Short-term outcome after total hip arthroplasty using dual-mobility cup: report from Lithuanian Arthroplasty Register

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked FilesPURPOSE: The purpose of the study was to investigate how the use of dual-mobility cups (DMCs) affected the risk of revision due to dislocation as well as overall risk of revision compared with a conventional total hip arthroplasty (THA) system in the short term. METHODS: A total of 12,657 primary THAs were registered from the start of 2011 to the end of 2014. 620 THAs were with DMCs. For comparison, we included all registered THAs with Exeter cup and a cemented Exeter stem combined with 28-mm femoral head. Patients were followed up with respect to revision and/or death until 1 January 2016. For survival analysis, we used revision as an endpoint. Cox proportional hazards models were used to analyse the influence of various covariates (age, gender, surgical approach, THA model and pre-operative diagnosis). RESULTS: Of the 620 dual-mobility THAs and 2170 Exeter THAs, 100 had been revised. The overall unadjusted cumulative revision rate (CRR) for any reason of revision at five years after surgery was 3.9% in the dual-mobility group and 5.2% in the Exeter group. Cox regression analysis, adjusting for age, gender, THA type, surgical approach and pre-operative diagnosis, showed that the risk of revision was less in patients operated with DMCs and in patients having their operation for osteoarthritis. CONCLUSION: The DM implant had a lower short-term complication rate than a conventional well defined THA. Low dislocation rate suggests that it is a good choice for high risk patients

Femoral neck fractures in Lithuania and Sweden. The differences in care and outcome

Hip fractures constitute a serious and common health problem from both individual and public health perspectives. Unified data collection and comparison between countries is recognised as an effective tool for care improvements. However, the variation in patients' demography, treatment methods and other local cultural aspects in different countries should be considered. The aim of our study was to compare femoral neck fracture patients treated in Kaunas and Lund, concerning functional outcome and quality of life. We investigated 99 patients treated by arthroplasty in Kaunas Clinics and 117 patients in Lund University Hospital. Patients were investigated according to the National Swedish Hip Fracture Register model and were followed up for a period of four months after the injury. The patient's place of residence, mobility, complaints of pain and additional hospital stay were recorded. The EQ-5D questionnaire was used to evaluate quality of life. Patients in Kaunas were significantly younger, had lower ASA grade and were more mobile before trauma and at four moths follow-up. However, when comparing quality of life at four months follow-up between the institutions, Lund patients reported significantly better self care, felt less pain and discomfort, and had less symptoms of anxiety and depression. The difference observed in quality of life rating between institutions might be related to local cultures of the countries and should be considered when comparing the data

Factors affecting health-related quality of life in patients after femoral neck fracture

Quality of life in patients with femoral neck fracture is an issue frequently discussed in the literature. There is ongoing research on identifying factors that have an impact on quality of life in this particular group of patients. A great variety of factors affecting quality of life and lack of information on their importance encouraged us to perform a systematic literature review analyzing quality of life of patients who sustained femoral neck fracture. The search was performed in the PubMed and Medline databases according to the selected key words. In our systematic review, we included clinical and clinical randomized trials investigating patients with femoral neck fracture and their quality of life. Our analysis showed that treatment of femoral neck fracture with hip replacement was superior to osteosynthesis with regard to patients' quality of life. The data regarding the impact of different rehabilitation programs on quality of life were controversial; a few reports showed that special rehabilitation programs were associated with better health-related quality life. However, other studies did not report any differences in patients' quality of life when different rehabilitation programs were applied. Patient's nutrition may be an important factor affecting the quality of life in patients with femoral neck fractures; however, data supporting this fact are insufficient

Factors affecting health-related quality of life in patients after femoral neck fracture

Quality of life in patients with femoral neck fracture is an issue frequently discussed in the literature. There is ongoing research on identifying factors that have an impact on quality of life in this particular group of patients. A great variety of factors affecting quality of life and lack of information on their importance encouraged us to perform a systematic literature review analyzing quality of life of patients who sustained femoral neck fracture. The search was performed in the PubMed and Medline databases according to the selected key words. In our systematic review, we included clinical and clinical randomized trials investigating patients with femoral neck fracture and their quality of life. Our analysis showed that treatment of femoral neck fracture with hip replacement was superior to osteosynthesis with regard to patients' quality of life. The data regarding the impact of different rehabilitation programs on quality of life were controversial; a few reports showed that special rehabilitation programs were associated with better health-related quality life. However, other studies did not report any differences in patients' quality of life when different rehabilitation programs were applied. Patient's nutrition may be an important factor affecting the quality of life in patients with femoral neck fractures; however, data supporting this fact are insufficien

Upper cervical spine injuries and their diagnostic features

The upper cervical spine includes the articulations of the occiput with atlas and the atlas with the axis, as well as the bony structures of the base of the skull, axis, and atlas. The unique anatomy of the upper cervical spine and the typical mechanisms of injury yield a predictable variety of injury patterns. Injuries to this area include occipital condyle fractures, occipitoatlantal dislocations, subluxations and dislocations of the atlantoaxial articulation, atlas fractures, odontoid fractures, and fractures of the arch of the axis. Injuries to this region are relatively common and can be easily overlooked because patients with the upper cervical injury may have an associated head injury, which can alter their level of consciousness and complicate obtaining an accurate history and physical examination. The complex regional anatomy and overlying structures make plain radiographic images difficult to interpret. Delayed recognition can result in significant disability. A thorough understanding of the clinical presentation, radiographic assessment, and mechanisms of injury can minimize morbidity and enhance treatment effectiveness for the more common upper cervical ligamentous and bony injuries

Exeter total hip arthroplasty with matte or polished stems

Objective. To compare implant survival rates after total hip arthroplasty with Exeter matte or polished stems and to determine the relationship of synovitis/joint effusion to signs of implant loosening and stem type. Material and methods. The first part of the study included retrospective revision rate analysis of 118 primary hip replacements performed during 1991–1995. Two different designs of Exeter stems were used: matte surface stems during 1991–1995 (matte surface group – 47 cases), and polished stems during 1992–1995 (polished stem group – 71 cases). During the second part of the study, 24 patients (11 in polished stem group and 13 in matte stem group) were prospectively examined with radiography and sonography. Sonography was performed in order to evaluate capsular distension, i.e. the distance between prosthetic femoral neck and anterior capsule. Capsular distension depends on synovitis and/or synovia in prosthetic hip. The relationship between capsular distension, stem type, and radiographic signs of loosening was assessed. Results. For the first part of our study, total implant survival was 78% with matte stems and 61% with polished stems 13 years postoperatively (P=0.27). Stem survival was 82% for matte stems, and 88% for polished stems (P=0.54). In the second part of study, a significant relationship between increased capsular distension and cup loosening was determined (P=0.04). We did not find significant difference in capsular distension when compared matte and polished stems. Conclusion. Implant survival rates did not differ between the groups. The relationship between capsular distension and cup loosening was statistically significant

Hemodinaminių pokyčių pobūdis ir priežastys atliekant kepenų rezekcijas

Tyrimo tikslas. Nustatyti kepenų rezekcinių operacijų metu vykstančių hemodinaminių pokyčių priežastis bei jų pobūdį, kai nenaudojamos kepenų kraujotakos sustabdymo metodikos, bei parinkti labiausiai tinkamus paciento stebėsenos metodus. Metodai. Į prospektyvųjį tyrimą įtraukti 55 pacientai, kuriems 2003–2008 m. Lietuvos sveikatos mokslų universiteto ligoninės Kauno klinikose (tuometinėse KMUK) Chirurgijos klinikoje buvo atliktos kepenų rezekcinės operacijos. Papildomai buvo stebimi pacientų centrinės hemodinamikos rodmenys, arterinis kraujo spaudimas, centrinis veninis spaudimas ir slėgis apatinėje tuščiojoje venoje invaziniais metodais. Rezultatai. 53 pacientams operacijos metu konstatuoti hipotenzijos epizodai (iš viso 186) – 3,4 (2,0) vienam pacientui. Slėgio šlaunies venoje pokyčiai, nustatyti 54 pacientams (iš viso 262) – 4,8 (3,2) vienam pacientui. Hipotenzijos epizodo metu reikšmingai kito, atsižvelgiant į pradines reikšmes, slėgis šlaunies venoje, širdies minutinis tūris, širdies indeksas, sisteminis periferinių kraujagyslių priešinimosi indeksas, centrinis veninis slėgis. Netekto kraujo kiekis ir slėgio šlaunies venoje pokyčių skaičius tarpusavyje koreliavo teigiamai reikšmingai (r=0,5; p<0,001). Daugiau kaip 450 ml kraujo neteko 69,0 proc., jei centrinis veninis spaudimas didėjo, 38,3 proc., jei jis mažėjo (p<0,01). Daugiau kaip 450 ml kraujo neteko 41,6 proc. neigiamo slėgio šlaunies venoje pokyčio grupėje, 88,0 proc. – teigiamo pokyčio grupėje (p<0,001). Išvados. Kepenų operacijų metu dažniausiai stebimi hemodinaminiai pokyčiai yra hipotenzija, širdies indekso sumažėjimas ir slėgio apatinėje tuščiojoje venoje padidėjimas. Hipotenzijos priežastis dažniau yra apatinės tuščiosios venos perspaudimas, rečiau – kraujo netekimas. Kraujo netekimas susijęs su apatinės tuščiosios venos perspaudimų skaičiumi ir su didėjančiu slėgiu viršutinėje tuščiojoje venoje. Hipotenzijos priežastį kepenų rezekcinių operacijų metu galima nustatyti stebint slėgius viršutinėje bei apatinėje tuščiojoje venoje

Intracapsular pressure and elasticity of the hip joint capsule in osteoarthritis

We investigated intracapsular pressure and elasticity of the hip joint capsule in osteoarthritis. HOOS hip score, sonography of the hip joint, and radiographic assessment of osteoarthritis were performed in 31 patients before total hip arthroplasty. The intracapsular hydrostatic pressure was measured perioperatively, and 0.9% saline solution was then injected in the hip joint, 1 mL at a time with continuous pressure recording up to 300 mm Hg. The mean radiographic grade of severity of osteoarthritis was 8 (SD, 2.4). The mean hydrostatic intracapsular pressure in 45 degrees of flexion was 2.2 mm Hg (SD, 10.0) in extension, 15.8 mm Hg (SD, 33.0); in inward rotation, 13.7 mm Hg (SD, 26.0); and in outward rotation, 12.1 mm Hg (SD, 24.3). Severe osteoarthritis was associated with lower intracapsular pressure and lower elasticity of the joint capsule