Chapter 1 - Introduction to hip implants and biomarker testing

Recent Advances in Venous Thromboembolic Prophylaxis in Major Orthopedic Surgery: A Regional Perspective

An explicit finite element method was applied to simultaneously predict both kinematics and contact mechanics of artificial hip and knee joints under normal walking condition. Mesh sensitivity and numbers of time interval were examined on the model prediction for an artificial hip joint under the condition of three-dimensional forces and rotations. Furthermore, the explicit method was used to predict both contact pressure and accumulated sliding distance of the tibial insert of an artificial knee joint. The contact pressure and accumulated sliding distance predicted for the hip joint model showed good agreement with previous studies. The contact pressure and accumulated sliding distance at both the femoral-tibial interface and the insert-tray interface were also found to be similar to previous studies and those using a standard implicit method.

Objective: To explore the clinical application effect of a functional exercise program for patients with kinesiophobia after total hip arthroplasty based on the Health Action Process Approach (HAPA) theory on the functional recovery of patients with kinesiophobia after total hip arthroplasty. Methods: A total of 46 patients with kinesiophobia after total hip arthroplasty in the Department of Traumatic Hip Surgery of Tianjin Hospital from February to May 2024 were selected and randomly divided into a control group and an experimental group, with 23 patients in each group. The control group received the conventional functional exercise program for hip arthroplasty, while the experimental group received a functional exercise program for patients with kinesiophobia after hip arthroplasty based on the HAPA theory. The kinesiophobia scores and hip joint function scores of the two groups were compared before surgery, at discharge, and at 1 and 3 months after surgery to explore the clinical application effect of the functional exercise program for patients with kinesiophobia after hip arthroplasty based on the HAPA theory. Results: The longitudinal analysis of the experimental group (n=23) and the control group (n=23) showed that the kinesiophobia scores of the experimental group were significantly lower than those of the control group after surgery (at discharge: 26.91±2.37 vs. 36.04±2.35; at three months: 20.09±1.12 vs. 28.04±2.84, with P values all <0.001), and the interaction effect of time×group was significant (F=289.54, P<0.001, partial η²=0.768), indicating that the intervention accelerated symptom relief. Meanwhile, the hip joint function scores of the experimental group were significantly higher than those of the control group (at discharge: 48.65±4.12 vs. 40.52±3.85; at three months: 87.78±5.76 vs. 66.57±5.02, all P<0.001), with a strong interaction effect (F=498.26, P<0.001, partial η²=0.847), suggesting that the intervention effectively promoted functional recovery. The time, group, and interaction effects were all highly significant (P<0.001, partial η²>0.76), confirming that the intervention could significantly reduce the level of kinesiophobia and accelerate hip joint rehabilitation, with the effect continuously increasing over time. Conclusion: Compared with the conventional functional exercise program for hip arthroplasty, the functional exercise program for patients with kinesiophobia after hip arthroplasty based on the HAPA theory can more effectively reduce the perception of movement fear in patients with kinesiophobia after hip arthroplasty and improve hip joint function.

There are several pathological conditions in children, such as Legg-Calvé-Perthes disease, slipped capital femoral epiphysis, and femoral head avascular necrosis, which can progress to disabling hip joint destruction. These children undergo surgeries, such as hip arthrodesis, in an attempt to postpone hip replacement so that it can be done at an older age. Unfortunately, hip arthrodesis significantly limits their ability to actively engage in activities that require full hip mobility. For these children, active participation in games and sports activities remains an important factor for their physical development and mental health. On the contrary, hip arthroplasty can ensure a pain-free, unrestricted range of hip movement, but are doubts as to its viability over time, especially in young people who exhibit intense activity. We report successful hip replacement in two children, fourteen years of age and younger, with femoral head collapse and disabling joint degeneration due to avascular necrosis of the femoral head, whom the hip replacement was considered the only surgical treatment ensuring a painless hip joint. For the clinical assessment of these two hips, we used the online Harris hip score, preoperatively and postoperatively. No intraoperative or early postoperative complications occurred. Follow-up was conducted at six weeks, six months, and then at an annual clinical and radiological evaluation. At the final seven-year follow-up, these two children had greatly improved their function hip score considerably. Hip arthroplasty can ensure a pain-free, unrestricted range of hip movement in young children when their hip joint is severely affected.

Objective To study the effect of different hip replacement surgeries on hip function in patients with acetabular fractures and observe postoperative complications. Methods Ninety-six patients with acetabular fractures treated in our hospital between January 2011 and December 2014 were divided into observation group (n=51) and control group (n=45) according to different surgeries. Under general anesthesia, the patients in observation group were treated by total hip replacement, and the patients in control group were treated by total hip resurface replacement. Hip function score (Harris score) before and 1 month, 1 year after surgery, hip range of motion, and complications were compared between two groups. The degree of hip pain was compared between two groups by numerical rating scale (NRS). Results Harris score significantly improved in two groups 1 month, 1 year after surgery, those 1 year after surgery were significantly higher than those 1 month after surgery, with statistically significant differences (P 0.05). The range of motion of hip flexion, abduction, adduction, extorsion, and intorsion in two groups 1 year after surgery were significantly larger than those before surgery, with statistically significant differences (P 0.05). The degree of hip pain in two groups after surgery significantly decreased, with statistically significant differences (P 0.05). Conclusions The effect of total hip replacement and total hip resurface replacement on hip function are similar. Both can relieve hip pain, with few complications. Therefore, surgery can be chosen according to patients' condition and needs. Key words: Hip replacement; Acetabular fractures; Hip function; Postoperative complications

Traumatic femoral neck fracture is a common disease that can be treated by hip arthroplasty, which is divided into hemiarthroplasty (HA) and total hip arthroplasty (THA). The difference between HA and THA are incompletely understood. The objective of this study was to investigate the effect of hip arthroplasty on hip function in patients with traumatic femoral neck fracture. A total of 132 patients with traumatic femoral neck fracture admitted to our hospital from January 2019 to January 2021 were selected and divided into control group (HA group) and study group (THA group) with 66 cases in each group by random number table method. The duration of operation, intraoperative blood loss, postoperative drainage and length of hospital stay were compared between the two groups. The degree of pain before operation, 3days after operation and 7days after operation were observed, the hip joint function before operation, 6months after operation and 12months after operation was analyzed, and the occurrence of short-term and long-term complications was compared between the two groups. Compared with the HA group, the operative time, intraoperative blood loss, postoperative drainage and hospital stay were higher in the THA group. The degree of pain in THA group was higher than that in HA group on 3 and 7days after operation; At 6 and 12months after surgery, the scores of pain, range of motion, joint function and deformity in the THA group were higher than those in the HA group with statistically significant. Compared with HA group, IGF-1 and Leptin in THA group were increased significantly, while inflammatory cytokines TNF-α was decreased in THA group. The total incidence of short-term and long-term complications was lower in THA group. Total hip arthroplasty can effectively restore hip joint function in patients with traumatic femoral neck fracture, with low incidence of short-term and long-term complications, high safety, and worthy of clinical application.

AB0319 Is DAS28 a Useful Tool for Evaluating Hip Joint Disorders in Rheumatoid Arthritis?

Postoperative Deep Vein Thrombosis (DVT) In Patients With Hemophilia Undergoing Major Orthopedic Surgery

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are effective methods for the treatment of end-stage osteoarthritis. Furthermore, rehabilitation training and psychological interventions play significant roles in the recovery of hip and knee joint function after THA and TKA. A total of 46 patients who received hip replacement and knee replacement are equally divided into two groups, with the control group being prescribed routine rehabilitation intervention and the observation group prescribed an early rehabilitation pathway with Morita therapy intervention. According to the results, the observation group displayed a significantly decreased incidence of deep venous thrombosis, while simultaneously reducing the recovery time of lower limb function (P < 0.05), including straight leg raising time, walking time, and vertical knee flexion time. In addition, the treatment program demonstrates a significant ability to improve the joint function score, pain score, quality of life score, and range of motion score (P < 0.05). Moreover, serum D-dimer, fibrin degradation products (FDP), and femoral vein blood flow peak also are significantly reduced (P < 0.05). Therefore, we have determined that an early rehabilitation pathway combined with Morita therapy can effectively reduce stress pain, improve the recovery process of joint motor function, and reduce the incidence of thrombosis. However, an increased sample size would facilitate the confirmation of the safety and efficacy of the program. In addition, the overall financial expenditure and feasibility of the treatment need to be considered.

The aim of the study is to demonstrate, using a clinical example, the possibility of treating a patient with a severe acetabular defect by performing a one-stage revision arthroplasty using an individual design.&#x0D; Materials and methods. A 45-year-old female patient was admitted with complaints of pain, limitation of movement in the right hip joint, and gait disturbance. From anamnesis at the age of 5 years, reconstructive operations of the hip joints were performed. In 1991, CITO performed primary total arthroplasty of the right hip joint with an endoprosthesis from ESKA Implants. In 1998, due to the instability of the acetabular component of the total endoprosthesis of the right hip joint, revision arthroplasty was performed, and the cup was placed with a cement fixation. In 2001, for left-sided dysplastic coxarthrosis, primary total arthroplasty of the left hip joint was performed. In 2012, due to the instability of the total endoprosthesis of the left hip joint, revision arthroplasty was performed using an ESI anti-protrusion ring (ENDOSERVICE) with a cement cup and a Zweimller-type femoral component; the femur defect was repaired using a fresh frozen cortical graft. In October 2019, instability of the total endoprosthesis of the right hip joint was revealed, for which revision endoprosthetics was performed using an individual acetabular component.&#x0D; Results. The HHS index before revision arthroplasty was 21 points, after 1 month after surgery 44 points, after 3 months after surgery 65, after 6 months 82. Quality of life was assessed according to the WOMAC scale: before surgery 73 points, after 1 month after surgery 54 points, after 3 months 31, after 6 months 15 points. At the time of the last consultation, the patient moves with a cane, lameness persists, associated with scar reconstruction and atrophy of the gluteal muscles.&#x0D; Conclusion. The use of individual structures allows to restore the support ability of the lower limb and the function of the hip joint in the case of an extensive defect of the pelvic bones of the pelvic discontinuity type.

BackgroundTotal knee and hip arthroplasties are one of the most common and costly surgical procedures. They are performed to relieve pain and improve the patient’s quality of life.Purpose To describe...

Acute calcium pyrophosphate (CPP) crystal arthritis is a distinct manifestation of calcium pyrophosphate crystal deposition (CPPD). No studies have specifically examined whether acute CPP crystal arthritis is associated with progressive structural joint damage. The objective of this retrospective cohort study was to evaluate the relative rate of hip and knee joint arthroplasties as an estimate of structural joint damage accrual, in a population of patients with acute CPP crystal arthritis. Data were collected from Waikato District Health Board (WDHB) to identify an acute CPP crystal arthritis cohort with clinical episodes highly characteristic of acute CPP crystal arthritis. Data on hip and knee joint arthroplasties were collected from the New Zealand Orthopaedic Association's Joint Registry. The rate of arthroplasties in the cohort was compared with the age-ethnicity-matched New Zealand population. Additional analysis was performed for age, obesity (BMI) and ethnicity. The acute CPP crystal arthritis cohort included 99 patients; 63 were male and the median age was 77 years (interquartile range, 71-82). The obesity rate was 36% with a median BMI of 28.4 kg/m2 (interquartile range, 25.8-32.2), comparable to the New Zealand population. The standardized surgical rate ratio in the cohort vs the age-ethnicity-matched New Zealand population was 2.54 (95% CI: 1.39, 4.27). Our study identified a considerable increase in the rate of hip and knee joint arthroplasties in patients with episodes of acute CPP crystal arthritis. This suggests CPP crystal arthritis may be a chronic condition, leading to progressive joint damage.

Objective To evaluate the long-term results of total hip arthroplasty with Chinese porous coated anatomic prosthesis (11-17 years). Methods Ninty-five patients who received total hip arthroplasty with Chinese porous coated anatomic prosthesis in our center from January 1990 to April 1998 were followed up retrospectively. The clinical results analyzed with Harris hip score, and the roentgenographic results ana-lyzed with DeLee and Charnley methods, respectively. Results Of the 95 patients, 50 patients lost contact,and 16 patients died. The rest (14 males and 15 females, 37 hips) were reviewed with an average of 13.8 years follow-up. The mean Harris hip score was 70.3 (6-98). 48.5% of them were rated as excellent and good (16 hips), 30.3% of them rated as bad. 6 hips of them needed revision, mainly due to aseptic loosening. 18 cases of them considered that the pain disappeared or slight pain that didn't affect the function of the hip joints exists after the primary replacement. The roentgenogram showed that for the femoral components, 9 femoral stems were subsided by 9.3 mm on average, osteolysis occurred in 10 hips, radiolucency around the stem occurred in 12 hips, and for the acetabular components, radiolucency occurred in 13 hips, the porous coated layers shed in 2 hips. Conclusion The long-term results of total hip arthroplasty with Chinese porous coated anatomic prothesis done in our center during 1990 to 1999 are fair, and aseptic loosening is the main complication. Key words: Arthroplasty; replacement; hip; Prosthesis design; Follow-up study

Objective To evaluate the clinical efficacy of super PATH minimally invasive hip arthroplasty for the treatment of femoral neck fractures in the elderly patients. Methods From January 2014 through June 2015, 64 elderly patients with femoral neck fracture underwent hip joint replacement. Of them, 32 (15 men and 17 women with an age of 76.3±8.9 years) were treated by super PATH minimally invasive hip arthroplasty and 32 (14 men and 18 women with an age of 74.3±9.7 years) by conventional hip arthroplasty. All of them were treated through the conventional posterolateral approach. The 2 groups were compared in terms of hospital stay, operation time, change in hemoglobin on the 4th postoperative day, ambulation time, hospitalization costs, visual analogue scale (VAS) and hip Harris scores at different time points postoperatively. Results The minimally invasive group incurred significantly shorter hospital stay (8.4±1.0 d) and postoperative ambulation time (23.4±1.5 h), significantly lower hospitalization costs (48,544.9±12,336.0 yuan), and significantly higher hip Harris scores at 24 hours and one month postoperatively (75.0±5.7 points and 79.4±4.1 points) than the conventional group (10.7±1.1 d, 25.7±2.7 h, 55, 318.9±10, 896.6 yuan, 65.6±6.4 points and 75.5±3.1 points, respectively) (P 0.05). No prosthesis loosening, postoperative dislocation, periprosthetic infection or deep vein thrombosis occurred in either group during follow-up. Conclusion In the treatment of femoral neck fractures in the elderly patients, super PATH minimally invasive hip arthroplasty may be obviously advantageous over conventional replacement surgery in decreased ambulation time and hospital stay, improved short-term hip function, and reduced hospitalization costs. Key words: Arthroplasty, replacement, hip; Femoral neck fractures; Surgical procedures, minimally invasive

Objective According to the assessment of the curative effect on different operation time of total hiparthroplasty for femoral neck fractures,to explore the effect of the different timing of surgery,itraoperative and postoperative blood loss,early postoperative complications and hip function recovery,and provide theoretical basis for selection of operation time of total hip arthroplasty for femoral neck fractures,to better guide clinical practice.Methods Retrospective analysis 90 femoral neck fracture patients with complete follow-up data for total hip arthroplasty,90 patients were divided into two groups,observation group was given the emergency surgery,the control group was given the delayed operation group.The differences of two groups about operation time,intraoperative blood loss,postoperative drainage,early postoperative complications and postoperative functional restoration of hip joint were compared.Results After 3 months follow-up,the comparison of operation time,intraoperative blood loss and postoperative drainage for the emergency operation group and the delayed operation group,the difference was statistically significant(t=2.37,15.38,22.73,all P＜0.05).The emergency operation group and the delayed operation group in the postoperative complications,P＞0.05,the difference was not statistically significant.After 1 month,the difference of the two groups of hip joint function by Harris score was statistically significant(t=2.76,P＜0.05);and after 3 months,the difference was not statistically significant(P＞0.05).Conclusion Emergency surgery can effectively shorten the operation time,reduce blood loss and postoperative drainage and conducive to the recovery of hip function in patients,reduce the pain caused by the disease,but the ultimate the hip function is not affected. Key words: Femoral neck fractures; Arthroplasty,replacement,Hip; Operation time