Quality assurance in primary total hip arthroplasty.

OBJECTIVE: To compare two different methods of clinical outcomes documentation and investigate the potential impact of a quality assurance program. METHODS: Data on primary hip arthroplasties conducted between 2004 and 2014 were prospectively collected and analyzed. RESULTS: A total of 262/3395 patients suffered a postoperative complication. A reduction of complication rate was observed between 2010 and 2014. A significant difference between the two documentation methods was found in: "cardiovascular complications", "hematoma and postoperative hemorrhage" and "reintervention". Finally, the "normalized length of hospital stay" predicted the occurrence of complications. CONCLUSION: Reduction of the incidence of complications through time may be attributed to accumulated surgical experience.

Quality assurance in revision total hip arthroplasty.

OBJECTIVE: To compare two different methods of clinical outcomes prospective documentation after revision hip arthroplasty: external and internal. METHODS: Chi-squared test, Fisher's exact test and binary logistic regression analyses were performed. RESULTS: Eighty one patients experienced a complication (520 arthroplasties). A significant difference was found between the two documentation methods in the variable "hematoma and postoperative hemorrhage", and a significant reduction of the internally and externally documented "total complication rate". Furthermore, the "length of hospital stay" and "duration of operation" predicted independently the occurrence of complications. CONCLUSION: Further improvement of documentation methods is required to measure the perioperative morbidity.

Cost-Effective Mobile-Based Healthcare System for Managing Total Joint Arthroplasty Follow-Up.

OBJECTIVES: Long-term follow-up care after total joint arthroplasty is essential to evaluate hip and knee arthroplasty outcomes, to provide information to physicians and improve arthroplasty performance, and to improve patients' health condition. In this paper, we aim to improve the communication between arthroplasty patients and physicians and to reduce the cost of follow-up controls based on mobile application technologies and cloud computing. METHODS: We propose a mobile-based healthcare system that provides cost-effective follow-up controls for primary arthroplasty patients through questions about symptoms in the replaced joint, questionnaires (WOMAC and SF-36v2) and the radiological examination of knee or hip joint. We also perform a cost analysis for a set of 423 patients that were treated in the University Clinic for Orthopedics in Essen-Werden. RESULTS: The estimation of healthcare costs shows significant cost savings (a reduction of 63.67% for readmission rate 5%) in both the University Clinic for Orthopedics in Essen-Werden and the state of North Rhine-Westphalia when the mobile-based healthcare system is applied. CONCLUSIONS: We propose a mHealth system to reduce the cost of follow-up assessments of arthroplasty patients through evaluation of diagnosis, self-monitoring, and regular review of their health status.

Acute Injuries Sustained By Racing Drivers: A Cross-Sectional Study.

Aim of the present study was to investigate the prevalence and type of acute injuries sustained by 137 racing drivers. An ad hoc questionnaire was developed and was completed by 137 drivers with a mean age (SD) of 42 (15) years. Approximately half of the drivers had < 10 years of experience in auto racing (49%). Multiple logistic regression analyses were performed. There was a wide distribution of injuries of the knee (n=17, 12%), shoulder injuries (n=15, 11%), thorax/rib or ankle (n=13, 9%), hand (n=11, 8%), forearm (n=9, 7%) and neck or wrist injuries (n=7, 5%). Long-distance racing, more than 10 days per month spent on testing, short-distance racing, and full-time occupation were associated with increased incidence of injuries on multivariable analyses. The high incidence of acute injuries in race car driving indicates the need for further improvements.

Socioeconomic impact of e-Health services in major joint replacement: A scoping review.

BACKGROUND: e-Health is a widespread healthcare practice in the medical community, supported by technology-based applications aiming to deliver health services in an efficient manner, improving the quality of life and providing a wide range of health and socio-economic benefits to patients. OBJECTIVE: To investigate the use of e-Health and mobile applications for the follow-up of major joint arthroplasty patients and the socio-economic impact of e-Health services on arthroplasty patients. METHODS: Studies published after 2000 in English language, enrolling patients who underwent total knee or hip replacement, applying e-Health solutions and highlighting the economic benefits obtained by patients, doctors and healthcare systems were considered for inclusion in the present study. RESULTS: Five studies satisfied our inclusion criteria and were included in qualitative analysis. In this paper, the use of e-Health for the follow-up of major joint arthroplasty patients and the positive impact in terms of cost, time and hospital visits reduction by applying e-Health solutions on arthroplasty patients are reviewed in detail as reported in the included studies. CONCLUSION: The majority of the included studies reported a positive impact in terms of cost, time and hospital visits reduction.

Impact of Total Hip Resurfacing Arthroplasty on Health-Related Quality of Life Measures: A Systematic Review and Meta-Analysis.

The aim of this study was to investigate the effect of total hip resurfacing arthroplasty (RA) on general health-related quality of life (HRQOL) and disease/hip-specific measures. Original studies published after 2000, enrolling at least ten skeletally mature patients with a minimum follow-up of 6 months were considered. The standardized mean difference (SMD) was obtained with a random effects model. The cumulative patient population encompassed 1898 patients (2123 RA). Mean follow-up duration was 4 years. The physical component score (P<0.001) and mental component score (P=0.05) of SF-12, and the EuroQol-5D (P<0.0001) improved significantly. WOMAC global score and the subscales (P<0.00001) were also improved. Harris Hip Score (P<0.00001), Oxford Hip Score (P<0.001) and UCLA (P<0.00001) were markedly improved and patient satisfaction was favorable.

Musculoskeletal injuries in auto racing: a retrospective study of 137 drivers.

BACKGROUND AND PURPOSE: The effect of continuous exposure of a driver's bones and muscles to vibration and G forces to years of automobile racing and the effect on overall health have not yet been examined in detail. The goal of this study was to investigate via questionnaire the musculoskeletal injuries and influencing parameters in 130 amateur and 7 professional race car drivers. MATERIALS AND METHODS: A questionnaire, translated in English and German, was used to investigate the parameters that influence the racing performance and the character of resulting injuries. RESULTS: This investigation involved 137 drivers (133 men and 4 women) with a mean age of 42 years (standard deviation = 15). Approximately half of the drivers had < 10 years of experience in auto racing (49%). The drivers mainly complained about pains in the lumbar (n = 36; 26%), shoulder (n = 27; 20%), and neck regions (n = 25; 18%). The driver's posture and the comfort of the seat were statistically significant for causing lower back and upper legs pains. The race duration was relevant to neck and shoulder discomfort. CONCLUSION: The high incidence of musculoskeletal injuries in race car driving indicates the need for further improvements. Elimination of driver complaints about pain in the spine and upper extremities can be achieved through technical development, as already accomplished in Formula One racing.

Geographic Origin of Publications in Major Spine Journals.

Aim of the present study was to assess the contribution of each country in the field of spine surgery. Three major spine journals were included in our study and the search conducted in PubMed for a 5-year period (2007-2012). Publications on spine surgery were assessed according to the country. A total of 6312 articles were identified and 5842 were included. Fifteen countries generated 86.9% of publications, with 31.7% by the United States, followed by Japan (9.6%), China (8.1%) and Canada (5.2%). After correction for population size Switzerland (19 studies per 106 inhabitants), the Netherlands (10), Sweden (9), Canada (9) and Australia (6) ranked the top. The USA was placed 7th after correction for population size. Small European countries with modest research funding and non-native English speaking population are more productive in relation to their population size, despite the fact that the contribution of USA is the greatest in the field of the major peer-reviewed indexed spine surgery journals.

A simple and convenient method guide to determine the magnification of digital X-rays for preoperative planning in total hip arthroplasty.

Scaling of anteroposterior digital pelvic X-rays with variable magnification is the premise for accurate preoperative planning of total hip replacement with digital templating. Conn's method of placing a marker of known diameter beside the thigh at the level of the femur has been reproduced in many studies and confirmed as one of the most accurate methods. But in our experience, it is inconvenient for radiographers and is not well tolerated by some patients. We modified this method by placing a coin on the radiograph plate. One hundred patients who had undergone hip replacement were enrolled in the study and randomly divided into two groups. The actual diameter of the prosthesis head was taken as the gold standard for assessment of the magnification of the coin in Group A. The coin was within a mean of 117.95% (range 114.37-122.02%) of magnification for male, and 111.71% (range 114.37-120.93%) for female patients. The variation was small and limited, and had no correlation with body shape parameters (i.e. height, weight, BMI). Subsequently, the magnification of the coin was used to correct the measuring scale of the X-rays of the other 50 patients (Group B). Bias did not exceed 1.96 mm during measurement of the prosthesis with a diameter of less than 56 mm, and a range of absolute error of measurements of 56-66 mm (standard deviation, SD, 0.04-3.95 mm). Furthermore, in order to confirm the expressiveness of the modified method, CT scans of another 50 patients were randomly selected. The distance between the rotation center of the hip and the table, which is acknowledged to be a factor which influences magnification of the coin, changed little in response to body shape. Variation in magnification was caused by variation in distance between the rotation center of the hip and the table. The minimal change in distance for patients with different body shape led to easier and more convenient examination, and increased the feasibility of our modified coin method, except in cases where implantation of a very large-sized prosthesis is necessary.

Osteoarthitis of leptin-deficient ob/ob mice in response to biomechanical loading in micro-CT.

OBJECTIVE: Mechanotransduction is the mechanism that due to reacting chondrocytes on biomechanical loading of body mass. Higher biomechanical loading lead to increased degeneration of chondrocytes, whereas moderate loading is protecting. This suggests that body fat regulates bone metabolism first by means of hormonal factors and second that the effects of muscle and loading are signaling factors in mechanotransduction. Leptin, a peptide hormone produced predominantly by white fat cells, is one of these hormonal factors. The aim of this study was to investigate and measure the different effects of weight-bearing on trabecular bone formation in mice without the stimulation of leptin and with or without osteoarthritis. MATERIALS AND METHODS: 40 C57BL/ 6J ob/ob-mice in the age of 20 weeks have been devided into two groups with an ad-libitum-diet and with reduced diet. The hip- and knee-joints have been examinated in micro-CT-scan and histomorphologically. RESULTS: Animals with an ad-libitum-diet were found to increase body weight significantly at the age of six weeks in comparison with lean mice. At the age of twenty weeks the obese mice were almost twice as heavy as the lean mice. Significant statistical differences are shown between the two groups for body weight and bone mineral density. Examination of trabecular bone in micro-CT revealed that the only statistically significant difference between the two groups was the trabecular number for the proximal femur. High weight-bearing insignificantly improved all trabecular bone parameters in the obese mice. Correlation was found between trabecular number and bone mineral density on the one hand and body weight on the other hand. The correlation between body weight and osteoarthritis shows a significant increase in grade of osteoarthritis as body weight increases in hip-joint and knee-joint but not in osteoarthritis-positive (OP) versus osteoarthritis-negative (ON) mices. The correlation of the hip-joint between micro-CT data and body weight shows an increase in these data as body weight increases in OP mices. The correlation of the hip-joint between micro-CT data and osteoarthritis shows a decrease in these data as osteoarthritis increases in OP mices. The correlation of the knee-joint between micro-CT data and body weight shows differencies between ON and OP mices. The correlation of the knee-joint between micro-CT data and osteoarthritis shows an increase in these data as osteoarthritis increases in OP mices. CONCLUSION: biomechanical loading led to decreased bone mineral density by a decrease in the number of trabeculae. Trabecular thickness was not increased by biomechanical loading in growing mice. Decreased body weight in leptin-deficient mice protects against bone loss. This finding is consistent with the principle of light-weight construction of bone. Differences in osteoarthritis-positive and osteoarthritis-negative mices show the eventual importance of diet in leptin-deficience. It is not possible to conclude that these results also apply to human beings.

Differences in trabecular bone of leptin-deficient ob/ob mice in response to biomechanical loading.

OBJECTIVE: It is known that bone mineral density (BMD) and the strength of bone is predicted by body mass. Fat mass is a significant predictor of bone mineral density which correlates with body weight. This suggests that body fat regulates bone metabolism first by means of hormonal factors and second that the effects of muscle and loading are signaling factors in mechanotransduction. Leptin, a peptide hormone produced predominantly by white fat cells, is one of these hormonal factors. The aim of this study was to investigate and measure by micro-CT the different effects of weight-bearing on trabecular bone formation in mice without the stimulation of leptin. RESULTS: Animals with an ad-libitum-diet (Group A) were found to increase body weight significantly at the age of six weeks in comparison with lean mice (Group B). From this point on, the difference increased constantly. At the age of twenty weeks the obese mice were almost twice as heavy as the lean mice. Significant statistical differences are shown between the two groups for body weight and bone mineral density. Examination of trabecular bone (BV/TV, trabecular number (Tb.N.), trabecular thickness (Tb.Th.)) revealed that the only statistically significant difference between the two groups was the Tb.N. for the proximal femur. High weight-bearing insignificantly improved all trabecular bone parameters in the obese mice. Compared with the control-diet Group B, the BV/TV and Tb.N. were slightly higher in the controlled-diet Group A, but not the Tb.Th.. However, correlation was found between Tb.N. and BMD on the one hand and body weight on the other hand. CONCLUSION: biomechanical loading led to decreased bone mineral density by a decrease in the number of trabeculae. Trabecular thickness was not increased by biomechanical loading in growing mice. Decreased body weight in leptin-deficient mice protects against bone loss. This finding is consistent with the principle of light-weight construction of bone. Differences in cortical and trabecular bone will be examined in later studies. It is not possible to conclude that these results also apply to human beings.

Jumbo cups for revision of acetabular defects after total hip arthroplasty: a retrospective review of a case series.

The treatment of acetabular bone defects presents a great challenge in revision total hip arthroplasty (THA). The purpose of this study was to evaluate the clinical and radiological outcome of revision THA using jumbo cups for acetabular reconstruction after applying the bone-grafting technique. We studied 17 patients with acetabular defects ranging from Type 2A to Type 3A according to Paprosky's classification. According to the AAOS-score twelve patients were classified as Type II and five patients as Type III. Uncemented press-fit cups with an outer diameter larger than 64 mm were used in all cases. Fifteen patients received morselized bone allografts. In eight patients an additional screw fixation was necessary. The mean follow-up period was 82 months (range 33-149). The mean Harris Hip Score was preoperatively 62 and at the time of the last follow-up examination 83 points (p = 0.007). Two acetabular components failed, one due to aseptic loosening and another one due to septic loosening. There was a trend of displacement of the femoral head centre towards the infero-lateral position after using jumbo cups that approached statistical significance (p = 0.065). Closure of acetabular defects of Types 2A to 3A according to Paprosky's classification and type II to III according to the AAOS-score respectively can be satisfactorily accomplished using jumbo cups after applying the bone-grafting technique.

Digital templating in total hip arthroplasty with the Mayo stem.

PATIENTS: In 40 patients undergoing total hip arthroplasty with the Mayo femoral stem we studied how preoperative digital templating corresponded to the actual intraoperative choice of implant size, position, offset and restoration of leg length. RESULTS: The preoperatively planned sizes of the components showed a high rate of coincidence with the sizes used intraoperatively [Intraclass Correlation Coefficient (ICC) 0.661-0.810]. However, the agreements in offset and CCD correction were poor (ICC 0.476, 0.253). This could be statistically attributed to the change in the distance from the medial margin of the stem to the medial margin of the medial femoral cortex and the height of osteotomy. The agreement in leg length correction was moderate (ICC 0.583), which was attributed to the change in the hip rotation center and the height of osteotomy. CONCLUSION: Careful preoperative planning was useful for accurate size choice of the Mayo prosthesis. Factors such as the height of osteotomy and the distance from the medial margin of the stem to the medial margin of the medial femoral cortex in relation to the position of the Mayo stem should be taken into account in order to restore ideal offset and leg length.