Minimally Invasive Total Hip Replacement - THR - Nucleus Health
The therapeutic outcomes of Osteoarthritis OA has been unsatisfactory and often surgeries such as total hip arthroplasty THA is required. THA is an effective treatment for patients with end-stage arthritic hip conditions.
Hip Replacement Cost sf OA, four domains to be evaluated: pain, physical function, joint imaging, and patient global assessment. Thus, THA can be cost saving or, at least cost- effective in improving quality-adjusted life expectancy. The purpose of this review is to discuss Hip Replacement Cost sf recent advances as well as advantages and limitations of THA. Total hip arthroplasty THA is an effective treatment for patients with end-stage arthritic hip condition.
It provides pain relief, enhances mobility, and restores function. Some authors Hip Replacement Cost sf using an osteotomy or arthrodesis as an alternative to THA [ 2 ], but by the time patients seek medical advice, hip joint degeneration is often too extensive for osteotomy to be considered useful.
The arthrodesis caused often leads to patient dissatisfaction due to reduced mobility and subsequent back and knee deterioration resulting in pain. The success of THA in older patients, in concert with improvements in techniques and biomaterials, has stimulated demand of this procedure in young.
Hip arthroplasty is one of Hip Replacement Cost sf most common orthopedic interventions. In Sweden, about hip arthroplasties are performed annually, corresponding to an annual rate of about per inhabitants aged 50 and older. Patients Hip Replacement Cost sf surgeons may differ in their concerns and priorities for THA.
Initial cemented THA in young patients with osteoarthritis OA showed increased risk for Hip Replacement Cost sf due to aseptic loosening associated with OA and raised concerns of high rates of long-term failure.
Berry and colleagues [ 4 ]. Eighty-three percent of the hips were osteoarthritic. Implant survival was strongly associated with patient age Hip Replacement Cost sf diagnosis at time of procedure. Survival rates decreased with each decade of age, Hip Replacement Cost sf With improvements in cementing and other surgical techniques, the ability to achieve long-term fixation has been enhanced.
Cornell and Ranawat [ 5 ] reported a study on hips in patients with OA age 55 or younger, mean 7-year follow-up. Overall survival Hip Replacement Cost sf were At Hip Replacement Cost sf years, the survival rates of the femoral and acetabular components were Hartofilakidis and colleagues [ 8 ] reported THA survival rates of Cementless prostheses were introduced in the early s in an attempt to prevent aseptic loosening of the acetabular cup and the difficulties associated with revision of cemented THAs.
First-generation cementless devices, however, were associated with high thigh pain, femoral component subsidence, Hip Replacement Cost sf loosening, proximal bone loss attributed to adaptive bone remodeling, and osteolysis caused by polyethylene debris. Second-generation stems eg, Profile stem DePuy, Leeds, England were designed Hip Replacement Cost sf improve fit, reduce micromotion, and optimize resistance to axial, bending, and rotational forces and thereby minimizing some of these complications [ 10 ].
Eskelinen and colleagues [ 11 ], using the Finnish Arthroplasty Register, evaluated 5, hip arthroplasties performed for primary OA in patients younger than At a follow-up of 10 to 13 years, the femoral stem survival rate was Evidently, failure rates for cementlessacetabular and femoral components were not dramatically better than failure rates for cemented components. Increased wear rates have been associated with cementless acetabular Hip Replacement Cost sf, which is a concern, as survival curves in cemented THAs demonstrated an increase in rates of loosening and revision in the second decade.
Stress shielding, aseptic loosening, osteolysis, and thigh pain still remain problems with certain models as well [ 13 ]. The long-term durability of cemented femoral stems in young patients along with poor acetabular performance has led some surgeons to advocate using a press-fit acetabular component with a cemented Hip Replacement Cost sf component [ 14 ]. Bizot and colleagues [ 15 ] found a 9-year survival rate of Inflammation caused by polyethylene wear particles plays an important role in implant durability.
Trying to limit wear and subsequent osteolysis secondary to bioactive wear particles, surgeons are increasingly using improved polyethylene and alternative bearings for THA in younger patients in whom wear causes a significant concern.
Hip Replacement Cost sf vitro laboratory tests Hip Replacement Cost sf hip simulators and clinical retrieval studies have shown significant improvements in the wear properties of newer bearing surfaces metal on highly cross-linked UHMWPE [ 16 ], ceramic on ceramic, metal on metal over traditional bearing surfaces.
Clinical results for ceramic and metal-on-metal bearings have been equally promising. Dorr and colleagues [ 18 ] studied 56 Metasul Zimmer, Inc. THA provides patients suffering from hip OA complete pain relief and Hip Replacement Cost sf hip function. However, patients with hip OA have disturbed kinetics in adjacent joints and in the pelvis due to the impairment in the hip region [ 19 ]. In particular, progression of knee OA is associated with progression of hip OA.
Shakoor et al. However, the progress of knee OA in patients undergoing THA has not been examined during long-term follow up. Factors contributing to progression of knee OA include: pre-existing knee OA, high loading of the knee and shifts in mechanical axes of the lower leg that alter load distribution, in addition to obesity and female gender [ 21 ]. Total hip prostheses have relatively high neck-shaft angles, and therefore have a tendency to reduce the femoral offset, possibly leading to lateral shifts in mechanical axes.
The course of knee OA ipsilateral to THA may thus differ from the natural course during long-term follow up. Hip Replacement Cost sf selection of femoral anteversion and offset are essential in providing the hip with excellent function by improving abductor muscle strength, preventing dislocation and Hip Replacement Cost sf leg length [ 22 ]. However, surgeons do not commonly consider the Hip Replacement Cost sf on the mechanical axes of the lower extremities.
According to the long-term results obtained from the Scandinavian Arthroplasty Hip Replacement Cost sf, cemented total hip arthroplasty is the treatment of choice for OA of the hip in older patients [ 25 ]. However, data from the Finnish Arthroplasty Register [ 26 ] concluded that cementless hip replacements had a lower risk of revision for aseptic loosening than cemented implants in osteoarthritic patients aged from 55 to 74 years. Several studies [ 27 - 29 ] have shown that the survival rates of cementless stems have been satisfactory for all age groups, but cementless cups have a common problem Hip Replacement Cost sf liner wear, osteolysis, and high incidence of revision in the medium-to-long term [ 30 ].
Table 1 below reports material surfaces, design features, and manufacturer of the implant. Although most of the THAs performed are unilateral, orthopedic surgeons also encounter patients with hip arthritis Hip Replacement Cost sf require bilateral hip arthroplasty. To determine which therapeutic strategy is preferable, several studies have been conducted to compare the outcomes of simultaneous bilateral Hip Replacement Cost sf to those of unilateral THAor two stage bilateral THA [ 31 ].
Increased risk of complications have been reported Hip Replacement Cost sf 32 ], particularly pulmonary embolism resulting from the simultaneous procedure. On the other hand, studies have presented fewer medical risks than those of previous reports [ 33 ]. Simultaneous bilateral THA offers the benefit of a one-session anesthetic risk, a shorter disability period, and a shorter, less costly overall hospitalization.
In addition, the simultaneous procedure confers a potential benefit for greater postoperative hip function because contralateral hip disabilities do not adversely affect Hip Replacement Cost sf replaced hip. Previous studies showed that hip joint space narrowing was strongly associated with other radiological features and Hip Replacement Cost sf predictive of hip pain. Furthermore, progression of hip OA could be defined by a change in joint space narrowing, and narrowing correlated with changes in clinical status [ 3536 ].
A study by Nilsdotter et al [ 37 ] suggested that if the diagnosis of OA is unequivocal, symptoms and not the degree of radiographic change should provide the indication for surgery. Fortin and coworkers have shown that the postoperative outcome after hip replacement for OA is better when the preoperative functional status is better [ 38 ]. Also, no gender related Hip Replacement Cost sf was observed in preoperative status or in postoperative outcome. This may be due to Hip Replacement Cost sf in healthcare system for social structure between different countries [ 39 ].
Plain radiography is at present the most economical and easily available imaging technique for semi-quantitative measurement of the morphology of OA. Hip OA is one of the most common causes of pain and disability in adults aged 55 years and older. THA is often necessary in patients who are or become unresponsive to medical treatment. Although access to surgical care, socio-economic and individual factors influences the decision for surgery, it is evident that pain and radiographic changes like joint space narrowing [JSN].
At present, monitoring of patients with hip OA is chiefly based on the assessment of pain, disability and anatomical changes from plain radiographs. It was demonstrated that conventional radiography Hip Replacement Cost sf the best modality to assess articular cartilage thickness for hips and knees [ 40 ]. A study by Conrozier et al.
The results of the study showed that patients with a high rate of JSN progression and so with a greater functional disability were operated on at an earlier anatomical stage than those with a slower progression.
This suggested that action should be taken sooner if the progression is rapid. The age at operation The main predictive factors of the time to THA were the age at diagnosis, the joint space thickness at diagnosis and the rate of JSN. The rate of progression of JSN appears to be one of the main deciding factors for THA as it was inversely correlated with the duration of follow-up.
Post-thrombotic syndrome PTS is a chronic condition in the lower extremity that develops after deep vein thrombosis DVT. PTS is a syndrome generally consisting of edema, skin induration, hyperpigmentation, venous ectasia, redness, pain with calf compression, and venous ulceration [ 45 ].
The diagnosis of PTS is done based on the development of the mentioned clinical manifestations in patients with a history of DVT. Three clinical scales have been reported using various combinations of these clinical signs and imaging studies to diagnose and grade the severity of PTS [ 46 ]. The Ginsberg scale uses two criteria for the diagnosis of PTS including a presence of pain and swelling for more than 1 month in duration and occurring more than 6 months after acute DVT; and b objective evidence on venous Doppler of valvular incompetence.
If both criteria are present, the diagnosis of PTS is done. The Villalta scale uses a combination of five symptoms pain, cramps, heaviness, pruritis, paresthesia and six signs edema, skin induration, hyperpigmentation, venous ectasia, redness, pain with calf compression. These signs and symptoms are then numerically graded to establish a score to determine a diagnosis of PTS. The Brandjes scale uses separate scales to categorize patients as having no, mild Hip Replacement Cost sf moderate or severe PTS that include items on symptoms, signs, and differences in calf circumference.
Points for the items are summed into a total score and cutoff values are used to classify the presence of mild-to-moderate PTS and severe PTS. Hip arthroplasty patients also showed greater improvement in pain and function and were more satisfied with the outcomes than patients undergoing knee arthroplasty. Patients undergoing arthroplasty seem to have psychological distress, although it was not associated with self-perceived functional recovery among hip arthroplasty patients.
The stronger the anxiety trait, the more probable it is that the individual will experience more state anxiety in a threatening situation. Preoperative anxiety may influence coping behavior, which in turn appears to have a significant impact on surgical recovery. Pre-operative anxiety was also associated with post-operative state anxiety, and post-operatively, state anxiety was found to be the only significant predictor of pain among, for example, knee or hip replacement patients.
Background factors such as female gender and trait anxiety were associated with pre-operative state anxiety, whereas moderate- to-intense pain and depressive symptoms were related to pre- and post-operative state anxiety in elective surgery. HRQoL is thought to include the elements of biological function, symptoms, functional status and general health perceptions that are influenced by individual and environmental characteristics.
Psychosocial improvements were seen sooner than physical improvements, but after 6 months, improvements in all dimensions of HRQoL were found [ 48 ]. These investigators reported a mean preoperative utility score of 0.
They reported mean preoperative utility to be 0. James et al [ 55 ] performed a cost-utility analysis of various commonly performed orthopedic procedures for the purpose of prioritizing elective orthopedic procedures in the northwest of England. The values generated ranged from 0. Utility values generated from the Rosser index were uniformly lower than those derived from the EQ-5D.