Bilateral Hip Arthroplasty: When Is It Safe to Operate the Second Hip? A Systematic Review

Introduction. Patients with degenerative hip disease frequently present with bilateral involvement that requires surgical management. The main goal when treating these patients is to achieve the maximum efficiency without increasing risk of perioperative complications; therefore, the decision regarding the best moment to operate the second hip becomes relevant. Although studies have addressed this topic, whether a simultaneous or staged surgery should be performed remains controversial. The purpose of this study was to determine, based on available evidence, the optimum strategy in terms of safety to operate the second hip in patients with bilateral involvement. Materials and Methods. A meta-analysis was planned. A systematic review of the literature was performed including clinical trials or observational analytical studies comparing the safety of bilateral arthroplasty performed simultaneously or staged by measuring major and minor complications. The appropriateness of a meta-analysis was evaluated through the detailed analysis of the risk of bias and clinical heterogeneity of the included studies. Results. Thirteen studies were selected after the systematic review. A wide variability in the methodological designs was found with a critical risk of bias in most of them. Considerable heterogeneity was detected in defining staged surgery in the cointerventions and how the outcomes were defined and measured. In response to these findings, a meta-analysis was considered not appropriate. The results showed no differences in the risk of mortality or systemic complications in young and healthy patients between simultaneous or staged surgeries. However, increased risk of complications for staged surgeries performed during the same hospitalization was observed. Conclusions. Available evidence is very heterogeneous and the quality of evidence is low. The available evidence supports the performance of simultaneous hip arthroplasty in selected patients (not older than 65 years, ASA 1-2, without cardiovascular comorbidities) and suggests the avoidance of staged surgeries within the same hospitalization

Prospective monitoring improves outcomes of primary total hip replacement: a cohort study

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Extended thromboprophylaxis for hip or knee arthroplasty. Does the administration route and dosage regimen affect adherence? A cohort study

Purpose: Prevention of thromboembolic disease requires patients’ adherence to the extended thromboprophylaxis scheme. Oral anticoagulants are expected to improve adherence as a result of their route of administration; however, this assumption is yet to be confirmed. The purpose of this study was to assess the impact of the route of administration and dosage regimen on the compliance to the prescription. Materials and methods: This prospective cohort study included hip and knee arthroplasty patients who received pharmacological extended thromboprophylaxis with one daily injection, one daily oral tablet, or two daily oral tablets. A telephonic questionnaire was applied 35 days after the day of the surgery. Patients who omitted one or more doses of medication during the follow-up period were classified as “non-adherent.” Differences of adherence rates were assessed. Results: Five hundred and twenty patients were included: 153 received Apixaban (oral, twice a day), 155 Enoxaparin (injectable, once a day), and 212 Rivaroxaban (oral, once a day). Patients receiving oral once a day medication was more compliant compared with those who received an oral medication twice a day. Non-adherence rates were 3.2 and 9.2%, respectively (p = 0.033). No significant differences (p = 0.360) were found between oral once a day and injectable once a day medication. Conclusions: The number of daily doses prescribed was related to adherence to extended chemical prophylaxis, while the route of administration did not seem to have a significant impact. Strategies to promote outpatient compliance must be implemented, especially when regimes including more than one daily dose are prescribed. © 2019, SICOT aisbl

Protocolos para el diseño in vitro de cartílago articular animal basados en métodos de ingeniería de tejidos

EI cartílago articular es la estructura que recubre las superficies óseas en las articulaciones. Tiene funciones biomecánicas especificas que lo hacen el tejido mas importante en el mantenimiento de la homeostasis articular. Se lesión a con mucha frecuencia generando consecuencias discapacitantes. Infortunadamente cuenta con una muy escasa capacidad de autorreparo por lo cual se han generado múltiples tratamientos con éxitos parciales, dado el hecho de que el tejido de reparo que se crea es biomecánicamente subóptimo con relación al nativo. Por lo anterior, la ingeniería de tejidos ofrece una alternativa basada en la creación de un nuevo tejido con características biológicas y biomecánicas similares a las originales. En este trabajo se describen los protocolos por seguir para la creación de un tejido cartilaginoso que intente cumplir con tales fines. Se describen los pasos para obtener condrocitos animales, su posterior cultivo celular, la siembra de los mismos en las matrices fabricadas como soporte, la estimulación mecánica de los implantes en creación como base demostrativa del papel que las deformaciones mecánicas en los condrocitos tienen en el resultado final de los implantes, y finalmente la evaluaci6n estructural y biomecánica de los tejidos creados. Por último se exponen algunos resultados alcanzados hasta la fecha por el grupo de autores, en donde se validan experimentalmente algunas de las metodologías propuestas

Protocols for the in vitro design of animal articular cartilage based on tissue engineering methods

The articular cartilage is the structure that covers the joint ends. It has some specific tasks crucial to the correct joint physiology. It may experience a large amount of injuries that could generate considerable disabilities. Unfortunately its selfrepair capacity is too limited; therefore, many treatments have been developed with partial success, given the suboptimal biomechanical behavior of the resultant tissue. Given that, Tissue Engineering offers an alternative, based on the design of a new tissue with biological and biomechanical features which resembles the native tissue. In this work, the authors describe the methodologies followed to accomplish that goal, studying the chondrocytes harvesting, the cellular cultures, the scaffold seeding processes, the mechanical stimulation and the structural and biomechanical evaluation. Finally, exposed some of the preliminary results, as a experimental validation of the methods proposed are.</p

Extended thromboprophylaxis for hip or knee arthroplasty. Does the administration route and dosage regimen affect adherence? A cohort study

Purpose: Prevention of thromboembolic disease requires patients’ adherence to the extended thromboprophylaxis scheme. Oral anticoagulants are expected to improve adherence as a result of their route of administration; however, this assumption is yet to be confirmed. The purpose of this study was to assess the impact of the route of administration and dosage regimen on the compliance to the prescription. Materials and methods: This prospective cohort study included hip and knee arthroplasty patients who received pharmacological extended thromboprophylaxis with one daily injection, one daily oral tablet, or two daily oral tablets. A telephonic questionnaire was applied 35 days after the day of the surgery. Patients who omitted one or more doses of medication during the follow-up period were classified as “non-adherent.” Differences of adherence rates were assessed. Results: Five hundred and twenty patients were included: 153 received Apixaban (oral, twice a day), 155 Enoxaparin (injectable, once a day), and 212 Rivaroxaban (oral, once a day). Patients receiving oral once a day medication was more compliant compared with those who received an oral medication twice a day. Non-adherence rates were 3.2 and 9.2%, respectively (p = 0.033). No significant differences (p = 0.360) were found between oral once a day and injectable once a day medication. Conclusions: The number of daily doses prescribed was related to adherence to extended chemical prophylaxis, while the route of administration did not seem to have a significant impact. Strategies to promote outpatient compliance must be implemented, especially when regimes including more than one daily dose are prescribed. © 2019, SICOT aisbl

Protocolos para el diseño in vitro de cartílago articular animal basados en métodos de ingeniería de tejidos

EI cartílago articular es la estructura que recubre las superficies óseas en las articulaciones. Tiene funciones biomecánicas especificas que lo hacen el tejido mas importante en el mantenimiento de la homeostasis articular. Se lesión a con mucha frecuencia generando consecuencias discapacitantes. Infortunadamente cuenta con una muy escasa capacidad de autorreparo por lo cual se han generado múltiples tratamientos con éxitos parciales, dado el hecho de que el tejido de reparo que se crea es biomecánicamente subóptimo con relación al nativo. Por lo anterior, la ingeniería de tejidos ofrece una alternativa basada en la creación de un nuevo tejido con características biológicas y biomecánicas similares a las originales. En este trabajo se describen los protocolos por seguir para la creación de un tejido cartilaginoso que intente cumplir con tales fines. Se describen los pasos para obtener condrocitos animales, su posterior cultivo celular, la siembra de los mismos en las matrices fabricadas como soporte, la estimulación mecánica de los implantes en creación como base demostrativa del papel que las deformaciones mecánicas en los condrocitos tienen en el resultado final de los implantes, y finalmente la evaluaci6n estructural y biomecánica de los tejidos creados. Por último se exponen algunos resultados alcanzados hasta la fecha por el grupo de autores, en donde se validan experimentalmente algunas de las metodologías propuestas.The articular cartilage is the structure that covers the joint ends. It has some specific tasks crucial to the correct joint physiology. It may experience a large amount of injuries that could generate considerable disabilities. Unfortunately its selfrepair capacity is too limited; therefore, many treatments have been developed with partial success, given the suboptimal biomechanical behavior of the resultant tissue. Given that, Tissue Engineering offers an alternative, based on the design of a new tissue with biological and biomechanical features which resembles the native tissue. In this work, the authors describe the methodologies followed to accomplish that goal, studying the chondrocytes harvesting, the cellular cultures, the scaffold seeding processes, the mechanical stimulation and the structural and biomechanical evaluation. Finally, exposed some of the preliminary results, as a experimental validation of the methods proposed are

Thromboprophylaxis for Hip Revision Arthroplasty: Can We Use the Recommendations for Primary Hip Surgery? A Cohort Study

The risk of thromboembolic events after hip revision arthroplasty might be higher than in primary hip arthroplasty. However, evidence regarding the use of thromboprophylaxis in revisions is scarce. The purpose of this study is to determine whether thromboprophylaxis recommendations for primary arthroplasty produce similar results in hip revision arthroplasty. This comparative cohort study retrospectively analyzed consecutive patients undergoing primary hip arthroplasty and hip revision surgery between March 2004 and December 2015, who received thromboprophylaxis according to local clinical practice guidelines for primary hip arthroplasty. The prevalence of deep vein thrombosis and pulmonary embolism and the presence of major bleeding events were assessed during hospitalization and at 3 months after discharge and compared between groups. The overall prevalence of thromboembolic events in the hip revision surgery cohort and in the primary hip cohort was 1.62% and 1.35%, respectively (P =.801). The 38.4% of hip revision patients and 20.3% of primary hip patients presented major bleeding events. Thromboembolic disease outcomes with the use of a standardized thromboprophylaxis regimen were similar in both cohorts, regardless of the high variability of hip revision surgery and the increased risk of complications. Implementation of this regimen is recommended in patients requiring joint replacement revision surgery. © The Author(s) 2019

Bilateral hip arthroplasty : When is it safe to operate the second hip? A systematic review

Introduction. Patients with degenerative hip disease frequently present with bilateral involvement that requires surgical management. The main goal when treating these patients is to achieve the maximum efficiency without increasing risk of perioperative complications; therefore, the decision regarding the best moment to operate the second hip becomes relevant. Although studies have addressed this topic, whether a simultaneous or staged surgery should be performed remains controversial. The purpose of this study was to determine, based on available evidence, the optimum strategy in terms of safety to operate the second hip in patients with bilateral involvement. Materials and Methods. A meta-analysis was planned. A systematic review of the literature was performed including clinical trials or observational analytical studies comparing the safety of bilateral arthroplasty performed simultaneously or staged by measuring major and minor complications. The appropriateness of a meta-analysis was evaluated through the detailed analysis of the risk of bias and clinical heterogeneity of the included studies. Results. Thirteen studies were selected after the systematic review. A wide variability in the methodological designs was found with a critical risk of bias in most of them. Considerable heterogeneity was detected in defining staged surgery in the cointerventions and how the outcomes were defined and measured. In response to these findings, a meta-analysis was considered not appropriate. The results showed no differences in the risk of mortality or systemic complications in young and healthy patients between simultaneous or staged surgeries. However, increased risk of complications for staged surgeries performed during the same hospitalization was observed. Conclusions. Available evidence is very heterogeneous and the quality of evidence is low. The available evidence supports the performance of simultaneous hip arthroplasty in selected patients (not older than 65 years, ASA 1-2, without cardiovascular comorbidities) and suggests the avoidance of staged surgeries within the same hospitalization. © 2018 Meilyn Muskus et al