The primary aim of this study was to investigate the effect of
an enhanced recovery program (ERP) on the short-term functional
outcome after total hip arthroplasty (THA). Secondary outcomes included
its effect on rates of dislocation and mortality. Data were gathered on 1161 patients undergoing primary THA which
included 611 patients treated with traditional rehabilitation and
550 treated with an ERP. Aims
Patients and Methods
The highly cross-linked polyethylene Exeter RimFit flanged cemented
acetabular component was introduced in the United Kingdom in 2010.
This study aimed to examine the rates of emergence of radiolucent
lines observed when the Rimfit acetabular component was implanted
at total hip arthroplasty (THA) using two different techniques: firstly,
the ‘rimcutter’ technique in which the flange sits on a pre-prepared
acetabular rim; and secondly, the ‘trimmed flange’ technique in
which the flange is trimmed and the acetabular component is seated
inside the rim of the acetabulum. The radiographs of 150 THAs (75 ‘rimcutter’, 75 ‘trimmed flange’)
involving this component were evaluated to assess for radiolucencies
at the cement/bone interface by three observers. Aims
Patients and Methods
In this study we evaluated whether pre-operative
Western Ontario and McMaster Universities (WOMAC) osteoarthritis
scores can predict satisfaction following total hip arthroplasty
(THA). Prospective data for a cohort of patients undergoing THA
from two large academic centres were collected, and pre-operative
and one-year post-operative WOMAC scores and a 25-point satisfaction
questionnaire were obtained for 446 patients. Satisfaction scores
were dichotomised into either improvement or deterioration. Scatter
plots and Spearman’s rank correlation coefficient were used to describe
the association between pre-operative WOMAC and one-year post-operative WOMAC
scores and patient satisfaction. Satisfaction was compared using
receiver operating characteristic (ROC) analysis against pre-operative,
post-operative and δ WOMAC scores. We found no relationship between pre-operative WOMAC scores and
one-year post-operative WOMAC or satisfaction scores, with Spearman’s
rank correlation coefficients of 0.16 and –0.05, respectively. The
ROC analysis showed areas under the curve (AUC) of 0.54 (pre-operative
WOMAC), 0.67 (post-operative WOMAC) and 0.43 (δ WOMAC), respectively,
for an improvement in satisfaction. We conclude that the pre-operative WOMAC score does not predict
the post-operative WOMAC score or patient satisfaction after THA,
and that WOMAC scores can therefore not be used to prioritise patient
care. Cite this article:
Muscle atrophy has been demonstrated in patients suffering from osteoarthritis of the hip, but little is known about muscular recovery after total hip replacement (THR). A total of 20 patients with unilateral osteoarthritis of the hip were assessed before, six months and two years after THR. The cross-sectional area and radiological density of the muscles of the hip, thigh, calf and back were measured using CT. We hypothesised that the muscles would not recover fully after operation. After two years comparison of the limb with the THR with the healthy limb showed that there was such a reduction in the cross-sectional area in iliopsoas (7.0%; p = 0.006) and the hip adductors (8.4%, p = 0.003) and in the radiological density in gluteus maximus (10.1 Hounsfield units; p <
0.001), gluteus medius/minimus (5.6 Hounsfield units; p = 0.011), iliopsoas (3.9 Hounsfield units; p <
0.001) and the adductors (2.4 Hounsfield units; p = 0.022). Thus, there was persistent muscle atrophy in muscles acting about the hip two years after THR. We suggest that an earlier operation or a more intensive rehabilitation may reverse these changes.
Tranexamic acid (TXA), an inhibitor of fibrinolysis,
reduces blood loss after total knee arthroplasty. However, its effect
on minimally invasive total hip arthroplasty (THA) is not clear.
We performed a prospective, randomised double-blind study to evaluate
the effect of two intravenous injections of TXA on blood loss in
patients undergoing minimally invasive THA. In total, 60 patients (35 women and 25 men with a mean age of
58.1 years; 17 to 84) who underwent unilateral minimally invasive
uncemented THA were randomly divided into the study group (30 patients,
20 women and ten men with a mean age of 56.5 years; 17 to 79) that
received two intravenous injections 1 g of TXA pre- and post-operatively
(TXA group), and a placebo group (30 patients, 15 women and 15 men
with a mean age of 59.5 years; 23 to 84). We compared the peri-operative
blood loss of the two groups. Actual blood loss was calculated from
the maximum reduction in the level of haemoglobin. All patients
were followed clinically for the presence of venous thromboembolism. The TXA group had a lower mean intra-operative blood loss of
441 ml (150 to 800) This prospective, randomised controlled study showed that a regimen
of two intravenous injections of 1 g TXA is effective for blood
conservation after minimally invasive THA. Cite this article:
To investigate the longevity of uncemented fixation of a femoral
component in total hip arthroplasty (THA) in patients with Dorr
type C proximal femoral morphology. A total of 350 consecutive uncemented THA in 320 patients were
performed between 1983 and 1987, by a single surgeon using the Taperloc
femoral component. The 63 patients (68 hips) with Dorr type C proximal
femoral morphology were the focus of this review. The mean age of
the patients was 69 years (24 to 88) and mean follow-up was 16.6
years (ten to 29). Survival analysis included eight patients (eight
hips) who died without undergoing revision surgery prior to obtaining
ten years follow-up. All 55 surviving patients (60 hips) were available
for clinical assessment and radiographic review. As a comparator
group, the survival and implant fixation in the remaining 282 THAs
(257 patients) with Dorr type A and B morphology were evaluated.
The mean age of these patients was 52 years (20 to 82).Aims
Patients and Methods
We describe the results of 76 total arthroplasties of the hip for stage-III or stage-IV avascular necrosis of the femoral head. Harris Galante Porous cups were used in 63 patients between 1986 and 1994 and followed prospectively. We reviewed 70 hips with a follow-up of more than five years (mean 7.6). At the latest review the mean Harris Hip Score had improved from a preoperative value of 29 ± 14.7 to 94 ± 6.8. Radiologically, there was no evidence of acetabular migration. The rate of revision for the femoral component was 8.6%, three being undertaken for loosening and three to allow downsizing of the femoral head. The rate of revision for the acetabular component was 7.1% (five cups). At the time of revision none of the cups was clinically loose, and only required the liner to be changed. The rate of complications was low with no case of deep infection or dislocation, but nine of the 76 hips (11.8%) showed grade-III heterotopic ossification. Previous studies of patients undergoing cemented total hip arthroplasty for the treatment of advanced avascular necrosis have indicated a high incidence of loosening of the acetabular component. Our findings show good medium-term results using the Harris Galante Porous cup for acetabular reconstruction, together with a variety of cemented femoral components, for the treatment of this difficult problem.
An intact barrier between the hands of the surgeon and the patient remains the single most important factor in protection against infection for both. Increasing the awareness of possible glove perforation without skin penetration will decrease the risk of contamination. We performed a prospective, randomised trial comparing the incidence of glove perforation using a new type of glove (Regent Biogel Reveal) and standard double-gloves in total hip and knee replacement. One or more perforations was detected in 14.6% of all gloves. The new gloves increased significantly the awareness of perforation. Multiple perforations at the base of the ring finger were found in surgeons who wore wedding rings during the operation and we recommend that rings be removed before undertaking surgery.
Pseudotumour is a rare but important complication of metal-on-metal hip resurfacing that occurs much more commonly in women than in men. We examined the relationship between head-neck ratio (HNR) and pseudotumour formation in 18 resurfaced hips (18 patients) revised for pseudotumour and 42 asymptomatic control resurfaced hips (42 patients). Patients in whom pseudotumour formation had occurred had higher pre-operative HNR than the control patients (mean 1.37 ( We suggest that reducing the size of the femoral head, made possible by a high pre-operative HNR, increases the risk of impingement and edge loading, and may contribute to high wear and pseudotumour formation. As the incidence of pseudotumour is low in men, it appears safe to perform resurfacing in men. However, this study suggests that it is also reasonable to resurface in women with a pre-operative HNR ≤ 1.3.
We report the results of cementless total joint replacement in 18 patients with old tuberculosis of the hip, performed, on average, 34 years after the onset of infection. Mean follow-up was 3.5 years. Only seven of the patients had antituberculous drugs during or after the operation. Using the Mayo hip score, 15 patients had excellent or good results and two had a fair rating. One patient had the prosthesis removed more than one year postoperatively for late haematogenous staphylococcal infection and had a poor rating. All the patients had relief of hip-related pain. Despite the absence of any reactivation of tuberculosis in our series, we recommend the use of specific prophylaxis.