Is Robotic Arm Assisted Total Hip Arthroplasty More Bone Preserving than Conventional Hip Replacements and Hip Resurfacing?

Background: Total hip arthroplasty (THA) is a common procedure that is increasingly being performed in younger patients. Deep acetabular reaming will result in more bone loss and the need for large acetabular components to be implanted. It can also lead to impingement, loosening, an altered center of rotation, and intraoperative periprosthetic fracture. The purpose of this study is to determine whether the single ream, robotic arm-assisted (RAA) THA can preserve a greater volume of bone stock compared to conventional hip replacement and resurfacing. Methods: We prospectively recruited 69 patients who had undergone primary THA using the Stryker Trident Acetabular System®in combination with the Stryker RAA System (MAKO)®and compared their mean reaming weight (g) with that of conventional hip replacement and resurfacing, as measured by Brennan et al. Comparison of acetabular reaming during hip resurfacing versus uncemented THA (J Orthop Surg. 2009;17(1): 42-46). Results: The mean reaming weight using the MAKO system was 9.08 g, which was 29% less than the reaming weight using uncemented THA and hip resurfacing of 12.75 g. None of the acetabular cups required screw fixation. During the 35-month follow-up period, there were no complications related to cup placement or positioning. Conclusions: The use of RAA THA results in statistically significant preservation of acetabular bone compared to conventional hip replacement and resurfacing. This approach reflects the increased precision offered by RAA single reaming. Surgeons may consider utilizing RAA THA, particularly in younger patients, to better preserve bone stock as this could potentially impact future revision procedures.

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.

Intraoperative application of three-dimensional printed guides in total hip arthroplasty: A systematic review

BACKGROUND Acetabular component positioning in total hip arthroplasty(THA)is of key importance to ensure satisfactory post-operative outcomes and to minimize the risk of complications.The majority of acetabular components are aligned freehand,without the use of navigation methods.Patient specific instruments(PSI)and three-dimensional(3D)printing of THA placement guides are increasingly used in primary THA to ensure optimal positioning.AIM To summarize the literature on 3D printing in THA and how they improve acetabular component alignment.METHODS PubMed was used to identify and access scientific studies reporting on different 3D printing methods used in THA.Eight studies with 236 hips in 228 patients were included.The studies could be divided into two main categories;3D printed models and 3D printed guides.RESULTS 3D printing in THA helped improve preoperative cup size planning and post-operative Harris hip scores between intervention and control groups(P=0.019,P=0.009).Otherwise,outcome measures were heterogeneous and thus difficult to compare.The overarching consensus between the studies is that the use of 3D guidance tools can assist in improving THA cup positioning and reduce the need for revision THA and the associated costs.CONCLUSION The implementation of 3D printing and PSI for primary THA can significantly improve the positioning accuracy of the acetabular cup component and reduce the number of complications caused by malpositioning.

Total hip arthroplasty following the failure of intertrochanteric nailing:First implant or salvage surgery?

BACKGROUND Proximal femur fractures,including both intracapsular(femoral neck fractures)and extracapsular fractures(intertrochanteric femoral fractures,IFFs),affect around 1.5 million people per year worldwide.Mechanical failures of intertrochanteric nailing in IFFs could be managed with revision total hip arthroplasty(THA).AIM To describe the surgical complexity and the procedure-related complication rates in patients with trochanteric nailing failure and treated with THA.METHODS Patients referred to our level I trauma center between April 2012 and July 2018 with failed cephalomedullary nailing following trochanteric fractures were retrospectively recruited.All patients underwent a salvage surgical procedure,i.e.,cephalomedullary nail removal and conversion to THA.The same surgical and anesthesiology team performed the surgical procedures under spinal anesthesia.All patients underwent clinical and radiographic follow-ups for at least 24 mo.Complications and re-operations were recorded.RESULTS Seventy-four patients met the inclusion criteria(male:29;female:45;mean age:73.8-years-old;range:65-89)and were included in the current study.The average operative time was 117 min(76-192 min).The average blood loss was 585 mL(430-1720 mL).Among the 74 patients,43(58.1%)required transfusion of three or more blood units.Two patients died within the 4th d after surgery because of pulmonary embolism,and 1 patient died 9 mo after surgery due to ischemic myocardial infarction.The complication rate in the 71 patients who completed the minimum 24-mo follow-up was 22.5%.In 3 cases out of 71(4.2%)periprosthetic acetabular fracture was observed during the followup.One of these periacetabular fractures occurred intraoperatively.An intraoperative periprosthetic femur fracture was observed in 5 patients out of 71(7.0%).Four of these patients needed a re-operation to fix the fracture with plates and cerclages;in one of these patients,femoral stem revision was also necessary.In 4 patients out of 71(5.6%),an early THA dislocation was observed,whereas in 1 case(1.4%)a late THA dislocation was observed.Three patients out of 71(4.2%)developed a periprosthetic joint infection during the study follow-up.CONCLUSION The present study demonstrated that salvage options for IFF fixation failure are complex procedures with a relevant intraoperative and postoperative complication rate.

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.

Crystalloid and colloid preload for maintaining cardiac output in elderly patients undergoing total hip replacement under spinal anesthesia

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, respec-tively （P = 0.362）. Intravascular volume preload with colloid is more effective than crystalloid solution in main-taining CO, which may be improved the hemodynamic stability in elderly patients during SA.

Usefulness of Hammering Sound Frequency Analysis as an Evaluation Method for the Prevention of Trouble during Hip Replacement

In total hip arthroplasty, judgment of the appropriateness of stem hammering is dependent on the experience and feelings of the surgeon and no objective evaluation method has been established. In this study, a frequency analysis of the hammering sounds in total hip arthroplasty was performed to investigate objective judgment criteria capable of preventing problems during surgery. Stem hammering was applied following the surgeon’s feelings as usual in an operating room. A directional microphone was placed at a distance about 2 m from the surgical field and the peak frequency reaching the maximum amplitude was determined by Fourier analysis. It was clarified that the same peak frequency repeats when appropriate fixation is acquired during surgery, suggesting that intraoperative fracture and postoperative loosening can be prevented by stopping hammering at the time the peak frequency converged. Investigation of changes in the hammering sound frequency may serve as objective judgment criteria capable of preventing problems during surgery.

Physiologic postoperative presepsin kinetics following primary cementless total hip arthroplasty:A prospective observational study

BACKGROUND Presepsin is an emerging biomarker in the diagnosis of sepsis.In the field of orthopaedics,it could be useful in diagnosing and managing periprosthetic joint infections.AIM To define the normal postoperative presepsin plasmatic curve,in patients undergoing primary cementless total hip arthroplasty(THA).METHODS Patients undergoing primary cementless THA at our Institute were recruited.Inclusion criteria were:Primary osteoarthritis of the hip;urinary catheter time of permanence<24 h;peripheral venous cannulation time of permanence<24 h;no postoperative homologous blood transfusion administration and hospital stay≤8 d.Exclusion criteria were:The presence of other articular prosthetic replacement or bone fixation devices;chronic inflammatory diseases;chronic kidney diseases;history of recurrent infections or malignant neoplasms;previous surgery in the preceding 12 mo;diabetes mellitus;immunosuppressive drug or corticosteroid assumption.All the patients received the same antibiotic prophylaxis.All the THA were performed by the same surgical and anaesthesia team;total operative time was defined as the time taken from skin incision to completion of skin closure.At enrollment,anthropometric data,smocking status,osteoarthritis stage according to Kellgren and Lawrence,Harris Hip Score,drugs assumption and comorbidities were recorded.All the patients underwent serial blood tests,including complete blood count,presepsin(PS)and C-reactive protein 24 h before arthroplasty and at 24,48,72 and 96 h postoperatively and at 3,6 and 12-mo follow-up.RESULTS A total of 96 patients(51 female;45 male;mean age=65.74±5.58)were recruited.The mean PS values were:137.54 pg/mL at baseline,192.08 pg/mL at 24 h post-op;254.85 pg/mL at 48 h post-op;259 pg/mL at 72 h post-op;248.6 pg/mL at 96-h post-op;140.52 pg/mL at 3-mo follow-up;135.55 pg/mL at 6-mo follow-up and 130.11 pg/mL at 12-mo follow-up.In two patients(2.08%)a soft-tissue infection was observed;in these patients,higher levels(>350 pg/mL)were recorded at 3-mo follow-up.CONCLUSION The dosage of plasmatic PS concentration is highly recommended in patients undergoing THA before surgery to exclude the presence of an unknown infection.The PS plasmatic concentration should be also assessed at 72 h postoperatively,evaluate the maximum postoperative PS value,and at 96 h post-operatively when a decrease of presepsin should be found.The lack of a presepsin decrease at 96 h post-operatively could be a predictive factor of infection.

The effect of post-discharge telephone intervention on rehabilitation following total hip replacement surgery

Purpose:To determine the effect of post-discharge telephone intervention with both patients and family caregivers on patient compliance with doctors’advice and rehabilitation progress in total hip replacement patients.Methods:In total,249 participants were assigned to either the control or telephone intervention group according to the discharge date.The patients in the intervention group were contacted by phone three to seven days after discharge,at one month,and at three months post-discharge.Their family caregivers received were contacted by phone twice a month.Content of the telephone intervention included discussion of exercise,cautions in daily life,and regular examination.The patients in the control group received routine health education and follow-up.All participants were evaluated by the questionnaire of compliance with doctors’advice when they were discharged at one,three,and six months after discharge.The Harris Hip Score of patients was assessed on discharge day and six months after discharge.Results:There was no significant difference between the patients’compliance scores in the two groups on discharge day or one month after discharge.Three and six months after discharge,the scores in the intervention group were significantly higher than the control group(p<0.05).There was no significant difference between the groups in the Harris Hip Score on discharge day.Six months after discharge,the Harris Hip Score in the intervention group was significantly higher than the control group(p<0.05).Conclusion:Telephone intervention with patients and family caregivers improved patient compliance with doctors’advice and promoted functional hip joint rehabilitation.

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.

Anterior muscle sparing approach for total hip arthroplasty

The purpose of this review is to examine the validity of positive claims regarding the direct anterior approach(DAA) with a fracture table for total hip arthroplasty. Recent literature regarding the DAA was searched and specific claims investigated including improved early outcomes, speed of recovery, component placement, dislocation rates, and complication rates. Recent literature is positive regarding the effects of total hip arthroplasty with the anterior approach. While the data is not definitive at present, patients receiving the anterior approach for total hip arthroplasty tend to recover more quickly and have improved early outcomes. Component placement with the anterior approach is more often in the "safe zone" than with other approaches. Dislocation rates tend to be less than 1% with the anterior approach. Complication rates vary widely in the published literature. A possible explanation is that the varianceis due to surgeon and institutional experience with the anterior approach procedure. Concerns remain regarding the "learning curve" for both surgeons and institutions. In conclusion, it is not a matter of should this approach be used, but how should it be implemented.

Total hip arthroplasty in developmental dysplasia of the hip: Review of anatomy, techniques and outcomes

Total hip arthroplasty(THA) in developmental dysplasia of the hip(DDH) presents many challenges to the reconstructive surgeon. The complex femoral and acetabular anatomy makes standard reconstruction technically challenging. Acetabular coverage can be improved by medialization of the component or augmentation of the deficient areas with bone graft. Femoral shortening osteotomies are considered in cases of severe dysplasia and frankly dislocated hips. Each patient's unique anatomy dictates what options of reconstruction are available. The functional outcomes of THA in DDH are generally excellent, though higher rates of mechanical failure have been reported in this group. This article reviews the anatomy, classification, technical considerations, and outcomes of THA in patients with DDH.

Current concepts in total femoral replacement

Total femoral replacement(TFR) is a salvage arthroplasty procedure used as an alternative to lower limb amputation. Since its initial description in the mid-20^(th) century, this procedure has been used in a variety of oncologic and non-oncologic indications. The most compelling advantage of TFR is the achievement of immediate fixation which permits early mobilization. It is anticipated that TFR will be increasingly performed as the rate of revision arthroplasty rises worldwide. The existing literature is mainly composed of a rather heterogeneous mix of retrospective case series and a wide assortment of case reports. Numerous TFR prostheses are currently available and the surgeon must understand the unique implications of each implant design. Long-term functional outcomes are dependent on adherence to proper technique and an appropriate physical therapy program for postoperative rehabilitation. Revision TFR is mainly performed for periprosthetic infection and the severe femoral bone loss associated with aseptic revisions. Depending on the likelihood of attaining infection clearance, it may sometimes be advisable to proceed directly to hip disarticulation without attempting salvage of the TFR. Other reported complications of TFR include hip joint instability, limb length discrepancy, device failure, component loosening, patellar maltracking and delayed wound healing. Further research is needed to better characterize the long-term functional outcomes and complications associated with this complex procedure.

Randomised controlled trial of triclosan coated vs uncoated sutures in primary hip and knee arthroplasty

BACKGROUND Triclosan-coated vicryl plus suture(Ethicon, Inc.) was developed to reduce microbial colonisation during surgical procedures. However, its effect on wound healing and surgical site infections remain unclear after hip and knee arthroplasty surgery.AIM To determine the effect of triclosan-coated sutures(TCS) vs non-coated sutures on wound healing, following primary hip and knee arthroplasties.METHODS A single-centred, double-blind randomised controlled trial(RCT) was undertaken. We randomly allocated patients to receive either the triclosan-coated sutures(TCS vicryl plus) or non-coated sutures(NCS vicryl) during the closure of unilateral primary hip and knee arthroplasties. We utilised the ASEPSIS wound scoring system to evaluate wound healing for the first 6 weeks post-operatively.RESULTS One hundred and fifty patients undergoing primary total hip or knee arthroplasty over a one-year period were included. Eighty-one were randomised to the TCS group and 69 to the NCS group. Despite no statistically significant difference in the ASEPSIS scores among the study groups(P = 0.75), sensitivity analysis using the Mann Whitney test(P = 0.036) as well as assessment of the wound complications at 6 weeks follow up, demonstrated significantly higher wound complication rates in the TCS group(8 vs 1, P = 0.03).CONCLUSION No clear advantage was demonstrated for using the TCS. However, larger multicentred RCTs are required to validate their use in hip and knee arthroplasty surgery.

Clinical efficacy and perioperative safety of simultaneous or staged bilateral total hip arthroplasty:A Meta analysis

Objective:To investigate the clinical efficacy and perioperative safety of simultaneous or staged bilateral total hip arthroplasty(THA)using meta-analysis.Methods:Relevant retrieval methods were developed to retrieve PubMed,Embase,Cochrane Library,CNKI,Wanfang and VIP databases,and the time was set to build the database until September 2020.All the literatures related to simultaneous or staged total hip arthroplasty were screened out.The final included literatures were determined according to the inclusion and exclusion criteria,and the quality of the literatures was evaluated.Meta analysis of all indexes was performed using Review Manager 5.3 software.Results:A total of 22 articles were included,including 3415 patients.Meta analysis results showed that the total hospitalization time in the simultaneous group was significantly lower than that in the staged group[MD=-9.99,95%CI(-14.72,-5.26),P<0.0001].Total hospitalization expenses in the simultaneous group were lower than those in the staged group[MD=-1.3,95%CI(-1.73,-0.86),P<0.00001].The operative time in the simultaneous group was less than that in the staged group[MD=-27.08,95%CI(-40.89,-13.26),P=0.0001].The total blood loss in the simultaneous group was less than that in the staged group[MD=-176.55,95%CI(-282.5,-70.6),P=0.001].The surgical transfusion volume in the simultaneous group was higher than that in the staged group[MD=69.85,95%CI(40.48,99.22),P<0.00001].Postoperative Harris score of hip joint in the simultaneous group was higher than that in the staged group[MD=1.79,95%CI(0.8,2.79),P=0.0004].The incidence of operative complications in the simultaneous group was lower than that in the staged group[OR=0.73,95%CI(0.56,0.96),P<0.05].Conclusion:Compared with staged bilateral total hip replacement,simultaneous bilateral total hip replacement has advantages in terms of reducing hospitalization time,saving hospitalization expense,shortening operation time and reducing surgical bleeding amount,and can promote postoperative hip function recovery,reduce postoperative complications,but increase total blood transfusion volume.

Preoperative and postoperative risk factors for periprosthetic joint infection in primary total hip arthroplasty:A 1-year experience

BACKGROUND Periprosthetic joint infection(PJI)in primary total hip replacement(THR)is one of the most important threats in orthopedic surgery,so one important surgeon’s target is to avoid or early diagnose a PJI.Although the incidence of PJI is very low(0.69%)in our department,with an average follow-up of 595 d,this infection poses a serious threat due to the difficulties of treatment and the lower functional outcomes after healing.AIM To study the incidence of PJI in all operations occurring in the year 2016 in our department to look for predictive signs of potential infection.METHODS We counted 583 THR for 578 patients and observed only 4 cases of infection(0.69%)with a mean follow-up of 596 d(min 30,max 1451).We reviewed all medical records to collect the data:duration and time of the surgery,presence,type and duration of the antibiotic therapy,preoperative diagnosis,blood values before and after surgery,transfusions,presence of preoperative drugs(in particularly anticoagulants and antiaggregant,corticosteroids and immunosuppressants),presence of some comorbidities(high body mass index,blood hypertension,chronic obstructive pulmonary disease,cardiac ischemia,diabetes,rheumatological conditions,previous local infections).RESULTS No preoperative,intraoperative,or postoperative analysis showed a higher incidence of PJI.We did not find any class with evident major odds of PJI.In our study,we did not find any border value to predict PJI and all patients had similar values in both groups(non-PJI and PJI).Only some categories,such as female patients,showed more frequency of PJI,but this difference related to sex was not statistically significant.CONCLUSION We did not find any category with a higher risk of PJI in THR,probably due to the lack of few cases of infection.

Risk Factors for Surgical Site Infection after Hip Arthroplasty: A Multicentric Study

The objective of this study is to answer three main questions: What is the risk of wound infection for patients undergoing hip arthroplasty? What are the main etiologicagents of surgical site infection (SSI)? What are the risk factors most associated with surgical site infection? Method: This was a multicentric, retrospective cohort study which analyzed data collected in five general hospitals in Belo Horizonte, Brazil, between the period of January 2009 and December 2013. The continuous parameters studied were age, length of hospital stay before surgery, duration of surgery, number of professionals at surgery and number of hospital admissions. Categorical variables were surgical wound classification (clean, clean contaminated, contaminated, dirty/infected), American Society of Anesthesiologists (ASA) score (I, II, III, IV, V), type of surgery (elective, emergency), general anesthesia (yes, no), prophylactic antibiotic (yes, no), trauma surgery (yes, no) and Nosocomial Infections Surveillance (NNIS) risk index (IRIC = 0, 1, 2, 3). Results: Estimated SSI risk was 3.2% (95% C.I. = 2.6% to 4.1%) and risk of osteomyelitis was 0.6% (95% C.I. = 0.4% to 1.1%). ASA score > 2, general anesthesia, length of hospital stay before surgery higher than four days, more than two professionals at surgical field and duration of surgery higher than five hours were risk factors for SSI after hip prosthesis (p < 0.05). The final multiple logistic regression analysis indicated that the modified NNIS risk was independently associated with surgical site infection after arthroplasty of hip. Conclusion: Despite the modified NNIS index being a risk factor for SSI, none of its independent variables was statistically significantly in the logistic model (p > 0.100). Each modified NNIS risk category increased the chance of a patient being infected by almost three times, when compared with the previous category (OR = 2.82;p = 0.011).

Comparative study of anterolateral approach versus posterior approach for total hip replacement in the treatment of femoral neck fractures in elderly patients

Objective： To compare the clinical outcome of anterolateral minimally invasive approach versus conventional posterior approach for total hip replacement against femoral neck fractures in elderly patients. Methods： The retrospective study was carried out on 42 patients who suffered from displaced femoral neck fractures （19 cases of Garden type Ⅲ, 23 cases of Garden type Ⅳ） treated by total hip replacement via anterolateral minimally invasive approach or conventional posterior approach by the same experienced surgeon. The average age of the patients was 78.1 years （range： 65-89 years）. They were divided into anterolateral mini-invasive group （22 cases） and posterior group （20 cases）. The mean time of follow-up was 13 months （range： 6-36 months）. The anterolateral approach described by Hardinge goes through between anterior 1/3 and posterior 2/3 of the gluteus medius muscle, reaching the femoral neck from anterior capsule. The traditional posterior approach described by Moore （Southern incision） goes through the insertions of short external rotation muscles, reaching the femoral neck from posterior capsule. The related variables under observation were length of incision, operation time, postoperative limp, length of hospital stay and bed stay and dislolcation rate. Results： The length of the skin incision varied between 7 cm and 12 cm with the anterolateral minimally invasive technique, compared to 15-22 cm in the conventional procedure. It took less time （average 15 minutes） to complete the anterolateral minimally invasive approach （72 15 min）, compared with the conventional approach （87 min ±10 min）. The average Harris hip score was 91.23±10.20 in anterolateral approach, 90.03±11.05 in the posterior approach. The average length of hospital stay for patients with the anterolateral approach was （6.4±2.2） days （range： 4-9 days）, while that in posterior approach was （9.2 ±3.1） days （range： 6-13 days）. The average length of bed stay was （3.4±1.1） days （range： 2-5 days） in anterolateral group and （6.2±2.8） days （range： 3-10 days） in posterior group. No patients in anterolateral group experienced dislocation. One （5%） hip in posterior approach had dislocation. Conclusions： Anterolateral mini-invasive approach can decrease trauma, operation time, length of hospital stay and bed stay and rehabilitation time. The stability and minimal muscular damage permit the acceleration of postoperative rehabilitation, which can subsequently reduce the perioperative risk in the treatment of femoral neck fractures in the elderly undergoing total hip replacement.

Clinical Trial on the Role of Tuina in Rehabilitation Therapy Following Total Hip Replacement

Objective： To observe the clinical effect of tuina in rehabilitation following total hip replacement. Methods： 60 cases were randomly allocated into a treatment group and control group, 30 cases in each group. Cases in the treatment were treated with combined tuina and rehabilitation, while cases in the control group were treated with rehabilitation alone. All treatment retained for two weeks. The results were observed 7 d, 2 weeks and 6 weeks following the total hip replacement using Harris scale and Hamilton Anxiety Rating Scale （HAMA）. Results： For Harris scale, there were significant intra-group differences in different time frames （P〈0.05）; there were no statistical differences between the two groups 1 d, 7 d and 6 weeks following the total hip replacement （P〉0.05）; and there were statistical differences between the two groups 2 weeks following the total hip replacement. For HAMA scale, there were significant intra-group differences in different time frames （P〈0.05）; there were no significant differences between the two groups 1 d following the total hip replacement; and there were substantial differences between the two groups 7 d, 2 weeks and 6 weeks following the total hip replacement. Conclusion： In a given unit time, combined tuina and rehabilitation is superior to rehabilitation alone in improving the patients＇ post-operative pain, articular range of motion and anxiety.

Local infiltration analgesia following total hip replacement： a review of current literature

Controlling postoperative pain after total hip replacement is important and controversy remains regarding different regimens.By reviewing 18 studies,we attempt to find whether local infiltration analgesia after total hip replacement has any effect on postoperative pain,length of hospital stay and opioid consumption.We conclude that local infiltration analgesia is an effective method for decreasing postoperative pain.