ABSTRACT
Introducción Existe una diferencia estadísticamente significativa del 1.2% en la tasa de revisión a 15 años a favor de cerámica- polietileno altamente entrecruzado (CP), demostrada en el registro nacional de artroplastia australiano. Nuestro objetivo es evaluar la costo-efectividad entre los pares: cerámica-polietileno altamente entrecruzado (CP) y metal- polietileno altamente entrecruzado (MP) para el pagador en Colombia. Materiales y métodos Se construyó un árbol de decisiones TreeAge Pro® comparando CP vs MP desde la perspectiva del Sistema de Salud Colombiano (SSC). Los parámetros se tomaron de la mejor evidencia disponible, para la efectividad se realizó una revisión sistemática de la literatura y para los costos se usaron tarifas del mercado local. Se determinó la relación de costo-efectividad incremental, asumiendo un horizonte temporal de 15 años y aplicando una tasa de descuento del 5% para costos y efectividad. La incertidumbre fue controlada por un análisis de sensibilidad determinístico y probabilístico. Resultados Para el SSC, con un umbral de 1 PIB per cápita por año de vida ganado ajustado por calidad (AVAC), en adultos llevados a RTC el uso de CP no es costo-efectiva, dado que la efectividad es similar (MP:11,32 AVAC vs CP: 11,36 AVAC) y el costo es tres veces mayor (MP $ 861.826 COP vs CP $ 2.298.090 COP). El análisis de sensibilidad determinístico demuestra que la variable más importante en el resultado es el costo de la cerámica. Discusión Para el SSC el uso rutinario de cabezas de cerámica en RTC no es una estrategia costo-efectiva.
Background There is a statistically significant difference of 1.2% in the revision rate in a 15 year follow in favour of the use of ceramic on highly cross-linked polyethylene (CP) recently described in the Australian National Joint Registry. The purpose of this study is to compare the cost-effectiveness of CP implants and metal-on-highly cross-linked polyethylene (MP) implants in patients undergoing total hip replacement (THR). Materials and methods A TreeAge Pro® decision tree was constructed in order to determine cost-effectiveness between two bearing surfaces: CP or MP from the perspective of the Colombian Health Care System (CHCS). The model parameters where taken from the best available evidence. For the effectiveness, a systematic review of the literature was performed, and costs were taken from local market rates. The incremental cost-effectiveness ratio was determined assuming a time horizon of 15 years, and a discount rate of 5% was used for costs and effectiveness. Cost-effectiveness uncertainty was controlled with deterministic and probabilistic sensitivity analysis. Results For the CHCS, with a 1PIB per capita threshold adjusted per QALY in adults undergoing (THR), the use of a CP implant is not cost-effective, given that the effectiveness is similar (11.32 QALY for MP vs 11.36 QALY for CP), and the cost is three times higher (MP $ 861.826 COP vs CP $ 2.298.090 COP). The deterministic sensitivity analysis showed that the most important variable in the results is the ceramic cost. Discussion for the CHCS the routine use of ceramic-highly cross-linked polyethylene bearing surface in a THR is not a cost-effective strategy.
Subject(s)
Humans , Arthroplasty, Replacement, Hip , Polyethylene , Ceramics , Cost-Benefit Analysis , MetalsABSTRACT
The risk of thromboembolic events after hip revision arthroplasty might be higher than in primary hip arthroplasty. However, evidence regarding the use of thromboprophylaxis in revisions is scarce. The purpose of this study is to determine whether thromboprophylaxis recommendations for primary arthroplasty produce similar results in hip revision arthroplasty. This comparative cohort study retrospectively analyzed consecutive patients undergoing primary hip arthroplasty and hip revision surgery between March 2004 and December 2015, who received thromboprophylaxis according to local clinical practice guidelines for primary hip arthroplasty. The prevalence of deep vein thrombosis and pulmonary embolism and the presence of major bleeding events were assessed during hospitalization and at 3 months after discharge and compared between groups. The overall prevalence of thromboembolic events in the hip revision surgery cohort and in the primary hip cohort was 1.62% and 1.35%, respectively ( P = .801). The 38.4% of hip revision patients and 20.3% of primary hip patients presented major bleeding events. Thromboembolic disease outcomes with the use of a standardized thromboprophylaxis regimen were similar in both cohorts, regardless of the high variability of hip revision surgery and the increased risk of complications. Implementation of this regimen is recommended in patients requiring joint replacement revision surgery.
Subject(s)
Anticoagulants/therapeutic use , Arthroplasty, Replacement, Hip/methods , Adult , Aged , Aged, 80 and over , Anticoagulants/pharmacology , Cohort Studies , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
PURPOSE: Acetabular cup positioning in extreme angles of vertical position affects both stability and long-term survivorship of total hip arthroplasty. The purpose of this study is to determine whether native Sharp's angle is associated with an increased abduction angle of the acetabular component. METHODS: Consecutive patients who underwent primary total hip replacement between February 2012 and August 2015 were included. Vertical positioning of acetabular implant in the antero-posterior post-operative radiographs were measured. The proportion of implants positioned outside the safe zone (40° ± 10°) was calculated and through a multivariate analysis, Sharp's angle and other factors possibly associated with cup malpositioning were evaluated. RESULTS: Five hundred twenty-eight hip arthroplasties were analyzed. Prevalence of cup malpositioning was 7.6% and 25 patients had an altered native acetabular angle. An altered pre-operative Sharp's angle was associated with a higher risk of vertical malpositioning of the acetabular component (OR 2.51 IC 95%: 1.17-5.39) (p = 0.02). Body mass index, surgeon's volume, size of the implant, gender, pre-operative diagnose and age, were not associated with the position of the cup. CONCLUSIONS: The alteration of the Sharp's angle as an indicator of hip dysplasia in native hips increases the odds of acetabular cup malpositioning. Other factors explored did not correlate with the position of the acetabular prosthesis. Systematic assessment of Sharp's angle should be included in the pre-operative planning of primary hip arthroplasty.
Subject(s)
Acetabulum/surgery , Arthroplasty, Replacement, Hip/adverse effects , Hip Dislocation, Congenital/complications , Hip Prosthesis/adverse effects , Prosthesis Failure/etiology , Adolescent , Adult , Aged , Aged, 80 and over , Female , Hip Dislocation, Congenital/surgery , Hip Joint/diagnostic imaging , Hip Joint/surgery , Humans , Male , Middle Aged , Registries , Retrospective Studies , Risk Factors , Young AdultABSTRACT
INTRODUCTION: Rapidly destructive osteoarthritis is characterized by a severe destruction of the hip joint developing over short periods of time. However, to date, there is no agreement on the biological process that triggers this condition. The aim of this report is to present a case of rapidly destructive osteoarthritis. CASE REPORT: We report a case of a 76 year-old female who presented with hip pain of sudden onset and normal X-rays. Six weeks later she presented with increased pain intensity, functional limitation and evidence of a collapse of the femoral head in the X-rays. DISCUSSION: Rapidly destructive osteoarthritis of the hip is a complex entity that might be more frequent than previously described and which clinical course could vary between few weeks and several months. In order to make an accurate diagnosis, other causes of massive destruction of the joint should be excluded.
Subject(s)
Enoxaparin , Tranexamic Acid , Anticoagulants , Arthroplasty , Arthroplasty, Replacement, Knee , Hemorrhage , Humans , Venous ThromboembolismABSTRACT
La cirugía de salvamento de extremidad luego de la resección de sarcomas óseos ha demostrado mejoría en el resultado funcional de los pacientes y la sobrevida libre de enfermedad. El reemplazo total del fémur es una cirugía infrecuente. Este es el reporte del primer reemplazo total de fémur realizado en el Instituto Nacional de Cancerología.
