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Clinical Updates in Hip Arthroplasty

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (15 December 2023) | Viewed by 4325

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Special Issue Editors

Prof. Dr. Vittorio Calvisi

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Guest Editor

Unit of Orthopaedics and Traumatology, Department of Life Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
Interests: total hip arthroplasty; hip resurfacing arthroplasty; periprosthetic joint infection

Dr. Emilio Romanini

E-Mail Website
Guest Editor

RomaPro Center for Hip and Knee Arthroplasty, Polo Sanitario San Feliciano, Rome, Italy
Interests: arthroplasty; knee arthroplasty; hip arthroplasty; hip fractures

Special Issue Information

Dear Colleagues,

Hip arthroplasty is a cost-effective intervention for patients with hip fractures or severe osteoarthritis, refractory to conservative treatment. Due to the aging population, this procedure is becoming increasingly frequent, with far-reaching effects both on the individual and the community. Even though the good results of hip arthroplasty, the aim is now to optimize the perioperative path and to improve functional outcomes and patient satisfaction.

Promising new technologies have been developed to achieve optimal surgical results by minimizing surgical stress and improving implant positioning accuracy. Though the economic limits that weigh on national healthcare systems, the use of customized and robotic-assisted devices represents the new frontier of this surgery.

Despite these futuristic considerations, there is still no consensus among orthopedic surgeons regarding some classical questions as the choice of the surgical approach, the use of un-cemented or cemented devices, the use and indications for dual-mobility systems, the role of hip resurfacing, the choice for ceramic on ceramic or ceramic on polyethylene, short stem or long stem, collared stems or collarless stems, fast-track or ultra-fast-track, the use of patient-specific instrumentations, the need for customized implants and robotic-assisted systems, in-presence rehabilitation or telerehabilitation and so on.

A growing number of digital data are collected in this research area, including electronic health records, national registries, administrative databases, and insurance claims-based data. These so-called “real-world data” are increasingly used by healthcare professionals to evaluate technologies and outcomes, and decision-makers for regulatory and reimbursement reasons.

This Special Issue provides an overview of the current concepts and recent advances in hip arthroplasty, showing the range of potential technologies already in use and the insights they provide to the understanding and development of research in this field of orthopedic surgery. We are looking forward to your contributions.

Prof. Dr. Vittorio Calvisi
Dr. Emilio Romanini
Guest Editors

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Keywords

total hip arthroplasty
hip resurfacing arthroplasty
periprosthetic joint infection
robotic surgery
navigation
fast track
arthroplasty registries
big data
real-world evidence
artificial intelligence

Published Papers (5 papers)

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12 pages, 799 KiB

Open AccessArticle

Long-Term Outcome of Metal-on-Metal Total Hip Arthroplasty with Modular Neck Stem

by Hiroki Wakabayashi, Masahiro Hasegawa, Yohei Naito, Shine Tone and Akihiro Sudo

J. Clin. Med. 2024, 13(6), 1525; https://doi.org/10.3390/jcm13061525 - 7 Mar 2024

Viewed by 698

Abstract

Background: This study aimed to report the long-term outcomes of total hip arthroplasty (THA) using a Conserve Plus (Wright Medical, Japan) metal-on-metal (MoM) acetabular prosthesis with a modular neck stem. Methods: This study enrolled 50 patients (10 men and 40 women; mean age, 65.8 (39–87) years) who underwent primary THA using a Conserve Plus MoM acetabular prosthesis with a modular neck stem. The preoperative diagnosis in most patients was osteoarthritis. Clinical function of hip joint outcomes was investigated using the Japanese Orthopedic Association (JOA) hip score preoperatively and at the final follow-up. The perfect JOA hip score was 100, while the worst score was 0. Radiological analyses were evaluated during the final follow-up visit. Magnetic resonance imaging (MRI) images were evaluated to screen for pseudotumors in 43 hips postoperatively. Results: Six patients did not visit before their 10-year follow-up for unknown reasons. Therefore, 44 patients were evaluated at a mean of 11-years of follow-up (10–12 years). The mean (±SD) preoperative JOA hip score of 44.2 (±15.5) improved significantly to 85.1 (±12.9) postoperatively at the final follow-up (n = 36 hips, excluding eight revision cases). One patient underwent femoral fixation for a periprosthetic fracture due to trauma that occurred 4 years postoperatively. Spot welds were identified in 93.2% (41/44 hips) of cases. Severe (third- and fourth-degree) stress shielding was identified in 40.9% (18/44 hips) of cases. Twenty-two patients (51.2%) had pseudotumors attributable to MoM articulation based on MRI results, 2 to 10 years after arthroplasty. Three hips showed cup osteolysis (7%) and three showed trochanteric region osteolysis (7%). There were seven cup and/or three stem revisions for aseptic loosening and/or osteolysis at 4 months (with trauma) and 3.3 to 11 years (with pseudotumor) postoperatively. The Kaplan–Meier survivorship for the THA construct in this group was constant at 93.0% and 75.9% at 10 and 12 years after arthroplasty, respectively. The rates of survivorship of revision and loss of follow-up at 10 and 12 years were 83.9% and 66.8%, respectively. Conclusions: In summary, we reported on the long-term treatment results of MoM THA, precautions based on our cohort’s findings, and the measures taken to address these issues, such as revision replacement and its outcomes. Clinical scores revealed good outcomes during the mean 11-year follow-up period. However, the prevalence of pseudotumors (PTs) was 51.2%. Some cases required revisions even after the 10 years following surgery. This is because in MoM THA, PT occurrence increases over time, and as a result, there were cases in which revised THA was required even after 10 years. Full article

(This article belongs to the Special Issue Clinical Updates in Hip Arthroplasty)

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14 pages, 1422 KiB

Open AccessArticle

The True Dislocation Incidence following Elective Total Hip Replacement in Sweden: How Does It Relate to the Revision Rate?

by Peter H. J. Cnudde, Jonatan Nåtman, Ola Rolfson and Nils P. Hailer

J. Clin. Med. 2024, 13(2), 598; https://doi.org/10.3390/jcm13020598 - 20 Jan 2024

Viewed by 674

Abstract

(1) Background: The true dislocation incidence following THA is difficult to ascertain in population-based cohorts. In this study, we explored the cumulative dislocation incidence (CDI), the relationship between the incidence of dislocation and revision surgery, patient- and surgery-related factors in patients dislocating once or multiple times, and differences between patients being revised for dislocation or not. (2) Methods: We designed an observational longitudinal cohort study linking registers. All patients with a full dataset who underwent an elective unilateral THA between 1999 and 2014 were included. The CDI and the time from the index THA to the first dislocation or to revision were estimated using the Kaplan–Meier (KM) method, giving cumulative dislocation and revision incidences at different time points. (3) Results: 136,810 patients undergoing elective unilateral THA were available for the analysis. The 30-day CDI was estimated at 0.9% (0.9–1.0). The revision rate for dislocation throughout the study period remained much lower. A total of 51.2% (CI 49.6–52.8) suffered a further dislocation within 1 year. Only 10.9% of the patients with a dislocation within the first year postoperatively underwent a revision for dislocation. (4) Discussion: The CDI after elective THA was expectedly considerably higher than the revision incidence. Further studies investigating differences between single and multiple dislocators and the criteria by which patients are offered revision surgery following dislocation are urgently needed. Full article

(This article belongs to the Special Issue Clinical Updates in Hip Arthroplasty)

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9 pages, 1397 KiB

Open AccessArticle

Activity Following Total Hip Arthroplasty: Which Patients Are Active, and Is Being Active Safe?

by Laura Elisa Streck, Yu-Fen Chiu, Sebastian Braun, Anisa Mujaj, Carola Hanreich and Friedrich Boettner

J. Clin. Med. 2023, 12(20), 6482; https://doi.org/10.3390/jcm12206482 - 12 Oct 2023

Cited by 1 | Viewed by 1049

Abstract

Background: Younger and physically active patients demand a return to sport after total hip arthroplasty (THA). However, because of the risk of implant wear and loosening, high-impact activities are often not recommended. The current study evaluates predictive factors and revision rates in patients with higher activity levels. Methods: This retrospective study included 4152 hips in 3828 patients aged 45–75 that underwent primary THA for primary osteoarthritis between 2009 and 2019 with a minimum follow-up of 2 years. Pain and Lower Extremity Activity Scale (LEAS) were assessed before and 2 years after surgery. Activity was classified as low (LEAS 1–6), moderate (LEAS 7–13), or high (LEAS 14–18). Results: Pain and LEAS improved from preoperative to 2-years postoperative (p < 0.001). The activity level was low in 6.2%, moderate in 52.9%, and high in 40.9% of the patients. Younger age, lower BMI, ASA, and CCI, male sex, and higher preoperative LEAS correlated with higher activity at 2 years (p < 0.001). The predicted revision-free survival rates between the activity groups were better for more highly active patients (p < 0.001). Conclusions: High physical activity 2 years following THA, with participating in sports like jogging several times a week, did not increase the risk of revision surgery. THA patients should not be prevented from a highly active lifestyle. Full article

(This article belongs to the Special Issue Clinical Updates in Hip Arthroplasty)

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9 pages, 227 KiB

Open AccessArticle

Peripheral Nerve Blockade in Total Hip Arthroplasty: A Retrospective Study with Propensity Score Matching

by Hyuck Min Kwon, Tae Sung Lee, Heon Jung Park, Bora Lee, Yong Seon Choi and Kwan Kyu Park

J. Clin. Med. 2023, 12(17), 5514; https://doi.org/10.3390/jcm12175514 - 25 Aug 2023

Viewed by 665

Abstract

The effect of peripheral nerve block (PNB) according to leg lengthening following total hip arthroplasty (THA) has not been studied yet. The purpose of this study was to investigate the effect of PNB according to the change in leg length after THA. From January 2016 to August 2021, 353 patients who underwent unilateral THA for osteonecrosis of the femoral head or osteoarthritis of the hip joint were retrospectively reviewed. The patients were divided into two groups for comparison: 217 patients who controlled postoperative pain using only intravenous venous patient-controlled analgesia (IV PCA) (PCA group) and 136 patients who controlled postoperative pain using PNB and IV PCA (PCA + PNB group). We further divided the patients into two groups (leg lengthening after surgery < 10 mm and >10 mm) and compared them. After propensity score matching, the PCA and PCA + PNB groups, with 134 patients each, were compared and analyzed. The pain intensity at rest was significantly lower in the PCA + PNB group compared with that in the PCA group at postoperative 6, 24, and 48 h (p = 0.0001, 0.0009, and <0.0001, respectively). In the subgroup analysis, for patients whose limb lengthening was less than 10 mm after THA, the pain intensity at rest was significantly lower in the PCA + PNB group compared with that in the PCA group at postoperative 24 and 48 h (p = 0.0165 and 0.0015, respectively). However, in patients whose limb lengthening was more than 10 mm after THA, there was no significant difference between the pain intensity at activity and rest in the two groups at postoperative 6, 24, and 48 h (p > 0.05). PNB did not show superiority in terms of pain reduction in patients whose limb lengthening was more than 10 mm after THA. Further investigations on methods for reducing pain in patients whose leg length is increased by more than 10 mm are needed. Full article

(This article belongs to the Special Issue Clinical Updates in Hip Arthroplasty)

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10 pages, 376 KiB

Open AccessSystematic Review

Predicting Functional Outcomes of Total Hip Arthroplasty Using Machine Learning: A Systematic Review

by Nick D. Clement, Rosie Clement and Abigail Clement

J. Clin. Med. 2024, 13(2), 603; https://doi.org/10.3390/jcm13020603 - 21 Jan 2024

Viewed by 891

Abstract

The aim of this review was to assess the reliability of machine learning (ML) techniques to predict the functional outcome of total hip arthroplasty. The literature search was performed up to October 2023, using MEDLINE/PubMed, Embase, Web of Science, and NIH Clinical Trials. Level I to IV evidence was included. Seven studies were identified that included 44,121 patients. The time to follow-up varied from 3 months to more than 2 years. Each study employed one to six ML techniques. The best-performing models were for health-related quality of life (HRQoL) outcomes, with an area under the curve (AUC) of more than 84%. In contrast, predicting the outcome of hip-specific measures was less reliable, with an AUC of between 71% to 87%. Random forest and neural networks were generally the best-performing models. Three studies compared the reliability of ML with traditional regression analysis: one found in favour of ML, one was not clear and stated regression closely followed the best-performing ML model, and one showed a similar AUC for HRQoL outcomes but did show a greater reliability for ML to predict a clinically significant change in the hip-specific function. ML offers acceptable-to-excellent discrimination of predicting functional outcomes and may have a marginal advantage over traditional regression analysis, especially in relation to hip-specific hip functional outcomes. Full article

(This article belongs to the Special Issue Clinical Updates in Hip Arthroplasty)

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