Incidence of postoperative complications and non- periprosthetic fractures after total hip arthroplasty: A more than 10-year follow-up retrospective cohort study.

OBJECTIVE: Postoperative complications and non-periprosthetic fractures (NPPFs), which was defined as a fracture existing non- periprosthetic implant, after total hip arthroplasty (THA) have a negative effect on the patients' ability to perform activities of daily living. Thus, investigating these incidences of patients after THA will be valuable as it lead to a more strategic physical therapy interventions and advanced research to prevent these problems. The purpose of this study was to investigate the incidence of postoperative complications related to implants and NPPFs in patients after THA, a more than 10-year follow-up. METHODS: This is a retrospective cohort study. A total 892 patients with hip osteoarthritis who underwent primary THA were analyzed (age at surgery was 45-79 years; 805 women; the average follow-up period was 12.4-year). The postoperative complications related to implants and NPPFs were calculated using data from their medical records. RESULTS: The postoperative complications occurred in 37 patients, and NPPFs occurred in 72 patients, who were significantly older, and hip and knee OA diagnosis, compared to patients without NPPFs ( p <.05). The most common cause of NPPFs was minor trauma. In patients aged ≧ 65 years, significantly more NPPFs occurred during the first year after surgery( p <.05). CONCLUSION: More than 10-year after THA, the incidence of NPPFs was higher than that of postoperative complications related to implants. Older patients who had hip and knee OA were a significantly higher risk of developing NPPFs due to falls within the first year after surgery.

Clinical efficacy of risk-stratified prophylaxis with low-dose aspirin for the management of symptomatic venous thromboembolism after total hip arthroplasty.

BACKGROUND: Pulmonary thromboembolism (PTE) and deep vein thrombosis (DVT) are serious complications after total hip arthroplasty (THA). Aspirin has been considered a safe and cost-effective prophylaxis for venous thromboembolism (VTE), and there have been some reports about the incidence of PTE (0%-0.57%) and DVT (0.1%-0.35%) with low-dose aspirin for prophylaxis after THA. The aim of this study was to investigate the incidence of postoperative symptomatic VTE in our hospital and to evaluate the clinical efficacy of our prophylactic regimen. PATIENT AND METHODS: We retrospectively reviewed the medical records of consecutive patients who underwent THA in our hospital between 2011 and 2016. A total of 3295 hips (male: 337 patients, 365 hips; female: 2527 patients, 2930 hips) were enrolled in this study. Patients were divided into low-risk and high-risk groups. Low-risk patients were administered aspirin (100 mg/day) for 28 days postoperatively. High-risk patients, such as those diagnosed with obesity and/or with a history of VTE, received anticoagulants (enoxaparin or edoxaban) for 5 days postoperatively, followed by a dose of aspirin for 28 days. Based on our criteria, 218 of 3295 hips were considered high risk. RESULTS: No VTE-related mortality was observed. One patient developed symptomatic PTE, and one patient developed symptomatic DVT. Both were successfully treated. Postoperative fatal bleeding or bleeding from any organ such as gastrointestinal and cerebral hemorrhage were not observed. A low incidence (0.03%) was observed for symptomatic DVT and PTE. CONCLUSIONS: This study demonstrated that the hospital's risk-stratified protocol using low-dose aspirin or anticoagulants was clinically effective in preventing symptomatic VTE. These results were considerably better than those reported from Western countries. However, all patients in this study were the Japanese. It was unclear whether similar results were given to non-Japanese patients. Therefore, this protocol needs severe carefulness to be applied to non-Japanese populations.

Additional intraarticular tranexamic acid further reduced postoperative blood loss compared to intravenous and topical bathed tranexamic acid in total hip arthroplasty: a retrospective sequential series study.

BACKGROUND: Topical tranexamic acid (TXA) administration has been described to be effective in decreasing blood loss in total hip arthroplasty (THA). The aim of this retrospective study was to evaluate whether topical intraarticular TXA administration in addition to intravenous (IV) and topical bathed TXA further reduces blood loss in THA patients. STUDY DESIGN AND METHODS: Four-hundred patients were enrolled in this sequential series study with two different phases during four different time periods. Patients were divided based on TXA usage and route of administration: those with and without IV TXA (IVTA-I and no-IVTA groups, respectively) and those with and without intraarticular TXA (TITA and IVTA-II groups, respectively). Both IVTA-II and TITA groups had IV TXA, and all four groups used topical bathed TXA. These four groups had 100 cases each. The primary outcomes were evaluated with total blood loss and postoperative hemoglobin level. RESULTS: The total blood loss was 1106 and 875 mL in the no-IVTA and IVTA-I groups, respectively (p < 0.05). Postoperative Hb was 10.9 and 11.51 g/dL in the no-IVTA and IVTA-I groups, respectively (p < 0.05). Total blood loss was 813 and 646 mL in the IVTA-II and TITA groups, respectively (p < 0.05). Intraarticular with IV and bathed TXA administration was more effective than IV and bathed TXA in reducing blood loss. CONCLUSION: This study suggests that the combined administration of topical intraarticular, bathed, and IV TXA was effective in reducing blood loss in THA patients.

Quantitative evaluation of fatty degeneration of the supraspinatus and infraspinatus muscles using T2 mapping.

BACKGROUND: Although fatty degeneration of the rotator cuff muscles has been reported to affect the outcomes of rotator cuff repairs, only a few studies have attempted to quantitatively evaluate this degeneration. T2 mapping is a quantitative magnetic resonance imaging technique that potentially evaluates the concentration of fat in muscles. The purpose of this study was to investigate fatty degeneration of the rotator cuff muscles by using T2 mapping, as well as to evaluate the reliability of T2 measurement. METHODS: We obtained magnetic resonance images including T2 mapping from 184 shoulders (180 patients; 110 male patients [112 shoulders] and 70 female patients [72 shoulders]; mean age, 62 years [range, 16-84 years]). Eighty-three shoulders had no rotator cuff tear (group A), whereas 101 shoulders had tears, of which 62 were incomplete to medium (group B) and 39 were large to massive (group C). T2 values of the supraspinatus and infraspinatus muscles were measured and compared among groups. Intraobserver and interobserver variabilities also were examined. RESULTS: The mean T2 values of the supraspinatus in groups A, B, and C were 36.3 ± 4.7 milliseconds, 44.2 ± 11.3 milliseconds, and 57.0 ± 18.8 milliseconds, respectively. The mean T2 values of the infraspinatus in groups A, B, and C were 36.1 ± 5.1 milliseconds, 40.0 ± 11.1 milliseconds, and 51.9 ± 18.2 milliseconds, respectively. The T2 value significantly increased with the extent of the tear in both muscles. Both intraobserver and interobserver variabilities were more than 0.99. CONCLUSION: T2 mapping can be a reliable tool to quantify fatty degeneration of the rotator cuff muscles.

Effectiveness of thermotherapy using a heat and steam generating sheet for cartilage in knee osteoarthritis.

[Purpose] Superficial heat treatment is one of the most widely used physical therapies for osteoarthritis (OA). We clinically evaluated the effects of local heat treatment and exercise therapy for knee OA, and evaluated the articular cartilage using magnetic resonance imaging (MRI) T2 mapping. [Subjects and Methods] Eighteen females aged 50-69 (59.5 ± 8.5 years, mean ± SD) years diagnosed with early-stage knee OA were randomly assigned using computer-generated random numbers to either a local heat treatment group (LH group, 9 subjects) or an exercise therapy group (EX group, 9 subjects). These groups were subjected to a 12-week intervention experiment. MRI T2 mapping was performed for cartilage imaging and quantitative evaluation. For clinical evaluation, the Japanese Knee Osteoarthritis Measure (JKOM) and the Timed Up and Go (TUG) test were performed. Both clinical and MRI evaluations were performed at the beginning and end of the intervention (0 week (Time 0) and 12 weeks). [Results] The total JKOM score had a significantly decreased in the LH group at 12 weeks. However, in the EX group the total JKOM scores at Time 0 and 12 weeks were not significantly different. The TUG time in the EX group was significant shorter at 12 weeks, whereas it showed no significant change in the LH group at 12 weeks, though the TUG times of 7 of the 9 patients decreased, exhibiting some improvement. The T2 value of the LH group was significantly shorter at 12 weeks. However, the T2 value in the EX group showed no significant change at 12 weeks. [Conclusion] After local heat treatment using heat- and steam moisture-generating sheets for 12 weeks, we observed improvements in clinical symptoms and walking abilities. Moreover, positive effects on cartilage metabolism were suggested.

Asymmetrical pedicle subtraction osteotomy for rigid degenerative lumbar kyphoscoliosis.

STUDY DESIGN: A prospectively study. OBJECTIVE: Our objective was to clarify the safety and efficacy of asymmetrical pedicle subtraction osteotomy (PSO) in the treatment of severe adult lumbar deformities prospectively. SUMMARY OF BACKGROUND DATA: Vertebral wedge osteotomy provides good correction of kyphosis but has rarely been applied to degenerative lumbar kyphoscoliosis. METHODS: A total of 14 patients who had undergone corrective osteotomy were enrolled. The average age at PSO was 67 years (range, 45-76 yr). The minimum follow-up was 2 years. Patient questionnaires were administered prospectively. Radiographical parameters including sagittal and coronal balance were analyzed. RESULTS: Average operative time was 310 minutes (range, 254-375 min). Average blood loss was 1090 mL (range, 700-2900 mL).Mean preoperative lumbar lordosis improved from -3° to 42° at the final follow-up, and sagittal balance improved from 12 to 3 cm, respectively. Mean lumbar scoliosis improved from 40° to 12°, and coronal offset improved from 3 to 1 cm, respectively. There was also statistically significant improvement from preoperative to final evaluation in all clinical domains. There were 4 complications: 1 dural tear, 2 hook dislodgements at the cephalad side requiring revision instrumentation, and 1 rod breakage not requiring surgical intervention. Overall, all 14 patients were satisfied with their surgical management and would choose to repeat the procedure. CONCLUSION: Our data suggest that the surgical procedure of asymmetrical PSO is to correct the scoliosis, to restore the lumbar lordosis by way of convex-sided posterolateral wedge osteotomy, and may go a long way toward solving the problems of rigid lumbar degenerative kyphoscoliosis.

Transpedicular hydroxyapatite grafting with indirect reduction for thoracolumbar burst fractures with neurological deficit: A prospective study.

BACKGROUND: The major problem after posterior correction and instrumentation in the treatment of thoracolumbar burst fractures is failure to support the anterior spinal column leading to loss of correction of kyphosis and hardware breakage. We conducted a prospective consecutive series to evaluate the outcome of the management of acute thoracolumbar burst fractures by transpedicular hydroxyapatite (HA) grafting following indirect reduction and pedicle screw fixation. MATERIALS AND METHODS: Eighteen consecutive patients who had thoracolumbar burst fractures and associated incomplete neurological deficit were operatively treated within four days of admission. Following indirect reduction and pedicle screw fixation, transpedicular intracorporeal HA grafting to the fractured vertebrae was performed. Mean operative time was 125 min and mean blood loss was 150 ml. Their implants were removed within one year and were prospectively followed for at least two years. RESULTS: The neurological function of all 18 patients improved by at least one ASIA grade, with nine (50%) patients demonstrating complete neurological recovery. Sagittal alignment was improved from a mean preoperative kyphosis of 17°to -2°(lordosis) by operation, but was found to have slightly deteriorated to 1° at final followup observation. The CT images demonstrated a mean spinal canal narrowing preoperatively, immediate postoperative and at final followup of 60%, 22% and 11%, respectively. There were no instances of hardware failure. No patient reported severe pain or needed daily dosages of analgesics at the final followup. The two-year postoperative MRI demonstrated an increase of one grade in disc degeneration (n = 17) at the disc above and in 11 patients below the fractured vertebra. At the final followup, flexion-extension radiographs revealed that a median range of motion was 4, 6 and 34 degrees at the cranial segment of the fractured vertebra, caudal segment and L1-S1, respectively. Bone formation by osteoconduction in HA granules was unclear, but final radiographs showed healed fractures. CONCLUSIONS: Posterior indirect reduction, transpedicular HA grafting and pedicle screw fixation could prevent the development of kyphosis and should lead to reliable neurological improvement in patients with incomplete neurological deficit. This technique does not require fusion to a segment, thereby preserves thoracolumbar motion.