Browsing by Subject "total hip arthroplasty"

Now showing 1 - 4 of 4
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    Contemporary Dual Mobility Head Penetration at Five Years: Concern for the Additional Convex Bearing Surface?
    (Elsevier, 2018) Deckard, Evan R.; Azzam, Khalid A.; Meneghini, R. Michael; Orthopaedic Surgery, School of Medicine
    Background Dual mobility (DM) bearings are increasingly popular and second-generation designs contain highly cross-linked polyethylene. The purpose of this study is to report head penetration rates in modern DM bearings. Methods A review of 63 consecutive DM bearings was performed. Radiographs were analyzed for head penetration using Martell methodology at regular postoperative intervals. Results Thirty-four DM bearings were analyzed. Mean linear head penetration was 1.59 mm/y at 1 year, 1.07 mm/y at 2 years, and 0.27 mm/y at 5 years following an exponential regression model (R2 = 0.999). Mean volumetric wear was 783 mm3/y at 1 year, 555 mm3/y at 2 years, and 104 mm3/y at 5 years following an exponential regression model (R2 = 0.986). Conclusion Initial head penetration of DM bearings is larger than contemporary cross-linked polyethylene bearings; however, rates approach steady state after 2 years, analogous to traditional bearings. The larger “bedding-in” head penetration may be due to the additional convex bearing surface, creating 2 surfaces for deformation/wear.
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    Internet Promotion of Direct Anterior Approach Total Hip Arthroplasty by Members of the American Association of Hip and Knee Surgeons
    (Elsevier, 2017) Shofoluwe, Ademola; Naveen, Neal; Inabathula, Avinash; Ziemba-Davis, Mary; Meneghini, R. Michael; Callaghan, John J.; Warth, Lucian C.; Department of Orthopaedic Surgery, School of Medicine
    Introduction The Direct Anterior approach (DAA) in total hip arthroplasty (THA) is of significant interest to both patients and surgeons, largely due to intense marketing. This study addressed the question, ‘What is the level of promotion of DAA THA on the internet by American Association of Hip and Knee Surgeons (AAHKS) members?’ Methods An internet search was performed to identify surgeon-specific websites for each member of the AAHKS using the members’ full name and a previously published set of criteria. Each website was evaluated utilizing a questionnaire to systematically identify claims made regarding proposed DAA specific risks, benefits, as well as the presence/absence of supporting data. Results We identified 1,855 qualified websites. The DAA was referenced on 22.8% (423/1,855) of these websites. Claims regarding DAA specific benefits included; less invasive/muscle sparing (46.3%), quicker recovery (45.2%), decreased pain (28.1%), decreased hospital stay (22.0%), and decreased dislocation risk (16.3%). Potential DAA risks including lateral femoral cutaneous nerve injury, peri-prosthetic/greater trochanteric fracture, and wound complication/hematoma were addressed on only 4.7%, 3.1%, and 1.7% of websites, respectively. Supporting peer-reviewed literature was identified on only 3.6% of DAA websites. Conclusions Over one fifth of AAHKS members promoted the DAA on the internet. Member websites claimed DAA benefits such as faster recovery and decreased pain approximately nine times more frequently than any potential risk of the procedure (p < 0.001). While AAHKS policy does not regulate member marketing, it is the responsibility of all orthopaedic surgeons to disseminate accurate, validated information concerning the procedures we perform.
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    Is Operative Diagnosis for Aseptic Revision Total Hip Arthroplasty Related to Patient Reported Outcomes?
    (2018-07) Holder, Erik; Ciesielski, Alex; Ziemba-Davis, Mary; Meneghini, R. Michael
    Background and Hypothesis: Component loosening and instability are the leading causes of revision total hip arthroplasty (THA). The purpose of this study was to compare patient-reported outcomes after revision THA based on failure etiology. We hypothesized that outcomes would differ based on reason for revision. Project Methods: 187 consecutive revision THAs performed between 2010 and 2017 were retrospectively reviewed. Prospectively collected preoperative and minimum one-year Hip Disability and Osteoarthritis Outcome Score/HOOS Jr., UCLA Activity Level, WOMAC Index, and patient satisfaction were assessed based on failure etiology. Demographic variables and covariates were accounted for including sex, age, BMI, ASA classification, heart disease, lumbar spine pathology, narcotic use, fibromyalgia, depression, and autoimmune arthritis. Results: Latest UCLA activity level did not differ based on failure etiology (p=0.381). However, the degree of improvement in activity level was higher (p= 0.04) in patients revised for loosening, instability, and infection compared to ALTR and polyethylene wear. HOOS Jr (p=0.949) and WOMAC total (p=0.147) scores did not differ based on failure etiology at latest follow-up, although patients revised for loosening had greater WOMAC improvement compared to all other groups except polyethylene wear (p=0.016). Satisfaction did not vary based on failure etiology (p=0.365), and demographic and covariates were unrelated to outcomes (p³0.165). Conclusion and Potential Impact: We observed that patient-reported outcomes following revision THA vary based on revision reason and activity level improvement is mitigated patients revised for ALTR and poly wear. These findings may help surgeons and patients alike set expectations for recovery following revision THA.
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    Periprosthetic femoral fractures following total hip and total knee arthroplasty
    (Elsevier, 2018-11) King, Samuel W.; Lamb, Jonathan N.; Cage, Emily S.; Pandit, Hemant; Graduate Medical Education, School of Medicine
    Total joint arthroplasties are increasing worldwide in both frequency and prevalence. When successful, they offer great improvements in quality of life. However, fractures around implants are often difficult to manage and require prolonged inpatient stays in tertiary hospitals. Management may differ between surgeons, but most patients will be managed surgically if mobility or joint stability is threatened. Those affected are often at higher risk from surgery, are frailer and at higher risk of mortality and a lifelong reduction in mobility. The incidence of these fractures is increasing, and patients should appreciate the risk and implications of this recognised complication of joint arthroplasty.