Delay of total hip arthroplasty to advanced stage worsens post-operative hip motion in patients with femoral head osteonecrosis

Jo, Woo-Lam; Lee, Yong Seuk; Ha, Yong‐Chan; Kim, Tae Young; Koo, Kyung‐Hoi

doi:10.1007/s00264-018-3952-5

Cited by 13 publications

(6 citation statements)

References 26 publications

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“…Another aspect to consider is that patients may have had some operations before the THA or may have wait a long time before arthroplasty which may in some circumstances worsen the functional result [36].…”

Section: Total Hip Arthroplasty and Osteonecrosismentioning

confidence: 99%

Hip osteonecrosis: stem cells for life or behead and arthroplasty?

Hernigou¹,

Daltro

Hernigou

2018

International Orthopaedics (SICOT)

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Section: Total Hip Arthroplasty and Osteonecrosismentioning

confidence: 99%

Hip osteonecrosis: stem cells for life or behead and arthroplasty?

Hernigou¹,

Daltro

Hernigou

2018

International Orthopaedics (SICOT)

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“…Our study showed that if the threshold probability was between 0.06 and 0.96, as shown by the constructed decision curves, the AI-based nomogram could predict postoperative ONFH compared with treating either all or no patients. This indicated that early postoperative prediction using this hybrid of patient and radiograph variables can be useful for the application of early interventions that may even allow for a reasonable delay of the onset of arthroplasty (50). Substantial positive rehabilitation can be applied after accurate predictions are obtained after the operation for patients with a lower prediction probability, which will also relieve patient anxiety (51).…”

Section: Discussionmentioning

confidence: 99%

Deep Learning Improves Osteonecrosis Prediction of Femoral Head After Internal Fixation Using Hybrid Patient and Radiograph Variables

et al. 2020

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Femoral neck fractures (FNFs) are a great public health problem that leads to a high incidence of death and dysfunction. Osteonecrosis of the femoral head (ONFH) after internal fixation of FNF is a frequently reported complication and a major cause for reoperation. Early intervention can prevent osteonecrosis aggravation at the preliminary stage. However, at present, failure to diagnose asymptomatic ONFH after FNF fixation hinders effective intervention at early stages. The primary objective of this study was to develop a predictive model for postoperative ONFH using deep learning (DL) methods developed using plain X-ray radiographs and hybrid patient variables. A two-center retrospective study of patients who underwent closed reduction and cannulated screw fixation was performed. We trained a convolutional neural network (CNN) model using postoperative pelvic radiographs and the output regressive radiograph variables. A less experienced orthopedic doctor, and an experienced orthopedic doctor also evaluated and diagnosed the patients using postoperative pelvic radiographs. Hybrid nomograms were developed based on patient and radiograph variables to determine predictive performance. A total of 238 patients, including 95 ONFH patients and 143 non-ONFH patients, were included. A CNN model was trained using postoperative radiographs and output radiograph variables. The accuracy of the validation set was 0.873 for the CNN model, and the algorithm achieved an area under the curve (AUC) value of 0.912 for the prediction. The diagnostic and predictive ability of the algorithm was superior to that of the two doctors, based on the postoperative X-rays. The addition of DL-based radiograph variables to the clinical nomogram improved predictive performance, resulting in an AUC of 0.948 (95% CI, 0.920-0.976) and better calibration. The decision curve analysis showed that adding the DL increased the clinical usefulness of the nomogram compared with a clinical approach alone. In conclusion, we constructed a DL facilitated nomogram that incorporated a hybrid of radiograph and patient variables, which can be used to improve the prediction of preoperative osteonecrosis of the femoral head after internal fixation.

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“…However, substantial high-level evidence implicates that if THA is performed too early in young, active patients, it shows poor long-term outcomes, shorten implant survival time, and requires at least one and even multiple revisions [ 7 ]. Clinically, for those who are young or have not yet experienced secondary osteoarthritis, the surgeons tend to choose hip preservation treatment and delay the time of THA until the final stage of ONFH [ 8 ]. Unfortunately, this may increase the risk of postoperative adverse events of THA and compromise its clinical efficacy.…”

Section: Introductionmentioning

confidence: 99%

“…To our knowledge, few existing studies have explored the differences in outcomes of THA performed at different ARCO stages, and sporadically published ones are also limited by inadequate design, insufficient study variables and small sample size. For example, Jo et al showed that delaying THA to advanced stage reduced postoperative hip motion in a controlled study of ONFH patients after THA at different ARCO stages [ 8 ]. However, they focused only on hip function and ignored other outcomes such as intraoperative information and postoperative adverse events.…”

Section: Introductionmentioning

confidence: 99%

Comparison of outcomes after total hip arthroplasty between patients with osteonecrosis of the femoral head in Association Research Circulation Osseous stage III and stage IV: a five-year follow-up study

Wang,

Wu,

et al. 2024

J Orthop Surg Res

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Background No large cohort study has evaluated the surgical outcomes of THA between different stages of ONFH patients. This study aimed to compare the surgical outcomes of ONFH patients who underwent THA in ARCO stage III versus IV, in terms of operative parameters, one-year hip function assessments and postoperative at least five-year complications, to inform optimized management of ONFH. Method From our prospectively collected database, 876 patients undergoing THA between October 2014 and April 2017 were analyzed and divided into ARCO stage III group (n = 383) and ARCO stage IV group(n = 493). Details of demographics, medical record information, adverse events and clinical scores of both groups were collected and compared. Proper univariate analysis was used for the analysis. Result There were no statistically significant differences in baseline characteristics between the two groups. Compared to ARCO stage IV patients, ARCO stage III patients showed a shorter operative time (p < 0.01), less bleeding (p < 0.01), fewer one-year readmissions (p = 0.026) and complications (p = 0.040), and significantly higher HHS (p < 0.01) one year after THA. In addition, ARCO stage IV patients seem more likely to suffer prosthesis dislocation (p = 0.031). Conclusion Although ARCO stage IV patients in the study cohorts appeared to suffer more one-year complications, no significant difference was observed at long-term follow-up. Enhanced clinical guidance on preventing early prosthesis dislocation may help improve the prognosis of final-stage ONFH patients.

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Delay of total hip arthroplasty to advanced stage worsens post-operative hip motion in patients with femoral head osteonecrosis

Abstract: The progression of ONFH negatively affected post-operative hip ROM as well as baseline hip ROM at the time of THA. Surgeons should consider a delay of THA negatively affects the hip ROM after the arthroplasty, when they determine the treatment modality for ONFH patients.

Cited by 13 publications

References 26 publications

Hip osteonecrosis: stem cells for life or behead and arthroplasty?

Hip osteonecrosis: stem cells for life or behead and arthroplasty?

Deep Learning Improves Osteonecrosis Prediction of Femoral Head After Internal Fixation Using Hybrid Patient and Radiograph Variables

Comparison of outcomes after total hip arthroplasty between patients with osteonecrosis of the femoral head in Association Research Circulation Osseous stage III and stage IV: a five-year follow-up study

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