HIP International最新文献

{"title":"Medial opening wedge valgus intertrochanteric osteotomy for femoral neck nonunion: a femoral anatomy-preserving surgical approach.","authors":"Boopalan Ramasamy, Kaushik Bhowmick, Anand Ashok, Abel Livingston, Viju D Varghese","doi":"10.1177/11207000251324118","DOIUrl":"10.1177/11207000251324118","url":null,"abstract":"<p><strong>Background: </strong>Valgus osteotomy is a femoral head-preserving surgery to treat femoral neck non-union in young, active patients. The traditional approach, however, causes medialisation of the femoral shaft during valgus correction, which alters femoral anatomy and complicates conversion to total hip arthroplasty if head osteosynthesis fails. This study aims to outline a novel surgical technique, medial opening wedge valgus intertrochanteric osteotomy (VITO), and evaluate its clinical and radiographic outcomes, focusing on restoring hip biomechanics and improving union rates.</p><p><strong>Methods: </strong>Between 2007 and 2022, this technique was used in 18 cases (mean age :39; range :16-51 years). There were 14 males and 4 females. In 10 cases,non-union was due to failed internal fixation, while in 8 cases, it was due to neglected fractures. Treatment outcomes were evaluated by assessing union, pre- and postoperative neck-shaft angle (NSA) correction, and functional outcomes by the Harris Hip Score (HHS).</p><p><strong>Results: </strong>16 out of 18 patients were available for follow-up. The average duration of non-union was 10.7 (range 1-60) months, and the mean follow-up was 64 (range 24-140) months. All achieved successful union, with an average neck shaft angle correction of 16°. 3 patients were converted to total hip arthroplasty (THA) due to implant failure. Complications included 3 cases of avascular necrosis (AVN). Despite these complications, 62% of patients had excellent HHS, while 19% had good HHS. The mean HHS improved from 46(preoperative) to 92 (postoperative).</p><p><strong>Conclusions: </strong>The medial opening wedge VITO is an effective technique for restoring hip biomechanics and achieving high union rates in patients with femoral neck non-union. This technique preserves proximal femoral anatomy, facilitating easier conversion to THA when necessary.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"301-307"},"PeriodicalIF":1.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Constrained acetabular liners in total hip arthroplasty: analysis of 265 primary and revision cases from the Dutch Arthroplasty Register (2007-2022).","authors":"Jetze Visser, Mirthe H W van Veghel, Liza N van Steenbergen, Bart A Swierstra, Esther M Bloemheuvel, B Willem Schreurs","doi":"10.1177/11207000251331147","DOIUrl":"10.1177/11207000251331147","url":null,"abstract":"<p><strong>Introduction: </strong>Constrained acetabular liners (CALs) are predominantly used as a salvage procedure in patients with a severe risk for dislocation after total hip arthroplasty (THA). However, the constrained design of CALs bears the risk of impingement with subsequent loosening or failure of the integrity of the implant. We investigated the use and survival of CALs in primary and revision THA in the Dutch Arthroplasty Register (LROI).</p><p><strong>Methods: </strong>Use of CAL in THAs was extracted from the LROI in the period 2007-2022. 423,773 primary THAs and 52,706 revision THAs have been registered, of which 29 CALs were implanted in primary THA and 236 CALs in revision THA. Patient characteristics and survival of the CAL placed in primary and revision THA were separately analysed.</p><p><strong>Results: </strong>Of the CALs placed in primary THA, no revisions of the implant occurred during a median follow-up of 5.4 years (interquartile range [IQR] 4.0-12.4). The CALs in revision THA were most frequently used for cases with recurrent dislocation (183/236). Median follow-up was 4.8 (IQR 2.3-8.2) years. The re-revision rate was 10% (95% CI, 6.6-14) at 5-year follow-up and 12% (CI, 8.1-17) at 9-year follow-up. The most frequently registered reason for re-revision was dislocation (<i>n</i> = 19, 70%).</p><p><strong>Conclusions: </strong>In the Netherlands there is a relatively low use of CALs in primary as well as revision THA. The survival rate of CALs is acceptable, with recurrent dislocation as the main reason for re-revision. The use of CALs should be reserved for specific cases with high risk for dislocation.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"273-277"},"PeriodicalIF":1.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12069818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the necessity of pre-transfusion testing in primary total hip arthroplasty: a systematic review and meta-analysis.","authors":"Jorge H Nuñez, Berta Escudero, Juan Diego Montenegro, Ernesto Guerra Farfán, Agusti Bartra-Ylla, Francesc Angles-Crespo","doi":"10.1177/11207000251317891","DOIUrl":"10.1177/11207000251317891","url":null,"abstract":"<p><strong>Introduction: </strong>The unnecessary over-ordering of routine pre-transfusion tests (blood typing, screening, and cross-matching) for surgical cases results in substantial avoidable costs and imposes an undue burden on transfusion services. This study specifically focuses on conducting a systematic review of the literature to assess the necessity of routine pre-transfusion tests before total hip arthroplasty (THA) and aims to provide a comprehensive summary of the outcomes associated with this practice.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted to analyse the study's characteristics, assess the prevalence of over-ordering, defined as ordering more routine pre-transfusion tests than clinically necessary, examine transfusion rates, and evaluate potential cost savings to the healthcare system.</p><p><strong>Results: </strong>The study included 12,178 patients. Pooled results revealed an 88.1% over-ordering pre-transfusion test rate (95% CI, 0.80-0.96; <i>p</i> < 0.001) among patients undergoing primary THA. The pooled prevalence of hospital transfusion rate was 11.9%, with a percentage of intraoperative transfusion of 0.4% (95% CI, 0.001-0.007; <i>p</i> = 0.007). There were statistically significant differences in preoperative haemoglobin (Hb) levels between patients not requiring 14.1 g/dl (95% CI, 13.2-14.9; <i>p</i> < 0.001) and those needing transfusion 11.9 g/dl (95% CI, 10.9-12.9; <i>p</i> < 0.001) (<i>p</i> < 0.001). The per-patient total cost savings ranged from 2.10 to 191.27 dollars.</p><p><strong>Conclusions: </strong>Our findings indicate that routine pretransfusion testing for all patients undergoing primary THA may be unnecessary. We recommend restricting pre-transfusion test orders to patients with preoperative haemoglobin levels below 12 g/dl specifically in the context of unilateral primary THA, always considering individual patient and surgical risk factors. This focused approach has the potential to yield substantial cost savings for healthcare systems and transfusion services by mitigating the unnecessary over-ordering of pre-transfusion tests associated with these surgical procedures.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"226-238"},"PeriodicalIF":1.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of the dislocated hip hemiarthroplasty: a multi-centre study.","authors":"Gareth Chan, Keegan Curlewis, Rahmeh Aladwan, Samantha E Hook, Benedict A Rogers, David M Ricketts, Philip Stott","doi":"10.1177/11207000251326038","DOIUrl":"10.1177/11207000251326038","url":null,"abstract":"<p><strong>Introduction: </strong>Hip hemiarthroplasties are performed in medically frail and/or comorbid patients who sustain a displaced intracapsular hip fracture. Dislocations occur in approximately 0.6-5.0% patients and are associated with worse outcomes, including mortality when compared against a similar cohort of patients who do not suffer a dislocation of their hemiarthroplasty.This study aimed to quantify the outcomes from the management of dislocated hip hemiarthroplasties in a cohort of contemporaneously used implants and the associated 1-year mortality.</p><p><strong>Methods: </strong>A retrospective review of a prospectively collected database of 4116 consecutive patients treated with a cemented hip hemiarthroplasty, in which 63 dislocations were identified was performed.The outcomes of the management of each dislocation were quantified, including the number of dislocations sustained after a preceding successful closed reduction. 1-year mortality was ascertained and stratified for each treatment option.</p><p><strong>Results: </strong>63 patients with a dislocation of a cemented hip hemiarthroplasty performed for an intracapsular hip fracture were included. Closed reduction was unsuccessful in 72% of (31/43) patients who had a closed reduction of their first dislocation. Failure rates of a second closed reduction increased to 76.9% and 100.0% with a third closed reduction.1-year mortality rate after a dislocation was 46.0% for all patients and lowest in the cohort of patients who were treated with a revision arthroplasty (27.3%).</p><p><strong>Conclusions: </strong>Closed reduction of dislocated hip hemiarthroplasty is associated with a high failure rate, especially after a second dislocation. Consideration should be made to perform a revision procedure after a second dislocation with a high suspicion for soft tissue repair failure and/or infection.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"315-322"},"PeriodicalIF":1.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hydroxyapatite-coated total primary hip replacement: 28-year follow-up survivorship.","authors":"Manel Fa-Binefa, Julia Serra, Esther Moya, Xavier Crusi, Ignasi Gich-Saladich, Marius Valera","doi":"10.1177/11207000241306004","DOIUrl":"10.1177/11207000241306004","url":null,"abstract":"<p><strong>Background: </strong>Survival at 25 years' follow-up for total hip arthroplasty (THA) has been reported at 5%-77%, with hydroxyapatite (HA) coating, due to its osteo-conductive properties, used to enhance implant fixation and survival. The progressive increase in life expectancy raises doubts regarding HA-coated THA survival and THA revision surgery risk. The aim of our study was to retrospectively analyse survival for primary uncemented fully HA-coated THA after 28 years' follow-up.</p><p><strong>Methods: </strong>Our cohort survival study of the JRI Furlong HA-coated system retrospectively included patients aged 18-75 years who had undergone THA between 1992 and 1998 at our centre and who were followed up according to clinical records by orthopaedic surgeons to 2022. Data on THA revision surgery and its causes, follow-up, and death were analysed using Kaplan-Meier survival and Cox regression modelling.</p><p><strong>Results: </strong>The cohort included 196 patients (268 hips) followed up to a maximum of 27.5 years (mean 15.54 (SD 6.01) years) with 62 patients (88 hips) >25 years. THA revision surgery was performed in 7.5% of cases, occurring a mean of 11.1 years following primary surgery. Aseptic loosening accounted for 4.4% of these revisions, affecting both the acetabular component (2.2%) and the femoral stem (1.3%). THA survival at 15 years', 20 years', and 27.5 years' follow-up was 95.5%, 88.3%, and 79.3%, respectively. According to the log-rank and Cox regression analysis, no significant relationships were found.</p><p><strong>Conclusions: </strong>Furlong HA-coated stem provides excellent long-term bone fixation for a long-term follow-up over 27.5 years with an aseptic loosening stem revision rate of 1.3%.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"159-166"},"PeriodicalIF":1.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The accuracy of a patient-specific femoral planning and delivery system for total hip arthroplasty.","authors":"Jason M Jennings, Tristan Jones, Chameka S Madurawe, Jim Pierrepont, Paula Abila, Douglas A Dennis","doi":"10.1177/11207000241307378","DOIUrl":"10.1177/11207000241307378","url":null,"abstract":"<p><strong>Introduction: </strong>A primary objective when performing a total hip arthroplasty (THA) is to restore hip biomechanics in accordance with a chosen surgical plan. The aim of this study was to assess the accuracy of a 3D-printed patient-specific guide for delivering a planned femoral osteotomy for both a posterior and an anterior approach.</p><p><strong>Methodology: </strong>40 patients (20 anterior and 20 posterior) scheduled for THA received a preoperative work-up allowing for patient-specific implant sizing and positioning. Following surgeon confirmation, a patient-specific guide was designed and printed, enabling the desired osteotomy to be executed. Achieved osteotomies were assessed using commercially available software platforms. Planning accuracy was also assessed using both the planning platform as well as more traditional 2D-templating techniques.</p><p><strong>Results: </strong>The mean deviation between the planned and achieved osteotomy level was -0.6 mm (range -4.1-6.4 mm). 95% of the achieved osteotomy levels were within 3 mm of the plan for both the posterior and anterior approach groups. 70% of the Optimized Positioning System (OPS) planned femoral components were the exact size as planned versus 25% of the 2D-planned components. 98% of the OPS planned femoral components were within 1 size of plan versus 58% for the 2D-planned components. No sizing accuracy difference was observed between planning approaches (<i>p</i> = 0.70).</p><p><strong>Conclusions: </strong>A patient-specific osteotomy guide can be a simple and accurate method to reproduce a planned femoral neck resection through an anterior or posterior approach. Further, 3D planning appears to more accurately predict femoral sizing in THA than more conventional 2D methods.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"124-129"},"PeriodicalIF":1.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142947823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Achieving cup target as per spinopelvic assessment is associated with improved THA outcome: a prospective, multicentre study.","authors":"Jeroen C F Verhaegen, Moritz Innmann, Camille Vorimore, Christian Merle, George Grammatopoulos","doi":"10.1177/11207000241312654","DOIUrl":"10.1177/11207000241312654","url":null,"abstract":"<p><strong>Background: </strong>Different methods can help to optimise sagittal cup orientation in total hip arthroplasty (THA) based on individual spinopelvic characteristics. This study aimed to: (1) assess how often combined sagittal index (CSI) and hip-spine-classification targets were achieved post THA; (2) compare anteversion/inclination between cups in-/outside optimal CSI zone; and (3) determine association with outcome.</p><p><strong>Methods: </strong>This is a multicentre, prospective, case-cohort study of 435 primary THA for osteoarthritis (53% females; age: 65 ± 12 years; follow-up: 2.4 ± 0.6 years) (58% lateral, 29% anterior, 13% posterior approach). No robotics or dual-mobility were used. Patients underwent spinopelvic radiographs to measure parameters including lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), pelvic femoral angle (PFA), and ante-inclination (AI) on lateral spinopelvic radiographs. Unbalanced spine was defined as PI - LL ⩾ 10° (PI: pelvic incidence; LL: lumbar lordosis), stiffness as ∆LL < 20°. Optimal cup orientation was based on CSI targets: 205-245° for balanced spine (<i>n =</i> 327), or 215-235° for unbalanced spine (<i>n =</i> 108), hip-spine classification targets (±5°), and conventional inclination/anteversion (40/20° ± 10°) target. Patient-reported outcome was measured using Oxford Hip Score (OHS).</p><p><strong>Results: </strong>CSI targets were achieved in 60% (<i>n =</i> 261/435), whilst 44% had cup position within hip-spine classification targets (<i>n =</i> 125/284). Anteversion was higher among cups within CSI targets (26° ± 8° vs. 22° ± 10°; <i>p <</i> 0.001). Overall dislocation rate was 0.9% (<i>n =</i> 4/435), without difference whether CSI targets were achieved (0.4% vs. 1.7%; <i>p =</i> 0.178). Postoperative OHS was better among those within CSI targets (42 ± 8 vs. 40 ± 9; <i>p =</i> 0.003) or within hip-spine-classification targets (<i>p =</i> 0.028), but not according to conventional orientation (<i>p =</i> 0.384).</p><p><strong>Conclusions: </strong>Awareness of adverse spinopelvic characteristics and using sagittal characteristics (especially CSI) can help surgeons to achieve optimal cup orientation, improving outcome and reducing dislocation risk post-THA.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"130-141"},"PeriodicalIF":1.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"RM Pressfit vitamys: the 10-year follow-up.","authors":"Pascal C Haefeli, Zinedine M Zwahlen, Ralf Baumgärtner, Björn-Christian Link, Martin Beck","doi":"10.1177/11207000241304659","DOIUrl":"10.1177/11207000241304659","url":null,"abstract":"<p><strong>Introduction: </strong>The RM Pressfit vitamys is an uncemented, titanium particle-coated, isoelastic monoblock cup made of vitamin E blended highly cross-linked polyethylene. We addressed the following questions: (1) What are the clinical and (2) radiographic outcomes 10 years after implantation? (3) What is the revision rate?</p><p><strong>Methods: </strong>In this prospective observational study in a tertiary care centre we investigated all consecutive cases of total hip replacement with the RM Pressfit vitamys cup between September 2009 and November 2011. It was implanted in 162 hips, 49.4% in women. The mean age was 67.2 years (standard deviation [SD] 9.5), and the mean BMI was 27.3 kg/m² (SD 4.7). In 153 cases (94.4%), primary or secondary osteoarthritis was the diagnosis. We evaluated preoperative and follow-up data at 6 weeks, 1, 5, and 10 years. A modified Harris Hip Score (mHHS), pain and satisfaction on a visual analogue scale (VAS), radiographic evaluation, complications and revision rate were investigated.</p><p><strong>Results: </strong>At the 10-year follow-up (mean 120.5 months, SD 1.4, range 118-126), 99 hips were available for clinical and radiographic evaluation. (1) The mean mHHS was 94.8 (SD 9.9), rest pain 0.2 (SD 0.6), load pain 0.5 (SD 1.5), and satisfaction 9.5 (SD 1.1). The mean improvement as compared to preoperatively was +33.7 (SD 16.8), -3.3 (SD 2.7), -6.0 (SD 2.4) and +5.7 (SD 2.5), respectively. (2) In the radiographic evaluation, no loose cups, no acetabular lucent lines, or acetabular osteolysis were seen. (3) 2 cups were revised, both due to malpositioning. The 10-year cumulative revision rate was 2.0% (95%CI, 0.0-4.2%). The implant survival rate with aseptic loosening as endpoint was 100%. No adverse events were reported.</p><p><strong>Conclusions: </strong>At the 10-year follow-up, the RM Pressfit vitamys cup still had promising results with good clinical and radiographic outcomes and a low revision rate.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"142-149"},"PeriodicalIF":1.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142947820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ilio-femoral impingement angle: a new radiographic measurement.","authors":"Jackson Ellis, Isaac Rhee, Sina Babazadeh, Dirk Van Bavel","doi":"10.1177/11207000241311530","DOIUrl":"10.1177/11207000241311530","url":null,"abstract":"<p><strong>Background: </strong>Hip dislocations after total hip arthroplasty (THA) are a debilitating complication, often occurring in deep flexion. Current 3D modelling allows for simulating the flexion angle at which bone-on-bone impingement occurs, but it is resource-intensive and not widely available for routine clinical use. Therefore, we propose the ilio-femoral impingement angle (IFIa) as a novel, simple radiographic measure to help identify patients at higher risk for dislocation using standard radiographs.</p><p><strong>Methods: </strong>A radiographic study was performed on 117 consecutive patients who underwent preoperative planning for THA with 3D remodelling from 2021 to 2022 at a single institution. The flexion angle was recorded at which the femur impingement on the pelvis was identified from the 3D model. This was compared to the angle subtended between a vertical line, the centre of the femoral head and a line rotated upwards to the first point of contact with the ipsilateral ilium. This angle was named the ilio-femoral impingement angle (IFIa).</p><p><strong>Results: </strong>The mean IFIa was 142.29° ± 11.49°, and it demonstrated a strong correlation with the 3D impingement angle (r = 0.69, <i>p <</i> 0.05). The inter-rater reliability of the IFIa measurement was high, with an ICC of 0.87, confirming the consistency of this novel radiographic measure.</p><p><strong>Conclusions: </strong>This study demonstrates that the novel radiographic measurement of the IFIa represented the deep flexion impingement angle of the femur on the ilium. The IFIa may be used as simple and cost-effective alternative measurement to model impingement during flexion.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"174-180"},"PeriodicalIF":1.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142947817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative delirium following total joint arthroplasty: epidemiology, risk factors, and associated complications.","authors":"Ashley Knebel, Manjot Singh, Rhea Rasquinha, Mohammad Daher, Joseph E Nassar, John Hanna, Eric M Cohen, Bassel G Diebo, Alan H Daniels","doi":"10.1177/11207000241305771","DOIUrl":"10.1177/11207000241305771","url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative delirium (POD) is a feared complication following major surgery in elderly patients. Further investigation of the risk factors and consequences of POD following total joint arthroplasty is warranted.</p><p><strong>Methods: </strong>Patients who underwent total knee arthroplasty (TKA) or total hip arthroplasty (THA) were identified using PearlDiver. Patients were filtered into 2 cohorts based on the presence or absence of POD within 7 days of surgery. Epidemiological analyses were performed to examine trends in POD following TKA and THA by age group and year. Comparative analyses were performed on patient demographics and baseline cognitive status. After matching by age, sex, and comorbidities, electrolyte disturbances and 90-day postoperative complications were analysed.</p><p><strong>Results: </strong>Among 2,518,918 (99.7%) no POD and 7240 (0.3%) POD patients who underwent total knee or hip arthroplasty, mean age was 65.58 years, 60.2% were female, and mean CCI was 1.50 for the whole cohort. POD patients frequently had baseline cognitive impairment (<i>P</i> <i><</i> 0.001). Incidence of POD decreased from 0.54% in 2010 to 0.10% in 2022 (<i>P</i> <i><</i> 0.001) and increased with age (<i>P</i> <i><</i> 0.001). POD patients had higher 90-day costs (TKA = $19,572 vs. $10,397, <i>P</i> <i><</i> 0.001; THA = $18,496 vs. $9,877 <i>P</i> <i><</i> 0.001). After matching, POD TKA patients had higher rates of hypernatraemia (6.1% vs 4.5%, <i>P</i> <i>=</i> 0.001) and POD THA patients had higher rates of hyponatraemia (26.5% vs 23.1%, <i>P</i> <i>=</i> 0.008). POD patients had higher rates of 90-day postoperative medical and surgical complications (<i>P</i> <i><</i> 0.05) than no POD patients.</p><p><strong>Conclusions: </strong>Nearly 0.3% of patients who underwent either TKA or THA between 2010 and 2022 developed transient delirium. POD was most common in elderly patients with baseline cognitive impairment undergoing revision surgery. POD patients had higher rates of 90-day postoperative surgical and joint-related complications. While POD rates have decreased, continued initiative to prevent POD in total joint arthroplasty patients is imperative.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"150-158"},"PeriodicalIF":1.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}