Hip international : the journal of clinical and experimental research on hip pathology and therapy
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Comparative Study
Metal ion levels and revision rates in metal-on-metal hip resurfacing arthroplasty: a comparative study.
Metal-on-metal (MoM) bearings in hip surgery are related to increased blood levels of metal ions. The nature of the relationship between ion levels and failure is still not fully understood. This study compares three cohorts of patients, 120 patients in each cohort, treated with a hip resurfacing arthroplasty, grouped by brand and diameter of femoral component on average four years postoperatively: Birmingham Hip Resurfacing ≥50 mm, Durom resurfacing ≥50 mm and Durom resurfacing <50 mm. ⋯ When similar ion levels were reported for BHR and small Durom the latter had significantly higher revision rates. This suggests ion levels do not absolutely predict the rate of HRA failure. Since MoM generation of metal ions is not the sole reason of failure, regular clinical and radiographic follow-up should also be in place for patients with these joints.
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Infection is a devastating complication of total hip arthroplasty (THA). Risk factors have been recognised and prevention is possible. ⋯ Available data in the current literature is of poor quality and there is a lack of data comparing different techniques. Referral of patients to dedicated departments with the appropriate facilities may be more appropriate.
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Randomized Controlled Trial
Single tranexamic acid dose to reduce perioperative morbidity in primary total hip replacement: a randomised clinical trial.
Although prophylactic tranexamic acid (TXA) is a safe, low-cost option to reduce bleeding in patients undergoing total hip replacement (THR), its optimal dose and duration is unknown. We compared the safety and effectiveness of TXA given as either a single injection or continuous infusion in THR patients, hypothesising that a second TXA dose would not offer any clinical advantages over the single injection. ⋯ The 30 mg/kg TXA single shot was as safe as continuous infusion. As it is also less cumbersome, we recommend it as part of routine care in THR patients.
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In total hip replacement surgeons can choose from a various number of approaches, from posterior, lateral or direct anterior. Excellent results can be achieved with all approaches and there is no evidence for the use of a specific approach. Minimally invasive operating techniques might further contribute to that success. Early rehabilitation and functional outcome can be improved by the introduction of evidence based clinical pathways irrespective to the used approach.
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Total hip replacement is the treatment of choice for the patient suffering from end-stage hip osteoarthritis. Excellent long-term results have been published. In the presence of deformities due to congenital hip dislocation, total hip replacement is, in most of the cases, a difficult task, since the technique of performing such an operation is demanding and the results could vary. This paper presents our experience and preferred strategies focusing on challenges and surgical techniques associated with reconstructing the dysplastic hip.