Hip precautions

BACKGROUND: Instability remains a devastating complication following total hip arthroplasty. Here we describe a mini-posterior approach with a monoblock dual-mobility implant without "traditional posterior hip precautions" yielding excellent results. METHODS: There were 580 consecutive hips in 575 patients who underwent total hip arthroplasty utilizing a monoblock dual-mobility implant and a mini-posterior approach. With this technique, the acetabular component positioning does not rely on tradition intra-operative radiographic abduction and anteversion goals but rather uses patient-specific anatomic landmarks (anterior acetabular rim and, when visible, the transverse acetabular ligament) to set cup position; stability is assessed with a significant, dynamic intra-operative test of range of motion...

BACKGROUND: Studies suggest that posterior hip precautions are unnecessary after total hip arthroplasty; however, many surgeons and patients choose to follow these precautions to some extent. In this study, we hypothesized that 20° of hip abduction would be sufficient to prevent impingement and dislocation in motions requiring hip flexion when using larger prosthetic heads (≥36 mm) when the acetabular implant is placed within a reasonable orientation (anteversion:15-25° and inclination: 40-60°)...

PURPOSE: Standard post-operative care following sacrectomy requiring plastic surgical reconstruction limits hip flexion and avoids wound pressure. Extended bed rest adversely affects patient function, strength and range of movement. This feasibility study assessed whether early postoperative use of the tilt table was possible and promoted faster mobilisation. METHODS: Data from 10 patients were collected; five from a "standard tilt table group" and five from an "early tilt table group"...

PURPOSE: Prevalence of musculoskeletal disorders (MSD) is widely reported among nurses but not specific to nurses working in pediatric long-term ventilatory care (PLTVC) units. The purpose of this study is to determine the prevalence of MSD among nurses working in PLTVC settings. DESIGN AND METHODS: Cross-sectional descriptive design. Using the Extended Nordic Musculoskeletal Questionnaire, 127 nurses working in PLTVC units were recruited to examine the prevalence of single-site, two-site, and multi-site MSDs in nine body parts...

BACKGROUND: Proton pump inhibitors (PPIs) and H2 blockers are commonly prescribed medications to treat ulcers in the stomach and the upper part of the small intestine and prescribed for some other common gastrointestinal complications such as gastroesophageal reflux disease, esophagitis, irritable bowel syndrome, and dyspepsia. Previous studies claimed that, apart from other side effects, these anti-ulcerant therapies significantly altered bone mineral density by interfering with intestinal reabsorption of minerals and vitamin B12, and the most widely prescribed PPIs were significantly associated with increased risks of hip and spine fractures...

Background: Radiofrequency has seen an increase in use in orthopedics including cartilage lesion debridement in the hip and knee as well as many applications in arthroscopic shoulder surgery. The purpose of this systematic review is to evaluate the safety and usage of radiofrequency in the shoulder. Methods: This systematic review was registered with PROSPERO (international registry) and followed the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) guidelines...

Background: Hip fracture (HF) is a major challenge for healthcare systems in terms of increased costs and lengths of stay, and it has been estimated that by 2050, half of the projected 6.26 million global HFs will occur in Asia. Owing to the high morbidity and mortality associated with HF in elderly individuals, it is crucial to recognize at-risk elderly patients in the ED so that special precautions and preventive measures can be taken. While comprehensive geriatric assessment (CGA) has been shown to improve outcomes and prevent secondary fractures in elderly individuals with HF in outpatient settings, there is a lack of data to identify elderly Asian patients who are at risk of HF via using CGA in the emergency department (ED)...

Slightly more than 20 years after its first clinical use, highly cross-linked polyethylene (HXLPE) has been widely adopted. Despite initial concerns about oxidation and lack of fatigue resistance, first generation HXLPE, with 15 years of follow-up and widespread use, continues to provide excellent results, even in a young, active population. Remelted HXLPE might have a lower wear rate than annealed HXLPE and will no doubt have a better resistance to oxidation. Second generation materials, consisting of polyethylene (PE) that is sequentially irradiated then annealed, and PE that is infused with antioxidants, also have provided encouraging short- and medium-term results...

PURPOSE: To assess the apparent validity of observational studies of elective arthroplasty interventions. METHODS: Data from the nationwide Dutch Arthroplasty Register (LROI) were used. The first case study compared surgical approaches for total hip arthroplasty (posterolateral approach (PLA) versus straight lateral approach (SLA)), where allocation of the intervention was assumed to be mostly independent of patient characteristics. The second case study compared fixation methods (cemented versus uncemented), where choice of fixation method was expected to depend on patient characteristics...

Background: Treatment of acetabular dysplasia with a periacetabular osteotomy (PAO) has been shown to improve long term outcomes and is considered the gold standard in the setting of symptomatic hip dysplasia in patients younger than 35 years of age. Post-operative rehabilitation following a PAO plays an important role in helping patients return to their prior level of function and reduce the impact of strength deficits that may persist. Currently, there is a paucity of research supporting post-operative rehabilitation guidelines...

BACKGROUND: Postoperative precautions that limit hip movement reduce the incidence of postoperative dislocation following total hip replacement (THR). It is assumed that patients adhere to these precautions, but true adherence is unknown. AIMS: To assess adherence to postoperative precautions, including bending, twisting, crossing of legs, sleeping position and sitting position following primary THR surgery. METHODS: A self-reporting questionnaire explored patient adherence to precautions following primary THR...

BACKGROUND: Surgical site infections (SSIs) are an undesired perioperative outcome. Recent studies have shown increases in hospital acquired infections during the coronavirus disease 2019 (COVID-19) pandemic. The objective of this study was to evaluate postoperative SSIs in the COVID-19-era compared to a historical cohort at a large, multicenter, academic institution. METHODS: A retrospective review of all patients who underwent National Health and Safety Network (NHSN) inpatient surgical procedures between January 1, 2018 and December 31, 2020...

INTRODUCTION: Total hip arthroplasty (THA) remains one of the most successful orthopedic surgical procedures. The posterior approach is associated with a higher incidence of post-operative dislocations than others. Adequate posterior soft tissue repair techniques, including capsulorrhaphy and transosseous bone sutures in the greater trochanter effectively reduce the dislocation rate. Post-operative "posterior hip precautions" were historically believed to reduce dislocation risks, although not clearly proven...

Introduction: Osteonecrosis of the femoral head (ONFH) is a pathology that can be treated with many approaches by the hip surgeon. Advanced decompression is a technique that aims to prevent the collapse of the femoral head and the arthrosis process of the joint, a technique already widespread and used by hip surgeons. In this study, we performed the technique with a new retractable blade and a new bone substitute as graft for the femoral head. Objective: To evaluate the technique with new instruments (EasyCore Hip® ) and a calcium phosphate bone substitute (Graftys® HBS)...

BACKGROUND: It is unclear how epilepsy may affect total joint arthroplasty outcomes. The purpose of this study was to analyze the impact of epilepsy on prosthesis-related complications following primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). METHODS: A retrospective cohort study was conducted using a national database. Patients who have epilepsy underwent a primary THA (n = 6,981) and TKA (n = 4,987) were matched 1:4 (THA, n = 27,924; TKA, n = 19,948)...

Tumoral calcinosis is a rare disease characterized by massive subcutaneous soft tissue deposits of calcium phosphate around large joints in patients with chronic kidney disease. Invasion of bone by tumoral calcinosis is rare. We experienced a case involving a femoral neck pathologic fracture due to bony invasion of tumoral calcinosis in a 46-year-old female with chronic kidney disease who had been on dialysis for 15 years. Successful outcomes were obtained by performance of total hip arthroplasty for treatment of the pathologic fracture of the femoral neck...

BACKGROUND: The purpose of this study is to determine whether there is a higher dislocation rate when post-operative hip precautions are not used for primary THA. METHODS: A survey was conducted of the hip precautions used by orthopaedic departments in England performing elective primary THA. From the responses to the survey an interrupted time series analysis was performed using the hospital admissions data from the Hospital Episode Statistics (HES) database during the period 1st April 2011 to 31st December 2019 and subsequent dislocations of these prostheses up to 30th June 2020...

OBJECTIVE: Proximal femoral replacement (PFR) is a salvage procedure originally developed for reconstruction after resection of sarcomas and metastatic cancer. These techniques can also be adapted for the treatment of non-oncologic reconstruction for cases involving massive proximal bone loss. The direct anterior approach (DAA) is readily utilized for revision total hip arthroplasty (THA), but there have been few reports of its use for proximal femoral replacement. INDICATIONS: Aseptic, septic femoral implant loosening, periprosthetic femoral fracture, oncologic lesions of the proximal femur...

OBJECTIVE: Conversion total hip arthroplasty (CTHA) through a direct anterior approach (DAA) in supine position. INDICATIONS: Failed osteosynthesis of proximal femoral fractures or failed conservative hip surgery, with hardware in situ. CONTRAINDICATIONS: Decayed general conditions, infection (peri-implant or systemic infection), need for greater trochanter reconstruction, severe proximal femur deformity. SURGICAL TECHNIQUE: Supine position...

BACKGROUND: Coronavirus disease 2019 (COVID-19) has had an immense impact on the treatment protocols of orthopedic and trauma departments, yet its specific effect on mortality in patients with hip fractures due to possible surgical delays is still unclear. The purpose of this paper was to investigate whether the COVID-19 pandemic worsened the mortality rate of hip fracture patients. PATIENTS AND METHODS: This study comprised 175 prospectively included patients who (1) suffered from hip fractures, (2) presented during the Austrian state of emergency period from 15 March 2020 to 30 May 2021, and (3) were admitted to a level I trauma center...