Evaluation of core decompression outcome in systemic lupus erythematosus with hip osteonecrosis: a retrospective cohort study

Abstract Background Osteonecrosis is a major cause of morbidity for patients with systemic lupus erythematosus (SLE). Although core decompression is an approved and trusted technique to prevent further joint deterioration, this surgical method seems to be less beneficial for SLE patients. We aimed to evaluate the outcomes of core decompression in SLE patients with primary stages of femoral head osteonecrosis. Methods In this study, 23 patients (39 affected hip joints) with osteonecrosis of the femoral head with stage II of the disease, based on the Ficat-Arlet classification system, underwent core decompression. Also, patients demographic characteristics, clinical data, medication history, comorbidities, immunological findings, hip plain radiographs, history of total hip arthroplasty after core decompression, and patients satisfaction with joint function according to the Oxford hip score questionnaire were obtained. Results In the study, 53.8% of affected joints showed signs of radiographic deterioration in follow-up imaging. Sixty-one and a half percent (61.5%) of patients had unsatisfactory joint performance. A third (33.3%) of affected hip joints underwent total hip arthroplasty up to 5 years from core decompression. SLE patients with a history of receiving bisphosphonate were 83.2% less dissatisfied with their joint function than patients without a history of bisphospho-nate use (P < 0.02). Of the 23 studied cases, the mean cumulative dose of prednisolone before and after core decompression surgery was 46.41 mg and 14.74 mg respectively. Besides, one case (2.6%) that had a high anti-phospholipid antibodies level during follow-up did not have any radiographic deterioration, and 9 cases (23.1%) had some degrees of radiographic deterioration. Conclusions The patients group that used bis-phosphonate, had a higher level of satisfaction with joint function after core decompression. Patients with high-level anti-phospholipid antibodies are related to a poor prognosis after core decompression.

EVALUATION OF FUNCTIONAL OUTCOME OF DUAL MOBILITY CUPS IN TOTAL HIP ARTHROPLASTY IN ARTHRITIS HIP AND FEMORAL NECK FRACTURES

Background- Osteoarthritis hip and femoral neck fractures in old age can be treated by total hip arthroplasty using dual mobility cup designs. The posterior approach (Kocher-Langenbeck) was used earlier however, lateral (Harding) and anterior approach (Smith-Petersen) are more often used. Evaluation of functional outcomes of total h Aim- ip arthroplasty using dual mobility cups in patients with osteoarthritis hip and femur neck fractures in terms of time of surgery, re-operation rate and mortality in 1 year, length of hospital stay and post-operative complications, using Harris Hip Score (HHS). Study Design- Hospital based prospective cohort study. Material and Methods- 40 cases were include in the study of which, 20 cases are of osteoarthritis hip and 20 cases are of femur neck fracture managed by dual mobility total hip arthroplasty. Clinical and functional outcome was graded using HHS. Anatomical reduction was assessed at 8 weeks, 3months, 6 months and 9 months. The mean HHS at 8 weeks, 3months, 6 months and 9 mont Result- hs in osteoarthritis hip was 56.40, 69.80, 80.90 and 91.50 and in femur neck fractures was 51.10, 63.50, 74.60 and 84.50, achieved. Better result was found in osteoarthritis hip. Conclusion- We concluded that using dual mobility total hip arthroplasty in osteoarthritis hip is far better than femur neck fractures due to better clinical and functional outcome, better anatomical reduction.

Early mobilization after total hip or knee arthroplasty: a substudy of the POWER. 2 study

Abstract Background Early mobilization after surgery is a cornerstone of the Enhanced Recovery After Surgery (ERAS) programs in total hip arthroplasty (THA) or total knee arthroplasty (TKA). Our goal was to determine the time to mobilization after this surgery and the factors associated with early mobilization. Methods This was a predefined substudy of the POWER.2 study, a prospective cohort study conducted in patients undergoing THA and TKA at 131 Spanish hospitals. The primary outcome was the time until mobilization after surgery as well as determining those perioperative factors associated with early mobilization after surgery. Results A total of 6093 patients were included. The median time to achieve mobilization after the end of the surgery was 24 hours [16-30]. 4,222 (69.3%) patients moved in ≤ 24 hours after surgery. Local anesthesia [OR = 0.80 (95% confidence interval [CI]: 0.72-0.90); p= 0.001], surgery performed in a self-declared ERAS center [OR = 0.57 (95% CI: 0.55-0.60); p< 0.001], mean adherence to ERAS items [OR = 0.93 (95% CI: 0.92-0.93); p< 0.001], and preoperative hemoglobin [OR = 0.97 (95% CI: 0.96-0.98); p< 0.001] were associated with shorter time to mobilization. Conclusions Most THA and TKA patients mobilize in the first postoperative day, early time to mobilization was associated with the compliance with ERAS protocols, preoperative hemoglobin, and local anesthesia, and with the absence of a urinary catheter, surgical drains, epidural analgesia, and postoperative complications. The perioperative elements that are associated with early mobilization are mostly modifiable, so there is room for improvement.

Effects from Extramedullary Design of Femoral Stem on Hip Contact Force: A Musculoskeletal Multi-Body Dynamic Study / 医用生物力学

Objective To investigate the effects of design parameters such as neck-shaft angle, femoral offset and anteversion angle of total hip arthroplasty ( THA) prosthesis on contact forces of the hip. Methods A musculoskeletal multi-body dynamic model of THA was established based on AnyBody software. The effects of single or multiple factors on hip contact force were studied when the neck-shaft angle, eccentricity and anteversion angle varied within ±10°, ±20 mm and ±10°, respectively. Results The maximum hip contact force increased by 26. 08% when femoral offset was reduced by 20 mm. The maximum hip contact force increased by 5. 99% when the neck-shaft angle increased by 10°. When the anteversion angle increased by 10°, the hip contact force decreased at 0% -24% of gait cycle, with the peak decreasing by 19. 16% . However, the hip contact force was significantly increased at 38% -70% of gait cycle, with the peak increasing by 67. 78% . Conclusions In extramedullary design of the femoral stem, based on reconstruction of the patient’s anatomical parameters, the offset of the femoral stem can be appropriately increased, and the neck-shaft angle and anteversion angle can bereduced to avoid increasing forces on the hip.

Comparison of filling ratio, alignment, and stability between ABG Ⅱ short-stem and Corail long-stem in total hip arthroplasty for Dorr type C femur / 中国修复重建外科杂志

OBJECTIVE@#Using the mono-energy reconstruction images and X-ray films to investigate whether the ABG Ⅱ short-stem could improve the filling ratio, stability, and alignment in the Dorr type C femur, compared with the Corail long-stem.@*METHODS@#Among patients who were with Dorr type C femurs and treated with total hip arthroplasty between January 2006 and March 2012, 20 patients with a Corail long-stem (Corail group) and 20 patients with an ABG Ⅱ short-stem (ABG Ⅱ group) were randomly selected. The differences in gender, age, body mass index, and preoperative diagnoses between the two groups were not significant ( P>0.05). The ABG Ⅱ group was with a mean follow-up of 142 months (range, 102-156 months), and the Corail group was with a mean follow-up of 107 months (range, 91-127 months). There was no significant difference in the Harris score and subjective satisfaction score between the two groups at last follow-up ( P>0.05). At last follow-up, dual-energy CT scans with mono-energy image reconstruction were used to calculate the prosthetic filling ratio and to measure the alignment of the prosthesis in the coronal and sagittal positions. Stability assessment was performed based on X-ray films, and the subsidence distance was measured using EBRA-FCA software.@*RESULTS@#X-ray film observation showed that the prostheses in the two groups were stable and no signs of loosening was found. The incidence of pedestal sign was significantly lower in the ABGⅡ group than in the Corail group ( P<0.05), and the incidence of heterotopic ossification was significantly higher in the ABGⅡ group than in the Corail group ( P<0.05). The subsidence distance of femoral stem in ABG Ⅱ group was significantly greater than that in Corail group ( P<0.05), and the subsidence speed of femoral stem in ABG Ⅱ group was also greater than that in Corail group, but the difference was not significant ( P>0.05). The overall prosthesis filling ratio was significantly higher in the ABG Ⅱ group than in the Corail group ( P<0.05), while the coronal filling ratio at the lesser trochanter, 2 cm below the lesser trochanter, and 7 cm below the lesser trochanter were not significant ( P>0.05). The results of prosthesis alignment showed that there was no significant difference in the sagittal alignment error value and the incidence of coronal and sagittal alignment error >3° between the two groups ( P>0.05), while the coronal alignment error value in the ABG Ⅱ group was significantly greater than that in the Corail group ( P<0.05).@*CONCLUSION@#Although the ABG Ⅱ short-stem avoids the distal-proximal mismatch of the Corail long-stem in the Dorr type C femur and thus achieves a higher filling ratio, it does not appear to achieve better alignment or stability.

Meta-analysis of different joint interfaces in total hip arthroplasty under long-term follow-up / 中国骨伤

OBJECTIVE@#To compare the long-term follow-up effect and complications of ceramic on ceramic (CoC) interface and ceramic on polyethyleneon ceramic (CoP) interface in primary total hip arthroplasty, and provide clinical evidence.@*METHODS@#Search PubMed, EMBase, the CoChrane Library databases, Web of science, Wanfang database, and CNKI from January 2000 to September 2021, screening and inclusion of randomized controlled trials (RCTs) comparing the long-term efficacy and complications of CoC interface and CoP interface in total hip arthroplasty. Literature screening, quality evaluation and data extraction were carried out according to the inclusion and exclusion criteria, using Review Manager 5.3 statistical software. The software was used to perform statistical analysis on joint function, revision, prosthesis fracture, abnormal joint noise, and prosthesis wear rate after CoC or CoP.@*RESULTS@#Seven RCTs studies were included, including 390 cases of hips with CoC artificial joints and 384 cases of hips with CoP artificial joints. The long-term joint function improvement of CoC and CoP artificial joints was similar and there was no significant differences, with an average difference was MD=0.63, 95%CI=(-1.81, 3.07), P=0.61. About the postoperative complications, CoC artificial joints have higher incidence rate of abnormal joint noise, with odds ratio (OR)=11.05, 95%CI=(2.04, 59.84), P=0.005. CoP artificial joints wear faster, with an average MD=-87.11, 95%CI=(-114.40, -59.82), P<0.000 1. There was no significant difference between the two groups in the replacement-related complications such as joint dislocation, prosthesis loosening, osteolysis, and the rate of prosthesis revision caused by various reasons.@*CONCLUSION@#The clinical function results and complications of CoC artificial joints are comparable to those of CoP artificial joints. Although CoP artificial joint prosthesis has a faster wear rate, it does not affect joint function and increase complications, and there is no abnormal joint noise. CoC is expensive and the long-term efficacy is equivalent to CoP. Clinicians should consider cost performance when choosing CoC.

Evaluation of the effect of direct anterior total hip arthroplasty in the treatment of hip osteoarthritis / 中华地方病学杂志

Objective:To evaluate the clinical effect of direct anterior total hip arthroplasty in the treatment of hip osteoarthritis.Methods:From December 2017 to December 2020, 82 patients with hip osteoarthritis who received total hip arthroplasty in the department of orthopedics, 541 General Hospital, including 41 patients with direct anterior total hip arthroplasty as the observation group, and 41 patients with lateral total hip arthroplasty as the control group. The general indicators of the two groups of patients during the perioperative period (time of ambulatory activity, hospitalization, amount of intraoperative bleeding, and operation time) and the clinical efficacy evaluation indicators [visual analogue score (VAS), Harris hip joint function score, Western Ontario and McMaster Universities Arthritis Index (WOMAC) score] were compared.Results:The time of ambulatory activity was (15.54 ± 2.67) and (19.32 ± 3.18) h, after operation, respectively, and the time of hospitalization was (6.87 ± 0.87) and (8.03 ± 1.04) d, respectively, in the observation group and the control group. The differences between the two groups were statistically significant ( t = 5.83, 5.48, P < 0.001); there was no statistically significant difference between the two groups in the amount of intraoperative bleeding and operation time ( t = 0.81, 0.13, P > 0.05). There were statistically significant differences between the observation group and the control group in VAS (3 d, 1 month, 6 month after operation), Harris hip joint function score (1, 6 month after operation) and WOMAC score (1, 6 month after operation, t = 7.50, 11.03, 10.70, 6.20, 7.34, 7.10, 8.34, P < 0.001). The Harris hip joint function score and WOMAC score of patients in the same group between 1, 6 month after operation and pre-operation were significantly different ( P < 0.05). Conclusion:Direct anterior total hip arthroplasty is effective in the treatment of hip osteoarthritis, and can significantly improve the function of the hip joint and relieve the pain of the hip joint compared with lateral total hip arthroplasty.

Resultados post operatorios en pacientes con prótesis total de revisión de cadera mas injerto óseo cadavérico de banco de tejidos en el Hospital de Clínicas en el periodo 2017 al 2020 / Postoperative results in patients with total hip revision arthroplasty and cadaveric bone graft of tissue bank at the Hospital de Clínicas in the period 2017 to 2020

Introducción: La artroplastia total de cadera de revisión junto con la utilización de injerto óseo cadavérico de banco de tejidos es una alternativa de tratamiento eficaz ante los procedimientos de reemplazo con déficit óseo femoral o acetabular. El presente estudio, analizó los resultados post operatorios en pacientes intervenidos quirúrgicamente en el Hospital de Clínicas. Materiales y métodos: Estudio descriptivo. Muestreo no probabilístico de casos consecutivos atendidos en la Cátedra de Ortopedia y Traumatología de la Facultad de Ciencias Médicas (U.N.A). Fueron captados pacientes con indicación de artroplastia total de cadera de revisión (ATCR) más injerto óseo cadavérico de banco de tejidos, entre diciembre 2017 - octubre 2020, previo consentimiento informado. Se relevaron datos cuya caracterización fue posible mediante un instrumento establecido previamente, ingresado en base Excel. Resultados: 12 pacientes con déficit óseo femoral y acetabular han sido tratados con artroplastia total de cadera de revisión más injerto óseo cadavérico de banco de tejidos, en donde además de la funcionalidad y a través de seguimientos radiológicos se ha determinado la osteointegración total de los aloinjertos. La relación masculino-femenina fue 1/1, siendo el diagnóstico preoperatorio para la colocación de la prótesis de revisión más injerto óseo cadavérico de banco de tejidos el aflojamiento séptico en un 75%. El motivo de consulta más frecuente fue dolor y la secreción y el tiempo quirúrgico fue en promedio de 116 minutos. Conclusión: La artroplastia total de cadera de revisión más aloinjerto presenta óptimos resultados en relación a la osteointegración total y funcionalidad.

Introduction: Revision total hip arthroplasty with use of cadaveric bone graft is an effective treatment for replacement procedures in patients with bone loss femoral or acetabular. The present study analyzed the postoperative results in patients who underwent surgery at the Hospital de Clínicas. Materials and methods: Descriptive study. Non-probabilistic sampling of consecutive cases treated at the Department of Orthopedics and Traumatology of Hospital de Clínicas. Data of patients with indication for revision total hip arthroplasty plus cadaveric bone graft from a tissue bank with prior informed consent,were analyzed between December 2017 and October 2020. Results: 12 patients with femoral and acetabular bone deficits have been treated with revision total hip arthroplasty plus cadaveric bone graft from a tissue bank. A radiological and functional follow up was made. The male-female ratio was 1/1, with the preoperative diagnosis for placement of the revision prosthesis plus cadaveric bone graft,from the tissue bank,was septic loosening in 75%. The most frequent symptom was pain, all revision total hip arthroplasties were performed through a posterior approach, and the surgical time was an average of 116 minutes,using a later approach in all cases.Two intraoperative fracture was presented, and were resolved. Conclusion: Revision total hip arthroplasty plus allograft presents optimal results in relation to total osseointegration and functionality.

A rare case of osteonecrosis of hip in sickle cell disease

Avascular necrosis of bone is a severe complication of sickle cell disease (SCD) and Management of these problems is often difficult because of the diagnostic imprecision of most laboratory and imaging investigations and because of the lack of evidence for most surgical procedures in sickle cell disease. Its treatment is not standardized. The objective in this case is to determine the impact of core decompression and PRP infusion in the management of Avascular necrosis of hip. In this case, a young Indian male with a known history of sickle cell disease presented to the clinic with severe bilateral hip pain. The pain had lasted for several months and had not improved with anti- inflammatory medication and starting on alandronate. There was severe pain with internal and external rotation of the hip. MRI of the femur showed stage 2 or 3 avascular necrosis of the femoral head, while X-rays of the femur were unremarkable. Patient managed conservatively by Non weight- bearing for several weeks and oral medication shortly thereafter, the patient underwent core decompression of the bilateral femoral head as well as continuing on Alendronate, a bisphosphonate. The patient improved temporarily but regressed shortly thereafter. His avascular necrosis worsened radiographically over the next several months. At this point, the only other option would be to do a total hip arthroplasty, but the patient may need several more throughout his lifetime due to the lifespan of the artificial replacement. There have only been scarce reports of avascular necrosis in patients with sickle cell trait. This manuscript presents such a case and includes the trials and tribulations associated with its management.

Safety and preventive effects of rivaroxaban and low-molecular-weight heparin on deep vein thrombosis of lower extremity after total hip arthroplasty

Deep vein thrombosis (DVT) is a common complication of skeletal surgery, which can cause disability and death in severe cases. Here, we have compared the preventive effects of rivaroxaban and low molecular weight heparin on DVT of lower extremity after total hip arthroplasty and the safety. A total of 310 patients who received total hip arthroplasty from May 2014 to June 2016 were divided into a rivaroxaban group (n=153) and a low molecular weight heparin group (n=157). The rivaroxaban group was orally administered with rivaroxaban (10 mg, qd) 12 h after surgery for 30 consecutive days, and the other group was subcutaneously injected with low molecular weight heparin calcium injection (0.6 mL, ad) for 7 consecutive days. The incidence rate of lower extremity DVT, drainage blood volume, hemoglobin decline, as well as preoperative and postoperative 7-d prothrombin time (PT), activated partial thromboplastin time (APTT), platelet (PLT) count and D-dimer level of the two groups were compared. The two groups had similar incidence rates of lower extremity DVT, drainage blood volumes and extents of hemoglobin decline (P >0.05). There were no significant differences in the preoperative and postoperative 7-d PT, APTT, PLT counts and D-dimer levels between the two groups (P >0.05). Rivaroxaban and low molecular weight heparin show comparable preventive effects on lower extremity DVT after total hip arthroplasty. Results suggest that rivaroxaban is superior than the low molecular weight heparin in terms of convenient use (oral administration), good compliance and absence of dose adjustment.

Effectiveness and safety of vancomycin powder injection locally applied in theprevention of prosthetic joint infection

Prosthetic joint infection is a rare but serious complication that is associated with considerable morbidity and financialburdens and other hardships for the individual. The available treatment options for PJI include both surgery andantimicrobial therapy. The surgical option includes debridement, antibiotics and implant retention (DAIR), that is usuallyrecommended at initial stages, one stage or two stage revision arthroplasty at advanced stages. These treatments are muchexpensive and time consuming and have around 11-30% failure rate. Therefore, there is an urgent need for a appropriate andaffordable treatment strategy. Vancomycin serves as an active agent against the pathogens that have ability to causepotential damage to the wounds after surgery. In its powder form, it ensures adequate surgical site concentrations whileminimizing the adverse effects caused by undetectable systemic distribution. Thus, we explored the effectiveness and safetyof vancomycin powder injection locally applied in the prevention of prosthetic joint infection (PJI). A total of 90 inpatientswho underwent total hip and knee arthroplasty from January 2018 to December 2019 were selected and randomly dividedinto control group (routine preventive antibiotic therapy) and treatment group (vancomycin applied based on the treatmentof control group). The incidence of PJI and adverse reactions within 3 months after operation was observed. The changes inbody temperature, neutrophil count, interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hs-CRP) levels wererecorded before operation and 1, 3 and 7 days after treatment. Ninety days after treatment, the incidence rate of PJI intreatment group (0.00) was significantly lower than that of control group (8.89%) (P <0.05). Within a short period of time (1d and 3 d) after treatment, the body temperature, neutrophil count, IL-6 and hs-CRP levels were all lower in treatment groupthan those in control group (P <0.05). However, the above indices had no significant differences between the two groups at1 week (7 d) after treatment (P >0.05). There were 3 cases (6.67%) and 2 cases (4.44%) of adverse reactions in treatmentgroup and control group, respectively. The incidence rates of adverse reactions were similar (?2=0.212, P=0.645).Vancomycin powder injection locally applied can control the body temperature, and reduce the neutrophil count, IL-6 andhs-CRP levels within a short period of time after operation, which is superior to routine preventive antibiotic therapy. It candecrease the incidence rate of PJI after arthroplasty.

Artroplastia total de cadera bilateral en un tiempo: una opción quirúrgica para pacientes con coxartrosis severa bilateral / Simultaneous bilateral total hip arthroplasty: a surgical option for patients with several bilateral hip osteoarthritis

Total hip arthroplasty is a successful procedure with high rates of functional satisfaction and pain relief. A large number of patients with bilateral hip pathology will require both hip joint replacement, from there born the inquietude to knowing benefits and disadvantage of bilateral simultaneous hip arthroplasty. We present a female patient case who developed bilateral hip osteoarthritis secondary to development dysplasia of the hip which was surgically managed with bilateral arthroplasty at one time. We show a follow-up report of the case and a review of the literature to know the main advantages of this new current of hip arthroplasty in patients with bilateral hip pathology

Uso tópico de ácido tranexámico en artroplastías totales de cadera: análisis retrospectivo de sus ventajas / Topical use of tranexamic acid in total hip arthroplasties: retrospective analysis of its advantages

Resumen: Introducción: El ácido tranexámico (ATX) intravenoso (IV) ha demostrado su utilidad para evitar la anemia postquirúrgica, pero pocos estudios han analizado su administración tópica. Hace siete años implementamos una nueva administración tópica (humedeciendo tres compresas con 1.5 g de ATX) en nuestras artroplastías totales de cadera (ATC) primarias. El objetivo de este estudio ha sido comparar la pérdida de sangre, estancia hospitalaria y complicaciones sin uso de ATX, uso tópico o 10 mg/kg IV más tópico. Material y métodos: Serie retrospectiva consecutiva de 274 pacientes intervenidos de ATC (promedio 70 años [59-76], 59% mujeres) operados de 2014 a 2019. Se compararon pérdida de hemoglobina y hematocrito, transfusiones de sangre, estancia hospitalaria, complicaciones tromboembólicas y mortalidad a 30 días entre tres grupos: no tranexámico (44.2%), tópico (45.6%), tópico + IV (9.9%). Resultados: Después de 24 y 48 horas, la hemoglobina y el hematocrito disminuyeron menos (p < 0.05) en los pacientes tratados con ATX (tópico y/o IV). Se requirió transfusión de sangre en 32% de los pacientes sin ATX, 12% de los tratados sólo con ATX tópico (RR = 3.24 [IC de 95%: 1.69-6.20]) y 0% de los pacientes que recibieron ATX IV (p = 0.005) (RR = 4.07 [IC de 95%: 2.14-7.48]). La estancia hospitalaria se redujo en tres días con ATX (p < 0.001). No hemos observado efectos adversos relacionados con ATX. Conclusiones: El uso del ATX en ATC reduce significativamente la anemia, las transfusiones y la estancia hospitalaria sin aumentar las complicaciones. El ATX tópico aislado (compresas hemostáticas) es menos eficaz que el uso tópico IV + tópico, pero ambos mejoran significativamente la anemia, las transfusiones y la estancia hospitalaria en comparación con su no utilización.

Abstract: Introduction: Intravenous (IV) tranexamic acid (TXA) has shown its usefulness to prevent postsurgical anemia, but few studies have analyzed its topical administration. Seven years ago, we implemented a new topical administration (moistening three gauzes with 1.5 g of TXA) in our primary total hip arthroplasties (THA). The objective of this study was to compare blood loss, hospital stay and complications without the use of TXA, topical use or 10 mg/kg IV plus topical. Material and methods: Consecutive retrospective series of 274 patients undergoing CTA (mean 70 years [59-76], 59% women) operated from 2014 to 2019. Loss of hemoglobin and hematocrit, blood transfusions, hospital stay, thromboembolic complications were compared and 30-day mortality among three groups: non-tranexamic (44.2%), topical (45.6%), topical + IV (9.9%). Results: After 24 and 48 hours, hemoglobin and hematocrit decreased less (p < 0.05) in patients treated with TXA (topical and/or IV). Blood transfusion was required in 32% of patients without TXA, 12% of those treated with topical TXA only (RR = 3.24 [95% CI: 1.69-6.20]), and 0% of patients who received IV TXA (p = 0.005) (RR = 4.07 [95% CI: 2.14-7.48]). Hospital stay was reduced three days with TXA (p < 0.001). We have not observed any adverse effects related to TXA. Conclusions: The use of TXA in CTA significantly reduces anemia, transfusions and hospital stay without increasing complications. Isolated topical TXA (hemostatic pads) is less effective than topical IV + topical use, but both significantly improve anemia, transfusions, and hospital stay compared to no use.

Clinical effect of total hip arthroplasty via Watson-Jone approach in treatment of hip osteoarthritis caused by advanced Kashin-Beck disease / 中华地方病学杂志

Objective:To observe the clinical effect of total hip arthroplasty via Watson-Jone approach in treatment of hip osteoarthritis caused by advanced Kashin-Beck disease.Methods:Forty six patients with hip osteoarthritis caused by advanced Kashin-Beck disease who were admitted to Department of Orthopedics of 541 General Hospital from January 2018 to June 2019 were selected as observation subjects, of which 23 patients received the conventional posterolateral approach as the control group, and the other 23 patients received the Watson-Jone approach as the study group. The Harris scores of the hip joints, the degree of pain (visual analogue scale), and complication rate of postoperative follow-up were compared between the patients of two groups before and after operation at different time periods (3, 6, 12, 24 months).Results:The preoperative Harris scores of the study group and the control group were (36.28 ± 6.57) and (37.51 ± 6.29) points, respectively, and the difference was not statistically significant ( t = 0.65, P = 0.520); at 3, 6, 12 and 24 months after operation, the scores were (86.65 ± 5.26), (80.91 ± 5.39), (88.59 ± 5.08), (83.33 ± 5.26), (90.37 ± 4.55), (85.05 ± 4.61), (92.06 ± 4.37), and (88.72 ± 4.56) points, the differences were statistically significant ( P < 0.05). The preoperative hip pain scores of the study group and the control group were (8.08 ± 0.45) and (7.96 ± 0.49) points, respectively, and the difference was not statistically significant ( t = 0.87, P = 0.392) ; at 3, 6, 12 and 24 months after operation, the scores were (2.08 ± 0.51), (2.55 ± 0.55), (1.68 ± 0.46), (2.07 ± 0.41), (1.32 ± 0.38), (1.71 ± 0.41), (1.01 ± 0.22), and (1.18 ± 0.28) points, the differences were statistically significant ( P < 0.05). The complication rate of postoperative in the study group was 0 (0/23), which was significantly lower than that [17.39% (4/23)] of the control group (χ 2 = 4.38, P = 0.036). Conclusion:Watson-Jone approach is adopted in total hip arthroplasty for patients with hip osteoarthritis caused by advanced Kashin-Beck disease, which can significantly reduce the pain of the hip joint and improve the function of the hip joint, with fewer postoperative complications, and is conducive to postoperative rehabilitation.

Perioperative antithrombotic therapy in the patient undergoing revision total hip arthroplasty after coronary stent implantation: a case report and literature review / 药学实践杂志

Objective To explore the strategies of perioperative antithrombotic therapy in the patient undergoing revision total hip arthroplasty after coronary stent implantation. Methods The antithrombotic therapy in one patient undergoing revision total hip arthroplasty after coronary stent implantation was analyzed with the review of related literatures. Results The patient developed non-ST segment elevated myocardial infarction due to the stop of aspirin three days before operation and no low molecular weight heparin was used. The antithrombotic treatment and prevention of venous thromboembolism were analyzed. Conclusion Antithrombotic therapy should be selected reasonably in patients undergoing revision total hip arthroplasty after coronary stent implantation.

A Multi-Disciplinary Approach for the Management of Prosthetic Joint Infections: An Australian Perspective

@#Introduction: Prosthetic joint infections (PJI) are a major complication of hip and knee arthroplasty, imposing significant morbidity and mortality. Orthopaedic oncology units have utilised a multi-disciplinary team (MDT) approach for some time. PJI is not only an equally lifethreatening condition, it also requires input from multiple healthcare personnel and treatment can vary significantly between individuals given the diversity in microbiological, surgical and host factors. Our arthroplasty service established an MDT meeting to manage this complex patient group. This study describes the philosophy and implementation of an MDT approach to the management of PJIs at a tertiary hospital in Australia. Materials and methods: A retrospective review of all patients that presented to the MDT PJI meeting from October 2017 to April 2020 was performed. Patient characteristics, microbiological profile and management were reviewed. Results: One hundred and one patients were reviewed over 2.5 years with a mean age of 69.2 years (SD 11.9). Patients presenting predominantly had a primary TKR (32%) or primary THR (22%). Results of Microbiology cultures varied, with 42% Gram-positive organisms, 13% Gramnegative organisms, 2% fungus and 1% yeast origin. Management mainly consisted of two-stage revision (28%), debridement-antibiotics-and-implant retention (22%) and antibiotic suppression (14%). A total of 91.5% of patients who underwent surgical management were considered cured at one year. Conclusion: PJIs are complex and require coordinated care by a number of healthcare personnel. The MDT process has allowed collaboration between Orthopaedic, Infectious Disease and Microbiology departments and aims to improve the quality of care provided to patients, potentially reducing morbidity and mortality of patients with PJI.

Effects of Total Hip Arthroplasty on Proximal Femoral Bone Remodeling / 医用生物力学

Objective To analyze the influence of total hip arthroplasty (THA) on the process of proximal femoral bone remodeling by using the Wolff bone remodeling theory. Methods According to control equation of bone remodeling, the program of bone remodeling was written in Python language. Preoperative femur model and postoperative femur and prosthesis finite element models were established respectively in ABAQUS software. The process of bone reconstruction before and after THA operation was compared to analyze the effect of prosthesis implantation on mechanical properties of the femur in the middle and long term after THA operation. Results The stress in proximal femur continued to decrease after prosthesis implantation, and the stress site was transferred from the femoral head to the prosthesis, resulting in an obvious stress shielding phenomenon. Bone loss in the stress shielding area was serious. The femoral shaft cortical bone became thinner and the stress shielding was relieved. The medial side at the bottom of the prosthesis was compressed, and the stress was significantly higher than that of the lateral side, where the bone was unevenly distributed. Conclusions After THA operation, obvious stress shielding occured at proximal medial side of the femur, leading to bone loss and prosthesis loosening. The difference in stress levels on both sides at the bottom of the prosthesis resulted in an uneven bone distribution, causing the discordance between the prosthesis and the femur, as well as postoperative pain in the middle part of the thigh.

Premio de Investigación SCHOT 2020: desarrollo y validación de un modelo multivariables de predicción de estadía hospitalaria en pacientes mayores de 65 años sometidos artroplastia total de cadera electiva en Chile utilizando aprendizaje de máquinas / 2020 SCHOT Research award: Development an a multivariable prediction model of hospital stay in elderly chilean patients undergoing elective total hip arthroplasty using machine learning

INTRODUCCIÓN La predicción de la estadía hospitalaria luego de una artroplastia total de cadera (ATC) electiva es crucial en la evaluación perioperatoria de los pacientes, con un rol determinante desde el punto de vista operacional y económico. Internacionalmente, se han empleado macrodatos (big data, en inglés) e inteligencia artificial para llevar a cabo evaluaciones pronósticas de este tipo. El objetivo del presente estudio es desarrollar y validar, con el empleo del aprendizaje de máquinas (machine learning, en inglés), una herramienta capaz de predecir la estadía hospitalaria de pacientes chilenos mayores de 65 años sometidos a ATC por artrosis. MATERIALES Y MÉTODOS Empleando los registros electrónicos de egresos hospitalarios anonimizados del Departamento de Estadísticas e Información de Salud (DEIS), se obtuvieron los datos de 8.970 egresos hospitalarios de pacientes sometidos a ATC por artrosis entre los años 2016 y 2018. En total, 15 variables disponibles en el DEIS, además del porcentaje de pobreza de la comuna de origen del paciente, fueron incluidos para predecir la probabilidad de que un paciente presentara una estadía acortada (< 3 días) o prolongada (> 3 días) luego de la cirugía. Utilizando técnicas de aprendizaje de máquinas, 8 algoritmos de predicción fueron entrenados con el 80% de la muestra. El 20% restante se empleó para validar las capacidades predictivas de los modelos creados a partir de los algoritmos. La métrica de optimización se evaluó y ordenó en un ranking utilizando el área bajo la curva de característica operativa del receptor (area under the receiver operating characteristic curve, AUC-ROC, en inglés), que corresponde a cuan bien un modelo puede distinguir entre dos grupos. RESULTADOS El algoritmo XGBoost obtuvo el mejor desempeño, con una AUC-ROC promedio de 0,86 (desviación estándar [DE]: 0,0087). En segundo lugar, observamos que el algoritmo lineal de máquina de vector de soporte (support vector machine, SVM, en inglés) obtuvo una AUC-ROC de 0,85 (DE: 0,0086). La importancia relativa de las variables explicativas demostró que la región de residencia, el servicio de salud, el establecimiento de salud donde se operó el paciente, y la modalidad de atención son las variables que más determinan el tiempo de estadía de un paciente. DISCUSIÓN El presente estudio desarrolló algoritmos de aprendizaje de máquinas basados en macrodatos chilenos de libre acceso, y logró desarrollar y validar una herramienta que demuestra una adecuada capacidad discriminatoria para predecir la probabilidad de estadía hospitalaria acortada versus prolongada en adultos mayores sometidos a ATC por artrosis. CONCLUSIÓN Los algoritmos creados a traves del empleo del aprendizaje de máquinas permiten predecir la estadía hospitalaria en pacientes chilenos operado de artroplastia total de cadera electiva

Introduction The prediction of the length of hospital stay after elective total hip arthroplasty (THA) is crucial in the perioperative evaluation of the patients, and it plays a decisive role from the operational and economic point of view. Internationally, big data and artificial intelligence have been used to perform prognostic evaluations of this type. The present study aims to develop and validate, through the use of artificial intelligence (machine learning), a tool capable of predicting the hospital stay of patients over 65 years of age undergoing THA for osteoarthritis. Material and Methods Using the electronic records of hospital discharges de-identified from the Department of Health Statistics and Information (Departamento de Estadísticas e Información de Salud, DEIS, in Spanish), the data of 8,970 hospital discharges of patients who had undergone THA for osteoarthritis between 2016 and 2018 were obtained. A total of 15 variables available in the DEIS registry, in addition to the poverty rate in the patient's borough of origin were included to predict the probability that a patient would have a shortened (< 3 days) or prolonged (> 3 days) stay after surgery. By using machine learning techniques, 8 prediction algorithms were trained with 80% of the sample. The remaining 20% was used to validate the predictive capabilities of the models created from the algorithms. The optimization metric was evaluated and ranked using the area under the receiver operating characteristic curve (AUC-ROC), which corresponds to how well a model can distinguish between two groups. Results The XGBoost algorithm had the best performance, with an average AUC-ROC of 0.86 (standard deviation [SD]: 0.0087). Secondly, we observed that the linear support vector machine (SVM) algorithm obtained an AUC-ROC of 0.85 (SD: 0.0086). The relative importance of the explanatory variables showed that the region of residence, the administrative health service, the hospital where the patient was operated on, and the care modality are the variables that most determine the length of stay. Discussion The present study developed machine learning algorithms based on freeaccess Chilean big data, which helped create and validate a tool that demonstrates an adequate discriminatory capacity to predict shortened versus prolonged hospital stay in elderly patients undergoing elective THA. Conclusion The algorithms created through the use of machine learning allow to predict the hospital stay in Chilean patients undergoing elective total hip arthroplasty Introduction The prediction of the length of hospital stay after elective total hip arthroplasty (THA) is crucial in the perioperative evaluation of the patients, and it plays a decisive role from the operational and economic point of view. Internationally, big data and artificial intelligence have been used to perform prognostic evaluations of this type. The present study aims to develop and validate, through the use of artificial intelligence (machine learning), a tool capable of predicting the hospital stay of patients over 65 years of age undergoing THA for osteoarthritis. Material and Methods Using the electronic records of hospital discharges de-identified from the Department of Health Statistics and Information (Departamento de Estadísticas e Información de Salud, DEIS, in Spanish), the data of 8,970 hospital discharges of patients who had undergone THA for osteoarthritis between 2016 and 2018 were obtained. A total of 15 variables available in the DEIS registry, in addition to the poverty rate in the patient's borough of origin were included to predict the probability that a patient would have a shortened (< 3 days) or prolonged (> 3 days) stay after surgery. By using machine learning techniques, 8 prediction algorithms were trained with 80% of the sample. The remaining 20% was used to validate the predictive capabilities of the models created from the algorithms. The optimization metric was evaluated and ranked using the area under the receiver operating characteristic curve (AUC-ROC), which corresponds to how well a model can distinguish between two groups. Results The XGBoost algorithm had the best performance, with an average AUC-ROC of 0.86 (standard deviation [SD]: 0.0087). Secondly, we observed that the linear

Restauración de la biomecánica en artroplastia total de cadera por luxación congénita alta / Restoration of Biomechanics in Total Hip Arthroplasty Due to High Congenital Dislocation

La osteoartritis secundaria a displasia o luxación congénita de cadera conlleva grandes dificultades para el cirujano que reconstruye la cadera. Los casos con escasa deformidad no difieren prácticamente de la reconstrucción primaria convencional. En el extremo opuesto están los casos con graves hipoplasias del acetábulo, escaso desarrollo femoral, luxación completa, discrepancia importante de las extremidades y gran cabalgamiento del trocánter mayor. Por las enormes dificultades que pueden representar para la cirugía, nos trazamos el objetivo de discutir nuestro caso, con las consideraciones y resultados del tratamiento elegido. Se presenta paciente femenina de 54 años de edad, con antecedentes de salud previa, que nos llegó a consulta con una grave deformidad congénita, acortamiento del miembro inferior derecho (6 cm) y limitación dolorosa de todos los movimientos de la cadera. Se constata una luxación congénita grado C de Hartofilakidis y IV de Crowe, que muestra como parte del tratamiento, la artroplastia total con injerto autólogo y reimplantación del cótilo en el acetábulo verdadero, para recuperar el centro de rotación del acetábulo y la osteotomía femoral de acortamiento para la implantación del vástago femoral. Se exponen los requerimientos, procederes técnicos y resultados alcanzados(AU)

Osteoarthritis secondary to congenital hip dysplasia or dislocation poses great difficulties for the surgeon reconstructing the hip. Cases with little deformity do not differ practically from conventional primary reconstruction. At the opposite end there are cases with severe acetabulum hypoplasia, poor femoral development, complete dislocation, significant limb discrepancy, and great thrust of the greater trochanter. Due to the enormous difficulties that they can represent for surgery, we set the objective of discussing our case, with the considerations and results of the chosen treatment. A 54-year-old female patient is reported, she has previous health history, and she came for consultation with severe congenital deformity, shortening of her right lower limb (6 cm) and painful limitation of all hip movements. Congenital dislocation grade C of Hartofilakidis and IV of Crowe was confirmed, which showed as part of the treatment, the total arthroplasty with autologous graft and reimplantation of the cup in the true acetabulum, to recover the center of rotation of the acetabulum and the shortening femoral osteotomy for implantation of the femoral stem. Requirements, technical procedures and results achieved are informed(AU)