Understanding the Pathoanatomy of Arthritic Hip for Improvising the Technique in Primary Uncemented Total Hip Arthroplasty | Chapter 7 | Advancement and New Understanding in Medical Science Vol. 10

 Background: Hip osteoarthritis is a condition that leads to significant morbidity and decreases the quality of patient’s life. Total Hip Arthroplasty (THA) is preferred by most of orthopaedic surgeons to relieve pain, provide motion while maintaining stability. In this study we aim to discuss the difficulties encountered in reference to patho-anatomy during THA in various conditions along with their solutions.

 

Materials and Methods: In our study, we had observed 100 hip joints of secondary osteoarthritis in 67 patients of with different type of underlying pathology like avascular necrosis, sickle cell disease, rheumatoid arthritis, ankylosing spondylitis. All the patients were evaluated using modified harris hip score. The findings were evaluated using SPSS software (Ilionois, Chicago) with p value less than 0.05 considered as significant.

 

Observation and Results: We had operated 100 hip joints (n=100) having arthritic changes among 67 patients (33 patients with bilateral hip affection, 34 patients with unilateral hip affection) at our tertiary care hospital from June 2015 till December 2019. The mean Harris Hip Score at the final follow up was 88 among them 98 hip joints had excellent and 2 hip joints had good to fair results. During our study we majorly encountered three types of collapse – Anterosuperior collapse (56%), Concentric collapse (25%) and hip arthritis due to inflammatory conditions (19%). We had found that according to duration and types of collapse different soft tissues were contracted and a step-wise release of those structures is necessary for proper intra-operation reduction and post-operative better range of motion. The steps for global release as and when required in different patients include adductor tenotomy, release of external rotator muscles, release of anterior fibers of  gluteus medius, release of tensor fascia lata and tendinous insertion of gluteus maximus along with release of posterior capsule, release of anterior capsule followed by release of iliopsoas tendinous insertion on lesser trochanter.

 

Conclusion: The chronicity of the disease will lead to anatomical changes of the surrounding soft tissue and that will affect the surgical dissection. We had described surgical problems encountered during the operation and their solutions for each type of pathoanatomy. This will help orthopedic surgeons to anticipate and prepare well in advance while performing total hip arthroplasty.

Author(s) Details:

Paresh Golwala,
SBKS& MIRC, Sumandeep Vidyapeeth (Deemed to be University), India.

Parth N. Rathi,
MM Hospital & Hariom Trust, Adipur, Bhuj Kutch 370205, Gujarat, India.

Prassana Shah,
Department of Orthopedics, Dhiraj Hospital, Smt. BK Shah Medical Institute & Research Centre, Sumandeep Vidyapeeth (Deemed to be University), Waghodia, Vadodara 391760, Gujarat, India.

Please see the link here: https://stm.bookpi.org/ANUMS-V10/article/view/13927

Modern Analgesic Techniques for Hip and Knee Arthroplasty: An Approach to Evidence-Based Medicine| Chapter 10 | Perspective of Recent Advances in Medical Research Vol. 4

In big orthopedic medical procedure, contemporary and patella arthroplasty plays an main part. Statistics from past years show united states of america decrease in the age of subjects bearing this type of enucleation.Effective examination pain administration endure admit accelerated patient group accompanying the possibility of discharge even in inferior two days. Therefore skilled is likewise a increasing bias to shift smart and patella arthroplasty from in-patient to person being treated for medical problem section. The combining several branches of learning approach of the fast-path program also depends on the administrative methodical conveniences of each organization.Our renovate aims to review the main models of classic and new pharmacological or non-pharmacological methods and analgesics secondhand contemporary in the postoperative ending. Their approximate study explains the benefits and aftereffects of each and guides us on by means of what to command evidence-located cure in our regularly practice.

Author(s) Details:

Denisa Madalina Anastase,
Department of Anesthesiology, Orthopedic Clinical Hospital Foisor, Bulevardul Ferdinand, No. 35-37, 021382 Bucharest, Romania.

Simona Cionac Florescu,
Department of Anesthesiology, Orthopedic Clinical Hospital Foisor, Bulevardul Ferdinand, No. 35-37, 021382 Bucharest, Romania.

Please see the link here: https://stm.bookpi.org/PRAMR-V4/article/view/9134

A Multicentric Analysis of Risk Factors for Surgical Site Infection after Hip Arthroplasty| Chapter 7 | Current Topics in Medicine and Medical Research Vol. 8

 The goal of this study is to address three key questions: What is the risk of wound infection for hip arthroplasty patients? What are the major etiologic agents for infection of the surgical site (SSI)? What risk factors are more associated with infection at the surgical site? Method: This is a multicentric, retrospective cohort study that examined data collected between January 2009 and December 2013 in five general hospitals in a major city in Brazil. Age, length of hospital stay before surgery, period of surgery, number of surgery practitioners and number of hospital admissions were the ongoing parameters examined. Surgical wound classification (clean, clean-contaminated, contaminated, dirty / infected), American Society of Anesthesiologists (ASA) score (I, II , III , IV, V), form of procedure (elective, emergency), general anaesthesia (yes, no), prophylactic antibiotics (yes, no), danger index for trauma surgery (yes, no) and Nosocomial Infections Surveillance (NNIS) (IRIC = 0 , 1, 2, 3) were categorical variables. Results: The approximate SSI risk was 3.2% (95% C.I. = 2.6% to 4.1%) and the risk of osteomyelitis was 0.6% (95% C.I. = 0.4% to 1.1%). The risk factors for SSI after hip prosthesis were ASA score > 2, general anaesthesia, hospital stay prior to surgery longer than four days, more than two surgical professionals and surgery period greater than five hours (p < 0.05). The final multiple logistic regression analysis showed that the changed NNIS risk after hip arthroplasty was independently correlated with surgical site infection. Conclusion: Despite the risk factor for SSI being the updated NNIS index, none of its independent variables were statistically significant (p>0.100) in the logistic model. As compared to the previous category, each changed NNIS risk category increases the likelihood of a patient being infected almost three times (OR = 2.82; p=0.011). Our study found out that the use of general anaesthesia and the number of surgical practitioners greater than 2 are risk factors for the development of SSI after THA with an ASA score higher than 2. Only the Updated NNIS risk index was referred to as a risk factor for SSI in our multivariate analysis. It is proposed that antibiotic prophylaxis is a preventive measure against SSI. This research has some drawbacks as a retrospective examination. Nevertheless, it indicates significant possibilities for improving the standard of treatment and preventing SSI in hip arthroplasty, such as avoiding general anaesthesia, keeping operational resources to a minimum and reducing operating room traffic. The creation of new pre-surgery procedures or the study and adherence of existing ones, as well as the proper collection of data for future research, may be effective steps to minimise the risk of infection in the hospitals studied.

Author(s) Details

Gabriel B. Tofani
Hospital MaterDei, Belo Horizonte, Brazil.

Gustavo P. Irffi
Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.

Gilberto D. Miranda
Universidade de Alfenas – Unifenas. Hospital Universitário Alzira Velano, Alfenas, Brazil.

Bráulio R. G. M. Couto

Centro Universitário de Belo Horizonte – UniBH, Belo Horizonte, Brazil.

Carlos E. F. Starling
Hospitals Life Center, Vera Cruz, and Baleia, Belo Horizonte, Brazil.

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