This study reports the long-term outcomes of a metaphyseal fit-and-fill cementless femoral component in total hip arthroplasty (THA) with a follow-up of 15-19 years.
We conducted a retrospective ...review of 376 consecutive THAs (345 patients), using a triple tapered stem performed between 2000 and 2003 with a view to assessing survivorship and radiological and functional outcomes. Images were assessed for initial alignment, terminal osteolysis, or subsidence, while clinical outcomes were assessed using the St Michael’s Hip Score.
Forty-five (11.9%) hips were lost to follow-up, 20 (5.31%) had died before our 15-year cutoff follow-up, and 4 (1.06%) had declined follow-up early on, leaving 307 hips (81.64%, 276 patients) available for both clinical and radiological follow-up at a minimum of 15 years (range 15-19). The mean age at the time of operation was 49.6 years (range 19-71) and the cohort included 131 (42.67%) male and 145 (47.23%) female patients. Seven stems (2.28%) were revised: 4 due to periprosthetic fractures, 2 for periprosthetic joint infection, and 1 for adverse reaction to metal debris at the trunnion. The St Michael’s Hip Score improved from 14.2 (range 9-23) preoperatively to 22.3 (range 13 to 25) at the last documented follow-up (P = .000). Kaplan-Meier survivorship with stem revision for any reason as the end point was 97.70%. Worst-case scenario Kaplan-Meier survivorship, where all lost to follow-up are considered as failures, was 85.3%. No stem was revised for aseptic loosening.
This triple tapered stem in THA shows excellent survivorship beyond a minimum of 15 years.
Lumbar fusion is a risk factor for hip dislocation following total hip arthroplasty (THA). The objective was to compare joint/segment angles during sit-stand-sit in participants that had a THA with ...and without a lumbar fusion. The secondary objective was to compare pain, physical function, disability, and quality of life. This cross-sectional study includes participants that had THA and lumbar fusion (THA-fusion; n = 12) or THA only (THA-only; n = 12). Participants completed sit-stand-sit trials. Joint/segment angles were measured using electromagnetic motion capture. Angle characteristics were determined using principal component analysis. Hierarchical linear models examined relationships between angle characteristics and groups. Pain, physical function, and disability were compared using Mann-Whitney U tests. Upper lumbar spine was more extended during sit-stand-sit in the THA-fusion group (b = 42.41, P = 0.04). The pelvis was more posteriorly and anteriorly tilted during down and end sit-stand-sit phases, respectively, in the THA-fusion group (b = 12.21, P = 0.03). There were no significant associations between group and other angles. THA-fusion group had worse pain, physical function, disability, and quality of life. Although differences in spine joint, pelvis segment, and hip joint angles existed, these findings are unlikely to account for the increased incidence of hip dislocation after total hip arthroplasty in patients that had spine fusion.
Osteoarthritis affects over 300 million people worldwide. Here, we conduct a genome-wide association study meta-analysis across 826,690 individuals (177,517 with osteoarthritis) and identify 100 ...independently associated risk variants across 11 osteoarthritis phenotypes, 52 of which have not been associated with the disease before. We report thumb and spine osteoarthritis risk variants and identify differences in genetic effects between weight-bearing and non-weight-bearing joints. We identify sex-specific and early age-at-onset osteoarthritis risk loci. We integrate functional genomics data from primary patient tissues (including articular cartilage, subchondral bone, and osteophytic cartilage) and identify high-confidence effector genes. We provide evidence for genetic correlation with phenotypes related to pain, the main disease symptom, and identify likely causal genes linked to neuronal processes. Our results provide insights into key molecular players in disease processes and highlight attractive drug targets to accelerate translation.
Display omitted
•A multicohort study identifies 52 previously unknown osteoarthritis genetic risk variants•Similarities and differences in osteoarthritis genetic risk depend on joint sites•Osteoarthritis genetic components are associated with pain-related phenotypes•High-confidence effector genes highlight potential targets for drug intervention
A multicohort genome-wide association meta-analysis of osteoarthritis highlights the impact of joint site types on the features of genetic risk variants and the link between osteoarthritis genetics and pain-related phenotypes, pointing toward potential targets for therapeutic intervention.
Purpose
To compare short-term complications and readmission rates, in patients treated with simultaneous versus staged bilateral total hip arthroplasty (THA) within a year from the index procedure.
...Methods
We reviewed the charts of patients that underwent simultaneous and staged—within a year—bilateral THA, between 2016 and 2020. Preoperative baseline characteristics were evaluated, while differences in terms of 30-day major and 30-day minor complications and readmission rates were compared between the groups.
Results
One-hundred-sixty patients (mean age, 64.3 years; SD, ± 11.7) were identified. Seventy-nine patients were treated with simultaneous (Group A) and eighty-one patients with staged (Group B) THA. There were no differences in baseline characteristic between the two groups (
p
>
0.050
). Group A was more likely to receive general anesthesia (43% vs. 9.9%,
p
<
0.001
) and had longer total operative time (182.8 vs. 128.0 min,
p
<
0.001
). Group A had an overall shorter total length of hospital stay (5.8 vs. 8.6 days,
p
<
0.001
). No differences in transfusion rates (
p
=
0.229
) and no differences in major and minor complications (
p
>
0.05
) were identified. Postoperative visits at the emergency department or readmissions were similar between the two groups (
p
>
0.050
).
Conclusion
This study shows that similar complication and readmission rates are expected after simultaneous and staged THA. Simultaneous bilateral THA is a safe and effective procedure, that should be considered for patients that present with radiologic and clinical bilateral hip disease.
Distal tibiofibular syndesmosis injuries can be stabilized with syndesmotic screws or suture-buttons. The objective was to compare ankle motion during gait and a step-down task between patients that ...had syndesmotic screw or suture-button fixation and healthy adults. This case series included two participants who received a syndesmotic screw and two participants that received a suture-button to fixate the distal tibiofibular syndesmosis. Time from surgery was 2 to 5 years. Ankle angles were measured during gait and a step-down task using an optical motion capture system and force plates. Peak angles and angle waveforms were compared to healthy adults (gait n=56, step-down n=14) using descriptive statistics. There was decreased ankle plantarflexion during gait for one participant that had a syndesmotic screw and one participant that had a suture-button compared to healthy adults. During step-down, there was decreased ankle dorsiflexion in three participants (1 suture-button, 2 syndesmotic screw) and decreased ankle eversion for both participants that had syndesmotic screws. There was no clear pattern of which surgical technique resulted in improved ankle motion. Other factors likely played a role in limiting ankle motion such as injury severity. Future studies should further compare ankle motion during functional activities between these surgical techniques in larger samples.
Fractures of the lesser tuberosity of the humerus are typically met in combination with other injuries of the shoulder. Case reports of isolated lesser tuberosity fractures are particularly rare and, ...consequently, therapeutic protocols have not yet been completely clarified. Conservative as well as surgical treatment has been recommended, while several operative techniques have been applied. We present a case of a 39-year-old man with an isolated lesser tuberosity fracture who was treated surgically in our institution. Due to fracture comminution, a two-level reconstruction technique with headless screws and buttress plate was applied. As far as we know, this method of fixation of this type of fracture has not been previously described in the literature. The patient tolerated the procedure well and excellent results were obtained at the latest follow-up.
PDF
