Bilateral pericapsular end nerve blocks for steroid-induced avascular necrosis following COVID-19 infection requiring bilateral total hip replacement

BACKGROUND Osteonecrosis or avascular necrosis(AVN)of the hip was one of the dreaded complications of coronavirus disease 2019(COVID-19),which emerged in patients who received steroid therapy.Corticosteroids have been a mainstay in the treatment protocol of COVID-19 patients.Popular corticosteroid drugs used in patients suffering from COVID-19 were intravenous(IV)or oral dexamethasone,methylprednisolone or hydrocortisone.The use of such high doses of corticost-eroids has shown very positive results and has been lifesaving in many cases.Still,long-term consequences were drug-induced diabetes,osteoporosis,Cushing syndrome,muscle wasting,peripheral fat mobilization,AVN,hirsutism,sleep disturbances and poor wound healing.A significant number of young patients were admitted for bilateral total hip replacements(THR)secondary to AVN following steroid use for COVID-19 treatment.AIM To assess the efficacy of bilateral pericapsular end nerve group(PENG)blocks in patients posted for bilateral THR post-steroid therapy after COVID-19 infection and assess the time taken to first ambulate after surgery.METHODS This prospective observational study was conducted between January 2023 and August 2023 at Care Hospitals,Hyderabad,India.Twenty young patients 30-35 years of age who underwent bilateral THR were studied after due consent over 8 months.All the patients received spinal anaesthesia for surgery and bilateral PENG blocks for postoperative analgesia.RESULTS The duration of surgery was 2.5 h on average.Seventeen out of twenty patients(85%)had a Visual Analog Score(VAS)of less than 2 and did not require any supplementation.One patient was removed from the study,as he required re-exploration.The remaining two patients had a VAS of more than 8 and received IV morphine post-operatively as a rescue analgesic drug.Fifteen out of seventeen patients(88.2%)could be mobilized 12 h after the procedure.CONCLUSION Osteonecrosis or AVN of the hip was one of the dreaded complications of COVID-19,which surfaced in patients who received steroid therapy requiring surgical intervention.Bilateral PENG block is an effective technique to provide post-operative analgesia resulting in early mobilization and enhanced recovery after surgery.

Safety and outcomes of hip and knee replacement surgery in liver transplant recipients

BACKGROUND Liver transplant(LT)is becoming increasingly common with improved life expectancy.Joint replacement is usually a safe procedure;however,its safety in LT recipients remains understudied.AIM To evaluate the mortality,outcome,and 90-d readmission rate in LT patients undergoing hip and knee replacement surgery.METHODS Patients with history of LT who underwent hip and knee replacement surgery between 2016 and 2019 were identified using the National Readmission Database.RESULTS A total of 5046119 hip and knee replacement surgeries were identified.3219 patients had prior LT.Mean age of patients with no history of LT was 67.51[95%confidence interval(CI):67.44-67.58],while it was 64.05(95%CI:63.55-64.54)in patients with LT.Patients with history of LT were more likely to have prolonged length of hospital stay(17.1%vs 8.4%,P<0.001).The mortality rate for patients with no history of LT was 0.22%,while it was 0.24%for patients with LT(P=0.792).Patients with history of LT were more likely to have re-admissions within 90 d of initial hospitalization:11.4%as compared to 6.2%in patients without history of LT(P<0.001).The mortality rate between both groups during readmission was not statistically different(1.9%vs 2%,P=0.871)respectively.CONCLUSION Hip and knee replacements in patients with history of LT are not associated with increased mortality;increased readmissions were more frequent in this cohort of patients.Chronic kidney disease and congestive heart failure appear to predict higher risk of readmission.

Excision of trochanteric bursa during total hip replacement:Does it reduce the incidence of post-operative trochanteric bursitis?

BACKGROUND Trochanteric bursitis is a common complication following total hip replacement(THR),and it is associated with high level of disability and poor quality of life.Excision of the trochanteric bursa prophylactically during THR could reduce the occurrence of post-operative trochanteric bursitis.AIM To evaluate whether synchronous trochanteric bursectomy at the time of THR affects the incidence of post-operative trochanteric bursitis.METHODS This retrospective cohort study was conducted in the secondary care setting at a large district general hospital.Between January 2010 and December 2020,954 patients underwent elective primary THR by two contemporary arthroplasty surgeons,one excising the bursa and the other not(at the time of THR).All patients received the same post-operative rehabilitation and were followed up for 1 year.We reviewed all cases of trochanteric bursitis over this 11-year period to determine the incidence of post-THR bursitis.Two proportion Z-test was used to compare incidences of trochanteric bursitis between groups.RESULTS 554 patients underwent synchronous trochanteric bursectomy at the time of THR whereas 400 patients did not.A total of 5 patients(incidence 0.5%)developed trochanteric bursitis following THR;4 of whom had undergone bursectomy as part of their surgical approach,1 who had not.There was no statistically significant difference between the two groups(Z value 1.00,95%CI:-0.4%to 1.3%,P=0.32).There were also 8 other patients who had both trochanteric bursitis and hip osteoarthritis prior to their THR;all of whom were treated with THR and synchronous trochanteric bursectomy,and 7 had resolution of their lateral buttock pains but 1 did not.CONCLUSION Synchronous trochanteric bursectomy during THR does not materially affect the incidence of post-operative bursitis.However,it is successful at treating patients with known trochanteric bursitis and osteoarthritis requiring THR.

Cementless Buechel-Pappas Resurfacing Total Hip Replacement: A 45-Year Personal Journey to Overcome Wear, Osteolysis, Loosening and Femoral Neck Fractures

Background: Resurfacing-type total hip replacement (THR) has been successfully developed over the past 50 years through collaborative efforts between engineers and surgeons. Much of the development was pursued by individuals or groups, each of which participated in adding further refinements to the implants, instruments and surgical procedures, thus minimizing the serious problems of wear, osteolysis, loosening and femoral neck fractures. The purpose of this study is to explore the development process to optimize the resurfacing total hip replacement into its current application. Methods: In the early 1980s, cementless resurfacing implants were developed using “thin shell” technology to minimize bony resection of the acetabulum and femoral head. Femoral components utilized short, non-porous coated, tapered straight stems to reduce shear stresses in the femoral neck to prevent fractures and stress shielding, while mechanically stabilizing and aligning the components. Acetabular components were anatomically designed to be recessed inside bony borders to avoid neck-cup impingement and loosening. Initially, ultrahigh molecular weight polyethylene (UHMWPE) was used as a bearing, but due to high levels of wear and osteolysis, it was replaced by wear-resistant highly crossed-linked polyethylene (HXLPE) in 2008. Results: Use of HXLPE as a bearing material in both Co-Cr-Mo and titanium nitride (TiN) ceramic-coated resurfacing implants has led to excellent patient outcomes for more than 10 years. In clinical studies, 87% of patients with bilateral total hip replacements prefer their resurfacing-type total hip over their stem-type total hip. The author’s own personal resurfacing total hips, now at 8 and 5 years, respectively, provide “normal” function and no radiographic osteolysis. Conclusions: After 45 years of active evaluation, including mechanical design considerations, prosthetic design development, clinical and radiographic analysis of results, as well as availability of components cleared by the FDA 510 K process, the author has stated a personal preference for the BP Resurfacing Hip System. His excellent mid-term results in both of his resurfaced hips are similar to the long-term results presented in published studies.

Dexmedetomidine-induced anesthesia in elderly patients undergoing hip replacement surgery

BACKGROUND A femoral neck fracture is a common and frequently reported issue in orthopedics, with a greater rate of incidence among the elderly. Due to their advanced age and the presence of some primary diseases, both anesthesia and surgery are increasingly difficult in elderly patients with a femoral neck fractures. In fact,general anesthesia can easily induce complications such as cognitive dysfunction,which is not conducive to postoperative recovery.AIM To analyze the efficacy of dexmedetomidine in inducing anesthesia for elderly patients undergoing hip replacement surgery.METHODS A total of 98 elderly patients undergoing hip replacement in our hospital from June 2020 to June 2021 were randomly divided into control group(49 cases) and observation group(49 cases). The control group was given general anesthesia, and the observation group was combined with dexmedetomidine for anesthesia on the basis of the control group. Both groups were observed until the patients were discharged. The vital signs, serum inflammatory factors and renal function indexes of the two groups were compared before, during and 6 h after operation.The postoperative recovery and adverse events of the two groups were statistically analyzed.RESULTS Compared with the mean arterial pressure of the two groups, the intraoperative and postoperative 6 h was higher than that before the operation, the intraoperative was lower than the postoperative 6 h(P < 0.05);the blood oxygen saturation of the two groups was higher than that before operation and 6 h after operation, and the observation group was higher than the control group 6 h after operation(P < 0.05). The heart rate of the two groups was lower during and 6 h after operation than that before operation, and higher at 6 h after operation than that during operation(P < 0.05).The levels of serum C-reactive protein, tumor necrosis factor-α, interleukin-1β and kidney injury molecule-1 in the two groups were higher during operation and 6 h after operation than those before operation(P < 0.05). The level of serum urea nitrogen in the two groups was higher than that before operation, and that in the observation group was lower than that in the control group(P < 0.05). During hospitalization, the first time of getting out of bed, recovery time of grade Ⅱ muscle strength, recovery time of grade Ⅲ muscle strength and hospitalization time in the observation group were shorter than those in the control group(P < 0.05).CONCLUSION Dexmedetomidine can effectively improve the vital signs of elderly patients undergoing hip replacement surgery, reduce the body’s inflammatory response and renal function damage, and promote postoperative recovery. Meanwhile, dexmedetomidine showcased a good safety profile and a good anesthetic outcome.

Total hip replacement using MINIMA^(■)short stem:A short-term follow-up study

BACKGROUND Total hip replacement has become one of the most successful orthopaedic procedures.The length of the femoral stem constitutes one of the most important geometrical and mechanical features of the prosthesis.Several different implants are currently available but data are limited concerning the clinical results for some of these implants.AIM To report the short-term clinical and radiological results of a novel squared section,tapered design–with four conicity-short stem in total hip replacement.METHODS This is a retrospective study of a prospectively collected data using of MINIMA?short stem in 61 consecutive patients with at least 1 year follow-up.The collected data included patients’demographics,type of arthritis,bone morphology,perioperative data,clinical results using Harris Hip Score,EuroQol(EQ-5D),pain score and satisfaction rate,complications and radiological results.RESULTS Total 61 patients were included in our study with a mean age of 56 years of age(range 25-73 years).The majority of them(68.6%)were women,thirty seven patients(56.9%)were less than 60 years of age and almost half of patients(45.1%)suffered from secondary osteoarthritis(hip dysplasia,osteonecrosis,etc.).The mean time of follow-up examination was 33.4 mo(2.8 years)with a range of 12-57 months(1-4.8 years).In 35 patients(56.9%)the follow-up examination was more than 3 years.No major complications such as revision,periprosthetic fracture,dislocation or infection were presented.Re-admission 90 d postoperatively or laterwas deemed unnecessary for any reason regarding the operation.Respectively,the mean pain score,mean Harris hip score,and mean EQ-5D were improved from 6.3,58.7 and 77.3 preoperatively to 0.1,95.1,and 79.8 postoperatively.The Satisfaction rate at the final follow-up was 9.9(SD 0.3,range 8.0-10.0).All stems were classified as stable bone ingrowth and no radiolucent lineswere revealed in any of the modified Gruens’zone at the postoperative Xrays.Stem subsidence was within acceptable limits and the incidence of distal cortical hypertrophy was relatively low.CONCLUSION The clinical and radiological results concerning the MINIMA?short stem are excellent according to this first report of this specific design of the short femoral stems.Because of the small number of cases and short-term follow-up of this study,a longer follow up time and more patients’enrollment is required.

Which approach of total hip arthroplasty is the best efficacy and least complication?

BACKGROUND Total hip arthroplasty is as an effective intervention to relieve pain and improve hip function.Approaches of the hip have been exhaustively explored about pros and cons.The efficacy and the complications of hip approaches remains inconclusive.This study conducted an umbrella review to systematically appraise previous meta-analysis(MAs)including conventional posterior approach(PA),and minimally invasive surgeries as the lateral approach(LA),direct anterior approach(DAA),2-incisions method,mini-lateral approach and the newest technique direct superior approach(DSA)or supercapsular percutaneouslyassisted total hip(SuperPath).AIM To compare the efficacy and complications of hip approaches that have been published in all MAs and randomized controlled trials(RCTs).METHODS MAs were identified from MEDLINE and Scopus from inception until 2023.RCTs were then updated from the latest MA to September 2023.This study included studies which compared hip approaches and reported at least one outcome such as Harris Hip Score(HHS),dislocation,intra-operative fracture,wound compliData were independently selected,extracted and assessed by two reviewers.Network MA and cluster rank and surface under the cumulative ranking curve(SUCRA)were estimated for treatment efficacy and safety.RESULTS Finally,twenty-eight MAs(40 RCTs),and 13 RCTs were retrieved.In total 47 RCTs were included for reanalysis.The results of corrected covered area showed high degree(13.80%).Among 47 RCTs,most of the studies were low risk of bias in part of random process and outcome reporting,while other domains were medium to high risk of bias.DAA significantly provided higher HHS at three months than PA[pooled unstandardized mean difference(USMD):3.49,95%confidence interval(CI):0.98,6.00 with SUCRA:85.9],followed by DSA/SuperPath(USMD:1.57,95%CI:-1.55,4.69 with SUCRA:57.6).All approaches had indifferent dislocation and intraoperative fracture rates.SUCRA comparing early functional outcome and composite complications(dislocation,intra-operative fracture,wound complication,and nerve injury)found DAA was the best approach followed by DSA/SuperPath.CONCLUSION DSA/SuperPath had better earlier functional outcome than PA,but still could not overcome the result of DAA.This technique might be the other preferred option with acceptable complications.

Hip Tuberculosis at Stage IV: Outcomes and Some Conditions for Total Hip Replacement

Background: Treatment of hip disorders during active hip tuberculosis has long been a controversial issue. Some authors have reported performing hip replacement with different strategies with very good outcomes. This study aimed to describe the surgical outcomes and necessary conditions for total hip replacement in active hip tuberculosis. Methods: We conducted a quasi-experimental study. The study enrolled 40 patients with 42 active tuberculosis hips at stage IV treated by total hip replacement from October 2016 to December 2019 at the National Lung Hospital. We followed up with the patients for at least 12 months, evaluated surgical outcomes, and investigated the factors associated with these outcomes by logistic regression analysis. Results: Surgical outcomes showed that 37 patients (88.1%) had excellent hip function, no abscesses, and no sinus tract formation. Four cases (9.5%) had sinus tract formations. One case (2.4%) had good hip function. Binary logistic regression models revealed that sinus tract formation was associated with preoperative tuberculosis infection syndrome. The average time to obtain antituberculosis drug treatment preoperatively was 4.6 weeks. Conclusion: Total hip replacement for active hip tuberculosis is a practical and promising treatment method. Surgeons should consider improving patients’ conditions before performing total hip replacement, administering antitubercular drugs, and arthrotomy to eliminate all abscesses, and decrease the risk of tuberculosis infection syndrome and the inflammatory response.

Nomogram to predict postoperative complications in elderly with total hip replacement

BACKGROUND By analyzing the risk factors of postoperative complications in elderly patients with hip replacement,We aimed to develop a nomogram model based on preoperative and intraoperative variables and verified the sensitivity and specificity for risk stratification of postoperative complications in elderly with total hip replacement patients.AIM To develop a nomogram model for risk stratification of postoperative complications in elderly with total hip replacement patients.METHODS A total of 414 elderly patients who underwent surgical treatment for total hip replacement hospitalized at the Affiliated Hospital of Guangdong Medical University from March 1,2017 to August 31,2019 were included into this study.Univariate and multivariate logistic regression were conducted to identify independent risk factors of postoperative complication in the 414 patients.A nomogram was developed by R software and validated to predict the risk of postoperative complications.RESULTS Multivariate logistic regression analysis revealed that age(OR=1.05,95%CI:1.00-1.09),renal failure(OR=0.90,95%CI:0.83-0.97),Type 2 diabetes(OR=1.05,95%CI:1.00-1.09),albumin(ALB)(OR=0.91,95%CI:0.83-0.99)were independent risk factors of postoperative complication in elderly patients with hip replacement(P<0.05).For validation of the nomogram,receive operating characteristic curve revealed that the model predicting postoperative complication in elderly patients with hipreplacement was the area under the curve of 0.8254 (95%CI: 0.78-0.87), the slope of the calibrationplot was close to 1 and the model passed Hosmer-Lemeshow goodness of fit test (χ^(2) = 10.16, P =0.4264), calibration in R E_(max) = 0.176, E_(avg) = 0.027, which all demonstrated that the model was ofgood accuracy.CONCLUSIONThe nomogram predicting postoperative complications in patients with total hip replacementconstructed based on age, type 2 diabetes, renal failure and ALB is of good discrimination andaccuracy, which was of clinical significance.

Preliminary Report on Phenom^®Femoral Component in Total Hip Replacement: The Correlation between Outcome Scores in a Cross-Seccional Study

Background: The main purpose of the present study was to assess the short term performance of a cementless femoral stem in total hip replacement. Methods: Cross-sectional observational study of a 48-patient cohort with Phenom? femoral stems implanted between June 1, 2014 and September 1, 2018, to determine clinical performance, stability, and radiographic osseointegration. Patients were followed-up from 13 to 76 months (mean: 44.5 months) and assessed using the Harris Hip Score-HHS, the Hip Disability and Osteoarthritis Outcome Score-HOOS and radiographs. Results: All stems were radiologically stable. Mean Harris Hip Score was 89.8 and the HOOS was 80.4. No statistical differences were observed among patients with different diagnoses. Conclusions: The short-term results revealed satisfactory clinical outcomes and radiological signs of implant stability in all cases. Using two functional scores was useful in detecting biases and a low to moderate agreement was found between the scores.

Reduction in pulmonary complications in high risk patients undergoing surgery for total hip replacement under general anesthesia by preoperative intensive inspiratory muscle training:A randomized controlled clinical trial

Objective： To evaluate the effects of preoperative inspiratory muscle training （IMT） on the incidence of atelectasis in patients at high risk of postoperative pulmonary complications scheduled for elective total hip replacement surgery under general anesthesia. Methods： Thirty two high-risk patients undergoing elective total hip replacement surgery under general anesthesia were chosen from Nanjing Medical University, Affiliated Nanjing First Hospital. In this single-blind randomized controlled clinical triM, patients were randomly assigned to receive preoperative inspiratory muscle training or conventional treatment （CT）. The major effectiveness outcome variables were atelectasis and duration of postoperative hospitalization. Results： Both groups were comparable prior to surgery. Seven patients in the CT group and 3 in the IMT group developed atelectasis （P = 0.25）. Median duration of postoperative hospitalization was 13 days （range, 10～17 days） in the IMT group versus 16 days （range, 11～23 days） in the CT group （Mann- Whitney U statistics, Z = -2.22, P = 0.03）. Mean postoperative inspiratory pressure was 5% higher in the IMT group. Conclusion： Preoperative intensive inspiratory muscle training appears to reduce the incidence of atelectasis and duration of postoperative hospitalization in patients at high risk of developing postoperative pulmonary complications who were scheduled for elective total hip replacement surgery under general anesthesia.

Effect of sevoflurane inhalation and general anesthesia on serum IL-6 and S100β levels and coagulation function in elderly patients undergoing total hip replacement

Objective:To investigate the effects of sevoflurane inhalation general anesthesia on serum IL-6,brain injury protein S100βand coagulation function in elderly patients undergoing total hip arthroplasty.Method:From May 2017 to May 2019,84 patients,age 60-75 underwent total hip arthroplasty in our hospital.were randomly divided into two groups:group A(n=42)and group B(n=42).Group A was maintained with sevoflurane inhalation by general anesthesia and group B with propofol by intravenous anesthesia.The surgical related indexes and postoperative complications in the two groups were compared.The level of serum IL-6,S100β,Coagulation function index[platelet count(PLT),Fibrinogen(FIB),plasma D-dimer(D-D),activated partial enzyme activity time(APTT),prothrombin time(PT)],MMSE score and MoCA score were compared between two groups before and after operation.Results:There was no significant difference in anesthesia time,operation time,intraoperative bleeding and postoperative drainage(P>0.05).1h,1d and 7d after operation,the level of PLT,D-D and FIB in group A were significantly lower than that in group B(P<0.05),PT and APTT were significantly higher than that in group B(P<0.05).1h,1d and 7d after operation,the level of IL-6,S100βin group A were significantly lower than that in group B(P<0.05).1d after operation,the MMSE and MoCA scores in group B were significantly lower than those in group A(P<0.05).The incidence of lower extremity deep venous thrombosis(2.38%)and cognitive impairment(2.38%)in group A was lower than that in group B(14.29%,16.67%)(t1=3.896,P1=0.048;t2=4.974,P2=0.026).Conclusion:sevoflurane anesthesia can reduce the incidence of deep venous thrombosis and cognitive impairment of the lower extremity after operation in elderly patients with thr,stabilize the coagulation index of patients,and downregulate the expression of il-6 and S100β.

Comparison of DAA and PLA Approaches for Total Hip Replacement in the Treatment of Femoral Neck Fractures

Objectives: Femoral neck fractures are becoming more common within nowadays. This research is to explore the clinical effect of primary total hip replacement (THA) via direct anterior approach (DAA) and posterolateral approach (PLA) in the treatment of femoral neck fracture. Methods: Retrospective analysis of 100 cases of elderly patients with femoral neck fracture who underwent total hip arthroplasty admitted to Tianyou Hospital affiliated to Wuhan University of Science and Technology from January 2019 to January 2022. 50 patients treated with DAA approach were included in the observation group, and 50 patients treated with PLA approach were included in the control group. The operation indexes, postoperative acetabular abduction angle and anteversion angle, hip joint function, Harris score and complications were compared between the two groups. Result: The length of incision in the observation group was shorter than that in the control group, and the amount of intraoperative bleeding and postoperative hospital stay were shorter than those in the control group (P < 0.05);There was a statistically significant difference between the two groups in the ratio of acetabular abduction angle and its safe zone, and the length difference of both lower limbs (P < 0.05), while there was no statistically significant difference between the two groups in the ratio of acetabular anteversion angle and its safe zone, eccentricity, and its recovery rate (P > 0.05);Harris score of hip joint: 6 months after operation, the anterior approach group was significantly higher than the posterolateral approach group (P < 0.05), and there was no statistical difference between the two groups 12 months after operation (P > 0.05);The total incidence of complications in the observation group was lower than that in the control group, with a statistically significant difference (P Conclusion: DAA and PLA approaches for total hip replacement can restore the hip joint structure of patients with femoral neck fractures and achieve good results, but DAA approach has greater advantages in early postoperative recovery, improvement of hip joint function, small surgical injury, high application value, so it is recommended.

Participating in health care for total hip replacement patients:an integrative review

In recent years,with the continuous improvement of people's health requirements,the awareness of participating in disease diagnosis and treatment has also been constantly enhanced.Patient’s participation has become a hot issue in medical care policies and research practices.This article intends to review the research background of patient participation and necessity,status,form,significance and existing problems of total hip replacement patients'participation in health care in order to provide reference for the promotion participation in practice.

A LONG TERM EFFECT EVALUATION OF TOTAL HIP PROSTHETIC REPLACEMENT

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Causes and management of prosthesis dislocation after artificial hip replacement

Objective To explore the causes and management of prosthesis disocation after artificaial hip replacement (AHR).Methods Seventeen patients with prosthesis dislocation after AHR during January 2000 to July 2010 were studied

A Biomimetic Hip Joint Simulator and its Application in in vitro Study of the Integrity of Replacement Cemented Hip

A biomimetic hip joint simulator that can be used to evaluate the outcome of the cemented total hip replacement has been designed, manufactured and evaluated. The simulator produces motion in the extension/flexion plane, with a socket to rotate internal/externally. At the same time a dynamic loading cycle is applied. A validation test was performed on a cemented femoral stem within a novel composite femur. The hone quality has a strong effect on the stem migration and on the integrity of the interfaces. The migration of the stem is a combination of 3-D translation and rotation of the stem. Under the same loading conditions, weak bone allows more stem migration than strong bone. There is a great decrease in the strength of the stem-cement interface after the dynamic test, and the weak bone composite exhibited a greater reduction in interfacial strength than the strong bone composite. The decrease of the interfacial strength indicates that the primary bonding between the stem and the cement mantle had deteriorated and the integrity of stem-cement interface was damaged. The study demonstrates the value of using a hip joint simulator to investigate stem migration and interface integrity within the cemented hip replacement, suggesting that method can be used for in vitro evaluation of the biomaterials used in the cemented hip replacements.

Application of Functional Exercise Nursing Plan Based on Evidence-based Nursing After Hip Replacement

Objective:To explore the effect of functional exercise nursing plan based on evidence-based nursing in patients after hip replacement.Methods:A total of 150 patients who underwent hip replacement in the orthopedic second ward of our hospital during the research period from January 2010 to January 2020 were selected as the research object.The random number expression method was applied to achieve grouping of patients.Among them,the control group received conventional rehabilitation treatment;the experimental group guided rehabilitation exercises according to the functional exercise nursing plan after hip replacement,and the rehabilitation conditions of the two groups were compared.Results:Compared with the patients in the control group,the bed time(7.45±2.10)days and average hospital stay(15.84±3.29)of the experimental group were relatively shorter.The incidence of complications in the experimental group and the control group was 6.67%and 16.00%,which are significantly different.The difference in Harris hip score before surgery was small,and the difference when discharge and after discharge was gradually increased,showing a better care effect in the experimental group.There was no significant difference in preoperative quality of life scores between the two groups before surgery(P>0.05).The life quality of the experimental group was significantly higher than that of the control group at discharge,1 month after discharge and 3 months after discharge,and showed most significantly after 3 months.Conclusion:The effect of functional exercise nursing plan based on evidence-based nursing in patients after hip replacement is remarkable,which can promote the recovery of patients,improve the quality of life,reduce the hospitalization time,reduce the incidence of postoperative complications,and has a positive significance in promoting clinical development in China.

Total hip replacement for arthritis following tuberculosis of hip

AIM: To present the results of total hip arthroplasty(THA) for post tubercular arthritis of the hip joint.METHODS: Sixty-five patients(45 male, 20 female) with previously treated tuberculosis of the hip joint underwent cementless THA for post tubercular arthritis. The average age at the time of THA was 48 years(range 29 to 65 years). Erythrocyte sedimentation rate, C reactive protein, chest X-ray and contrast enhanced magnetic resonance imaging were done preoperatively to confirm resolution of the disease and to rule out any residual disease. Intra-operative samples were taken for microbiological examination, polymerase chain reaction(PCR) and histological examination. Patients were started on anti-tubercular drugs one week before the operation and continued for 6 mo post operatively. The patients were followed up clinically using the Harris hip score as well as radiologically for any loosening of the implants, osteolysis and any recurrence of tuberculosis. Any complications especially the recurrence of the infection was also recorded.RESULTS: The mean interval from completion of antitubercular therapy for tuberculosis to surgery was 4.2 years(range, 2-6 years). Preoperatively, 17 patients had ankylosis whereas 48 patients had functional but painful range of motion. The mean surgical time was 97 min(range, 65-125) whereas the mean blood loss was 600 m L(range, 400-900 m L). The average follow up was 8.3 years(range 6-11 years). The average Harris Hip score improved from 27 preoperatively to 91 at the final follow up. Seventeen patients had acetabularprotrusion which was managed with impaction grafting and cementless acetabular cup. The bone graft had consolidated in all these 17 patients at the follow up. Two patients developed discharging sinuses at 9 and 11 mo postoperatively respectively. The discharge tested positive for tuberculosis on the PCR. Both these patients were put on antitubercular therapy for another year. Both of them recovered and had no evidence of any loosening or osteolysis on X-rays. There were no other complications recorded.CONCLUSION: Total hip replacement restores good function to patients suffering from post tubercular arthritis of the hip.

Total hip replacement:A meta-analysis to evaluate survival of cemented,cementless and hybrid implants

AIM To determine whether cemented, cementless, or hybrid implant was superior to the other in terms of survival rate.METHODS Systematic searches across MEDLINE, CINAHL, and Cochrane that compared cemented, cementless and hybrid total hip replacement(THR) were performed. Two independent reviewers evaluated the risk ratios of revision due to any cause, aseptic loosening, infection, and dislocation rate of each implants with a pre-determined form. The risk ratios were pooled separately for clinical trials, cohorts and registers before pooled altogether using fixed-effect model. Meta-regressions were performed to identify the source of heterogeneity. Funnel plots were analyzed. RESULTS Twenty-seven studies comprising 5 clinical trials, 9 cohorts, and 13 registers fulfilled the research criteria and analyzed. Compared to cementless THR, cemented THR have pooled RR of 0.47(95%CI: 0.45-0.48), 0.9(0.84-0.95), 1.29(1.06-1.57) and 0.69(0.6-0.79) for revision due to any reason, revision due to aseptic loosening, revision due to infection, and dislocation respectively. Compared to hybrid THR, the pooled RRs of cemented THR were 0.82(0.76-0.89), 2.65(1.14-6.17), 0.98(0.7-1.38), and 0.67(0.57-0.79) respectively. Compared to hybrid THR, cementless THR had RRs of 0.7(0.65-0.75), 0.85(0.49-1.5), 1.47(0.93-2.34) and 1.13(0.98-1.3).CONCLUSION Despite the limitations in this study, there was some tendency that cemented fixation was still superior than other types of fixation in terms of implant survival.