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Functional Outcome, Revision Rates and Mortality after Primary Total Hip Replacement – A National Comparison of Nine Prosthesis Brands in England  [PDF]
Mark Pennington, Richard Grieve, Nick Black, Jan H. van der Meulen
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0073228
Abstract: Background The number of prosthesis brands used for hip replacement has increased rapidly, but there is little evidence on their effectiveness. We compared patient-reported outcomes, revision rates, and mortality for the three most frequently used brands within each prosthesis type: cemented (Exeter V40 Contemporary, Exeter V40 Duration and Exeter V40 Elite Plus Ogee), cementless (Corail Pinnacle, Accolade Trident, and Taperloc Exceed), and hybrid (Exeter V40 Trilogy, Exeter V40 Trilogy, and CPT Trilogy). Methods and Findings We used three national databases of patients who had hip replacements between 2008 and 2011 in the English NHS to compare functional outcome (Oxford Hip Score (OHS) ranging from 0 (worst) to 48 (best)) in 43,524 patients at six months. We analysed revisions and mortality in 187,201 patients. We used multiple regression to adjust for pre-operative differences. Prosthesis type had an impact on post-operative OHS and revision rates (both p<0.001). Patients with hybrid prostheses had the best functional outcome (mean OHS 39.4, 95%CI 39.1 to 39.7) and those with cemented prostheses the worst (37.7, 37.3 to 38.1). Patients with cemented prostheses had the lowest reported 5-year revision rates (1.3%, 1.2% to 1.4%) and those with cementless prostheses the highest (2.2%, 2.1% to 2.4%). Differences in mortality according to prosthesis type were small and not significant (p = 0.06). Functional outcome varied according to brand among cemented (p = 0.05, with Exeter V40 Duration having the best) and cementless prostheses (p = 0.01, with Corail Pinnacle having the best). Revision rates varied according to brand among hybrids (p = 0.05, with Exeter V40 Trident having the lowest). Conclusions Functional outcomes were better with cementless cups and revision rates were lower with cemented stems, which underlies the good overall performance of hybrids. The hybrid Exeter V40 Trident seemed to produce the best overall results. This brand should be considered as a benchmark in randomised trials.
Revision Total Hip Replacement: A Case Report  [cached]
Md Hafizur Rahman,Md Mohoshin Sarker,Md Abdul Matin
Delta Medical College Journal , 2013, DOI: http://dx.doi.org/10.3329/dmcj.v1i2.15920
Abstract: Total hip replacement is a reconstructive procedure that has improved the management of those diseases of the hip joint that have responded poorly to conventional medical therapy. Conventional, primary total hip replacement is a durable operation in the majority of patients. A hip replacement is a mechanical device with parts that are assembled before and during the operation. But the possible complications of total hip arthroplasty, and its clinical performance over time, is a challenging occasion to the surgeons, and such a challenge we faced with our presenting patient. A 68 year old lady with history of cemented bipolar hemiarthroplasty done in a tertiary care hospital, due to fracture neck of the left femur having the history of diabetes, chronic kidney disease, heart disease, anaemia, and mental disorders presented with loosened prosthesis, thinning of medial proximal cortex of the femur which had broken within few months after surgery. She complained of painful walking at left hip joint. There was also evidence of chronic infective and degenerative arthritis of acetabular component of the affected hip joint. Cemented revision total hip replacement surgery was performed with expert multidisciplinary involvement. On 2nd postoperative day the patient was allowed to walk on operated limb with the aid of walker. On 12th postoperative day all the stitches were removed and wound was found healthy.
Joint replacement in Zambia: A review of Hip & Knee Replacement surgery done at the Zambian-Italian Orthopaedic Hospital
Y Mulla, J Munthali, E Makasa, K Kayumba
Medical Journal of Zambia , 2010,
Abstract: Background: Incidence of major joint replacement surgery is on the rise in Africa but this trend has not been matched by proper audits in the form of National Joint Registries. Objective: This paper presents the short-term findings from a joint replacement register started at the Zambian-Italian Orthopaedic Hospital (ZIOH) in Lusaka and compares the variables entered in this register with those captured in the Malawian National Joint Register for purposes of synchronizing these in the near future in the East, Central and Southern African region . Methods: Data captured by the different variables entered into the Joint Register covering the pre-op, intra-op and post-op period of all total hip and knee replacement surgery done at the ZIOH from 1998 to 2010 was entered into a spreadsheet after verification with individual patient medical records. This was then imported into spss for analysis yielding the following results. Results: 44 total hips and seven total knee replacement operations were done on 46 patients, 59% of which were female and 41% male. The average age was 58 years. The HIV sero-status of 86.3% was unknown. 36 (70.6%) of the patients had primary osteoarthritis as the diagnosis with pain and joint stiffness being the indication for surgery. Three consultants and one senior registrar did the operations mainly using the Hardinge approach to the hip. 43 (84.3%) were primary Total Hip replacement with only one revision. The 28mm hip head size was the commonest fitted with most patients, 48 (94.1%) being functionally mobile at six weeks post operation. Conclusion: This audit clearly shows a rising trend of major joint replacement over the years and highlights the gaps in variables entered into the ZIOH joint register such as HIV status. It also helps us recognize the need for setting up a National Joint Register that is comparable to others that have been set up in the region such as is the case in Malawi which is key in improving orthopaedic training and patient care.
Total hip and knee joint replacement: perioperative clinical aspects
Luciana Pereira Almeida de Piano,Ricardo Prado Golmia,Morton Scheinberg
Einstein (S?o Paulo) , 2010,
Abstract: Objective: To understand the profile of patients undergoing hip and knee replacement during two years, and to compare the data obtained with the literature. Methods: A total of 323 medical records were reviewed to analyze the perioperative data of patients submitted to hip and knee replacement. Results: Osteoarthritis was the main indication for both procedures and male patients were heavier than females (p < 0.05). Hypertension was the prevalent disease among patients. Blood loss was more frequent in knee surgery than in the hip. Conclusions: The profile of patients undergoing total arthroplasty improved substantially over the past decade due to shorter hospital stay, lower risk of thromboembolic events and no infection as compared to previous reports.
Reliability and concurrent validity of the Dutch hip and knee replacement expectations surveys
Inge van den Akker-Scheek, Jos JAM van Raay, Inge HF Reininga, Sjoerd K Bulstra, Wiebren Zijlstra, Martin Stevens
BMC Musculoskeletal Disorders , 2010, DOI: 10.1186/1471-2474-11-242
Abstract: Patients scheduled for total hip (N = 112) or knee replacement (N = 101) were sent the Dutch Expectations Surveys twice with a 2 week interval to determine test-retest reliability. To determine concurrent validity, the Expectation WOMAC was sent.The results for the Dutch Hip Replacement Expectations Survey revealed good test-retest reliability (ICC 0.87), no bias and good internal consistency (alpha 0.86) (N = 72). The correlation between the Hip Expectations Score and the Expectation WOMAC score was 0.59 (N = 86). The results for the Dutch Knee Replacement Expectations Survey revealed good test-retest reliability (ICC 0.79), no bias and good internal consistency (alpha 0.91) (N = 46). The correlation with the Expectation WOMAC score was 0.52 (N = 57).Both Dutch Expectations Surveys are reliable instruments to determine patients' expectations before total hip or knee arthroplasty. As for concurrent validity, the correlation between both surveys and the Expectation WOMAC was moderate confirming that the same construct was determined. However, patients scored systematically lower on the Expectation WOMAC compared to the Dutch Expectation Surveys. Research on patients' expectations before total hip and knee replacement has only been performed in a limited amount of countries. With the Dutch Expectations Surveys it is now possible to determine patients' expectations in another culture and healthcare setting.Osteoarthrosis is the most common joint disorder in the world [1]. Patients with osteoarthrosis of the hip or knee joint experience pain, stiffness and loss of joint function. When conservative treatment does not result in less pain and better functioning, a total hip or knee replacement is the most common and successful surgical treatment. In 2005, the incidence of hip replacements in the Netherlands was 124 per 105 inhabitants (20,281 operations); the incidence of knee replacements was 63 per 105 inhabitants (10,329 operations) (Statistics Netherlands 2005).In orth
Variability of indication criteria in knee and hip replacement: an observational study
Raquel Cobos, Amaia Latorre, Felipe Aizpuru, Jose I Guenaga, Cristina Sarasqueta, Antonio Escobar, Lidia García, Carmen Herrera-Espi?eira
BMC Musculoskeletal Disorders , 2010, DOI: 10.1186/1471-2474-11-249
Abstract: The pre-surgical condition of 1603 patients included was compared by their personal characteristics, clinical situation and self-perceived health status. Patients were asked to complete two health-related quality of life questionnaires: the generic SF-12 (Short Form) and the specific WOMAC (Western Ontario and Mcmaster Universities) scale. The type of patient undergoing primary arthroplasty was similar in the 15 different hospitals evaluated.The variability in baseline WOMAC score between hospitals in THR and TKR indication was described by range, mean and standard deviation (SD), mean and standard deviation weighted by the number of procedures at each hospital, high/low ratio or extremal quotient (EQ5-95), variation coefficient (CV5-95) and weighted variation coefficient (WCV5-95) for 5-95 percentile range. The variability in subjective and objective signs was evaluated using median, range and WCV5-95. The appropriateness of the procedures performed was calculated using a specific threshold proposed by Quintana et al for assessing pain and functional capacity.The variability expressed as WCV5-95 was very low, between 0.05 and 0.11 for all three dimensions on WOMAC scale for both types of procedure in all participating hospitals. The variability in the physical and mental SF-12 components was very low for both types of procedure (0.08 and 0.07 for hip and 0.03 and 0.07 for knee surgery patients). However, a moderate-high variability was detected in subjective-objective signs. Among all the surgeries performed, approximately a quarter of them could be considered to be inappropriate.A greater inter-hospital variability was observed for objective than for subjective signs for both procedures, suggesting that the differences in clinical criteria followed by surgeons when indicating arthroplasty are the main responsible factors for the variation in surgery rates.Total knee replacement (TKR) and total hip replacement (THR) are safe surgical procedures that achieve effecti
Two-stage revision of implant-associated infections after total hip and knee arthroplasty
Ellenrieder, Martin,Lenz, Robert,Haenle, Maximilian,Bader, Rainer
GMS Krankenhaushygiene Interdisziplin?r , 2011,
Abstract: Septic loosening of total hip and knee endoprostheses gains an increasing proportion of revision arthroplasties. Operative revisions of infected endoprostheses are mentally and physically wearing for the patient, challenging for the surgeon and a significant economic burden for healthcare systems. In cases of early infection within the first three weeks after implantation a one-stage revision with leaving the implant in place is widely accepted. The recommendations for the management of late infections vary by far. One-stage revisions as well as two-stage or multiple revision schedules have been reported to be successful in over 90% of all cases for certain patient collectives. But implant associated infection still remains a severe complication. Moreover, the management of late endoprosthetic infection requires specific logistics, sufficient and standardized treatment protocol, qualified manpower as well as an efficient quality management. With regard to the literature and experience of specialized orthopaedic surgeons from several university and regional hospitals we modified a commonly used treatment protocol for two-stage revision of infected total hip and knee endoprostheses. In addition to the achievement of maximum survival rate of the revision implants an optimisation of the functional outcome of the affected artificial joint is aimed for.
Relationship between body adiposity measures and risk of primary knee and hip replacement for osteoarthritis: a prospective cohort study
Yuanyuan Wang, Julie Simpson, Anita E Wluka, Andrew J Teichtahl, Dallas R English, Graham G Giles, Stephen Graves, Flavia M Cicuttini
Arthritis Research & Therapy , 2009, DOI: 10.1186/ar2636
Abstract: A total of 39,023 healthy volunteers from Melbourne, Australia were recruited for a prospective cohort study during 1990 to 1994. Their body mass index, waist circumference, and waist-to-hip ratio were obtained from direct anthropometric measurements. The fat mass and percentage fat were estimated from bioelectrical impedance analysis. Primary knee and hip replacements for osteoarthritis between 1 January 2001 and 31 December 2005 were determined by data linkage to the Australian Orthopaedic Association National Joint Replacement Registry. Cox proportional hazards regression models were used to estimate the hazard ratios (HRs) for primary joint replacement associated with each adiposity measure.Comparing the fourth quartile with the first, there was a threefold to fourfold increased risk of primary joint replacement associated with body weight (HR = 3.44, 95% confidence interval (CI) = 2.83 to 4.18), body mass index (HR = 3.44, 95% CI = 2.80 to 4.22), fat mass (HR = 3.51, 95% CI = 2.87 to 4.30), and percentage fat (HR = 2.99, 95% CI = 2.46 to 3.63). The waist circumference (HR = 2.77, 95% CI = 2.26 to 3.39) and waist-to-hip ratio (HR = 1.46, 95% CI = 1.21 to 1.76) were less strongly associated with the risk. Except for the waist-to-hip ratio, which was not significantly associated with hip replacement risk, all adiposity measures were associated with the risk of both knee and hip joint replacement, and were significantly stronger risk factors for knee.Risk of primary knee and hip joint replacement for osteoarthritis relates to both adipose mass and central adiposity. This relationship suggests both biomechanical and metabolic mechanisms associated with adiposity contribute to the risk of joint replacement, with stronger evidence at the knee rather than the hip.Total joint replacement is a very effective treatment for end-stage, symptomatic knee and hip osteoarthritis (OA), and has been considered a surrogate measure for severe OA. The rate of joint replacement is st
Meat consumption and risk of primary hip and knee joint replacement due to osteoarthritis: a prospective cohort study
Yuanyuan Wang, Julie Simpson, Anita E Wluka, Dallas R English, Graham G Giles, Stephen Graves, Flavia M Cicuttini
BMC Musculoskeletal Disorders , 2011, DOI: 10.1186/1471-2474-12-17
Abstract: Eligible 35,331 participants were selected from the Melbourne Collaborative Cohort Study recruited during 1990-1994. Consumption of fresh red meat, processed meat, chicken, and fish was assessed using a food frequency questionnaire. Primary hip and knee replacement for osteoarthritis during 2001-2005 was determined by linking the cohort records to the Australian National Joint Replacement Registry.There was a negative dose-response relationship between fresh red meat consumption and the risk of hip replacement (hazard ratio (HR) 0.94 per increase in intake of one time/week, 95% confidence interval (CI) 0.89-0.98). In contrast, there was no association with knee replacement risk (HR 0.98, 95% CI 0.94-1.02). Consumption of processed meat, chicken and fish were not associated with risk of hip or knee replacement.A high level consumption of fresh red meat was associated with a decreased risk of hip, but not knee, joint replacement for osteoarthritis. One possible mechanism to explain these differential associations may be via an effect of meat intake on bone strength and hip shape. Further confirmatory studies are warranted.Whilst the consumption of red meat is often recommended for its iron content [1], there is emerging evidence that red meat and processed meat are associated with carcinogenesis at several anatomic sites and increased mortality [2-5]. The mechanisms for these adverse effects are various but have been related to the constituent nutrients of red meat and methods of processing and cooking. Meat is a source of several multisite carcinogens including N-nitroso compounds, heterocyclic amines, and polycyclic aromatic hydrocarbons, some of which are formed during high-temperature cooking of meat [2]. Iron in red meat may increase oxidative damage and increase the formation of N-nitroso compounds [6]. Meat is also a major source of saturated fat which has been positively associated with cancer [7]. Current dietary recommendations are to consume small to modera
Approaches to Delivery of Care at Home Following Elective Hip and Knee Joint Replacement Surgery  [PDF]
M. Alnaib, N. R. Agni, N. Shaw
Open Journal of Therapy and Rehabilitation (OJTR) , 2015, DOI: 10.4236/ojtr.2015.33013
Abstract: Arthritis has a worldwide increasing prevalence with increased demands on healthcare systems to provide arthroplasty surgery. There is growing evidence that early discharge and rehabilitation at home following hip and knee replacement provide similar or better results in function, complication rates and patient satisfaction. We suggest that this method of rehabilitation is a cost-effective viable option in fitter patients whose medical demands will be low postoperatively.
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