Objective To retrieve and summarize the best evidence for fall prevention after total hip arthroplasty in elderly patients. Methods BMJ Best Practice, UpToDate, JBI evidence-based healthcare center database, National Institute for Health and Clinical Excellence, Scottish Intercollegiate Guidelines Network, Cochrane Library, PubMed, Web of Science, EBSCO, International Collaboration of Orthopaedic Nurisng website, American Academy of Orthopaedic Surgeons website, European Society for Trauma and Emergency Surgery website, Medlive, China National Knowledge Infrastructure, Wanfang, Chongqing VIP, and SinoMed were systematically searched. The retrieval time was from the establishment of the databases to June 30, 2024. The quality of literature was evaluated, and evidence was extracted, evaluated, and summarized. Results A total of 12 articles were included, including 4 guidelines, 2 randomized controlled trials, 2 cohort studies, and 4 expert consensus studies. A total of 18 pieces of evidence were extracted, including 13 A-level recommendations and 5 B-level recommendations. The evidence covers six major themes of risk factors, assessment, multidisciplinary team support, health education, medication management, safety environment, and assistive devices. Conclusions The fall prevention after total hip arthroplasty in elderly patients involves multiple factors, and the fall prevention should be based on multidisciplinary team cooperation, achieving linkage between the hospital and the family to jointly ensure patient safety. In the future, it is recommended to combine individual patient differences with actual clinical scenarios when applying evidence.
Objective To systematically evaluate the difference in leg length discrepancy (LLD) between robot-assisted total hip arthroplasty (THA) and traditional THA. Methods The Cochrane Library, PubMed, Web of Science, EMbase, CNKI, Wanfang, VIP, and CBM databases were searched by computer to collect cohort studies of robot-assisted and traditional THAs from inception to August 11th, 2021. Two researchers independently screened the literature, extracted the data, and evaluated the risk of bias of the included studies. Meta-analysis was performed using RevMan 5.3 software. ResultsA total of 10 high-quality cohort studies were included. The results of Meta-analysis showed that compared with traditional THA, LLD after robot-assisted THA was smaller [MD=−1.64, 95%CI (−2.25, −1.04), P<0.001], Harris scores at 3 and 12 months after operation were higher [MD=1.50, 95%CI (0.44, 2.57), P=0.006; MD=7.60, 95%CI (2.51, 12.68), P=0.003]. However, the operative time was longer [MD=8.36, 95%CI (4.56, 12.17), P<0.000 1], and the postoperative acetabular anteversion angle was larger [MD=1.91, 95%CI (1.43, 2.40), P<0.001]. There was no significant difference in Harris score at 6 months, amnesia index (Forgotten joint score, FJS), postoperative acetabular abduction angle, and incidence of complication between the two groups (P>0.05). Conclusion Robot-assisted THA is superior to traditional THA in postoperative LLD.
Objective To investigate the development trajectories of kinesiophobia and their influencing factors in patients after total hip arthroplasty (THA). Methods Patients after THA from three tertiary hospitals in Wuhan from February to June 2023 were selected by convenience sampling method. The general situation questionnaire, Tampa Scale for Kinesiophobia, Self-Efficacy for Exercise Scale (SEE), Groningen Orthopaedic Social Support Scale, Generalized Anxiety Disorder, Patient Health Questionnaire, and Visual Analogue Scale (VAS) were distributed 1-2 d after surgery (T1), which were used again 1 week (T2), 1 month (T3), and 3 months (T4) after surgery, to evaluate the level of kinesiophobia and the physical and psychological conditions of the patients. The latent category growth model was used to classify the kinesiophobia trajectories of patients after THA, and the influencing factors of different categories of kinesiophobia trajectories were analyzed. Results A total of 263 patients after THA were included. The kinesiophobia trajectories of patients after THA were divided into four potential categories, including 29 cases in the C1 high kinesiophobia persistent group, 41 cases in the C2 medium kinesiophobia improvement group, 131 cases in the C3 low kinesiophobia improvement group, and 62 cases in the C4 no kinesiophobia group. Multicategorical logistic regression analysis showed that compared to the C4 no kinesiophobia group, the influencing factors for the kinesiophobia trajectory in THA patients to develop into the C1 high kinesiophobia persistent group were age [odds ratio (OR)=1.081, 95% confidence interval (CI) (1.025, 1.140)], chronic comorbidities [OR=6.471, 95%CI (1.831, 22.872)], the average SEE score at T1-T4 time points [OR=0.867, 95%CI (0.808, 0.931)], and the average VAS score at T1-T4 time points [OR=7.981, 95%CI (1.718, 37.074)], the influencing factors for the kinesiophobia trajectory to develop into the C2 medium kinesiophobia improvement group were age [OR=1.049, 95%CI (1.010, 1.089)], education level [OR=0.244, 95%CI (0.085, 0.703)], and the average VAS score at T1-T4 time points [OR=8.357, 95%CI (2.300, 30.368)], and the influencing factors for the kinesiophobia trajectory to develop into the C3 low kinesiophobia improvement group were the average SEE score [OR=0.871, 95%CI (0.825, 0.920)] and the average VAS score at T1-T4 time points [OR=4.167, 95%CI (1.544, 11.245)] . Conclusion Kinesiophobia in patients after THA presents different trajectories, and nurses should pay attention to the assessment and intervention of kinesiophobia in patients with advanced age, low education level, chronic diseases, low exercise self-efficacy, and high pain level.
目的 观察强直性脊柱炎髋关节受累强直时行全髋关节置换术的临床疗效。 方法 对2003年1月-2008年1月45例(78髋)强直性脊柱炎患者行全髋关节置换术，其中38例(55髋)进行了平均4.5年（2~7年）的随访。 结果 38例患者术后髋关节功能均明显改善，Harris评分由术前（16.3±1.7）分提高到术后（83.4±4.6）分。髋关节屈曲畸形矫正，55个髋关节总活动度(屈伸、内收、外展、内旋、外旋等6个方向活动总和)由术前（38.7±7.6）°增加至术后（191.2±10.3）°。术后髋关节疼痛消失，膝关节痛、腰骶部疼痛明显改善，步态较术前改善，生活自理。 结论 短期随访全髋关节置换术治疗强直性脊柱炎髋关节受累强直安全、有效。
Objective To compare the effectiveness of internal fixation, hemiarthroplasty, and total hip arthroplasty in the treatment of displaced femoral neck fractures in elderly patients so as to provide the evidence for the selection of therapeutic methods. Methods Between May 2005 and April 2008, 108 elderly patients with displaced femoral neck fractures were treated by internal fixation with compression screw (IF group, n=31), hemiarthroplasty (HA group, n=37), and total hiparthroplasty (THA group, n=40). In IF group, there were 8 males and 23 females with an average age of 73 years (range, 65-80 years); fractures were caused by tumbl ing (25 cases) and traffic accident (6 cases), including 17 cases of Garden type III and 14 cases of Garden type IV; and the time from injury to operation ranged from 8 hours to 13 days with an average of 4.2 days. In HA group, there were 10 males and 27 females with an average age of 74 years (range, 65-80 years); fractures were caused by tumbl ing (29 cases) and traffic accident (8 cases), including 21 cases of Garden type III and 16 cases of Garden type IV; and the time from injury to operation ranged from 1 to 14 days with an average of 4.4 days. In THA group, there were 11 males and 29 females with an average age of 73 years (range, 66-80 years); fractures were caused by tumbl ing (32 cases) and traffic accident (8 cases), including 23 cases of Garden type III and 17 cases of Garden type IV; and the time from injury to operation ranged from 2 to 14 days with an average of 5.6 days. There was no significant difference in general data among 3 groups (P gt; 0.05). Results There were significant differences in operation time and blood loss among 3 groups (P lt; 0.05), and IF group was less than other 2 groups. All patients were followed up 1 year and 4 months to 2 years and 3 months with an average of 1 year and 8 months. In IF group, HA group, and THA group, the rates of early postoperative compl ications were 19.4% (6/31), 8.1% (3/37), and 7.5% (3/40), respectively; the rates of late postoperative compl ications were 29.0% (9/31), 13.5% (5/37), and 7.5% (3/40), respectively; and the reoperation rates were 29.0% (9/31), 10.8% (4/37), and 5.0% (2/40), respectively. The rates of the early postoperative compl ication, late postoperative compl ication, and reoperation rate were significantly higher in IF group than in HA group and THA group (P lt; 0.05), but there was no significant difference between HA group and THA group (P gt; 0.05). The mortal ity rates were 16.1% (5/31), 13.5% (5/37), and 15.0% (6/40) in IF group, HA group, and THA group, respectively; showing no significant difference (P gt; 0.05). According to Harris hip score, the excellent and good rates were 65.4% (17/26), 81.3% (26/32), and 85.3% (29/34) in IF group, HA group, and THA group, respectively; showing significant differences among 3 groups (P lt; 0.05). Conclusion According to patient’s age, l ife expectancy, and general conditions, THA is a reasonable choice for the patients aged 65-80 years with displaced femoral neck fracture.
Objective To compare the difference in the inclination and anteversion angles of the acetabular cup measured by intraoperative robot-assisted total hip arthroplasty (THA) and postoperative X-ray films and CT imaging. MethodsThe clinical data of 54 patients (54 hips) who underwent robot-assisted THA between May 2020 and December 2020 were retrospectively analyzed. Among them, there were 26 males (26 hips) and 28 females (28 hips), with an average age of 58.4 years (range, 39-71 years). The body mass index was 19.2-29.3 kg/m2, with an average of 25.2 kg/m2. All the patients had their first THA, including 31 cases of osteonecrosis of the femoral head, 12 cases of hip arthritis, 8 cases of femoral neck fracture, and 3 cases of developmental dysplasia of the hip. The anteversion and inclination angles of the acetabular cup were obtained through the surgical data in the robot host system. All patients underwent X-ray and CT scan examination within 2-7 days after operation to obtain the postoperative anteversion and inclination angles of the acetabular cup. According to the concept of “Lewinnek safe zone”, the proportion of acetabular in the safe zone intra- and post-operation were compared. ResultsThe operation time was 57.8-89.2 minutes, with an average of 68.3 minutes; the intraoperative blood loss was 125.0-450.0 mL, with an average of 204.8 mL. No adverse events such as dislocation of hip joint and infection occurred during hospitalization. The anteversion angle of acetabular cup was (40.8±0.6)° during operation and (41.2±2.8)° after operation, with no significant difference (t=1.026, P=0.307). The anteversion angle of acetabular cup measured during operation was (17.6±1.4)°, which was significantly smaller than that measured after operation (23.4±3.8)°(t=10.520, P=0.000). According to “Lewinnek safe zone”, 54 hips (100%) were in the safety zone during operation, and 16 hips were out of the safety zone, 38 hips were in the safty zone after operation, the ratio of the hips in the safty zone was 70.4%, showing a significant difference (χ2=18.783, P=0.000). ConclusionRobot-assisted THA can obtain accurate placement of the acetabular cup, but there is a large deviation between the anteversion angle of the acetabular cup in the lateral position during operation and the supine position after operation. Further study is needed to define the intraoperative placement position of the acetabular cup.
ObjectiveTo evaluate the accuracy of using smartphone to measure the angle of acetabular component in total hip arthroplasty (THA). MethodsBetween June 2012 and September 2015, the acetabular abduction and anteversion angles were measured in 50 patients undergoing THA. There were 24 males and 26 females, aged 37 to 83 years (mean, 71 years). The left hip was involved in 22 cases and the right hip in 28 cases. Of 50 patients, 34 suffered from fracture of the femoral neck, and 16 suffered from avascular necrosis of the femoral head. Acetabular dysplasia was excluded in all cases. A smartphone was used to measure the acetabular abduction and anteversion angles during operation; standard Picture Archiving and Communication Systems (PACS) was used to measured the acetabular abduction and anteversion angles on the X-ray film at 1 week after operation. It was defined as positive that the component angle values by PACS measurement were greater than those by the smartphone measurement, whereas as negative. The two measurement methods were compared, and intra-observer variability was assessed by analyzing the intraclass correlation coefficient (ICC), the Mann-Whitney U-test was used to analyze difference. ResultsThe ICC was 0.84 in the acetabular component angles by smartphone and PACS measurement methods. The acetabular component abduction angle was (44.02±1.33)° and the anteversion angle was (17.62±2.20)° by smartphone measurement. The acetabular component abduction angle was (44.74±4.05)° and the anteversion angle was (17.22±5.57)° by PACS measurement. There was no significant difference between two measurement methods (Z=-1.977, P=0.482; Z=-0.368, P=0.713). The acetabular component angle was in the safe zone in 44 cases; and the acetabular component anteversion angle was beyond safe range of 1 to 5°, and the abduction angle was beyond safe range of 1 to 3° in 6 cases. Intra-measurement variability was -21 to +10° for the anteversion angle and -10 to + 9° for the abduction angle, indicating that the acetabular component anteversion angle by smartphone measurement was greater than that by the PACS measurement, and the abduction angle was less than that by PACS measurement. ConclusionSmartphone is a convenient tool to measure the acetabular component angle in THA.