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Advances in Hip Replacement Surgery

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (10 December 2022) | Viewed by 25465

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Dr. William G. Blakeney

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Guest Editor

1. Associate Professor, Department of Orthopaedic Surgery, Royal Perth Hospital, Perth, WA, Australia
2. Department of Surgery, University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009, Australia
Interests: orthopaedic trauma; shoulder, hip and knee surgery
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Markus Kuster

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Guest Editor

Department of Orthopaedic Surgery, Sir Charles Gairdner Hospital, Perth, WA, Australia
Interests: orthopaedic trauma; fracture management; adult reconstruction; hip and knee arthroplasty; osteotomies
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Total hip arthroplasty is one of the most successful surgical operations. It is not uncommon for patients to experience a natural or forgotten joint post-operatively. Many of the recent advances in hip arthroplasty are targeted at reducing the small number of patients that experience complications or are unsatisfied with surgery. Technology that improves the precision of implantation—robotics, navigation and patient-specific instrumentation (PSI)—has allowed for personalized alignment strategies as well as reducing surgical outliers. The recognition of the importance of the spino-pelvic alignment and how this affects the surgeon’s positioning of the components has led to dynamic pre-operative planning. Newer prosthetic designs, such as dual-mobility or large-head ceramic-on-ceramic articulations, are now being reported with mid- to long-term results. The benefits of these advances in reducing complications such as dislocation and prosthetic wear, as well as improving patient-reported outcomes and patient satisfaction, will be explored in this Special Issue.

Dr. William G. Blakeney
Prof. Dr. Markus Kuster
Guest Editors

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Keywords

total hip arthroplasty
spino-pelvic alignment/ spine-hip relationship
robotics, navigation, and patient-specific instrumentation (PSI)
personalized/kinematic/anatomic
implant design
enhanced recovery after surgery (ERAS)
reduction of complications (such as infection)
hip approaches
improving patient-reported outcomes

Published Papers (10 papers)

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Editorial

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3 pages, 174 KiB

Open AccessEditorial

Advances in Hip Replacement Surgery

by William G. Blakeney and Markus Kuster

J. Clin. Med. 2023, 12(10), 3439; https://doi.org/10.3390/jcm12103439 - 12 May 2023

Cited by 1 | Viewed by 1555

Abstract

Total hip arthroplasty (THA) is one of the most successful types of surgical operation, with some considering it “the operation of the century” [...] Full article

(This article belongs to the Special Issue Advances in Hip Replacement Surgery)

Research

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11 pages, 3021 KiB

Open AccessArticle

Femoral Head Autograft to Manage Acetabular Bone Loss Defects in THA for Crowe III Hips by DAA: Retrospective Study and Surgical Technique

by Cesare Faldini, Matteo Brunello, Federico Pilla, Giuseppe Geraci, Niccolò Stefanini, Leonardo Tassinari and Alberto Di Martino

J. Clin. Med. 2023, 12(3), 751; https://doi.org/10.3390/jcm12030751 - 17 Jan 2023

Cited by 2 | Viewed by 1715

Abstract

Introduction: The pathologic anatomy of Crowe III is characterized by the erosion of the superior rim of acetabulum, with a typical bone defect in its supero–lateral portion. The performance of a total hip arthroplasty requires the management of the acetabular bone defect, and femoral head autograft can be a valid option to optimize implant coverage. Material and Methods: In all, eight Crowe III patients (nine hips), seven of which having unilateral hip affected, and one with bilateral involvement by secondary osteoarthritis in DDH; maximum limb length discrepancy (LLD) of 3.5 cm in unilateral patients. All were operated on by direct anterior approach. Patients were evaluated in terms of clinical, surgical, and radiological (center-edge, horizontal coverage, cup inclination) parameters. Results: Cup placement was implanted with a mean of 39.5 ± 7.5°. Stem alignment showed average 1.5 ± 2.3° in valgus. LLD showed an overall average preoperative of −29.5 ± 10.5 mm at the affected side, with a significant improvement to −2.5 ± 6.4 mm (p = 0.023). The mean initial coverage evaluated like a percentage of the horizontal bone host was 52.1 ± 7.1%, while the mean final coverage at the last post-operative X-ray from femoral autograft bone was 97.0 ± 4.5% with an average improvement of 44.5%. Average CE improved from −9.5 ± 5.2° (CE I) to the immediate post-operative (CE II) of 40.6 ± 8.2°. At the final follow up, CE III showed a mean of 38.6 ± 6.2°, with an average decrease of 2.0°. Discussion: Acetabular bone defect in Crowe III DDH patients undergoing THA by DAA, can be efficiently managed by massive autograft femoral head, which allowed an adequate and long-lasting coverage of the implant, with cup positioning at the native acetabulum. Full article

(This article belongs to the Special Issue Advances in Hip Replacement Surgery)

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10 pages, 710 KiB

Open AccessEditor’s ChoiceArticle

Unstable Total Hip Arthroplasty: Should It Be Revised Using Dual Mobility Implants? A Retrospective Analysis from the R.I.P.O. Registry

by Alberto Di Martino, Matteo Brunello, Barbara Bordini, Valentino Rossomando, Leonardo Tassinari, Claudio D’Agostino, Federico Ruta and Cesare Faldini

J. Clin. Med. 2023, 12(2), 440; https://doi.org/10.3390/jcm12020440 - 5 Jan 2023

Cited by 6 | Viewed by 1735

Abstract

Total hip arthroplasty (THA) is one of the most common surgical procedures in orthopedics; however, it is subjected to different kinds of failures, one of them being dislocation. Many different prosthetic designs have been developed to overcome this problem, such as dual mobility coupling. The main purpose of this article is to determine whether there are differences regarding the revision surgery of unstable THA comparing the risk of failure between dual mobility cup (DMC) implants, standard implants, and among different head sizes. A registry-based population study has been conducted by analyzing data collected by the Emilia Romagna Registry of Orthopedic Prosthetic Implants (RIPO), including a total of 253 implants failed for dislocation and instability that were operated on by cup revision surgery between 2000 and 2019. The selected population has been divided into two groups based on the insert type: standard and DMC. The age at revision surgery was significantly lower in the standard cup group with respect to DMC (p = 0.014 t-test), with an average age of 71.2 years (33–96 years range) for the standard cups and 74.8 years (48–92 years range) for the DMC group. The cumulative survival of DMC implants was 82.0% at 5-years, decreasing to 77.5% at a 10-year follow-up, which is not significantly different from standard cups (p = 0.676, Log-Rank test). DMC implants showed a significantly lower risk of re-revision for dislocation compared to standard cups (p = 0.049). Femoral heads ≥36 mm had a higher overall survival compared to smaller femoral heads (p = 0.030). This study demonstrated that DMC or femoral heads ≥36 mm are a valid choice to manage THA instability and to reduce the revision rate for dislocation at a mid-term follow-up; in those selected and targeted patients, these options should be taken into consideration because they are associated with better outcomes. Full article

(This article belongs to the Special Issue Advances in Hip Replacement Surgery)

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9 pages, 701 KiB

Open AccessArticle

Minimum 10-Year Results of Modular Metal-On-Metal Total Hip Arthroplasty

by Hiroki Wakabayashi, Masahiro Hasegawa, Yohei Naito, Shine Tone and Akihiro Sudo

J. Clin. Med. 2022, 11(21), 6505; https://doi.org/10.3390/jcm11216505 - 2 Nov 2022

Cited by 4 | Viewed by 1798

Abstract

Background: this study aimed to assess the long-term outcomes of (a minimum of 10-years) total hip arthroplasty with a metal-on-metal acetabular prosthesis. Methods: Eighty-nine primary total hip arthroplasties (82 patients) were performed using a Pinnacle modular metal-on-metal acetabular prosthesis. Clinical hip function outcomes were evaluated using the Japanese Orthopaedic Association hip score preoperatively and at the final follow-up. Radiological analysis was performed at the final follow-up and magnetic resonance imaging in all hips postoperatively. Results: Out of 82 patients, 17 were excluded who were followed up for <10 years. Of the remaining 65 patients (70 hips), 19 (20 hips) developed pseudotumors during 2–10 years postoperatively. After 10 and 13 years, the survival rates of revision endpoint were 93.6% and 90.4%, respectively. Clinical hip function outcomes had improved significantly at the final follow-up. In the radiological analysis, the mean cup angle of inclination and mean ratio of femoral offset on the operated hip to the contralateral hip was highest in patients with revision surgery for adverse reactions to metal debris. Conclusions: This study showed a 29.0% prevalence of pseudotumors. Some cases required revisions even after 10 years following surgery. Regular clinical surveillance is recommended for the early detection of adverse reactions to metal debris. Full article

(This article belongs to the Special Issue Advances in Hip Replacement Surgery)

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8 pages, 1815 KiB

Open AccessArticle

Degree of Pelvic Rotation in the Coronal Plane on Postoperative Radiographs Obtained after Total Hip Arthroplasty

by Kuei-Lin Yeh, Tai-Yin Wu, Chiou-Shann Fuh, Chu-Song Chen, Sheng-Mou Hou, Chen-Hao Chiang and Chen-Kun Liaw

J. Clin. Med. 2022, 11(21), 6353; https://doi.org/10.3390/jcm11216353 - 27 Oct 2022

Viewed by 1736

Abstract

There are many published cup anteversion measurements for postoperative total hip arthroplasty (THA), including Liaw’s, Lewinnek’s, and Murray’s methods. However, most measurements ignore the potential pelvic rotation on radiographs except in Liaw’s method. Without considering pelvic rotation, clinicians can miscalculate cup anteversion. Therefore, we aimed to quantify the mean degree of pelvic rotation. Herein, we collected 388 radiographs of 98 postoperative THA hips of 77 patients and measured pelvic rotation by measuring h, the horizontal displacement of the sacrococcygeal junction associated with the upper pole of the symphysis pubis, and ssd, the distance between the sacrococcygeal junction and pubic symphysis. The angle θ of pelvic rotation was defined as θ = arc sin (h/ssd) × (180°/π). The mean degree of pelvic rotation was then calculated. The standard deviation of h was 7.84 mm, and the mean ssd was 158 mm. The potential pelvic rotation was 2.50°. The p-values from the paired t-test were all >0.05 when interobserver and intraobserver errors were assessed. This is the first study to quantify the potential pelvic rotation in the coronal plane on postoperative plain radiographs. The potential pelvic rotation was too large to be neglected during the measurement of cup anteversion. Full article

(This article belongs to the Special Issue Advances in Hip Replacement Surgery)

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9 pages, 1248 KiB

Open AccessArticle

The Incidence of Severe Hypercalcaemia-Induced Mental Status Changes in Patients Treated with Antibiotic-Loaded Calcium Sulphate Depot for Orthopaedic Infections

by Faustine Vallon, Christoph Meier, Emanuel Gautier and Peter Wahl

J. Clin. Med. 2022, 11(16), 4900; https://doi.org/10.3390/jcm11164900 - 20 Aug 2022

Cited by 2 | Viewed by 2172

Abstract

Local application of antibiotics with calcium-containing carrier materials (CCCM) might deliver large quantities of calcium, with some cases of hypercalcaemia reported. The incidence of symptomatic hypercalcaemia was estimated retrospectively in a consecutive, prospective series of patients treated between 10/2006 and 02/2019 with antibiotic-loaded CCCM for various orthopaedic infections. Risk factors were analysed. In the study period, 215 CCCM applications were performed. Two patients (0.9%) developed symptomatic hypercalcaemia. In one case, hypercalcaemia occurred 14 days after a second CCCM application during a staged septic hip revision. In the other case, hypercalcaemia became symptomatic six days after application of vancomycin-loaded CCCM in a component-retaining septic revision hip arthroplasty. In both cases, hypercalcemia was not imputable solely to the CCCM. Prolonged immobilization, renal impairment and other specific risk factors were present. Implantation of a CCCM for local application of antibiotics exposes the patient to large quantities of calcium during dissolution. This might induce symptomatic hypercalcaemia, a potentially life-threatening complication. The observed incidence of symptomatic hypercalcaemia remained rare (<1%). In some patients, compensatory mechanisms might be overwhelmed in the presence of other risk factors. Postoperative monitoring of calcaemia as well as elimination of risk factors is mandatory for all patients treated with CCCM. Full article

(This article belongs to the Special Issue Advances in Hip Replacement Surgery)

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9 pages, 1454 KiB

Open AccessArticle

Bone Density May Be a Promising Predictor for Blood Loss during Total Hip Arthroplasty

by Wei Zhu, Zhanqi Wei, Tianjun Zhou, Chang Han, Zehui Lv, Han Wang, Bin Feng and Xisheng Weng

J. Clin. Med. 2022, 11(14), 3951; https://doi.org/10.3390/jcm11143951 - 7 Jul 2022

Cited by 1 | Viewed by 2087

Abstract

Background: Total hip arthroplasty (THA), which is performed mostly in elderly individuals, can result in substantial blood loss and thereby imposes a significant physical burden and risk of blood transfusion. The femoral neck cut and reamed acetabulum are the main sites of intraoperative bleeding. Whether the bone density in that region can be used to predict the amount of blood loss in THA is unknown. Methods: We retrospectively analyzed adult patients undergoing primary THA in the Department of Orthopedics, Peking Union Medical College Hospital, from January 2018 to January 2020. All these patients underwent primary unilateral THA. Patients had their bone mineral density (BMD) recorded within the week before surgery and were stratified and analyzed for perioperative blood loss. Multivariable regressions were utilized to adjust for differences in demographics and comorbidities among groups. Results: A total of 176 patients were included in the study. Intraoperative blood loss was 280.1 ± 119.56 mL. Pearson correlation analysis showed a significant correlation between blood loss and preoperative bone density of both the femoral greater trochanter (R = 0.245, p = 0.001) and the Ward’s triangle (R = 0.181, p = 0.016). Stepwise multiple linear regression showed that preoperative bone density of the greater trochanter (p = 0.015, 95% CI: 0.004–0.049) and sex (p = 0.002) were independent risk factors for THA bleeding. The area under the receiver operating characteristic curve (AUROC) of the greater trochanter and Ward’s triangle was 0.593 (95% CI: 0.507–0.678, p = 0.035) and 0.603 (95% CI: 0.519–0.688, p = 0.018), respectively. The cutoff T value on the femoral greater trochanter for predicting higher bleeding was −1.75. Conclusions: In THA patients, preoperative bone density values of the femoral greater trochanter and sex could be promising independent predictors for bleeding during surgery. Osteoporosis and female patients might have lower blood loss in the THA operation. Full article

(This article belongs to the Special Issue Advances in Hip Replacement Surgery)

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10 pages, 615 KiB

Open AccessArticle

Modernizing Total Hip Arthroplasty Perioperative Pathways: The Implementation of ERAS-Outpatient Protocol

by Sivan Sivaloganathan, William G. Blakeney and Pascal-André Vendittoli

J. Clin. Med. 2022, 11(12), 3293; https://doi.org/10.3390/jcm11123293 - 8 Jun 2022

Cited by 9 | Viewed by 2682

Abstract

Pressure to reduce healthcare costs, limited hospital availability along with improvements in surgical technique and perioperative care motivated many centers to focus on outpatient pathway implementation. However, in many short-stay protocols, the focus has shifted away from aiming to reduce complications and improved rehabilitation, to using length of stay as the main factor of success. To improve patient outcomes and maintain safety, the best way to implement a successful outpatient program would be to combine it with the principles of enhanced recovery after surgery (ERAS), and to improve patient recovery to a level where the patient is able to leave the hospital sooner. This article delivers a case for modernizing total hip arthroplasty perioperative pathways by implementing ERAS-outpatient protocols. Full article

(This article belongs to the Special Issue Advances in Hip Replacement Surgery)

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Review

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16 pages, 8819 KiB

Open AccessReview

Personalized Hip Joint Replacement with Large Diameter Head: Current Concepts

by Pascal-André Vendittoli, Sagi Martinov, Mina Wahba Morcos, Sivan Sivaloganathan and William G. Blakeney

J. Clin. Med. 2022, 11(7), 1918; https://doi.org/10.3390/jcm11071918 - 30 Mar 2022

Cited by 12 | Viewed by 3401

Abstract

Hip arthroplasty is a common procedure in elective orthopaedic surgery that has excellent outcomes. Hip replacement surgery aims to create a “forgotten” joint, i.e., a pain-free joint akin to a native articulation. To achieve such goals, hip arthroplasty must be personalised. This is achieved by restoring: the centre of rotation of the native hip; leg length equality; femoral offset; femoral orientation; soft tissue tension; joint stability with an unrestricted hip range of motion; and having appropriate stress transfer to the bone. In addition, the whole pathway should provide an uneventful and swift postoperative recovery and lifetime implant survivorship with unrestricted activities. At our institution, the preferred option is a personalized total hip arthroplasty (THA) with a large diameter head (LDH) using either monobloc or dual-mobility configuration for the acetabular component. LDH THA offers an impingement-free range of motion and a reduced risk of dislocation. The larger head-neck offset allows for a supraphysiologic range of motion (ROM). This can compensate for a patient’s abnormal spinopelvic mobility and surgical imprecision. Additionally, LDH bearing with a small clearance exerts a high suction force, which provides greater hip micro-stability. With appropriate biomechanical reconstruction, LDH THA can restore normal gait parameters. This results in unrestricted activities and higher patient satisfaction scores. We use LDH ceramic on ceramic for our patients with a life expectancy of more than 20 years and use LDH dual mobility bearings for all others. Full article

(This article belongs to the Special Issue Advances in Hip Replacement Surgery)

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Other

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18 pages, 3929 KiB

Open AccessSystematic Review

Resurfacing Hip Arthroplasty Is a Safe and Effective Alternative to Total Hip Arthroplasty in Young Patients: A Systematic Review and Meta-Analysis

by Michele Palazzuolo, Alessandro Bensa, Stefan Bauer, William G. Blakeney, Giuseppe Filardo and Martin Riegger

J. Clin. Med. 2023, 12(6), 2093; https://doi.org/10.3390/jcm12062093 - 7 Mar 2023

Cited by 3 | Viewed by 4275

Abstract

This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed at comparing resurfacing hip arthroplasty (RHA) and total hip arthroplasty (THA) in terms of rate of complications, revisions, functional outcomes, blood loss, operative time and metal ions levels. The search was conducted on three databases (PubMed, Cochrane and Web of Science) updated until 13 October 2022. The inclusion criteria were RCTs) written in the English language, with no time limitation, comparing RHA and THA. Among the retrieved 4748 articles, 18 RCTs were eligible for a total of 776 patients (mean age 53.1 ± 5.0). A meta-analysis was performed. RHA reported significantly lower blood loss compared to THA (p < 0.001) but with longer operative time (p < 0.001). No statistically significant difference was found between RHA and THA in terms of complications (12.08% and 16.24%, respectively) and revisions (6.32% and 6.14%, respectively). Both RHA and THA provide excellent clinical results in a population of young and active patients. Functional outcomes were not significantly different between the groups. Moreover, no significant difference in metal ion levels was found. These findings provide evidence concerning the safety and clinical effectiveness of RHA. Because of its bone-preserving properties, the lack of drawbacks and good outcomes, RHA appears to be a valid alternative to THA in young and active patients. Full article

(This article belongs to the Special Issue Advances in Hip Replacement Surgery)

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