Total Hip Arthroplasty—Current Challenges: Part II

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (15 November 2023) | Viewed by 5575

Special Issue Editor

Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
Interests: hip; arthroplasty; fracture (acetabulum; periprosthetic); orthogeriatric
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

In Germany in 1891, Professor Themistocles Glück was the first to replace a femoral head in hip joints destroyed by tuberculosis using ivory, followed by Marius Smith-Petersen in 1925 using a mold arthroplasty out of glass. Further attempts in hip joint replacement followed until Sir Jon Charnely significantly advanced total hip arthroplasty in the 1960s. In the following decades, further innovations in materials and design enhanced the outcomes. As a result of the enhanced survivorship and low revision rates in 2007, total hip replacement was called the “operation of the century”. However, due to an increasing number of performed total hip arthroplasties in an aging population, hip surgeons have to face various challenges in 2021 and in the near future.

The aim and scope of this Special Issue is to discuss current and future challenges in primary and revision total hip arthroplasty (THA) such as (i) primary complex THA (Perthes diseases, DDH, post-traumatic conditions, acetabular fractures, bone loss/osteolysis, osteoporosis), (ii) complication management (instability, infection, periprosthetic fractures at the femoral and acetabular site), (iii) in specific patients (young, very demanding, older adults, obesity, dissatisfied patients, when to deny total hip arthroplasty), (iv) modern patient management protocols (prehabilitation, enhanced recovery protocols, fast track surgery, orthogeriatric co-management), (v) outcome analysis (focus on PROMS, predictors and strategies to improve satisfaction), (vi) revision surgery (cement in cement, modularity, dual mobility, trunnionosis, metallosis, pseudotumor), and (vii) new technologies in cutting-edge research topics (robotic surgery, virtual versus augmented reality, 3D printing, learning curves, teaching).

We are soliciting preclinical studies (anatomical, biomechanical, technical reports) and clinical studies (PROM, outcome, registry data, epidemiological) with a focus on original articles. For the submission of reviews, reporting according to the PRISMA guidelines is required.

Prof. Dr. Johannes Dominik Bastian
Guest Editor

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Keywords

  • hip
  • arthroplasty
  • replacement
  • complex
  • Perthes
  • dysplasia
  • complication
  • PROM
  • outcome
  • robotic

Published Papers (5 papers)

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Research

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11 pages, 880 KiB  
Article
Efficacy of Supplemental Ultrasound-Guided Pericapsular Nerve Group (PENG) Block Combined with Lateral Femoral Cutaneous Nerve Block in Patients Receiving Local Infiltration Analgesia after Hip Fracture Surgery: A Prospective Randomized Controlled Trial
Medicina 2024, 60(2), 315; https://doi.org/10.3390/medicina60020315 - 12 Feb 2024
Viewed by 741
Abstract
Background and Objectives: Local infiltration analgesia (LIA) represents a potential approach to reducing pain in patients undergoing total hip arthroplasty (THA). The pericapsular nerve group (PENG) block also provides adequate analgesia for fractures and THA. As most hip surgeries use a lateral [...] Read more.
Background and Objectives: Local infiltration analgesia (LIA) represents a potential approach to reducing pain in patients undergoing total hip arthroplasty (THA). The pericapsular nerve group (PENG) block also provides adequate analgesia for fractures and THA. As most hip surgeries use a lateral incision, affecting the cutaneous supply by branches of the lateral femoral cutaneous nerve (LFCN), the LFCN block can contribute to postoperative analgesia. However, no studies have investigated the effectiveness of supplemental PENG block combined with LFCN block in patients undergoing LIA after hip fracture surgery. Our study aimed to assess the effectiveness of PENG combined with LFCN block following hip fracture surgery in patients who underwent LIA. Materials and Methods: Forty-six patients were randomly assigned to LIA or PENG + LFCN + LIA groups. The primary outcome was the pain score at rest and during movement at 2, 6, 12, 24, and 48 h postoperatively. The total opioid dose for postoperative analgesia was also measured at the same time points. Secondary outcomes included postoperative cognitive function assessment. Results: The median pain scores at rest and during movement were lower in the PENG + LFCN + LIA group throughout the study periods compared to the LIA group, except at 2 h (at rest) and 48 h (during movement) after surgery. The total fentanyl dose was lower in the PENG + LFCN + LIA group at all time points after surgery when compared to the LIA group. Postoperative delirium incidence and the median abbreviated mental test scores were not significantly different between the two groups. Conclusions: The combination of PENG and LFCN blocks may contribute to enhanced recovery for patients undergoing LIA after hip fracture surgery. However, further well-controlled research is necessary to determine the effectiveness of supplemental PENG combined with LFCN block in addressing cognitive deficits in these patients. Full article
(This article belongs to the Special Issue Total Hip Arthroplasty—Current Challenges: Part II)
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14 pages, 2278 KiB  
Article
Use of Short Stems in Revision Total Hip Arthroplasty: A Retrospective Observational Study of 31 Patients
Medicina 2023, 59(10), 1822; https://doi.org/10.3390/medicina59101822 - 13 Oct 2023
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Abstract
Background and Objectives: Implantation of a short femoral stem in revision total hip arthroplasty (rTHA) could reduce the perioperative time, soft tissue damage, and preserve the bone stock of the proximal femur. The objective of this study was to describe the clinical [...] Read more.
Background and Objectives: Implantation of a short femoral stem in revision total hip arthroplasty (rTHA) could reduce the perioperative time, soft tissue damage, and preserve the bone stock of the proximal femur. The objective of this study was to describe the clinical and radiographic outcomes after the use of short stems in rTHA with a follow-up of 1 to 5 years. Materials and Methods: This retrospective, single center, and observational study analyzed the data of 31 patients (12 female, 19 male) with a median (interquartile range) age of 68.2 years (61.2–78.4) and BMI of 26.7 kg/m2 (24.6–29.4) who received an uncemented short femoral stem in rTHA between 2015 and 2020. Clinical outcomes were extracted from medical reports and assessed using the modified Harris Hip Score (mHHS), the numerical rating scale (NRS) for pain and satisfaction, and the UCLA Physical Activity Score. Radiographs were analyzed for stem subsidence, fixation, and bone parameters. The Wilcoxon test was used for pre–post rTHA differences (p < 0.05); clinical relevance was interpreted based on effect sizes according to Cohen’s d. Results: All the clinical outcome measures improved significantly (p ≤ 0.001) at follow-up compared to preoperative status, with large effect sizes (Cohen’s d) ranging from 2.8 to 1.7. At the last follow-up, the median (interquartile) mHHS was 80.9 (58.6–93.5). Stem fixation was stable in all cases. Complications included stem subsidence of 3 mm (n = 1) and 10 mm (n = 1), heterotopic ossification Brooker stage III (n = 2), intraoperative femur perforation (n = 1), periprosthetic fracture Vancouver type A (n = 1), and dislocation (n = 2). Conclusions: The good clinical results in our selective study population of patients with mild to moderate bone deficiency, supported by large effect sizes, together with a complication rate within the normal range, support the consideration of short stems as a surgical option after a thorough preoperative analysis. Full article
(This article belongs to the Special Issue Total Hip Arthroplasty—Current Challenges: Part II)
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10 pages, 3967 KiB  
Article
Accuracy of Personalized Computed Tomographic 3D Templating for Acetabular Cup Placement in Revision Arthroplasty
Medicina 2023, 59(9), 1608; https://doi.org/10.3390/medicina59091608 - 06 Sep 2023
Viewed by 699
Abstract
Background: Revision hip arthroplasty presents a surgical challenge, necessitating meticulous preoperative planning to avert complications like periprosthetic fractures and aseptic loosening. Historically, assessment of the accuracy of three-dimensional (3D) versus two-dimensional (2D) templating has focused exclusively on primary hip arthroplasty. Materials and [...] Read more.
Background: Revision hip arthroplasty presents a surgical challenge, necessitating meticulous preoperative planning to avert complications like periprosthetic fractures and aseptic loosening. Historically, assessment of the accuracy of three-dimensional (3D) versus two-dimensional (2D) templating has focused exclusively on primary hip arthroplasty. Materials and Methods: In this retrospective study, we examined the accuracy of 3D templating for acetabular revision cups in 30 patients who underwent revision hip arthroplasty. Utilizing computed tomography scans of the patients’ pelvis and 3D templates of the implants (Aesculap Plasmafit, B. Braun; Aesculap Plasmafit Revision, B. Braun; Avantage Acetabular System, Zimmerbiomet, EcoFit 2M, Implantcast; Tritanium Revision, Stryker), we performed 3D templating and positioned the acetabular cup implants accordingly. To evaluate accuracy, we compared the planned sizes of the acetabular cups in 2D and 3D with the sizes implanted during surgery. Results: An analysis was performed to examine potential influences on templating accuracy, specifically considering factors such as gender and body mass index (BMI). Significant statistical differences (p < 0.001) in the accuracy of size prediction were observed between 3D and 2D templating. Personalized 3D templating exhibited an accuracy rate of 66.7% for the correct prediction of the size of the acetabular cup, while 2D templating achieved an exact size prediction in only 26.7% of cases. There were no statistically significant differences between the 2D and 3D templating methods regarding gender or BMI. Conclusion: This study demonstrates that 3D templating improves the accuracy of predicting acetabular cup sizes in revision arthroplasty when compared to 2D templating. However, it should be noted that the predicted implant size generated through 3D templating tended to overestimate the implanted implant size by an average of 1.3 sizes. Full article
(This article belongs to the Special Issue Total Hip Arthroplasty—Current Challenges: Part II)
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11 pages, 1285 KiB  
Article
Anterior Approach to Hip Arthroplasty with Early Mobilization Key for Reduced Hospital Length of Stay
Medicina 2023, 59(7), 1216; https://doi.org/10.3390/medicina59071216 - 28 Jun 2023
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Abstract
Background and Objectives: This study aimed to explore the preoperative factors related to early mobilization and length of stay (LOS) after total hip arthroplasty and the benefits of the anterior approach over the traditional lateral approach. Materials and Methods: Every patient benefits from [...] Read more.
Background and Objectives: This study aimed to explore the preoperative factors related to early mobilization and length of stay (LOS) after total hip arthroplasty and the benefits of the anterior approach over the traditional lateral approach. Materials and Methods: Every patient benefits from information regarding details of the surgery approach, possible intra, and postoperative complications, post-operator medical care, and steps in the early mobilization protocol. The patient underwent a pre-anesthetic evaluation, was checked for preoperatory vital function, and was reevaluated for mobilization at 6, 12, 24, 36, 48, and 96 h after total hip arthroplasty using the anterior versus lateral approach. Results: The result of the statistical calculations indicates the independent negative risk factors for reaching the mobilization target: age with a coefficient of −0.046, p = 0.0154 and lateral approach with a relative risk of 0.3802 (95% CI: 0.15–0.90), p = 0.0298. Statistical data concerning the length of stay (LOS) showed significant differences in the total days spent in the hospital. The patients who were operated on using the lateral approach presented a higher body mass index than those with the anterior approach, but this difference did not reach the threshold of statistical significance. Conclusions: In our study, patient mobilization is crucial to reduce LOS. Full article
(This article belongs to the Special Issue Total Hip Arthroplasty—Current Challenges: Part II)
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Review

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11 pages, 522 KiB  
Review
The Top Three Burning Questions in Total Hip Arthroplasty
Medicina 2023, 59(4), 655; https://doi.org/10.3390/medicina59040655 - 26 Mar 2023
Viewed by 1664
Abstract
Total hip arthroplasty (THA) for end-stage osteoarthritis is one of the most effective surgical treatments in medicine. Impressive outcomes have been well documented in the literature with patients gaining ambulation and recovery of hip joint function. Nevertheless, there are still debatable issues and [...] Read more.
Total hip arthroplasty (THA) for end-stage osteoarthritis is one of the most effective surgical treatments in medicine. Impressive outcomes have been well documented in the literature with patients gaining ambulation and recovery of hip joint function. Nevertheless, there are still debatable issues and controversies that the orthopedic community has not been able to provide a definitive answer for. This review is focused on the current three most debatable issues surrounding the THA procedure: (1) new cutting-edge technology, (2) spinopelvic mobility, and (3) fast-track protocols. The scope of the herein narrative review is to analyze the debatable issues surrounding the three aforementioned topics and conclude the best contemporary clinical approaches regarding each issue. Full article
(This article belongs to the Special Issue Total Hip Arthroplasty—Current Challenges: Part II)
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