Arthroplasty

About: Arthroplasty is a research topic. Over the lifetime, 24431 publications have been published within this topic receiving 697795 citations.

Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation

Abstract: An end-result analysis is presented of thirty-nine mold arthroplasties performed at the Massachusetts General Hospital between 1945 and 1965 in thirty-eight consecutive private patients for arthritis of the hip following fractures of the acetabulum or dislocations of the hip. Of the nineteen unilateral cases in the second half of the series, sixteen were rated good or excellent. Results in the second half of the series were significantly better statistically than those in the first half of the series. Possible reasons for this improvement are discussed. No significant deterioration occurred with the passage of time. Among the thirty-nine hips, three revisions were required. One patient had postoperative sepsis after arthroplasty. Four patients who had had intra-articular sepsis prior to arthroplasty showed no evidence of sepsis postoperatively. Factors influencing the choice between hip fusion and hip arthroplasty in these cases are presented. A new system for rating hip function is proposed and is compared with the systems of Larson and Shepherd.

Ectopic ossification following total hip replacement. Incidence and a method of classification.

Abstract: A method to classify the degree of ectopic-bone formation about the hip following total hip arthroplasty revealed that 21 per cent of 100 consecutive patients treated by total hip arthroplasty had ectopic-bone formation about the hip of various degrees when reviewed six months following the operation. Ectopic-bone formation, however, did not seem to affect the functional result as judged by the Harris hip evaluation unless apparent bone ankylosis resulted.

Functional results of hip arthroplasty with acrylic prosthesis

Abstract: Late results in 243 arthroplasties with an acrylic prosthesis for traumatic or osteoarthritic conditions are reported. Early results (after one year) show the importance of the restoration of the normal mechanics of the hip joint by the preservation or the restoration of normal length of the femoral neck, the exact correction of anteversion, and the precise fit of the prosthetic head to the acetabulum. A good exposure of the joint through the posterolateral approach appears necessary in order to fulfill these conditions. Late results (from two to five years) show deterioration of the functional results in 20 per cent. These deteriorations appear to be caused by bone absorption around the Judet prosthesis and the consequent loosening of the prosthesis. A new type of cervico-capital prosthesis is proposed which makes possible: 1. Restoration of the normal length of the femoral neck when it is congenitally or pathologically short; 2. Correction of anteversion, even when very marked; 3. A weight-bearing surface on a more vascularised part of the femur; 4. The distribution of pressure on bone so as to lessen bone absorption, to prevent its ill effects, and, particularly, to decrease mobility of the prosthesis.

Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature.

Abstract: Background: Total hip and total knee arthroplasties are well accepted as reliable and suitable surgical procedures to return patients to function. Health-related quality-of-life instruments have been used to document outcomes in order to optimize the allocation of resources. The objective of this study was to review the literature regarding the outcomes of total hip and knee arthroplasties as evaluated by health-related quality-of-life instruments. Methods: The Medline and EMBASE medical literature databases were searched, from January 1980 to June 2003, to identify relevant studies. Studies were eligible for review if they met the following criteria: (1) the language was English or French, (2) at least one well-validated and self-reported health-related quality of life instrument was used, and (3) a prospective cohort study design was used. Results: Of the seventy-four studies selected for the review, thirty-two investigated both total hip and total knee arthroplasties, twenty-six focused on total hip arthroplasty, and sixteen focused on total knee arthroplasty exclusively. The most common diagnosis was osteoarthritis. The duration of follow-up ranged from seven days to seven years, with the majority of studies describing results at six to twelve months. The Short Form-36 and the Western Ontario and McMaster University Osteoarthritis Index, the most frequently used instruments, were employed in forty and twenty-eight studies, respectively. Seventeen studies used a utility index. Overall, total hip and total knee arthroplasties were found to be quite effective in terms of improvement in health-related quality-of-life dimensions, with the occasional exception of the social dimension. Age was not found to be an obstacle to effective surgery, and men seemed to benefit more from the intervention than did women. When improvement was found to be modest, the role of comorbidities was highlighted. Total hip arthroplasty appears to return patients to function to a greater extent than do knee procedures, and primary surgery offers greater improvement than does revision. Patients who had poorer preoperative health-related quality of life were more likely to experience greater improvement. Conclusions: Health-related quality-of-life data are valuable, can provide relevant health-status information to health professionals, and should be used as a rationale for the implementation of the most adequate standard of care. Additional knowledge and scientific dissemination of surgery outcomes should help to ensure better management of patients undergoing total hip or total knee arthroplasty and to optimize the use of these procedures. Level of Evidence: Therapeutic study, Level III-3 (systematic review of Level-III studies). See Instructions to Authors for a complete description of levels of evidence.

The epidemiology of revision total hip arthroplasty in the United States.

Abstract: Background: Understanding the causes of failure and the types of revision total hip arthroplasty performed is essential for guiding research, implant design, clinical decision-making, and health-care policy. The purpose of the present study was to evaluate the mechanisms of failure and the types of revision total hip arthroplasty procedures performed in the United States with use of newly implemented ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) diagnosis and procedure codes related specifically to revision total hip arthroplasty in a large, nationally representative population. Methods: The Healthcare Cost and Utilization Project Nationwide Inpatient Sample database was used to analyze clinical, demographic, and economic data from 51,345 revision total hip arthroplasty procedures performed between October 1, 2005, and December 31, 2006. The prevalence of revision procedures was calculated for population subgroups in the United States that were stratified according to age, sex, diagnosis, census region, primary payer class, and type of hospital. The cause of failure, the average length of stay, and total charges were also determined for each type of revision arthroplasty procedure. Results: The most common type of revision total hip arthroplasty procedure performed was all-component revision (41.1%), and the most common causes of revision were instability/dislocation (22.5%), mechanical loosening (19.7%), and infection (14.8%). Revision total hip arthroplasty procedures were most commonly performed in large, urban, nonteaching hospitals for Medicare patients seventy-five to eighty-four years of age. The average length of hospital stay for all types of revision arthroplasties was 6.2 days, and the average total charges were $54,553. However, the average length of stay, average charges, and procedure frequencies varied considerably according to census region, hospital type, and type of revision total hip arthroplasty procedure performed. Conclusions: Hip instability and mechanical loosening are the most common indications for revision total hip arthroplasty in the United States. As further experience is gained with the new diagnosis and procedure codes specifically related to revision total hip arthroplasty, this information will be valuable in directing future research, implant design, and clinical decision-making. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.