What’s New in Hip Replacement

Morgan, Patrick M.

doi:10.2106/jbjs.21.00612

Cited by 4 publications

(3 citation statements)

References 49 publications

(52 reference statements)

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“…14,15 THA is an effective treatment for end-stage hip osteoarthritis, but there are few reports of THA in poliomyelitis patients, which may be related to the low incidence of this disease. 16 Most studies focus on the follow-up results of THA on the paralyzed side due to osteoarthritis or fracture, only a few studies report the functional outcomes and complications after THA on the nonparalytic side and these reports are case reports or case series. 11,14,15,17 With the aging of the residual poliomyelitis population, higher evidence level studies are needed to explore the clinical outcomes of THA on the nonparalytic limb.…”

Section: Introductionmentioning

confidence: 99%

Total Hip Arthroplasty in the Nonparalytic Limb of Residual Poliomyelitis Patients: A Propensity Score Matched Study

Chen

et al. 2023

Orthopaedic Surgery

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Objective Poliomyelitis is a rare neuromuscular disease that can cause hip osteoarthritis on the contralateral side due to an abnormal mechanical weight‐bearing state, making some residual poliomyelitis patients candidates for total hip arthroplasty (THA). The aim of this study was to investigate the clinical outcome of THA in the nonparalytic limbs of these patients compared with those of non‐poliomyelitis patients. Methods Patients treated between January 2007 and May 2021 were retrospectively identified in a single center arthroplasty database. Eight residual poliomyelitis cases that met the inclusion criteria were matched to non‐poliomyelitis cases in a ratio of 1:2 based on age, sex, body mass index (BMI), age‐adjusted Charlson comorbidity index (aCCI), surgeon, and operation date. The hip function, health‐related quality of life, radiographic outcomes, and complications were analyzed with unpaired Student's t test, Mann–Whitney test, Fisher's exact test or analysis of covariance (ANCOVA). Survivorship analysis was determined using the Kaplan–Meier estimator analysis and Gehan‐Breslow‐Wilcoxon test. Results After a mean follow‐up of about 5 years, patients with residual poliomyelitis had worse postoperative mobility outcomes(P < 0.05), but there was no difference in total modified Harris hip score (mHHS) or European quality of life‐visual analogue scale (EQ‐VAS) between the two groups (P > 0.05). There was no difference in radiographic outcomes or complications between the two groups, and patients had similar postoperative satisfaction (P > 0.05). No readmission or reoperation occurred in the poliomyelitis group (P > 0.05), but the postoperative limb length discrepancy (LLD) in the residual poliomyelitis group was greater than that in the control group (P < 0.05). Conclusion Functional outcomes, health‐related quality of life improvement were similarly significantly improved in the nonparalytic limb of residual poliomyelitis patients after THA compared with conventional osteoarthritis patients. However, the residual LLD and weak muscle strength of the affected side will still influence mobility, so residual poliomyelitis patients should be fully informed of this outcome before surgery.

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Section: Introductionmentioning

confidence: 99%

Total Hip Arthroplasty in the Nonparalytic Limb of Residual Poliomyelitis Patients: A Propensity Score Matched Study

Chen

et al. 2023

Orthopaedic Surgery

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“…The subject of opioid use for pain management is ‘one of intense international interest’, according to Morgan et al [ 23 ] Dependence can develop following the use of prescription opioids after surgery. [ 24 ] Health systems internationally have flagged this as an area of concern and strategies aimed at minimising postoperative opioid prescriptions are increasingly suggested.…”

Section: Discussionmentioning

confidence: 99%

A multi-disciplinary program for opioid sparse arthroplasty results in reduced long-term opioid consumption: a four year prospective study

et al. 2023

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Introduction The current opioid epidemic poses patient safety and economic burdens to healthcare systems worldwide. Postoperative prescriptions of opioids contribute, with reported opioid prescription rates following arthroplasty as high as 89%. In this multi-centre prospective study, an opioid sparing protocol was implemented for patients undergoing knee or hip arthroplasty. The primary outcome is to report our patient outcomes in the context of this protocol, and to examine the rate of opioid prescription on discharge from our hospitals following joint arthroplasty surgery. This is possibly associated with the efficacy of the newly implemented Arthroplasty Patient Care Protocol. Methods Over three years, patients underwent perioperative education with the expectation to be opioid-free after surgery. Intraoperative regional analgesia, early postoperative mobilisation and multimodal analgesia were mandatory. Long-term opioid medication use was monitored and PROMs (Oxford Knee/Hip Score (OKS/OHS), EQ-5D-5 L) were evaluated pre-operatively, and at 6 weeks, 6 months and 1 year postoperatively. Primary and secondary outcomes were opiate use and PROMs at different time points. Results A total of 1,444 patients participated. Two (0.2%) knee patients used opioids to one year. Zero hip patients used opioids postoperatively at any time point after six weeks (p < 0.0001). The OKS and EQ-5D-5 L both improved for knee patients from 16 (12–22) pre-operatively to 35 (27–43) at 1 year postoperatively, and 70 (60–80) preoperatively to 80 (70–90) at 1 year postoperatively (p < 0.0001). The OHS and EQ-5D-5 L both improved for hip patients from 12 (8–19) preoperatively to 44 (36–47) at 1 year postoperatively, and 65 (50–75) preoperatively to 85 (75–90) at 1 year postoperatively (p < 0.0001). Satisfaction improved between all pre- and postoperative time points for both knee and hip patients (p < 0.0001). Conclusions Knee and hip arthroplasty patients receiving a peri-operative education program can effectively and satisfactorily be managed without long-term opioids when coupled with multimodal perioperative management, making this a valuable approach to reduce chronic opioid use.

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“…A study involving 139 surgeons asked their advice regarding participation in fifteen different activities post THA. The results showed that most of the surgeons allowed low impact activities such as swimming, bicycling or golf while high impact sports were commonly discouraged (Swanson et al, 2009;Morgan, 2021). It is important to note that the surgeons did not have strong scientific evidence for these recommendations.…”

Section: Introductionmentioning

confidence: 97%

How Does Bicycling Affect the Longevity of Total Hip Arthroplasty? A Finite Element Wear Analysis

et al. 2022

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What’s New in Hip Replacement

Cited by 4 publications

References 49 publications

Total Hip Arthroplasty in the Nonparalytic Limb of Residual Poliomyelitis Patients: A Propensity Score Matched Study

Total Hip Arthroplasty in the Nonparalytic Limb of Residual Poliomyelitis Patients: A Propensity Score Matched Study

A multi-disciplinary program for opioid sparse arthroplasty results in reduced long-term opioid consumption: a four year prospective study

How Does Bicycling Affect the Longevity of Total Hip Arthroplasty? A Finite Element Wear Analysis

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