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I had a total hip replacement (left side, anterior approach) on Jan 11, 2022, performed by Dr Gilbert Roc at the Kaiser Sunset facility in Los Angeles. I arranged to keep my femoral head and hip capsule, which were removed during the procedure. The kind folks at Thingergy (Burbank) produced a very high-resolution scan for me, which I am releasing for CC use.

This article is from Upsala Journal of Medical Sciences , volume 119 . Abstract Introduction: Accumulating evidence suggests that enhanced inflammatory responses contribute to the pathogenesis of postoperative cognitive dysfunction (POCD). Blood transfusion can trigger an enhancement of acute inflammatory responses. Therefore, we hypothesized that perioperative blood transfusion is associated with a higher risk of POCD in aged patients following total hip replacement surgery. Material and methods: Patients older than 65 years undergoing elective total hip replacement surgery were enrolled from October 2011 to December 2012. Neurocognitive tests were evaluated at baseline and at 7 d after surgery by a Mini-Mental State Test. Multivariate logistic regression analysis was used to determine risk factors associated with POCD. Results: Fifty-six patients (27.3%) developed POCD 7 d postoperatively. Patients who developed POCD were older, had a lower education level and preoperative hemoglobin concentration, had more blood loss, and had a lower body weight (p < 0.05). Patients with POCD were more likely to receive red blood cells (RBCs) transfusion (51.8% versus 31.5%; p < 0.05). A multivariable logistic regression model identified older age, lower education level, and perioperative blood transfusion of more than 3 units as independent risk factors for POCD 7 d postoperatively. Conclusion: Our data suggested that perioperative blood transfusion of more than 3 units of RBCs is an independent risk factor for POCD in aged patients following total hip replacement surgery.

A very high mortality and disability rate is predicted for hip fractures worldwide, which are predicted to rise from 1.26 million cases in 1990 to 4.5 million cases in 2050 as a result of the aging of our population. The frequency of hip illnesses in the elderly is also progressively rising [1]. The most common surgical procedure for treating femoral neck fractures, osteoarthritis, and femoral head osteonecrosis is total hip replacement (THA), which is performed on average on more than one million hip replacement patients annually worldwide. Approximately 20% of these patients need rehabilitation care [2].Nevertheless, the 1-year postoperative morbidity and mortality rate is 20% to 30% even after surgical treatment and rehabilitation, and 20% of patients will experience another fracture [3, 4]. As a result, hip fractures are becoming a major global public health concern that also place a significant financial and medical strain on families and society. Clinical research is now primarily focused on ways to raise patient functional recovery levels and enhance the standard of nursing care. The concept of accelerated recovery (Enhanced Recovery After Surgery, ERAS), as an emerging concept of surgical rehabilitation care in recent years, has been widely used in clinical guidance, which is based on following the medical evidence, implementing effective interventions in the perioperative period to reduce the surgical traumatic stress response and postoperative complications, and improving the safety and effectiveness of surgery to accelerate the patient's rehabilitation process [5,6]. In recent years, the integration of digital technology and healthcare applications has become increasingly frequent, covering healthcare services, testing equipment and diagnostic and therapeutic devices. Digital technology refers to the conversion of various forms of information (such as text, images, sound, etc.) into digital form for processing, storage, transmission and display of technology, and is widely used in various fields, clinically more common artificial intelligence (Artificial Intelligence, AI) technology, machine learning, virtual reality (virtual reality, VR) technology, Internet of Things, etc. [5,6]. VR) technology, Internet of Things (IoT), etc [7,8]. The popularization of these technologies helps healthcare professionals to provide faster and safer quality care to patients. The progress of clinical research on digital technologies in accelerated rehabilitation of THA is reviewed.

This article is from PLoS ONE , volume 9 . Abstract Background: Evolvements in the design, fixation methods, size, and bearing surface of implants for total hip replacement (THR) have led to a variety of options for healthcare professionals to consider. The need to determine the most optimal combinations of THR implant is warranted. This systematic review evaluated the clinical effectiveness of different types of THR used for the treatment of end stage arthritis of the hip. Methods: A comprehensive literature search was undertaken in major health databases. Randomised controlled trials (RCTs) and systematic reviews published from 2008 onwards comparing different types of primary THR in patients with end stage arthritis of the hip were included. Results: Fourteen RCTs and five systematic reviews were included. Patients experienced significant post-THR improvements in Harris Hip scores, but this did not differ between impact types. There was a reduced risk of implant dislocation after receiving a larger femoral head size (36 mm vs. 28 mm; RR = 0.17, 95% CI: 0.04, 0.78) or cemented cup (vs. cementless cup; pooled odds ratio: 0.34, 95% CI: 0.13, 0.89). Recipients of cross-linked vs. conventional polyethylene cup liners experienced reduced femoral head penetration and revision. There was no impact of femoral stem fixation and cup shell design on implant survival rates. Evidence on mortality and complications (aseptic loosening, femoral fracture) was inconclusive. Conclusions: The majority of evidence was inconclusive due to poor reporting, missing data, or uncertainty in treatment estimates. The findings warrant cautious interpretation given the risk of bias (blinding, attrition), methodological limitations (small sample size, low event counts, short follow-up), and poor reporting. Long-term pragmatic RCTs are needed to allow for more definitive conclusions. Authors are encouraged to specify the minimal clinically important difference and power calculation for their primary outcome(s) as well CONSORT, PRISMA and STROBE guidelines to ensure better reporting and more reliable production and assessment of evidence.

This article is from BMC Musculoskeletal Disorders , volume 14 . Abstract Background: Although hip information literature is given to people following total hip replacement (THR) almost routinely, little evaluation has been conducted on it to date. Our aim was therefore to analyse and evaluate the literature provided to patients by occupational therapists concerning elective hip surgery in the UK. Methods: This was a pragmatic, descriptive analysis of information leaflets routinely given to patients undergoing primary total hip replacement (THR). The literature was collected as part of a national survey of occupational therapy practice. In the absence of a suitable evaluation tool, the patient leaflets were compared using a checklist devised by the researchers. The three areas of interest were: accessibility including presentation of information, breadth of information covered and specific activities of daily living described. Results: 111 information leaflets and booklets were examined. These ranged from hospital publications which were professionally printed to those produced by individual departments. There was a variation in the readability of the leaflets ranging from 13% to 83%; the mean was 45% (SD 15). There was also variation in the content ranging from those covering surgery and possible complications, to those including diet and hip exercises. The most commonly covered activity of daily living was advice on sitting (99; 89%); the least commonly covered was work (26; 23%). Only 3 (2.7%) booklets had involved patients in their production and only 22 (20%) signposted obtaining information in another language or in Braille. Conclusions: There was a range of literature in terms of presentation and content given to people who had a total hip replacement (THR). Although some booklets and leaflets scored highly, some did not meet basic standards such as providing contact details for help, using good quality diagrams, suggesting further reading or involving patients in their design. These results highlight important and fundamental deficiencies in the literature routinely provided.

Bibliografia na stronach 100-101. ; Streszczenie w języku polskim. ; artykuł w: Annales Universitatis Mariae Curie-Skłodowska. Sectio D, Medicina Vol. 48, 16 (1993), strony 95-101 ; tyt. równoległy: Radiologiczny obraz kości udowej po wszczepieniu bezcementowej endoprotezy biodra w ocenie 3-letniej

Bibliografia na stronach 100-101. ; Streszczenie w języku polskim. ; artykuł w: Annales Universitatis Mariae Curie-Skłodowska. Sectio D, Medicina Vol. 48, 16 (1993), strony 95-101 ; tyt. równoległy: Radiologiczny obraz kości udowej po wszczepieniu bezcementowej endoprotezy biodra w ocenie 3-letniej

This article is from Acta Orthopaedica , volume 85 . Abstract Background and purpose: Previous work has shown that despite preventive measures, intraoperative contamination of joint replacements is still common, although most of these patients seem to do well in follow-up of up to 5 years. We analyzed the prevalence and bacteriology of intraoperative contamination of primary joint replacement and assessed whether its presence is related to periprosthetic joint infection (PJI) on long-term follow-up. Patients and methods: 49 primary total hip replacements (THRs) and 41 total knee replacements (TKRs) performed between 1990 and 1991 were included in the study. 4 bacterial swabs were collected intraoperatively during each procedure. Patients were followed up for joint-related complications until March 2011. Results: 19 of 49 THRs and 22 of 41 TKRs had at least 1 positive culture. Coagulase-negative staphylococci and Staphylococcus aureus were the most common organisms, contaminating 28 and 9 operations respectively. Where information was available, bacteria from 27 of 29 contaminated operations were susceptible to the prophylactic antibiotic administered. 13% of samples gathered before 130 min of surgery were contaminated, as compared to 35% collected after that time. 2 infections were diagnosed, both in TKRs. 1 of them may have been related to intraoperative contamination. Interpretation: Intraoperative contamination was common but few infections occurred, possibly due to the effect of prophylactic antibiotics. The rate of contamination was higher with longer duration of surgery. It appears that positive results from intraoperative swabs do not predict the occurrence of PJI.

This article is from Journal of Biomedical Research , volume 25 . Abstract The aim of the present study was to compare the effects of colloid and crystalloid preload on cardiac output (CO) and incidence of hypotension in elderly patients under spinal anesthesia (SA). A randomized, double-blinded study was conducted including 47 elderly patients undergoing scheduled total hip replacement (THR), who were randomized to three groups: the control group (C group, n = 15), crystalloid (RS group, n =16) and colloid group (HES group, n = 16). An intravenous preload of 8 mL/kg of either lactated Ringer's solution in the RS group or 6% hydroxyethyl starch in the HES group was infused within 20 min before SA induction, while no intravenous preload was given in the C group. There was a trend of decrease in CO and systolic blood pressure after SA with time in the C group. In the RS and HES groups, CO increased significantly after fluid preloading as compared with baseline (P < 0.01). Thereafter, CO remained higher than baseline until 30 min after SA in the HES group. The change of systolic blood pressure was similar to CO, but no significant difference from baseline was observed in each group. Hypotension occurred in 3 patients in the C group and one each in the RS and HES group, respectively (P = 0.362). Intravascular volume preload with colloid is more effective than crystalloid solution in maintaining CO, which may be improved the hemodynamic stability in elderly patients during SA.

Vascular injury during total hip replacement is a rare condition with the incidence varying between 0.1% and 0.3%. However when develops, it has a potential of serious complications such as extremity loss and even death. Prompt identification and appropriate surgical management of this condition are crucial and may decrease the rate of morbidity and mortality. In this report, we presented a case of iatrogenic iliac vein injury during total hip replacement and its successful surgical management.

Vascular injury during total hip replacement is a rare condition with the incidence varying between 0.1% and 0.3%. However when develops, it has a potential of serious complications such as extremity loss and even death. Prompt identification and appropriate surgical management of this condition are crucial and may decrease the rate of morbidity and mortality. In this report, we presented a case of iatrogenic iliac vein injury during total hip replacement and its successful surgical management.

Total joint replacement (TJR) is a mature and effective method for end-stage Osteoarthritis (OA) patients, but 25% of patients undergoing surgery do not meet the indications. These patients are more likely to feel dissatisfied or even regret, which greatly decrease their quality of life. Due to the limited time spent with patients and stereotyping, information provided by surgeons cannot meet patients’ demand for informational support. While patient decision aids (PtDAs), evidence-based sources of health information can solve the problem and facilitate shared decision-making. Nonetheless, existing systematic review only assess the effectiveness of PtDAs in hip and knee TJR decision-making. This review aims to assess the state of the literature on PtDAs for hip and knee TJR, to describe the features of PtDAs for OA patients considering primary elective TJR, and to identify the application on decision-making.

Total joint replacement (TJR) is a mature and effective method for end-stage Osteoarthritis (OA) patients, but 25% of patients undergoing surgery do not meet the indications. These patients are more likely to feel dissatisfied or even regret, which greatly decrease their quality of life. Due to the limited time spent with patients and stereotyping, information provided by surgeons cannot meet patients’ demand for informational support. While patient decision aids (PtDAs), evidence-based sources of health information can solve the problem and facilitate shared decision-making. Nonetheless, existing systematic review only assess the effectiveness of PtDAs in hip and knee TJR decision-making. This review aims to assess the state of the literature on PtDAs for hip and knee TJR, to describe the features of PtDAs for OA patients considering primary elective TJR, and to identify the application on decision-making.

This article is from Journal of Clinical Medicine Research , volume 3 . Abstract Early periprosthetic osteolysis following total hip replacement (THR) as a result of septic etiology has been well understood. Periprosthetic bone loss as a result of metastatic infiltration is an uncommon and infrequent cause of early, progressive loosening of joint replacement prosthesis. Proximal femur has been the most common site of involvement compared to acetabular prosthesis. The rarity of this clinical entity can lead to delay in definitive diagnosis and management, thus affecting the final outcome. Breast is the commonest site of carcinoma in female patients despite which not many cases of periprosthetic metastasis have been reported in the literature. We present the first case of extensive, isolated periacetabular bone destruction following a THR in a 59 years old female patient with a history of breast carcinoma. Patients with known primary malignancy should be screened thoroughly before operation and should be followed regularly after joint replacement surgery to detect any metastatic foci around the prosthesis.Keywords: Periprosthetic metastasis; Total hip replacement; Breast carcinoma

This scoping review aims to identify the key characteristics and factors that contribute to the burden of care experienced during outpatient total hip and knee arthroplasty. The specific research question is: (1) What are the most important characteristics and factors that contribute to the burden of care for caregivers providing care to patients undergoing primary total hip and knee arthroplasty as outpatients?

This scoping review aims to identify the key characteristics and factors that contribute to the burden of care experienced during outpatient total hip and knee arthroplasty. The specific research question is: (1) What are the most important characteristics and factors that contribute to the burden of care for caregivers providing care to patients undergoing primary total hip and knee arthroplasty as outpatients?

This article is from Acta Orthopaedica , volume 85 . Abstract Background and purpose: An earlier Nordic Arthroplasty Register Association (NARA) report on 280,201 total hip replacements (THRs) based on data from 1995–2006, from Sweden, Norway, and Denmark, was published in 2009. The present study assessed THR survival according to country, based on the NARA database with the Finnish data included. Material and methods: 438,733 THRs performed during the period 1995–2011 in Sweden, Denmark, Norway, and Finland were included. Kaplan-Meier survival analysis was used to calculate survival probabilities with 95% confidence interval (CI). Cox multiple regression, with adjustment for age, sex, and diagnosis, was used to analyze implant survival with revision for any reason as endpoint. Results: The 15-year survival, with any revision as an endpoint, for all THRs was 86% (CI: 85.7–86.9) in Denmark, 88% (CI: 87.6–88.3) in Sweden, 87% (CI: 86.4–87.4) in Norway, and 84% (CI: 82.9–84.1) in Finland. Revision risk for all THRs was less in Sweden than in the 3 other countries during the first 5 years. However, revision risk for uncemented THR was less in Denmark than in Sweden during the sixth (HR = 0.53, CI: 0.34–0.82), seventh (HR = 0.60, CI: 0.37–0.97), and ninth (HR = 0.59, CI: 0.36–0.98) year of follow-up. Interpretation: The differences in THR survival rates were considerable, with inferior results in Finland. Brand-level comparison of THRs in Nordic countries will be required.

2 MONTH FOLLOW UP TOTAL HIP REPLACEMENT UNCEMENTED https://youtube.com/shorts/Olf16YBd_Bk?feature=share

This article is from BMC Musculoskeletal Disorders , volume 14 . Abstract Background: The age- and gender-specific incidence of total hip replacement surgery has increased over the last two decades in all age groups. Recent studies indicate that non-surgical interventions are effective in reducing pain and disability, even at later stages of the disease when joint replacement is considered. We hypothesize that the time to hip replacement can be postponed in patients with severe hip osteoarthritis following participation in a patient education and supervised exercise program when compared to patients receiving patient education alone. Methods/design: A prospective, blinded, parallel-group multi-center trial (2 sites), with balanced randomization [1:1]. Patients with hip osteoarthritis and an indication for hip replacement surgery, aged 40 years and above, will be consecutively recruited and randomized into two treatment groups. The active treatment group will receive 3 months of supervised exercise consisting of 12 sessions of individualized, goal-based neuromuscular training, and 12 sessions of intensive resistance training plus patient education (3 sessions). The control group will receive only patient education (3 sessions). The primary end-point for assessing the effectiveness of the intervention is 12 months after baseline. However, follow-ups will also be performed once a year for at least 5 years. The primary outcome measure is the time to hip replacement surgery measured on a Kaplain-Meier survival curve from time of inclusion. Secondary outcome measures are the five subscales of the Hip disability and Osteoarthritis Outcome Score, physical activity level (UCLA activity score), and patient’s global perceived effect. Other measures include pain after exercise, joint-specific adverse events, exercise adherence, general health status (EQ-5D-5L), mechanical muscle strength and performance in physical tests. A cost-effectiveness analysis will also be performed. Discussion: To our knowledge, this is the first randomized clinical trial comparing a patient education plus supervised exercise program to patient education alone in hip osteoarthritis patients with an indication for surgery on the time to total hip replacement. Trial registration: NCT01697241

This article is from Journal of Orthopaedic Surgery and Research , volume 9 . Abstract Background: There has been no effective method to monitor the changes of blood coagulation after thromboprophylaxis for elective arthroplasty patients. The objective of this study is to assess the coagulation status of patients undergoing arthroplasty with thromboelastograph (TEG). Methods: Ninety patients undergoing primary elective unilateral arthroplasty were investigated. Thromboprophylaxis continued for at least 10 days. TEG was performed on the day before the operation and on postoperative days 1, 4, and 9. Results: The total hip and total knee groups showed significant changes in the distribution of different hypercoagulable states on days 1–4 and on days 4–9. On day 9 after operation, 34 out of 90 (37.8%) of the total hip and total knee patients were found with hypercoagulable state. Of these 34 patients with hypercoagulable state, 26 (76.5%) demonstrated platelet or mixed hypercoagulability. Conclusions: Thrombelastography was an effective way to identify hypercoagulability in patients undergoing elective primary total knee and total hip replacement. Platelet may play an important role in the progress of blood hypercoagulability.

This article is from BMC Health Services Research , volume 14 . Abstract Background: To facilitate the discussion on the increasing number of total hip replacements (THR) and their effectiveness, we apply a joint evaluation of hospital case costs and health outcomes at the patient level to enable comparative effectiveness research (CER) based on the preoperative health state. Methods: In 2012, 292 patients from a German orthopedic hospital participated in health state evaluation before and 6 months after THR, where health-related quality of life (HRQoL) and disease specific pain and dysfunction were analyzed using EQ-5D and WOMAC scores. Costs were measured with a patient-based DRG costing scheme in a prospective observation of a cohort. Costs per quality-adjusted life year (QALY) were calculated based on the preoperative WOMAC score, as preoperative health states were found to be the best predictors of QALY gains in multivariate linear regressions. Results: Mean inpatient costs of THR were 6,310 Euros for primary replacement and 7,730 Euros for inpatient lifetime costs including revisions. QALYs gained using the U.K. population preference-weighted index were 5.95. Lifetime costs per QALY were 1,300 Euros. Conclusions: The WOMAC score and the EQ-5D score before operation were the most important predictors of QALY gains. The poorer the WOMAC score or the EQ-5D score before operation, the higher the patient benefit. Costs per QALY were far below common thresholds in all preoperative utility score groups and with all underlying calculation methodologies.

Hip Replacement Merrimack Valley Total Hip Replacement Operation, Merrimack Valley explained using the actual parts used in a total hip replacement operation, by Dr Lawrence Johnson, MD, a Board Certified Orthopedic Surgeon. To know more :  http://lawrencejohnsonmd.com/

This article is from Acta Orthopaedica , volume 85 . Abstract Background and purpose: The continuously increasing demand for joint replacement surgery in the past decades imposes higher constraints on the budgets of hospitals and healthcare providers. We undertook an analysis of historical trends in total hip replacement performed in Sweden between 1968 and 2012 in order to provide projections of future demand. Data and methods: We obtained data on total hip replacements registered every year and on the evolution of the Swedish population between 1968 and 2012. We assumed the existence of a maximum incidence. So we adopted a regression framework that assumes the existence of an upper limit of total hip replacement incidence. Results: We found that the incidence of total hip replacement will continue to increase until a projected upper incidence level of about 400 total hip replacements per 105 Swedish residents aged 40 years and older will be reached around the year 2107. In 2020, the estimated incidence of total hip replacement will be 341 (95% prediction interval (PI): 302–375) and in 2030 it will be 358 (PI: 317–396). Using official forecasted population growth data, about 18,000 operations would be expected to be performed in 2020 and 20,000 would be expected to be performed in 2030. Interpretation: Growing incidence, population growth, and increasing life expectancy will probably result in increased demand for hip replacement surgery. Our findings could serve as a basis for decision making.

Objective The objective of this scoping review is to present the available scientific literature on iliopsoas issues in relation to hip replacements. We will make a structured management pathway for suspected iliopsoas issues that can be supported by the current literature. Introduction The iliopsoas complex is one possible cause of pain after total hip replacement. There are different options for diagnostics and treatment, without any widely accepted management pathway. There is to date no published or registered scoping reviews on this topic. Inclusion criteria Cadaver studies on the iliopsoas and clinical studies on suspected iliopsoas pathology will be covered. The main objective is to cover clinical studies in relation to total hip replacements, in which we endeavour to make an exhaustive literature search and coverage. In areas where there is little available literature on THR, we will include literature on native hips with iliopsoas issues. English literature from 2000 will be included. Methods The planned scoping review will follow the methodology described by JBI. The search will be done on MEDLINE/Pubmed, Google Scholar and Journal of Arthroplasty website. A data extraction template will be tailored for each research question in Microsoft Excel sheets. Results will be presented as a summary of the information gathered in the extractions sheet, and when applicable frequency tables will be used to summarize similar data across different publications.

Continuous fiber woven E-glass composite femoral shells having the ame elastic properties as bone were fabricated. The shells were then encrusted with filled epoxy wear resistant coatings and run dry against ultrahigh molecular weight polyethylene acetabular cups in 42,000 and 250,000 cycle were tests on a total hip simulator. The tribological characteristics of these shells atriculating with the acetabular cups are comparable to a vitallium bal articulating with an ultrahigh molecular weight polyethylene cup.

This article is from Indian Journal of Anaesthesia , volume 57 . Abstract Management of a case of ankylosing spondylitis can be very challenging when the airway and the central neuraxial blockade, both are difficult. Ultrasound-assisted central neuraxial blockade may lead to predictable success in the field of regional anaesthesia. We present a young patient with severe ankylosing spondylitis where conventional techniques failed and ultrasound helped in successful combined spinal–epidural technique for total hip replacement surgery.

This article is from Acta Orthopaedica , volume 81 . Abstract Background and purpose: Over the past 20 years, several changes in treatment policy and treatment options have taken place regarding hip replacement. For this reason, we wanted to investigate the results after hip replacement in terms of revision rate, during a 21-year period among hip replacements reported to the Norwegian Arthroplasty Register. Methods: 110,882 primary total hip replacements were reported to the Norwegian Arthroplasty Register from 1987 through 2007. Risk of revision during the time periods 1993–1997, 1998–2002, and 2003–2007 was compared to that of the reference period 1987–1992. Adjusted Cox regression analyses were performed to compare the risk of revision in different time periods and extended analyses were done to investigate revision within the first postoperative year and after the first year. Results: There was an overall reduced risk of revision in the time periods 1993–1997, 1998–2002, and 2003–2007 compared to the reference period: RR = 0.81 (95% CI 0.77–0.86), 0.51 (CI 0.47–0.55), and 0.77 (CI 0.68–0.85), respectively. The improved results were due to a marked reduction in aseptic loosening of the femoral and acetabular components in all time periods and in all subgroups of prostheses. A change in the timing of revision took place, with more early revisions and fewer late revisions in the later time periods. Revision due to dislocation and infection increased over time. Interpretation: The risk of revision decreased during the study period, due to fewer cases of aseptic loosening of prosthetic components. The best results were obtained with the use of cemented prostheses. Prevention of dislocation and infection should be a major goal in the future, as revision due to these causes increased during the study period.

This article is from BMC Musculoskeletal Disorders , volume 13 . Abstract Background: Prolonged physical impairments in range of movement, postural stability and walking speed are commonly reported following total hip replacement (THR). It is unclear from the current body of evidence what kind of exercises should be performed to maximize patient function and quality of life. Methods/design: This will be a single blind multi centre randomized control trial with two arms. Seventy subjects post primary total hip arthroplasty will be randomized into either an experimental group (n=35), or to a control group (n=35). The experimental group will attend a functional exercise class twice weekly for a six week period from week 12 to week 18 post surgery. The functional exercise group will follow a circuit based functional exercise class supervised by a chartered Physiotherapist. The control group will receive usual care. The principal investigator (BM) will perform blinded outcome assessments on all patients using validated measures for pain, stiffness, and function using the Western Ontario and Mc Master Universities Osteoarthritis index (WOMAC). This is the primary outcome measurement tool. Secondary outcome measurements include Quality of life (SF-36), 6 min walk test, Visual Analogue Scale, and the Berg Balance score. The WOMAC score will be collated on day five post surgery and repeated at week twelve and week eighteen. All other measurements will be taken at week 12 and repeated at week eighteen. In addition a blinded radiologist will measure gluteus medius cross sectional area using real time ultrasound for all subjects at week 12 and at week 18 to determine if the functional exercise programme has any effect on muscle size. Discussion: This randomised controlled trial will add to the body of evidence on the relationship between muscle size, functional ability, balance, quality of life and time post surgery in patients following total hip arthroplasty. The CONSORT guidelines will be followed to throughout. Ethical approval has been gained from the Ethics committee Health Services Executive Dublin North East. Trial registration: This trial is registered with ClinicalTrials.gov (a service of the United States National Institutes of Health) identifier NCT01683201

Includes bibliographical references and index

Dr. Lawrence Johnson is an orthopedic surgeon in North Chelmsford, Massachusetts and is affiliated with Lowell General Hospital. To know more:  http://lawrencejohnsonmd.com

Dr. Johnson is a Board Certified Orthopedic Surgeon in continuous practice in the Greater Lowell /Merrimack Valley area for the past 30 years.Dr. Johnson’s clinical interests include Hip, Knee and Shoulder Replacement Surgery, Arthroscopic Surgery for Sports Injuries, Low Back Surgery as well as Orthopedic Trauma Surgery. To know more : http://lawrencejohnsonmd.com/

Hip Replacement Surgery Robot Assisted

Hip Replacement Surgery Robot Assisted

Revision Total Hip Replacement Surgery in Asansol by Dr. Parth Singh ensures expert care for patients with failed or worn-out hip implants. With advanced techniques, precision, and compassionate treatment, Dr. Singh helps restore mobility, reduce pain, and improve quality of life.

This article is from Journal of Medical Case Reports , volume 6 . Abstract Introduction: Prosthetic joint infection due to Mycobacterium tuberculosis is occasionally encountered in clinical practice. To the best of our knowledge, this is the first report of a prosthetic joint infection due to Mycobacterium tuberculosis complicated by psoas abscesses and secondary Addison disease. Case presentation: A 67-year-old immunocompetent Caucasian woman underwent total left hip arthroplasty because of osteoarthritis. After 18 months, she underwent arthroplasty revision for a possible prosthetic infection. Periprosthetic tissue specimens for bacteria were negative, and empirical antibiotic therapy was unsuccessful. She was then admitted to our department because of complications arising 22 months after arthroplasty. A physical examination revealed a sinus tract overlying her left hip and skin and mucosal pigmentation. Her levels of C-reactive protein, basal cortisol, adrenocorticotropic hormone, and sodium were out of normal range. Results of the tuberculin skin test and QuantiFERON-TB Gold test were positive. Computed tomography revealed a periprosthetic abscess and the inclusion of the left psoas muscle. Results of microbiological tests were negative, but polymerase chain reaction of a specimen taken from the hip fistula was positive for Mycobacterium tuberculosis. Our patient's condition was diagnosed as prosthetic joint infection and muscle psoas abscess due to Mycobacterium tuberculosis and secondary Addison disease. She underwent standard treatment with rifampicin, ethambutol, isoniazid, and pyrazinamide associated with hydrocortisone and fludrocortisone. At 15 months from the beginning of therapy, she was in good clinical condition and free of symptoms. Conclusions: Prosthetic joint infection with Mycobacterium tuberculosis is uncommon. A differential diagnosis of tuberculosis should be considered when dealing with prosthetic joint infection, especially when repeated smears and histology examination from infected joints are negative. Clinical outcomes of prosthetic joint infection by Mycobacterium tuberculosis are unpredictable, especially given the limited literature in this field and the uncertainty of whether medical treatment alone can eradicate the infection without prosthesis removal. Furthermore, this case report raises interesting issues such as the necessity of a follow-up evaluation after treatment based on clinical conditions, the utility of a more standardized length of treatment for periprosthetic tuberculous infection, and the importance of a high diffusion capacity of anti-mycobacterial agents in order to eradicate the infection.

This article is from BMC Musculoskeletal Disorders , volume 15 . Abstract Background: The growing utilization of total joint replacement will increase the frequency of its complications, including periprosthetic fracture. The prevalence and risk factors of periprosthetic fracture require further study, particularly over the course of long-term follow-up. The objective of this study was to estimate the prevalence and risk factors for periprosthetic fractures occurring in recipients of total hip replacement. Methods: We identified Medicare beneficiaries who had elective primary total hip replacement (THR) for non-fracture diagnoses between July 1995 and June 1996. We followed them using Medicare Part A claims data through 2008. We used ICD-9 codes to identify periprosthetic femoral fractures occurring from 2006–2008. We used the incidence density method to calculate the annual incidence of these fractures and Cox proportional hazards models to identify risk factors for periprosthetic fracture. We also calculated the risk of hospitalization over the subsequent year. Results: Of 58,521 Medicare beneficiaries who had elective primary THR between July 1995 and June 1996, 32,463 (55%) survived until January 2006. Of these, 215 (0.7%) developed a periprosthetic femoral fracture between 2006 and 2008. The annual incidence of periprosthetic fracture among these individuals was 26 per 10,000 person-years. In the Cox model, a greater risk of periprosthetic fracture was associated with having had a total knee replacement (HR 1.82, 95% CI 1.30, 2.55) or a revision total hip replacement (HR1.40, 95% CI 0.95, 2.07) between the primary THR and 2006. Compared to those without fractures, THR recipients who sustained periprosthetic femoral fracture had three-fold higher risk of hospitalization in the subsequent year (89% vs. 27%, p 

   Total Hip Replacement (THR) is a significant surgical procedure aimed at alleviating pain and restoring mobility for individuals with severe hip joint damage. This guide provides insights on preparing for surgery, including vital pre-operative assessments and lifestyle adjustments to enhance recovery. After surgery, patients will participate in a structured rehabilitation program designed to restore strength and functionality, with an emphasis on low-impact exercises. Learn about the importance of following post-operative precautions to ensure a successful recovery and minimize complications. Whether you're considering surgery for yourself or helping a loved one, this resource covers essential aspects of the THR process to aid in a smooth and informed recovery journey.

This scoping review aims to gain an understanding of the various factors contributing to caregiver burden when traditional surgical procedures are shifted from inpatient hospitalization to outpatient settings. The specific research question is: (1) What are the most important factors that contribute to the burden of care for caregivers of patients undergoing outpatient knee and total hip replacement surgeries traditionally performed as inpatients?

Total Hip replacement - By Dr. Himanshu Bansal Orthopaedic surgeon https://youtube.com/shorts/eU2AjJvqc0w?feature=share

performed in November 2011 by Dr. Pasquale Petrera, MD at PRMC in Salisbury, Maryland.

This article is from Orthopedic Reviews , volume 6 . Abstract Since polyethylene is one of the most frequently used biomaterials as a liner in total hip arthroplasty, strong efforts have been made to improve design and material properties over the last 50 years. Antioxidants seems to be a promising alternative to further increase durability and reduce polyethylene wear in long term. As of yet, only in vitro results are available. While they are promising, there is yet no clinical evidence that the new material shows these advantages in vivo. To answer the question if vitamin-E enhanced ultra-high molecular weight polyethylene (UHMWPE) is able to improve long-term survivorship of cementless total hip arthroplasty we initiated a randomized long-term multicenter trial. Designed as a superiority study, the oxidation index assessed in retrieval analyses of explanted liners was chosen as primary parameter. Radiographic results (wear rate, osteolysis, radiolucency) and functional outcome (Harris Hip Scores, University of California-Los Angeles, Hip Disability and Osteoarthritis Outcome Score, Visual Analogue Scale) will serve as secondary parameters. Patients with the indication for a cementless total hip arthroplasty will be asked to participate in the study and will be randomized to either receive a standard hip replacement with a highly cross-linked UHMWPE-X liner or a highly cross-linked vitamin-E supplemented UHMWPE-XE liner. The follow-up will be 15 years, with evaluation after 5, 10 and 15 years. The controlled randomized study has been designed to determine if Vitamin-E supplemented highly cross-linked polyethylene liners are superior to standard XLPE liners in cementless total hip arthroplasty. While several studies have been started to evaluate the influence of vitamin-E, most of them evaluate wear rates and functional results. The approach used for this multicenter study, to analyze the oxidation status of retrieved implants, should make it possible to directly evaluate the ageing process and development of the implant material itself over a time period of 15 years.

artykuł w: Annales Universitatis Mariae Curie-Skłodowska. Sectio D, Medicina. Vol. 60, N2, 134 (2005), strony 683-686. ; Bibliografia na stronie 685.

This article is from Acta Orthopaedica , volume 85 . Abstract Background: While age is a common confounder, its impact on health-related quality of life (HRQoL) after total hip replacement is uncertain. This could be due to improper statistical modeling of age in previous studies, such as treating age as a linear variable or by using age categories. We hypothesized that there is a non-linear association between age and HRQoL. Methods: We selected a nationwide cohort from the Swedish Hip Arthroplasty Register of patients operated with total hip replacements due to primary osteoarthritis between 2008 and 2010. For estimating HRQoL, we used the generic health outcome questionnaire EQ-5D of the EuroQol group that consits or 2 parts: the EQ-5D index and the EQ VAS estimates.Using linear regression, we modeled the EQ-5D index and the EQ VAS against age 1 year after surgery. Instead of using a straight line for age, we applied a method called restricted cubic splines that allows the line to bend in a controlled manner. Confounding was controlled by adjusting for preoperative HRQoL, sex, previous contralateral hip surgery, pain, and Charnley classification. Results: Complete data on 27,245 patients were available for analysis. Both the EQ-5D index and EQ VAS showed a non-linear relationship with age. They were fairly unaffected by age until the patients were in their late sixties, after which age had a negative effect. Interpretation: There is a non-linear relationship between age and HRQoL, with improvement decreasing in the elderly.

This article is from PLoS ONE , volume 9 . Abstract Background: Displaced fracture of the femoral neck has been a common clinical problem, especially in aged patients. However, the optimal treatment choice remains controversial. The purpose of this study is to conduct a systematic review of randomized clinical trials assessing the results of hemiarthroplasty and total hip replacement in patients undergoing either alternative using meta-analysis. Methods: A literature search for randomized clinical trials was conducted through Medline, Embase and Cochrane library between 1969 and 2013 with no restrictions. Additional relevant articles were referred as source of information by way of manual searches on major orthopedic journals. Upon the search, two authors independently evaluated study quality and relevant data was extracted. Results: A total of 8 studies with 983 patients were included in this meta-analysis. After pooling the available data, a significant dominance of Harris hip score was found for total hip replacement compared with hemiarthroplasty (SMD: −7.11, 95%:−10.70,−3.53) one year postoperatively and the advantage kept over (SMD: −6.91, 95%:−12.98, −0.85) two years after surgery. A trend toward a higher dislocation rate was found in total hip replacement group (RR: 0.46, 95%: 0.21, 1.02), of which the difference was considered insignificant. The risk of revision in group hemiarthroplasty appeared to be more than two folds higher than that after total hip replacement (RR: 4.14, 95%CI: 2.09, 8.19). Conclusion: Even though there is a higher rate of dislocation after total hip replacement, this disadvantage could be accounted for, on the basis of a better functional score and the lower revision rate. However, from the results, it stands to reason that total hip replacement should be strongly suggested in elderly active patients with femoral neck fracture.

This article is from PLoS ONE , volume 9 . Abstract Background: Displaced fracture of the femoral neck has been a common clinical problem, especially in aged patients. However, the optimal treatment choice remains controversial. The purpose of this study is to conduct a systematic review of randomized clinical trials assessing the results of hemiarthroplasty and total hip replacement in patients undergoing either alternative using meta-analysis. Methods: A literature search for randomized clinical trials was conducted through Medline, Embase and Cochrane library between 1969 and 2013 with no restrictions. Additional relevant articles were referred as source of information by way of manual searches on major orthopedic journals. Upon the search, two authors independently evaluated study quality and relevant data was extracted. Results: A total of 8 studies with 983 patients were included in this meta-analysis. After pooling the available data, a significant dominance of Harris hip score was found for total hip replacement compared with hemiarthroplasty (SMD: −7.11, 95%:−10.70,−3.53) one year postoperatively and the advantage kept over (SMD: −6.91, 95%:−12.98, −0.85) two years after surgery. A trend toward a higher dislocation rate was found in total hip replacement group (RR: 0.46, 95%: 0.21, 1.02), of which the difference was considered insignificant. The risk of revision in group hemiarthroplasty appeared to be more than two folds higher than that after total hip replacement (RR: 4.14, 95%CI: 2.09, 8.19). Conclusion: Even though there is a higher rate of dislocation after total hip replacement, this disadvantage could be accounted for, on the basis of a better functional score and the lower revision rate. However, from the results, it stands to reason that total hip replacement should be strongly suggested in elderly active patients with femoral neck fracture.

This article is from BMJ Open , volume 4 . Abstract Objective: To synthesise the available evidence and estimate the comparative efficacy of control strategies to prevent total hip replacement (THR)-related surgical site infections (SSIs) using a mixed treatment comparison. Design: Systematic review and mixed treatment comparison. Setting: Hospital and other healthcare settings. Participants: Patients undergoing THR. Primary and secondary outcome measures: The number of THR-related SSIs occurring following the surgical operation. Results: 12 studies involving 123 788 THRs and 9 infection control strategies were identified. The strategy of ‘systemic antibiotics+antibiotic-impregnated cement+conventional ventilation’ significantly reduced the risk of THR-related SSI compared with the referent strategy (no systemic antibiotics+plain cement+conventional ventilation), OR 0.13 (95% credible interval (CrI) 0.03–0.35), and had the highest probability (47–64%) and highest median rank of being the most effective strategy. There was some evidence to suggest that ‘systemic antibiotics+antibiotic-impregnated cement+laminar airflow’ could potentially increase infection risk compared with ‘systemic antibiotics+antibiotic-impregnated cement+conventional ventilation’, 1.96 (95% CrI 0.52–5.37). There was no high-quality evidence that antibiotic-impregnated cement without systemic antibiotic prophylaxis was effective in reducing infection compared with plain cement with systemic antibiotics, 1.28 (95% CrI 0.38–3.38). Conclusions: We found no convincing evidence in favour of the use of laminar airflow over conventional ventilation for prevention of THR-related SSIs, yet laminar airflow is costly and widely used. Antibiotic-impregnated cement without systemic antibiotics may not be effective in reducing THR-related SSIs. The combination with the highest confidence for reducing SSIs was ‘systemic antibiotics+antibiotic-impregnated cement+conventional ventilation’. Our evidence synthesis underscores the need to review current guidelines based on the available evidence, and to conduct further high-quality double-blind randomised controlled trials to better inform the current clinical guidelines and practice for prevention of THR-related SSIs.

This article is from Clinics in Orthopedic Surgery , volume 5 . Abstract Background: Concerns of patients on sexual activity after total hip arthroplasty have not been well studied in Asian patients. This study aimed to determine the following: (1) what are the concerns of patients related to sexual activity after total hip arthroplasty? (2) what are the changes in sexual activity after total hip replacement in Korean patients? Methods: Details of sexual activity and concerns were obtained using a questionnaire designed specifically for the study. The questionnaire was administered to 64 patients in a face-to-face interview at an outpatient clinic. Results: Preoperatively, 53.1% of patients experienced difficulties, primarily due to hip pathology and limitations of motion. The median time to the resumption of sexual activity was 3 months postoperatively, and most patients had no increase in the frequency of sexual activity after the total hip replacement. In 39.1% of patients were seen having difficulties with leg positioning following total hip replacement, and they were likely to change coital positions. The most common concern regarding sexual activity of patients was the fear of dislocation. Furthermore, patients with a higher stress level had lower satisfaction rates. Most patients were unable to obtain information on sexual activity following the total hip arthroplasty, and they did not consult with a physician due to the private nature of the topic. Conclusions: Dislocation was the most common concern of patients during sexual activity following a total hip arthroplasty, and a higher stress level was found to be associated with a lower satisfaction rate. Because most patients were unprepared to consult a physician, the provision of appropriate information before a consultation might be beneficial.

The development of a biotelemetry system that is hermetically sealed within a total hip replacement implant is reported. The telemetry system transmits six channels of stress data to reconstruct the major forces acting on the neck of the prosthesis and uses an induction power coupling technique to eliminate the need for internal batteries. The activities associated with the telemetry microminiaturization, data recovery console, hardware fabrications, power induction systems, electrical and mechanical testing and hermetic sealing test results are discussed.

Continuous fiber, woven E glass composite femoral shells having the same elastic properties as bone were fabricated. The shells were then encrusted with filled epoxy wear resistant coatings and run dry against ultrahigh molecular weight polyethylene acetabular cups in 42,000 and 250,000 cycle wear tests on a total hip simulator. The tribological characteristics of these continuous fiber particulate composite femoral shells articulating with ultrahigh molecular weight polyethylene acetabular cups were comparable to those of a vitallium ball articulating with an ultrahigh molecular weight polyethylene acetabular cup.

Era's Journal of Medical Research  EJMR