Whatʼs New in Total Hip Arthroplasty

Huo, Michael H.; Gilbert, Nathan F.; Parvızı, Javad

doi:10.2106/jbjs.g.00509

Cited by 20 publications

(9 citation statements)

References 19 publications

(1 reference statement)

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“…The established protocol in our institution, therefore, does not include single-stage exchange arthroplasty due to its unreliable clinical results [17]. In our study, RA patients with PJI episodes treated with two-stage exchange had a risk of another infection of 25%, as compared with 5% in non-RA patients.…”

Section: Discussionmentioning

confidence: 88%

“…It has been estimated that up to 24% of patients with early RA will eventually require first major joint replacement 16–20 years after the diagnosis [16], and 5–7% of all patients undergoing THA or TKA have underlying RA [5]. Despite improvements in operative techniques, aseptic procedures, and the use of perioperative antibiotic prophylaxis have reduced the risk of infection to around 1% in general patients undergoing THA and TKA [17], this devastating complication remains a serious threat to RA patients, observed at an incidence of 3.1–4.2% [3], [4].…”

Section: Discussionmentioning

confidence: 99%

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Prosthetic Joint Infection in Patients with Rheumatoid Arthritis: An Outcome Analysis Compared with Controls

Hsieh

Huang

Shih³

2013

PLoS ONE

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BackgroundPatients with rheumatoid arthritis (RA) have been shown to have an increased susceptibility to the development of prosthetic joint infection (PJI) after hip or knee replacement. However, little information is available on the demographic data, outcome of treatment and prognostic factors in RA patients when compared to those in non-RA patients.Methods/Principal FindingsWe performed a retrospective cohort analysis of all cases of PJI that were treated at our institution between 2002 and 2008. Of 346 episodes of PJI during the study period, 46 (13.3%) occurred in patients with RA. Compared to the non-RA cohort, RA patients with PJI were female predominant (74% vs 27%, p<0.001), younger (median age, 51 vs 63 years, p<0.001) and developed infection earlier (median joint age, 72 vs 128 days, p<0.001). The 2-year survival rate free of treatment failure was lower in RA patients with PJI episodes either treated with débridement (22% vs 52%, p = 0.002) or two-stage exchange (78% vs 95%, p = 0.004). A longer duration of symptoms before débridement surgery (median, 11 vs 5 days, p = 0.015), and absence of antibiotics in bone cement for two-stage exchange (relative risk, 8.0; p = 0.02) were associated with treatment failure in patients with RA.DiscussionThe outcome of PJI in RA patients was generally worse than that in non-RA patients. Risk of treatment failure increased in the setting of delayed débridement and two-stage exchange without the use of antibiotic-impregnated bone cement. These findings highlight the importance of vigilant monitoring and aggressive treatment for PJI in RA patients.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Prosthetic Joint Infection in Patients with Rheumatoid Arthritis: An Outcome Analysis Compared with Controls

Hsieh

Huang

Shih³

2013

PLoS ONE

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“…These studies revealed markedly higher risks of prosthetic hip infection (PHI) in patients with liver cirrhosis as compared to non-cirrhotic patients in whom the incidence of PHI was approximately 1%. [4][5][6][7] Although cirrhosis of the liver is a well-known predisposing factor for PHI, the outcome of PHI management in cirrhotic patients, to our knowledge, has not been reported in the English language literature. Therefore, this study was designed to evaluate treatment outcomes among cirrhotic patients with PHI and to identify prognostic factors that might lead to treatment failure.…”

Section: Introductionmentioning

confidence: 90%

Prosthetic hip infection in patients with liver cirrhosis: an outcome analysis

Hsieh

Ueng

Lee

et al. 2010

International Journal of Infectious Diseases

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Liver cirrhosis is a common co-morbidity in patients with PHI treated at our institution. DWROP should be considered only when there is no sinus tract and the duration of symptoms is very short (less than 10 days). EA is an effective procedure to cure infection. However, reimplantation of hip prosthesis in these patients carries a high risk of infection recurrence, especially in those who develop hepatic decompensation.

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“…Surprisingly from the beginning, our results in terms of leg length discrepancy were good on average. We can accept <6 mm of lengthening [11], but we observed that with MAASH technique, the average from the first stage was 4.48 mm and at the last 2.37 mm, close to the anatomical restoration [12]. By drawing the ischiatic line through both lesser trochanter, we measured the leg limb impairment using the IMPAX® (Agfa-Gevaert Group) computer program.…”

Section: Discussionmentioning

confidence: 99%

MAASH Technique for Total Hip Arthroplasty: A Capsular Work

Delgado¹,

Broch²,

Reina

et al. 2013

HSS Jrnl

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BackgroundDislocation and leg length discrepancy are major complications following total hip arthroplasty (THA). Many surgical approaches for THA have been described, but none suggest a capsular incision that assures good exposure while maintaining adequate capsule integrity in closure.PurposesModified anterolateral approach for stable hip (MAASH) is a modification of the classical Hardinge approach, but specifically preserves the anterior iliofemoral lateral ligament and pubofemoral ligament excising the “weak area” of the capsule, in the so called “internervous safe zone” and introducing the “box concept” for the anterior approach to the hip. This is the main difference of the MAASH approach. This technique can be used as a standard for all THA standard models, but we introduce new devices to make it easier.MethodsFrom November 2007 to May 2012, data were collected for this observational retrospective consecutive case study. We report the results of 100 THA cases corresponding to the development curve of this new concept in THA technique.ResultsMAASH technique offers to hip surgeons, a reliable and reproducible THA anterolateral technique assuring accurate reconstruction of leg length and a low rate of dislocation. Only one dislocation and six major complications are reported, but most of them occurred at the early stages of technique development.ConclusionMAASH technique proposes a novel concept on working with the anterior capsule of the hip for the anterolateral approach in total hip arthroplasty, as well as for hemiarthroplasty in the elderly population with high dislocation risk factors. MAASH offers maximal stability and the ability to restore leg length accurately.Electronic supplementary materialThe online version of this article (doi:10.1007/s11420-013-9332-1) contains supplementary material, which is available to authorized users.

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Whatʼs New in Total Hip Arthroplasty

Cited by 20 publications

References 19 publications

Prosthetic Joint Infection in Patients with Rheumatoid Arthritis: An Outcome Analysis Compared with Controls

Prosthetic Joint Infection in Patients with Rheumatoid Arthritis: An Outcome Analysis Compared with Controls

Prosthetic hip infection in patients with liver cirrhosis: an outcome analysis

MAASH Technique for Total Hip Arthroplasty: A Capsular Work

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