Aims. The aim of this study was to identify patient- and surgery-related
risk factors for sustaining an early periprosthetic fracture following
primary total hip arthroplasty (THA) performed using a double-tapered
cementless femoral component (Bi-Metric femoral stem; Biomet Inc.,
Warsaw, Indiana). Patients and Methods. A total of 1598 consecutive hips, in 1441 patients receiving
primary THA between January 2010 and June 2015, were retrospectively
identified. Level of pre-operative osteoarthritis, femoral Dorr
type and cortical index were recorded. Varus/valgus placement of
the stem and canal fill ratio were recorded post-operatively. Periprosthetic
fractures were identified and classified according to the Vancouver
classification. Regression analysis was performed to identify risk
factors for early periprosthetic fracture. Results. The mean follow-up was 713 days (1 to 2058). A total of 48 periprosthetic
fractures (3.0%) were identified during the follow-up and median
time until fracture was 16 days, (interquartile range 10 to 31.5).
Patients with femoral Dorr type C had a 5.2 times increased risk
of
The accurate reconstruction of hip anatomy and
biomechanics is thought to be important in achieveing good clinical
outcomes following total hip arthroplasty (THA). To this end some
newer hip designs have introduced further modularity into the design
of the femoral component such that neckshaft angle and anteversion,
which can be adjusted intra-operatively. The clinical effect of
this increased modularity is unknown. We have investigated the changes
in these anatomical parameters following conventional THA with a
prosthesis of predetermined neck–shaft angle and assessed the effect
of changes in the hip anatomy on clinical outcomes. . In total, 44 patients (mean age 65.3 years (standard deviation
(. sd. ) 7); 17 male/27 female; mean body mass index 26.9 (kg/m²)
(. sd. 3.1)) underwent a pre- and
It has been suggested that cemented fixation of total hip arthroplasty
(THA) is associated with an increased peri-operative mortality compared
with cementless THA. Our aim was to investigate this through a nationwide
matched cohort study adjusting for age, comorbidity, and socioeconomic
background. A total of 178 784 patients with osteoarthritis who underwent
either cemented or cementless THA from the Swedish Hip Arthroplasty
Register were matched with 862 294 controls from the general population.
Information about the causes of death, comorbidities, and socioeconomic
background was obtained. Mortality within the first 90 days after
the operation was the primary outcome measure.Aims
Patients and Methods
We carried out a retrospective cohort study of 3309 patients undergoing primary total hip replacement to examine the impact of tobacco use and body mass index on the length of stay in hospital and the risk of short term
Autologous retransfusion and no-drainage are
both blood-saving measures in total hip replacement (THR). A new combined
intra- and
Aims. The aim of this study was to examine the efficacy and safety
of multiple boluses of intravenous (IV) tranexamic acid (TXA) on
the hidden blood loss (HBL) and inflammatory response following
primary total hip arthroplasty (THA). Patients and Methods. A total of 150 patients were allocated randomly to receive a
single bolus of 20 mg/kg IV TXA before the incision (group A), a
single bolus followed by a second bolus of 1 g IV-TXA three hours
later (group B) or a single bolus followed by two boluses of 1 g
IV-TXA three and six hours later (group C). All patients were treated
using a standard peri-operative enhanced recovery protocol. Primary
outcomes were HBL and the level of haemoglobin (Hb) as well as the
levels of C-reactive protein (CRP) and interleukin-6 (IL-6) as markers
of inflammation. Secondary outcomes included the length of stay
in hospital and the incidence of venous thromboembolism (VTE). Results. The mean HBL was significantly lower in group C (402.13 ml standard
deviation (. sd). 225.97) than group A (679.28 ml. sd. 277.16,
p <
0.001) or B (560.62 ml . sd. 295.22, p = 0.010). The
decrease in the level of Hb between the pre-operative baseline and
the level on the third
Aim and Methods. The goals of this study were to define the risk factors, nature,
chronology, and treatment strategies adopted for periprosthetic
femoral fractures in 32 644 primary total hip arthroplasties (THAs). . Results. There were 564 intra-operative fractures (1.7%); 529 during uncemented
stem placement (3.0%) and 35 during cemented stem placement (0.23%).
Intra-operative fractures were more common in females and patients
over 65 years (p <
0.001). The majority occurred during placement
of the femoral component (60%), and involved the calcar (69%). There
were 557
Aims. This study investigated whether the use of tranexamic acid (TXA)
decreased blood loss and transfusion related cost following surface
replacement arthroplasty (SRA). . Methods. A retrospective review of patients treated with TXA during a
SRA, who did not receive autologous blood (TXA group) was performed.
Two comparison groups were established; the first group comprised
of patients who donated their own blood pre-operatively (auto group)
and the second of patients who did not donate blood pre-operatively
(control). Outcomes included transfusions,
Aims. The goals of this study were to define the risk factors, characteristics,
and chronology of fractures in 5417 revision total hip arthroplasties
(THAs). . Patients and Methods. From our hospital’s prospectively collected database we identified
all patients who had undergone a revision THA between 1969 and 2011
which involved the femoral stem. The patients’ medical records and
radiographs were examined and the relevant data extracted. Post-operative
periprosthetic fractures were classified using the Vancouver system.
A total of 5417 revision THAs were identified. Results. There were 668 intra-operative fractures, giving an incidence
of 12%. Fractures were three times more common with uncemented stems
(19%) than with cemented stems (6%) (p <
0.001). The incidence
of intra-operative femoral fracture varied by uncemented stem type:
fully-coated (20%); proximally-coated (19%); modular fluted tapered
(16%) (p <
0.05). Most fractures occurred during the insertion
of the femoral component (35%). One-third involved the diaphysis
and 26% were of the calcar: 69% were undisplaced. There were 281
Objectives. In total hip arthroplasty (THA), the cementless, tapered-wedge stem design contributes to achieving initial stability and providing optimal load transfer in the proximal femur. However, loading conditions on the femur following THA are also influenced by femoral structure. Therefore, we determined the effects of tapered-wedge stems on the load distribution of the femur using subject-specific finite element models of femurs with various canal shapes. Patients and Methods. We studied 20 femurs, including seven champagne flute-type femurs, five stovepipe-type femurs, and eight intermediate-type femurs, in patients who had undergone cementless THA using the Accolade TMZF stem at our institution. Subject–specific finite element (FE) models of pre- and
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
A total of 31 patients, (20 women, 11 men; mean
age 62.5 years old; 23 to 81), who underwent conversion of a Girdlestone
resection-arthroplasty (RA) to a total hip replacement (THR) were
compared with 93 patients, (60 women, 33 men; mean age 63.4 years
old; 20 to 89), who had revision THR surgery for aseptic loosening
in a retrospective matched case-control study. Age, gender and the
extent of the pre-operative bone defect were similar in all patients.
Mean follow-up was 9.3 years (5 to 18). Pre-operative function and range of movement were better in the
control group (p = 0.01 and 0.003, respectively) and pre-operative
leg length discrepancy (LLD) was greater in the RA group (p <
0.001). The
There is evidence that morbidly obese patients have more intra- and postoperative complications and poorer outcomes when undergoing total hip arthroplasty (THA) with the direct anterior approach (DAA). The aim of this study was to determine the efficacy of DAA for THA, and compare the complications and outcomes of morbidly obese patients with nonobese patients. Morbidly obese patients (n = 86), with BMI ≥ 40 kg/m2 who underwent DAA THA at our institution between September 2010 and December 2017, were matched to 172 patients with BMI < 30 kg/m2. Data regarding demographics, set-up and operating time, blood loss, radiological assessment, Harris Hip Score (HHS), International Hip Outcome Tool (12-items), reoperation rate, and complications at two years postoperatively were retrospectively analyzed.Aims
Methods
We report the clinical and radiological outcomes
of a series of contemporary cementless ceramic-on-ceramic total hip
replacements (THRs) at ten years in patients aged ≤ 55 years of
age. Pre- and
Aims. The long-term functional outcome of total hip arthroplasty (THA)
performed by trainees is not known. A multicentre retrospective
study of 879 THAs was undertaken to investigate any differences
in outcome between those performed by trainee surgeons and consultants. . Patients and Methods. A total of 879 patients with a mean age of 69.5 years (37 to
94) were included in the study; 584 THAs (66.4%) were undertaken
by consultants, 138 (15.7%) by junior trainees and 148 (16.8%) by
senior trainees. Patients were scored using the Harris Hip Score
(HHS) pre-operatively and at one, three, five, seven and ten years
post-operatively. Surgical outcome, complications and survival were
compared between groups. The effect of supervision was determined
by comparing supervised and unsupervised trainees. A primary univariate
analysis was used to select variables for inclusion in multivariate
analysis. . Results. There was no evidence that the grade of the surgeon had a significant
effect on the survival of the patients or the rate of revision (p
= 0.987 and 0.405, respectively) up to 12 years post-operatively.
There was no significant difference in
We evaluated an operative technique, described
by the Exeter Hip Unit, to assist accurate introduction of the femoral
component. We assessed whether it led to a reduction in the rate
of leg-length discrepancy after total hip arthroplasty (THA). A total of 100 patients undergoing THA were studied retrospectively;
50 were undertaken using the test method and 50 using conventional
methods as a control group. The groups were matched with respect
to patient demographics and the grade of surgeon. Three observers
measured the depth of placement of the femoral component on post-operative
radiographs and measured the length of the legs. There was a strong correlation between the depth of insertion
of the femoral component and the templated depth in the test group
(R = 0.92), suggesting accuracy of the technique. The mean leg-length
discrepancy was 5.1 mm (0.6 to 21.4) pre-operatively and 1.3 mm
(0.2 to 9.3) post-operatively. There was no difference between Consultants
and Registrars as primary surgeons. Agreement between the templated
and
Aims. We report the incidence of radiolucent lines (RLLs) using two
flanged acetabular components at total hip arthroplasty (THA) and
the effect of the Rim Cutter. Patients and Methods. We performed a retrospective review of 300 hips in 292 patients
who underwent primary cemented THA. A contemporary flanged acetabular
component was used with (group 1) and without (group 2) the use
of the Rim Cutter and the Rimfit acetabular component was used with
the Rim Cutter (group 3). RLLs and clinical outcomes were evaluated
immediately post-operatively and at five years post-operatively. Results. There was no significant difference in the incidence of RLLs
on the immediate
We evaluated the outcome of primary total hip replacement (THR) in 3290 patients with the primary diagnosis of osteoarthritis at a minimum follow-up of two years. They were stratified into categories of body mass index (BMI) based on the World Health Organisation classification of obesity. Statistical analysis was carried out to determine if there was a difference in the
Aims. To examine incidence of complications associated with outpatient
total hip arthroplasty (THA), and to see if medical comorbidities
are associated with complications or extended length of stay. Patients and Methods. From June 2013 to December 2016, 1279 patients underwent 1472
outpatient THAs at our free-standing ambulatory surgery centre.
Records were reviewed to determine frequency of pre-operative medical
comorbidities and
There is great variability in acetabular component
orientation following hip replacement. The aims of this study were
to compare the component orientation at impaction with the orientation
measured on