An evaluation of peri-operative clinical, serological and radiological parameters in hip arthroplasties -a prospective observational study of Indian cohorts.

BACKGROUND: The scarcity of mortality data in our country led to systematic effort with aim of evaluating peri-operative parameters associated with mortality in hip arthroplasties to determine better fixation method and reducing avoidable variables. MATERIALS & METHODS: 252 consecutive patients (133 males and 119 females; Mean age 58.68 years) operated for hip arthroplasties (cemented & uncemented THR and bipolar hemiarthroplasty) were observed prospectively for 2 years. Heart-rate, O2 saturation and BP were recorded at specific surgical steps and post-operatively for 48 h. Post-operative Trop-T and 2D Echocardiography were done in all patients and D-Dimer and CTPA in indicated ones. All post-operative deaths were extensively studied. RESULTS: - Majority (63%) were operated for traumatic indications.48% belonged to ASA grade-1, 46% grade-2 and 4% grade-3. There was statistically significant association of diagnosis (traumatic aetiology), ASA grade 2, raised Troponin -T, raised D-dimer and pulmonary embolism with mortality. Mortality rate in our study at post-op 48 h was 5.5%, 30 day- 8% and 1-year mortality rate was 19%. With total of 14 deaths, 8 deaths (57.14%) occurred among 127 cemented arthroplasties and 6 deaths (42.86%) among 125 uncemented arthroplasties. CONCLUSIONS: Selection of implant (cemented or uncemented) made no difference in eventual mortality. Collaborative effort of orthopaedic surgeon, anaesthetist and experts from respective fields in elderly high-risk patient with vigilant post-operative surveillance for minimum 48 h would help in lowering mortality associated with hip arthroplasties.

Thresholds for meaningful improvement in WOMAC scores need to be adjusted to patient characteristics after hip and knee replacement.

PURPOSE: To calculate unstratified and patient-specific meaningful improvement (MI) and patient acceptable symptom states (PASS) for the WOMAC total score in patients after total hip (THR) or total knee replacement (TKR). METHODS: A retrospective observational cohort study. Anchor-based receiver operator characteristics curves were used to estimate MI and PASS thresholds. RESULTS: Recovery paths were specific to individual characteristics of patients. An unstratified 12-months MI threshold of 28.1 (PASS: 13.3) and 17.8 (PASS: 15.8) for patients after THR and TKR, respectively, would unfairly detect critical recovery paths. CONCLUSIONS: Thresholds for treatment success need to be as patient-specific as possible.

Short to long term outcomes of 154 cemented total hip arthroplasties in ankylosing spondylitis.

BACKGROUND: Long-term outcome of Total Hip arthroplasty (THA) in Ankylosing Spondylitis (AS) remains unreported. Literature suggests a higher overall failure rate in ankylosing spondylitis as compared to osteoarthritis. Concern has been expressed regarding joint survival, given that recipients are generally young. The results of cemented THA in patients with ankylosing spondylitis were studied to determine the utility of THA for these patients. METHODS: Consecutive series of 96 patients (77 males (80%) and 19 females (20%)) with ankylosing spondylitis who underwent 154 cemented THAs at a tertiary referral orthopaedic centre between January 1990-September 2015 were retrospectively analyzed for clinical and radiological outcomes; 58 patients (60.4%) underwent bilateral surgery. RESULTS: Mean age at surgery was 48 years. Average follow up was 12.8 (2.1-24.8) years. 95% of the patients had a good or excellent post-operative outcome.Out of the total 154 hips operated on, 11% (17 hips) developed post-operative complications. Overall, 15 hips (9.7%) required a revision of the procedure, with the most common indication being aseptic loosening of the acetabulum. Average time to revision was 8.5 years (2-15). Survivorship analysis revealed probability of survival of both components at the end of 10 years, with revision due to any reason as the end point to be 92% (with 95% confidence intervals).21 hips (14%) developed heterotopic ossification post-operatively, of which 4 patients (2%) had clinically significant ossification (Brooker III or IV). CONCLUSION: This is one of the largest series of patients with ankylosing spondylitis with long term follow up available. Cemented THA in patients with ankylosing spondylitis provided consistently good and predictable long term results, with low rate of complications and revisions.

Gunshot Wounds to The Hip.

Gunshot wounds to the hip region are likely to cause complex peritrochanteric fracture. The fracture patterns are often highly comminuted and accompanied by injuries to local structures and abdominal viscera. Our case series analyses 25 orthopaedic procedures performed. The overall union rate for primary fixation was 66%. Two patients underwent revision surgery for failed primary fixation. Two cases where fixation had failed were revised to total hip replacement successfully. These types of injuries present a formidable challenge. Preservation of the femoral head should be prioritised to avoid arthroplasty. Long-term follow-up is necessary in assessing the success of these procedures.

Effectiveness of home-based rehabilitation program in minimizing disability and secondary falls after a hip fracture: Protocol for a randomized controlled trial.

INTRODUCTION: Hip fractures are a major health problem globally and are associated with increased morbidity, mortality, and substantial economic costs. Successful operative treatment of hip fracture patients is necessary for the optimization of post-op mobility and functional recovery of the patient. Rehabilitation after surgical stabilization of a hip fracture is crucial in order to restore pre-fracture function and to avoid long-term institutionalization. In particular ongoing exercise which targets balance can prevent up to 40% of falls. Therefore, we have designed a post-discharge home-based physical rehabilitation intervention program to minimize disability and falls in this high-risk elderly population. METHODS AND ANALYSIS: The study will be an open label, simple randomized controlled trial at a single hospital. The two arms will be equally allocated on a 1:1 ratio into intervention and control groups. The control arm will receive the usual standard postoperative rehabilitation. The intervention group will receive an extended home-based rehabilitation program twice a week continued for 3 months (12 weeks) after discharge. The Primary outcome of the study is occurrence of falls. Falls will be measured at 3, 6, 12, and 24 months by research-assistant follow-up telephone calls for both the groups. Mobility-related disability will be measured with a self-reported test at every routine follow-up for up to two years using a performance-based short battery tool. Negative binomial regression model will be used to compare number of falls in both the groups by computing incidence ratio rates. ETHICS AND DISSEMINATION: Approval for the conduction of this study has been taken from the Ethical Review Committee (ERC) of the institution. Evidences which will be obtained from this study will facilitate to propose changes in existing guidelines and policies for treating fall and hip fracture patients.Trial registrationThis trial is registered on clinicaltrials.gov ID: NCT04108793.