Hip
Meta-Analysis: Spinal Cord Stimulation May Be Effective for Chronic Back and Leg Pain
15 Nov, 2024 | 13:43h | UTCBackground: Chronic back and leg pain causes significant disability worldwide. Spinal cord stimulation (SCS) offers treatment for patients unresponsive to conventional medical management (CMM). The comparative efficacy of conventional and novel SCS forms versus CMM is debated, requiring thorough evaluation.
Objective: To evaluate the efficacy of conventional and novel SCS therapies compared with CMM in adults with chronic back or leg pain who had not previously used SCS.
Methods: A systematic review and Bayesian network meta-analysis per PRISMA guidelines were performed. MEDLINE, Embase, and Cochrane Library were searched up to September 2, 2022. Thirteen RCTs with 1,561 patients were included. Interventions were conventional SCS, novel SCS modalities (e.g., high-frequency, burst stimulation), and CMM. Primary outcomes were pain intensity (visual analog scale) and responder rates (≥50% pain relief) in back or leg. Secondary outcomes were quality of life (EQ-5D index) and functional disability (Oswestry Disability Index).
Results: At 6 months, both conventional and novel SCS were superior to CMM in five of six outcomes. For back pain responder rates, conventional SCS had an OR of 3.00 (95% CrI, 1.49–6.72) and novel SCS had an OR of 8.76 (95% CrI, 3.84–22.31) versus CMM. Pain intensity in the back decreased significantly with conventional SCS (MD, –1.17; 95% CrI, –1.64 to –0.70) and novel SCS (MD, –2.34; 95% CrI, –2.96 to –1.73). Leg pain intensity also decreased significantly with conventional SCS (MD, –2.89; 95% CrI, –4.03 to –1.81) and novel SCS (MD, –4.01; 95% CrI, –5.31 to –2.75) compared to CMM. Quality of life improved with both SCS therapies (conventional SCS MD, 0.15; 95% CrI, 0.09–0.21; novel SCS MD, 0.17; 95% CrI, 0.13–0.21). Functional disability improved significantly with conventional SCS (MD, –7.10; 95% CrI, –10.91 to –3.36).
Conclusions: Both conventional and novel SCS therapies are associated with significant improvements in pain relief, quality of life, and functional ability compared with CMM in patients with chronic back and leg pain at 6 months.
Implications for Practice: The results support integrating SCS therapies into clinical practice for patients with chronic back and leg pain unresponsive to CMM.
Study Strengths and Limitations: Strengths include inclusion of recent RCTs and use of Bayesian network meta-analysis, allowing comprehensive evidence synthesis with both direct and indirect comparisons, enhancing reliability. Limitations involve potential biases due to challenges in blinding participants and assessors, as patients can perceive whether a device is active. Heterogeneity among studies in patient populations and interventions may affect generalizability. Inability to include long-term efficacy data due to crossover in many trials limits understanding of sustained outcomes.
Future Research: Long-term RCTs are needed to assess sustained efficacy and safety of SCS therapies. Future studies should compare different SCS modalities directly and identify patient subgroups most likely to benefit.
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: Diagnostic accuracy of clinical examination for dislocated hips in infants
28 Apr, 2024 | 16:52h | UTCThis systematic review assesses the diagnostic accuracy of clinical examinations in identifying dislocated hips in infants, using data from nine studies that compared clinical examinations to diagnostic ultrasound as the reference. The study involved 37,859 hips with a dislocation prevalence of 0.94%. The Barlow and Ortolani maneuvers showed a sensitivity of 46% and a specificity of 99.1%, with a positive likelihood ratio of 52, highlighting their effectiveness in predicting hip dislocation. Other methods such as limited hip abduction and a clicking sound were found to have minimal diagnostic utility. This evidence supports the clinical utility of specific maneuvers in early detection to prevent long-term complications.
Reference (link to abstract – $ for full-text):
RCT | Ferric derisomaltose plus tranexamic acid may reduce blood transfusion risk by 50% in hip surgery
3 Aug, 2023 | 13:18h | UTCFerric derisomaltose and tranexamic acid, combined or alone, for reducing blood transfusion in patients with hip fracture (the HiFIT trial): a multicentre, 2 × 2 factorial, randomised, double-blind, controlled trial – The Lancet Haematology (link to abstract – $ for full-text)
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
RCT | Comparable 1-year outcomes for intramedullary nail vs. sliding hip screw in trochanteric fractures
22 Jun, 2023 | 15:06h | UTCInvited Commentary: A Gap Between Evidence-Based Research and Clinical Practice in Management of Hip Fractures – JAMA Network Open
Commentary on Twitter
INSITE RCT: No significant benefit to using more costly intramedullary devices over sliding hip screws for the majority of patients with trochanteric hip fractures, adding to the body of evidence that the increasing use of these implants is unwarranted. https://t.co/15iJRW5xIS
— JAMA Network Open (@JAMANetworkOpen) June 6, 2023
Systematic Review | Tranexamic acid likely decreases red blood cell transfusion need in hip fracture surgery
16 Jun, 2023 | 14:09h | UTC
M-A | Post-surgery interventions for hip fracture
16 Jun, 2023 | 13:45h | 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
Development of evidence-based guidelines for the treatment and management of periprosthetic hip infection
15 May, 2023 | 12:39h | 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)
M-A | Artificial intelligence for hip fracture detection and outcome prediction
20 Mar, 2023 | 13:13h | UTC
RCT | The effect of skin traction on pain relief in patients with isolated intertrochanteric fractures
10 Mar, 2023 | 14:24h | 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
Consensus on primary cam morphology and femoroacetabular impingement syndrome
15 Feb, 2023 | 16:01h | UTCOxford consensus on primary cam morphology and femoroacetabular impingement syndrome – British Journal of Sports Medicine
Part 1: definitions, terminology, taxonomy and imaging outcomes
Part 2: research priorities on conditions affecting the young person’s hip
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 | Comparative efficacy of exercise therapy and oral NSAIDs and paracetamol for knee or hip osteoarthritis
1 Feb, 2023 | 13:28h | UTC
Commentary on Twitter
Network meta-analysis of 152 RCTs (17431 pts) comparing efficacy of exercise therapy, NSAIDs, Tylenol for knee or hip osteoarthritis: Found all 3 equivalent at 4 wk, 8 wk and 24 wks. https://t.co/rKck2AacL4 pic.twitter.com/YEAMh9UxTs
— Dr. John Cush (@RheumNow) January 10, 2023
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
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
Retrospective Study | Incidence, timing, and predictors of hip dislocation after primary total hip arthroplasty for osteoarthritis
11 Jan, 2023 | 14:01h | UTCIncidence, Timing, and Predictors of Hip Dislocation After Primary Total Hip Arthroplasty for Osteoarthritis – Journal of the American Academy of Orthopaedic Surgeons (link to abstract – $ for full-text)
Commentary: Who (and why) risks dislocation after hip arthroplasty? – Orthopedics This Week