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      Factors Affecting Periprosthetic Bone Loss after Hip Arthroplasty

      review-article
      Author(s): , MD, PhD, , MD, PhD * , , MD, PhD † , , MD * , , MD * ,
      Publication date (Electronic):
      Journal: Hip & Pelvis
      Publisher: Korean Hip Society
      Keywords: Osteoporosis, Arthroplasty, Osseointegration

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          Abstract

          Periprosthetic bone loss may lead to major complications in hip arthroplasty, including aseptic loosening, implant migration, and even periprosthetic fracture. Such a complication leads to revision surgeries, which are expensive, technically demanding, and result in a low satisfaction rate. Therefore, a study was conducted of the factors affecting the periprosthetic bone loss around the stem that caused these complications. Factors influencing periprosthetic bone loss include demographic factors such as age, sex, obesity, smoking, and comorbidity including diabetes and osteoporosis. The implant design and fixation method are also factors that are determined before surgery. In addition, there are surgical factors, such as surgical approach and surgical technique, and we wish to investigate the factors affecting periprosthetic bone loss around the stem by comparing the effects of postoperative rehabilitation protocols and osteoporosis drugs.

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          Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030.

          Steven Kurtz, Kevin Ong, Edmund Lau … (2007)
          Over the past decade, there has been an increase in the number of revision total hip and knee arthroplasties performed in the United States. The purpose of this study was to formulate projections for the number of primary and revision total hip and knee arthroplasties that will be performed in the United States through 2030. The Nationwide Inpatient Sample (1990 to 2003) was used in conjunction with United States Census Bureau data to quantify primary and revision arthroplasty rates as a function of age, gender, race and/or ethnicity, and census region. Projections were performed with use of Poisson regression on historical procedure rates in combination with population projections from 2005 to 2030. By 2030, the demand for primary total hip arthroplasties is estimated to grow by 174% to 572,000. The demand for primary total knee arthroplasties is projected to grow by 673% to 3.48 million procedures. The demand for hip revision procedures is projected to double by the year 2026, while the demand for knee revisions is expected to double by 2015. Although hip revisions are currently more frequently performed than knee revisions, the demand for knee revisions is expected to surpass the demand for hip revisions after 2007. Overall, total hip and total knee revisions are projected to grow by 137% and 601%, respectively, between 2005 and 2030. These large projected increases in demand for total hip and knee arthroplasties provide a quantitative basis for future policy decisions related to the numbers of orthopaedic surgeons needed to perform these procedures and the deployment of appropriate resources to serve this need.
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            Patient characteristics affecting the prognosis of total hip and knee joint arthroplasty: a systematic review.

            H Kreder, Roni Wright, Richard Glazier … (2008)
            Total joint arthroplasty is a highly efficacious and cost-effective procedure for moderate to severe arthritis in the hip and knee. Although patient characteristics are considered to be important determinants of who receives total joint arthroplasty, no systematic review has addressed how they affect the outcomes of total joint arthroplasty. This study addresses how patient characteristics influence the outcomes of hip and knee arthroplasty in patients with osteoarthritis. We searched 4 bibliographic databases (MEDLINE 1980-2001, CINAHL 1982-2001, EMBASE 1980-2001, HealthStar 1998-1999) for studies involving more than 500 patients with osteoarthritis and 1 or more of the following outcomes after total joint arthroplasty: pain, physical function, postoperative complications (short-and long-term) and time to revision. Prognostic patient characteristics of interest included age, sex, race, body weight, socioeconomic status and work status. Sixty-four of 14,276 studies were eligible for inclusion and had extractable data. Younger age (variably defined) and male sex increased the risk of revision 3-fold to 5-fold for hip and knee arthroplasty. The influence of weight on the risk of revision was contradictory. Mortality was greatest in the oldest age group and among men. Function for older patients was worse after hip arthroplasty (particularly in women). Function after knee arthroplasty was worse for obese patients. Although further research is required, our findings suggest that, after total joint arthroplasty, younger age and male sex are associated with increased risk of revision, older age and male sex are associated with increased risk of mortality, older age is related to worse function (particularly among women), and age and sex do not influence the outcome of pain. Despite these findings, all subgroups derived benefit from total joint arthroplasty, suggesting that surgeons should not restrict access to these procedures based on patient characteristics. In addition, future research needs to provide standardized measures of outcomes.
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              Uncemented and cemented primary total hip arthroplasty in the Swedish Hip Arthroplasty Register

              Nils Hailer, Göran Garellick, Johan Kärrholm (2010)
              Background and purpose Since the introduction of total hip arthroplasty (THA) in Sweden, both components have most commonly been cemented. A decade ago the frequency of uncemented fixation started to increase, and this change in practice has continued. We therefore analyzed implant survival of cemented and uncemented THA, and whether the modes of failure differ between the two methods of fixation. Patients and methods All patients registered in the Swedish Hip Arthroplasty Register between 1992 and 2007 who received either totally cemented or totally uncemented THA were identified (n = 170,413). Kaplan-Meier survival analysis with revision of any component, and for any reason, as the endpoints was performed. Cox regression models were used to calculate risk ratios (RRs) for revision for various reasons, adjusted for sex, age, and primary diagnosis. Results Revision-free 10-year survival of uncemented THA was lower than that of cemented THA (85% vs. 94%, p < 0.001). No age or diagnosis groups benefited from the use of uncemented fixation. Cox regression analysis confirmed that uncemented THA had a higher risk of revision for any reason (RR = 1.5, 95% CI: 1.4–1.6) and for aseptic loosening (RR = 1.5, CI: 1.3–1.6). Uncemented cup components had a higher risk of cup revision due to aseptic loosening (RR = 1.8, CI: 1.6–2.0), whereas uncemented stem components had a lower risk of stem revision due to aseptic loosening (RR = 0.4, CI: 0.3–0.5) when compared to cemented components. Uncemented stems were more frequently revised due to periprosthetic fracture during the first 2 postoperative years than cemented stems (RR = 8, CI: 5–14). The 5 most common uncemented cups had no increased risk of revision for any reason when compared with the 5 most commonly used cemented cups (RR = 0.9, CI: 0.6–1.1). There was no significant difference in the risk of revision due to infection between cemented and uncemented THA. Interpretation Survival of uncemented THA is inferior to that of cemented THA, and this appears to be mainly related to poorer performance of uncemented cups. Uncemented stems perform better than cemented stems; however, unrecognized intraoperative femoral fractures may be an important reason for early failure of uncemented stems. The risk of revision of the most common uncemented cup designs is similar to that of cemented cups, indicating that some of the problems with uncemented cup fixation may have been solved.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Hip Pelvis
                Journal ID (iso-abbrev): Hip Pelvis
                Journal ID (publisher-id): HP
                Title: Hip & Pelvis
                Publisher: Korean Hip Society
                ISSN (Print): 2287-3260
                ISSN (Electronic): 2287-3279
                Publication date (Print): June 2021
                Publication date (Electronic): 04 June 2021
                Volume: 33
                Issue: 2
                Pages: 53-61
                Affiliations
                Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
                [* ]Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea.
                [† ]Department of Orthopedic Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
                Author notes
                Address reprint request to Hwan-Hee Lee, MD. Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, 64 Daeheung-ro, Jung-gu, Daejeon 34943, Korea. TEL: +82-42-220-9530, FAX: +82-42-221-0429, hwanhee337@ 123456naver.com
                Author information
                https://orcid.org/0000-0002-6779-8075
                Article
                DOI: 10.5371/hp.2021.33.2.53
                PMC ID: 8190495
                PubMed ID: 34141691
                SO-VID: a05e29b3-93ee-4c62-80c8-86d204846e74
                Copyright © Copyright © 2021 by Korean Hip Society
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 29 January 2021
                Date revision received : 16 March 2021
                Date accepted : 29 March 2021
                Categories
                Subject: Review Article

                Keywords: osteoporosis,arthroplasty,osseointegration
                Data availability:
                Keywords: osteoporosis, arthroplasty, osseointegration

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