions; Postoperative antibiotic prophylaxis for procedures

This session will be practically oriented, focusing on important surgical decisions and on technical tips to avoid complications. The panel will be polled concerning individual preferences as regards the following issues in primary total hip arthroplasty: Peri-operative antibiotics/blood management/preferred anesthetic, Surgical approach for primary total hip arthroplasty: indications or preferences for direct anterior, anterolateral, posterior, less invasive exposures, Acetabular fixation, Tips for optimising acetabular component orientation, Femoral fixation: Indications for cemented and uncemented implants and Role of hip resurfacing, Preferred femoral head size, Choice of bearing surface, Tips for optimising intra-operative hip stability, Tips for optimising leg length, Post-operative venous thromboembolism prophylaxis, Heterotopic bone prophylaxis, Post-operative pain management, rehabilitation protocol, activity restrictions and antibiotic prophylaxis.

This session will be practically oriented, focusing on important surgical decisions and on technical tips to avoid complications. The panel will be polled concerning individual preferences as regards the following issues in primary total hip arthroplasty: 1.) Perioperative antibiotics/blood management/preferred anesthetics, 2.) Surgical approach for primary total hip arthroplasty: indications or preferences for direct anterior, anterolateral, posterior, 3.) Acetabular fixation, 4.) Tips for optimising acetabular component orientation, 5.) Femoral fixation: (a) Indications for cemented and uncemented implants. (b) Role of hip resurfacing, 6.) Femoral head size, 7.) Bearing surface, 8.) Tips for optimising intraoperative hip stability, 9.) Tips for optimising leg length, 10.) Postoperative venous thromboembolism prophylaxis, 11.) Heterotopic bone prophylaxis, 12.) Postoperative pain management, 13.) Postoperative rehabilitation protocol: weight bearing, role of physical therapy, 14.) Postoperative activity restrictions, and 15.) Postoperative antibiotic prophylaxis for procedures.

This session will be practically oriented, focusing on important surgical decisions and on technical tips to avoid complications. The panel will be polled concerning individual preferences as regards the following issues in primary total hip arthroplasty: 1.

Perioperative antibiotics/blood management/preferred anesthetics

Introduction

While total hip arthroplasty is considered to be one of the most cost-effective medical interventions, the total cost of care for a population patients treated by THR can present a significant burden on the payer, whether it be an employer, private insurer or government. Data on the true cost of care has rarely been made available to the treating physician. Such lack of information makes comprehensive management difficult. Bundled payment models of care require knowledge of all costs associated with the care of our patients and opens new opportunity for analysis to improve management and outcomes. The current study assess the influence of surgical technique on total cost of care for total hip arthroplasty.

Purpose of the study

We reviewed one hundred and twenty patients who had primary total hip replacement using Corail/Pinnacle Metal on metal bearing surfaces between 2006 and 2009.

We were interested in the metal ion levels of the whole cohort, the incidence of unexplained pain, pseudo tumour lesions (ALVAL) and early loosening and failure. We were particularly interested in the relationship of the acetabular cup position in relation to the pelvis and lumbar spine.

Aim. The aim of the present work was (i) to survey the situation of healthcare regarding the use of antibiotics in orthopaedics and trauma surgery in Germany, (ii) to determine which empiric antibiotic regimens are preferred in the treatment of periprosthethic joint infections (PJI) and (iii) to evaluate the hypothetical antibiotic adequacy of the applied empirical antibiotic therapy regimens based on a patient collective of a German university hospital. Method. A survey on empirical and prophylactic antibiotic therapy was conducted at German university and occupational health clinics (BG clinics), each in the specialties of orthopedics and trauma surgery. A total of 71 clinics were contacted by email. The questionnaire sent included open-ended questions on systemic antibiotic prophylaxis in primary hip arthroplasty; a distinction was made between hip arthroplasty due to femoral fractures and elective hip arthroplasty. In addition, the empirical antibiotic therapy used in PJIs was surveyed. To determine the success rate of prophylaxis and therapy according to sensitivity to the antibiotics applied, the survey results were compared with previously published data on antimicrobial treatment in n=81 PJI patients treated in our department between 2017 and 2020. Results. In 93.2% (elective) and 88.6% (fracture care) of the hospitals, 1st- and 2nd-generation cephalosporins are administered perioperatively for infection prophylaxis in primary hip arthroplasty. In contrast, empiric antibiotic treatment for PJI showed a clearly inhomogeneous therapeutic picture. Monotherapy with an aminopenicillin/betalactamase inhibitor is most frequently used (38.7%); 1st- and 2nd-generation cephalosporins are second most frequently used as monotherapy (18.2%). In addition, dual combination therapies have become established, mostly aminopenicillin/betalactamase inhibitor or 1st- and 2nd-generation cephalosporins, whose administration is supplemented with another antibiotic. The most common combination in PJI is aminopenicillin/betalactamase inhibitor + vancomycin (11.4%). The most widely used therapy (monotherapy with aminopenicillin/betalactamase inhibitor) would have covered 69.0% of PJI patients. Monotherapy with 1st- and 2nd-generation cephalosporins would have been susceptible to 57.8% of PJI patients. In contrast, a combination of vancomycin + 1st- and 2nd-generation cephalosporins would have been most effective, with an efficacy of 91.5% according to the resistograms, but this was used by only two hospitals. Conclusions. Empirical antibiotic therapy for the treatment of PJI is applied in more than half of the clinics with a single broad-spectrum beta-lactamase inhibitor antibiotic. This discrepancy between the everyday care in the clinics and the administration of clearly more effective combination therapies underlines the need for recommendation guidelines

Aims. As the peak of the COVID-19 pandemic passes, the challenge shifts to safe resumption of routine medical services, including elective orthopaedic surgery. Protocols including pre-operative self-isolation, COVID-19 testing, and surgery at a non-COVID-19 site have been developed to minimize risk of transmission. Despite this, it is likely that many patients will want to delay surgery for fear of contracting COVID-19. The aim of this study is to identify the number of patients who still want to proceed with planned elective orthopaedic surgery in this current environment. Methods. This is a prospective, single surgeon study of 102 patients who were on the waiting list for an elective hip or knee procedure during the COVID-19 pandemic. Baseline characteristics including age, ASA grade, COVID-19 risk, procedure type, surgical priority, and admission type were recorded. The primary outcome was patient consent to continue with planned surgical care after resumption of elective orthopaedic services. Subgroup analysis was also performed to determine if any specific patient factors influenced the decision to proceed with surgery. Results. Overall, 58 patients (56.8%) wanted to continue with planned surgical care at the earliest possibility. Patients classified as ASA I and ASA II were more likely to agree to surgery (60.5% and 60.0%, respectively) compared to ASA III and ASA IV patients (44.4% and 0.0%, respectively) (p = 0.01). In addition, patients undergoing soft tissue knee surgery were more likely to consent to surgery (90.0%) compared to patients undergoing primary hip arthroplasty (68.6%), primary knee arthroplasty (48.7%), revision hip or knee arthroplasty (0.0%), or hip and knee injections (43.8%) (p = 0.03). Conclusion. Restarting elective orthopaedic services during the COVID-19 pandemic remains a significant challenge. Given the uncertain environment, it is unsurprising that only 56% of patients were prepared to continue with their planned surgical care upon resumption of elective services. Cite this article: Bone Joint Open 2020;1-6:267–271

The selection of an acetabular component for primary hip arthroplasty has narrowed significantly over the past 10 years. Although monoblock components demonstrated excellent long-term success the difficulty with insertion and failure to fully appreciate full coaptation of contact with the acetabular floor has led to almost complete elimination of its utilization. Modular acetabular components usually with titanium shells and highly crosslinked polyethylene are by far the most utilised today. This is particularly true with mid-term results demonstrating excellent wear rates and extremely low failure rates and the concern of possible mechanical failure of highly crosslinked polyethylene not being a clinical problem. Ceramic liners are also used but problems with squeaking articulations and liner chipping have made highly crosslinked polyethylene the preferred liner material. Metal-on-metal except in surface replacement arthroplasty is rarely used in primary hip arthroplasty. With instability in total hip replacement still being a significant and the leading cause of revision hip replacement the dual mobility articulation has emerged as an increasingly used acetabular component. This is composed of either a monoblock cobalt chrome socket articulating with a large polyethylene liner into which the femoral head is constrained. The polyethylene liner becomes essentially a larger femoral head articulation and hip stability is significantly improved. A modular dual mobility can also be utilised with a titanium shell and a cobalt chrome liner inserted into the shell and then a dual mobility articulation. In a recent series of 182 dual mobility cups, all monoblock ADM, in high risk patients undergoing primary total hip replacement there was 1 interprosthetic dislocation which occurred during reduction of a dislocation. Average follow up was 4.4 years with a range of 2–6.6 years