Arthroplasty
RCT: Total Hip Replacement Superior to Resistance Training for Severe Hip Osteoarthritis
3 Nov, 2024 | 01:23h | UTCBackground: Severe hip osteoarthritis (OA) is often treated with total hip replacement (THR), yet randomized trials comparing THR with nonsurgical interventions like resistance training (RT) are lacking. While exercise is recommended for hip OA, its efficacy relative to surgery remains unclear.
Objective: To compare the effectiveness of THR with RT in patients aged 50 years or older with severe hip OA and an indication for surgery.
Methods: In a multicenter, randomized controlled trial, 109 patients were assigned to undergo THR (n=53) or participate in a 12-week supervised RT program (n=56). The primary outcome was the change in patient-reported hip pain and function from baseline to 6 months, measured by the Oxford Hip Score (OHS; range 0–48, higher scores indicate less pain and better function). Secondary outcomes included measures of pain, function, quality of life, physical activity, and functional performance. Safety was also assessed.
Results: At 6 months, the mean improvement in OHS was 15.9 points in the THR group and 4.5 points in the RT group (between-group difference: 11.4 points; 95% CI, 8.9 to 14.0; P<0.001). Significant improvements favoring THR were also observed in all secondary patient-reported outcomes. Serious adverse events occurred in 12% of patients in the THR group and 9% in the RT group; most were known complications of THR. At 6 months, 9% of patients assigned to THR had not undergone surgery, and 21% of those assigned to RT had undergone THR.
Conclusions: In patients aged 50 years or older with severe hip OA and an indication for surgery, THR resulted in clinically important, superior reductions in hip pain and improvements in function compared to RT at 6 months.
Implications for Practice: These findings support the use of THR over RT for patients with severe hip OA who are surgical candidates, affirming current clinical recommendations. However, RT may still be considered as an initial treatment option for some patients, especially those preferring to delay surgery.
Study Strengths and Limitations: Strengths include the randomized controlled design and multicenter approach. Limitations involve lack of blinding, potential selection bias due to low enrollment (14% of eligible patients), and crossovers between treatment groups, which may underestimate the true treatment effects.
Future Research: Further studies should investigate long-term outcomes, optimal timing of THR, and factors influencing patient choice and response to RT versus surgery.
RCT: Triple combination of paracetamol, ibuprofen, and dexamethasone reduces morphine use post-hip arthroplasty – Lancet Rheumatol
11 May, 2024 | 14:18h | UTCStudy Design and Population: The RECIPE trial was a randomized, blinded, placebo-controlled multicenter study conducted across nine Danish hospitals to evaluate the effectiveness of non-opioid analgesic combinations in managing postoperative pain following total hip arthroplasty. A total of 1,060 adults scheduled for surgery were enrolled and randomly assigned to one of four treatment groups, receiving combinations of paracetamol, ibuprofen, and dexamethasone. The study’s primary endpoint was the 24-hour intravenous morphine consumption, with a predefined minimal important difference set at 8 mg.
Main Findings: The trial results indicated significant reductions in 24-hour morphine consumption in the group receiving paracetamol, ibuprofen, and dexamethasone combined, compared to other groups, though none reached the minimal important difference. Specifically, this group consumed a median of 15 mg morphine, which was less than the other groups ranging from 16 mg to 24 mg. However, the differences did not meet the study’s threshold for a clinically important effect. Adverse events were lowest in the combined treatment group, suggesting a better safety profile primarily characterized by fewer incidents of nausea, vomiting, and dizziness.
Implications for Practice: The findings support the use of a combined regimen of paracetamol, ibuprofen, and dexamethasone for reducing morphine consumption post-total hip arthroplasty, which could be significant in clinical settings aiming to minimize opioid use. The improved safety profile also highlights the potential benefits of multimodal analgesia. Further research may explore the optimization of dosing schedules and long-term outcomes to enhance patient recovery and satisfaction.
Reference (link to abstract – $ for full-text):
Systematic Review | Ethical perspectives on surgical video recording for patients, surgeons and society
11 Jul, 2023 | 13:44h | UTC
Cohort Study | Increased revision rates seen in shoulder replacement surgeries by surgeons with less than 10 procedures annually
27 Jun, 2023 | 13:48h | UTCSummary: This prospective cohort study investigated the correlation between surgeon volume and patient outcomes after elective shoulder replacement surgeries. Utilizing data from 39,281 procedures performed by 638 surgeons in UK public and private hospitals between 2012-20, the study focuses on adults aged 18 years or older.
The results indicate a significant connection between a surgeon’s mean annual volume and risk of adverse patient outcomes. Surgeons performing fewer than 10.4 procedures per year demonstrated a significantly increased risk of revision surgery, with the hazard ratio being almost twice as high as that of the lowest risk surgeons. Higher mean annual surgical volume correlated with lower risks of reoperations, fewer serious adverse events, and shorter hospital stays.
These findings suggest the need for strategic resource planning in surgical services, with considerations given to surgeon’s annual procedure volume to improve patient outcomes after shoulder replacement surgery. It should be noted that the study was limited in scope to surgeries performed within the NHS and private hospitals in England. Furthermore, potential confounding factors like patients’ social circumstances, carer availability, or body mass index were not considered.
Editorial: Surgeon volume and patient outcomes in shoulder replacement surgery – The BMJ
News Release: Patients do better when surgeon averages 10 + annual shoulder ops – BMJ Newsroom
RCT | High-dose dual-antibiotic cement doesn’t lower infection rates in hip hemiarthroplasty
26 Jun, 2023 | 00:47h | UTCSummary: This randomized superiority trial studied the effect of high-dose dual-antibiotic loaded cement versus standard care single-antibiotic loaded cement on deep surgical site infection (SSI) rates in hip hemiarthroplasty patients. This large-scale study, conducted in 26 UK hospitals, included people aged 60 and older with a hip fracture.
The trial randomly allocated 4936 participants to either treatment group. The primary outcome was deep SSI at 90 days post-randomisation. Notably, no significant difference was found between the groups. About 1.7% of participants in the single-antibiotic group and 1.2% in the dual-antibiotic group experienced a deep SSI (adjusted odds ratio 1.43; 95% CI 0.87–2.35; p=0.16). This result contradicts previous findings suggesting that high-dose dual-antibiotic cement could reduce infection rates.
News release: Antibiotic bone cement found not to reduce infection after hip replacement – University of Oxford
Systematic Review | Tranexamic acid likely decreases red blood cell transfusion need in hip fracture surgery
16 Jun, 2023 | 14:09h | UTC
Exploratory Analysis of a RCT | Low-dose colchicine linked to reduced incidence of knee and hip replacements
7 Jun, 2023 | 13:50h | UTCAssociation of Low-Dose Colchicine With Incidence of Knee and Hip Replacements: Exploratory Analyses From a Randomized, Controlled, Double-Blind Trial – Annals of Internal Medicine (link to abstract – $ for full-text)
News Release: Low dose colchicine associated with lower incidence of total knee and hip replacements – American College of Physicians
Review | Fast track protocols and early rehabilitation after surgery in total hip arthroplasty
31 May, 2023 | 13:46h | UTCRelated:
Enhanced recovery pathways in orthopedic surgery – Journal of Anaesthesiology Clinical Pharmacology
Evidence-based recommendations | Mid- to late-term follow-up of primary hip and knee arthroplasty
16 May, 2023 | 14:57h | UTC
M-A | Postoperative clinical outcomes for kinematically, restricted kinematically, or mechanically aligned total knee arthroplasty
15 May, 2023 | 13:04h | UTC
Development of evidence-based guidelines for the treatment and management of periprosthetic hip infection
15 May, 2023 | 12:39h | UTC
M-A | Surgical interventions for symptomatic knee osteoarthritis
12 May, 2023 | 13:26h | UTC
Plasma D-Dimer may be useful in the diagnosis of periprosthetic joint infection
29 Mar, 2023 | 12:33h | UTCPlasma D-Dimer Is Noninferior to Serum C-Reactive Protein in the Diagnosis of Periprosthetic Joint Infection – The Journal of Bone and Joint Surgery (link to abstract – $ for full-text)
News Release: D-dimer blood test shows value in detecting prosthetic joint infections – Wolters Kluwer
RCT | Short-term indwelling foley catheters do not reduce the risk of postoperative urinary retention in THA and TKA
22 Mar, 2023 | 13:14h | UTCShort-Term Indwelling Foley Catheters Do Not Reduce the Risk of Postoperative Urinary Retention in Uncomplicated Primary THA and TKA: A Randomized Controlled Trial – The Journal of Bone and Joint Surgery (link to abstract – $ for full-text)
Review | Evidence-based informed consent form for total knee arthroplasty
17 Mar, 2023 | 12:58h | UTC
Updated Guideline | Management of hip fracture
17 Feb, 2023 | 13:17h | UTCHip fracture: management – National Institute for Health and Care Management
Quality Standard: Hip fracture in adults – National Institute for Health and Care Management
M-A | Evaluation of comparative efficacy and safety of surgical approaches for total hip arthroplasty
6 Feb, 2023 | 13:01h | UTC
Commentary on Twitter
For primary total hip arthroplasty, all surgical approaches except direct lateral approach had greater improvements in hip score compared to posterior approach. However, the safety of different approaches did not show significant differences. https://t.co/WHpDGiyXhg
— JAMA Network Open (@JAMANetworkOpen) January 31, 2023
Cohort Study | Risk of total hip arthroplasty in former elite athletes
2 Feb, 2023 | 14:43h | UTCCommentary: Elite athletes 2x more likely to need hip arthroplasty – Orthopedics This Week
M-A | Continuous cryotherapy vs. traditional cryotherapy after total knee arthroplasty
1 Feb, 2023 | 13:07h | UTC
M-A | Tourniquet application in primary total knee arthroplasty for osteoarthritis
31 Jan, 2023 | 13:41h | UTC
RCT | High-dose steroid in low pain responders undergoing total knee arthroplasty
27 Jan, 2023 | 12:08h | UTC
RCT | Comparison of functional recovery between unicompartmental and total knee arthroplasty
26 Jan, 2023 | 11:58h | UTCComparison of Functional Recovery Between Unicompartmental and Total Knee Arthroplasty: A Randomized Controlled Trial – The Journal of Bone and Joint Surgery (link to abstract – $ for full-text)
News Release: Functional outcome measures show faster recovery with ‘partial’ versus total knee arthroplasty – Wolters Kluwer
Commentary: Partial Knee Arthroplasty Shortens Recovery Time in Patients With Medial Knee OA – Consultant 360
Key elements of enhanced recovery after total joint arthroplasty: a reanalysis of the ERAS guidelines
20 Jan, 2023 | 14:49h | UTCRelated:
Enhanced recovery pathways in orthopedic surgery – Journal of Anaesthesiology Clinical Pharmacology
RCT | Does choice of patellar implant in total knee arthroplasty matter?
18 Jan, 2023 | 14:06h | UTCDoes Choice of Patellar Implant in Total Knee Arthroplasty Matter? A Randomized Comparative Trial of 3 Commonly Used Designs – The Journal of Bone and Joint Surgery (link to abstract – $ for full-text)
Commentary: To resurface the patellar: Onlay, Inlay or Onlay Oval? – Orthopedics This Week
Study shows many patients com safely wait 10 years for follow-up after primary hip and knee replacement
13 Jan, 2023 | 13:17h | UTC
Commentary on Twitter
Many people do not need a follow-up appointment after hip or knee replacement surgery. Research found that most people who had replacement surgery using UK-recommended replacement joints can safely wait 10 years: https://t.co/L0ZQ9M0Dno@srkingsbury @lindsayksmith6 @LeedsBRC pic.twitter.com/Db6GUZG4SA
— NIHR Evidence (@NIHRevidence) January 12, 2023