It is clinically unclear whether anterior capsular suture improves hip laxity in total hip arthroplasty using direct anterior approach (DAA-THA). This study aimed to clarify the impact of anterior ...capsular suture for hip laxity in DAA-THA. In this study, 121 hips of 112 patients who underwent DAA-THA were prospectively enrolled. Mean age was 64.7 ± 10.1 years, and the subjects consisted of 35 hips in 32 men and 86 hips in 80 women. To evaluate hip laxity after implantation, axial head transfer distance (HTD) when the hip was pulled axially at 15 kg was compared before and after anterior capsular suture at the hip intermediate and 10° extension positions. HTD in the intermediate and 10° extension positions averaged 5.9 ± 4.6 mm and 6.3 ± 4.6 mm before the suture, and 2.6 ± 2.7 mm and 2.9 ± 3.1 mm after the suture, respectively. HTD after the suture significantly decreased in both hip positions (p < 0.0001). The amount of change by the suture was greater in cases with greater pre-suturing HTD. In DAA-THA, the anterior capsular suture significantly improved hip laxity against axial traction force, it may contribute to improvement of postoperative hip stability, especially in cases with greater laxity before the suture.
Abstract
Periprosthetic joint infection (PJI) is suspected when local findings such as pain, swelling, hyperthermia, and sinus tract are present. However, the frequency of these findings and the ...difference between hip and knee are unclear. This study compared the positive rates of local findings in periprosthetic hip infection (PHI) with periprosthetic knee infection (PKI), and aimed to identify potential risk factors associated with the frequency. One hundred one PJI (46 hips and 55 knees) fulfilled the 2018 Musculoskeletal infection society criteria were analysed retrospectively to assess the positive rates of each local finding. Patients were categorized into two groups based on the presence or absence of each local finding, and the influence of two potential risk factors body mass index (BMI) and C-reactive protein (CRP) was investigated. Causative bacterial species were divided into high and low-virulent groups, and then culture negative cases were included in low-virulent group. PHI had significantly lower rates of pain, swelling and hyperthermia compared to PKI. Overall, up to one-third of PHI had pain as only symptom. High BMI and low-virulent bacteria were associated with lower frequency of swelling and hyperthermia in PHI. CRP had no impact on positive rates of local findings. PHI was oligosymptomatic in a significant percentage of cases. This is particularly important in obese patients and infection by low-virulent bacteria.
This study aimed to elucidate the accuracy of cup placement with the computed tomography (CT)-based navigation system (CTN) in the direct anterior approach (DAA)-total hip arthroplasty (THA) in the ...supine position compared with the mechanical cup alignment guide (MG) or the fluoroscopy (FS).
A total of 171 hips of 156 patients undergone primary THA were classified into the following three groups (the MG group: 63 hips, the FS group: 58 hips, the CTN group: 50 hips). Comparing the preoperative planning with postoperative CT measurement by three-dimensional templating software, the accuracy of cup placement was investigated in the three groups.
There were significant differences in the mean absolute error of radiographic inclination (RI) between the MG group (4.4° ± 3.2°) and the CTN group (2.8° ± 2.5°) (p = 0.01). The mean absolute error of radiographic anteversion (RA) also showed significant differences between the CTN group (2.8° ± 1.9°) and the MG group (5.8° ± 4.7°) (p = 0.0001) or the FS group (4.8° ± 4.1°) (p = 0.02). Regarding the cup center position, the mean absolute error of vertical position from preoperative planning was the smallest in the CTN group (1.8 ± 1.4 mm) compared with those in other groups (MG: 3.3 ± 3.2 mm, p = 0.007, FS: 3.2 ± 3.0 mm, p = 0.017).
The CTN guarantees accurate cup placement in the DAA-THA in the supine position compared with the MG and FS groups.
In patients with secondary osteoarthritis due to acetabular dysplasia, femoral anteversion has many variations. A changeable neck system is one useful option to adjust the femoral anteversion. ...Retroverted necks can effectively adjust anatomical anteversion (AA), femoral rotational angle (FRA), and functional anteversion (FA); however, effectiveness of anteverted necks for these adjustments has not been investigated. Moreover, although the lateral patellar tilt after total hip arthroplasty (THA) has been reported to externally rotate, the influence on lateral patellar tilt using a changeable neck system remains unknown. To clarify the effectiveness of anteverted necks in THA, 96 consecutive patients (111 hips) who underwent THA using anatomical short stem with a changeable neck system were retrospectively investigated using pre- and post-operative computed tomography. Patients were divided into the straight (ST) group using straight and 4-mm-high-offset neck (
N
= 34) and the anteverted (AV) group using 15°-anteverted and 15°-anteverted/3-mm-high-offset neck (
N
= 34) after age, body mass index, and surgical approach were matched using propensity scores. AA did not change in the ST group, while it increased by 14.0° in the AV group. FRA decreased after surgery in both groups. FA decreased after surgery in the ST group, while it did not change in the AV group. Lateral patella tilt did not significantly change in both groups between pre- and post-operative position. In conclusion, with a changeable neck system, straight and anteverted necks can adjust AA to achieve pre-operative planning while not influencing lateral patellar tilt.
One of the causes of patient dissatisfaction after total hip arthroplasty (THA) is leg length discrepancy (LLD). Even when radiographic LLD (R-LLD) is within 5 mm, some people perceive the affected ...side to be longer, while others perceive it is shorter. The purpose of this study was to investigate the relationship between perceived LLD (P-LLD), R-LLD, and Forgotten Joint Score (FJS-12) after THA.
A retrospective study of 164 patients with unilateral hip disease was conducted. Based on P-LLD after THA, they were classified into three categories: perceived short (PS 21 patients), no LLD (PN 121 patients), and perceived long (PL 22 patients). On the other hand, based on R-LLD after THA, they were divided into < - 5 mm (RS 36 patients), - 5 mm ≤ x < 5 mm (RN 99 patients), and 5 mm ≥ (RL 29 patients), respectively. The proportion of P-LLD in the RN group was also evaluated. In each group, the relationship between P-LLD, R-LLD and FJS-12 was investigated.
After THA, the PL group had significantly worse FJS-12 (PS: 68.3 ± 26.2, PN: 75.0 ± 20.9, PL: 47.3 ± 25.2, P < .0001). In the R-LLD evaluation, there was no difference in FJS-12 among the three groups (RS: 73.7 ± 21.1, RN: 70.0 ± 24.5, RL: 67.7 ± 25.4, P < .53). The RN group perceived leg length to be longer (RN-PL) in 12.1% of cases, and the RN-PL groups had significantly worse FJS-12 (RN-PS: 65.4 ± 24.8, RN-PN: 73.8 ± 23.1, RN-PL: 41.8 ± 27.6, P < .0001).
One year after THA, patients with longer P-LLD had worse FJS-12, even if the R-LLD was less than 5 mm.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
A fully hydroxyapatite (HA)-coated stem such as Corail stem, that compacts the cancellous bone around the stem in total hip arthroplasty (THA), is reported to have good long-term results for more ...than 20 years. Although various fully HA-coated stems have being used recently, it is unclear whether there are differences in the postoperative outcomes. In this study, 224 patients (234 hips) with THA using either the Corail collarless stem or the Hydra stem were enrolled. And then we performed a retrospective comparison of the data at 2 years postoperatively using propensity score matching analysis. The postoperative modified Harris hip scores in 84 hips each group were 93.6 ± 8.2 points in the Corail group and 92.8 ± 10.1 points in the Hydra group, and there was no significant difference between the two groups. However, there was significantly less stem subsidence and rate of 3rd degree or greater stress shielding in the Corail group. Although these two stems were similar collarless fully HA-coated stems and clinical outcomes were favorable results in both groups at 2 years postoperatively, radiographic evaluations showed statistically significant differences between the two groups.
The anteversion of the stem is occasionally intentionally changed by the surgeon for patients with smaller femoral neck anteversion during total hip arthroplasty (THA). However, the reproducibility ...of preoperative planning with increasing anteversion has been rarely assessed. The present study investigated it using two types of stems. This retrospective study included patients who underwent primary posterolateral THA using taper-wedge (TS group; 73 hips) and anatomical (AS group; 70 hips) stems. Characteristics of sex and age were matched in the two groups by propensity score matching. In both groups, the relationship between the preoperative three-dimensional planning and postoperative stem position, and the relationship between postoperative stem position and femoral neck anteversion (FNA) were evaluated. In the TS group, there were no significant differences in average stem anteversion (SA) between preoperative planning and postoperative placement (36.1° ± 7.0° and 36.6° ± 11.1°, respectively:
p
= 0.651). The absolute error of SA was 8.1° ± 6.4°. In the AS group, the postoperative SA was significantly smaller than the preoperative planning SA (22.7° ± 11.6° and 30.0° ± 9.3°, respectively:
p
< 0.001). The absolute error of SA was 9.0° ± 5.8°. The postoperative SA was significantly larger than the FNA in the TS group (36.6° ± 11.1° and 26.3° ± 10.9°, respectively:
p
< 0.001). However, no significant differences between the two were observed in the AS group (23.7° ± 10.1° and 22.7° ± 11.6°, respectively:
p
= 0.253). The preoperative planning of intentional increasing anteversion did not show high reproducibility with taper-wedge and anatomical stems. The anatomical stem was placed according to the femoral medullary canal regardless of preoperative planning with increased SA.
Purpose
It remains unclear whether simultaneous bilateral total hip arthroplasty (SimBTHA) or staged bilateral total hip arthroplasty (StaBTHA) is clinically superior. No study has compared these two ...procedures matching surgical approach and patient background. This study aimed to clarify the differences between SimBTHA using direct anterior approach (SimBTHA-DAA) and StaBTHA using the direct anterior approach (StaBTHA-DAA).
Methods
Patients who underwent THA between 2012 and 2020 were enrolled, resulting in a total of 1658 hips of 1388 patients. After propensity score matching for patient background, 204 hips of 102 patients (51 patients in each group) were examined. Clinical and radiographic outcomes, complications, intraoperative blood loss and blood transfusions (BT) were evaluated. In complications, we evaluated periprosthetic fractures, pulmonary embolism, deep venous thrombosis, surgical site infection and dislocation.
Results
At the final follow-up, clinical and radiographic outcomes and complications were not significantly different between the groups. Intraoperative blood loss was equivalent for SimBTHA and the sum in the first- and second-stage StaBTHA. The total-BT rate was significantly higher for SimBTHA-DAA than for StaBTHA-DAA (p < .0001). The allogeneic BT rate was significantly higher in SimBTHA-DAA in the supine position (32.3%) than in StaBTHA-DAA (8.3%) (p = .007). However, no patient who received autologous BT required allogeneic BT.
Conclusions
Clinical and radiographic outcomes were equivalent between SimBTHA-DAA and StaBTHA-DAA. The allogeneic BT rate was significantly higher in SimBTHA-DAA than in StaBTHA-DAA. Autologous BT reduced the use of allogeneic BT in SimBTHA-DAA. Auto-BT may be useful for avoiding allo-BT in SimBTHA.
Abstract
Background
Central sensitization is a condition in which even mild stimuli cause pain due to increased neuronal reactivity in the dorsal horn of the spinal cord. It is one of factors of ...chronic pain in patients with osteoarthritis. However, it is unknown whether central sensitization relates to clinical outcomes after total hip arthroplasty (THA). This study aimed to clarify whether preoperative central sensitization relates to the forgotten joint score-12 (FJS) after THA. Moreover, the secondary outcome was to identify which items in the FJS were most related by central sensitization.
Methods
This retrospective analysis included 263 hips (263 patients; 51 males and 212 females) that underwent primary THA in our institute and were available for evaluation one year postoperatively. The average patient age was 64.8 ± 11.9 years. The Central Sensitization Inventory (CSI) part A, which is a patient-reported outcome, was used to measure preoperative central sensitization. The correlation between preoperative CSI and postoperative FJS and the association between postoperative FJS and preoperative CSI severity were determined. Moreover, difference in each FJS item was evaluated by CSI severity.
Results
Twenty-six patients (9.9%) had central sensitization preoperatively. Preoperative CSI scores and postoperative FJS were negatively correlated (
r
= − 0.331,
p
< 0.0001). The postoperative FJS was significantly lower in patients with moderate or higher preoperative CSI severity than that in patients with subclinical or mild preoperative CSI severity (
p
< 0.05). FJS items with movement of daily life were significantly worse in the moderate or higher CSI severity compared with subclinical group (
p
< 0.05 or
p
< 0.01).
Conclusion
Central sensitization prior to THA negatively related to postoperative FJS. In particular, the relationship of central sensitization was found to be significant in FJS items with movement, which would lead to lower patient satisfaction after THA. To get better postoperative outcomes in patients with preoperative central sensitization, improving central sensitization would be important.
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