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Total Hip Arthroplasty In Young Patients, Aaron G. Chen

Electronic Thesis and Dissertation Repository

Total hip arthroplasty (THA) is the gold standard in treatment of hip arthritis yet is often avoided in young patients due to concerns of inferior survivorship. We aim to explore the role of THA in young patients and assess whether these historical concerns are valid in contemporary THA by presenting the results of: (1) a systematic review and meta-analysis of the current literature, (2) a retrospective database review, and (3) a retrospective population-based study. We found excellent long-term survivorship with modern THA in young patients, demonstrating greater than 90% revision-free survival up to 15 years. Factors that may increase risk …

Return To Physical Activity Post-Total Knee Arthroplasty And Total Hip Arthroplasty, Bob T. Gao, Ashley Lowndes, Denise M. Connelly

Undergraduate Student Research Internships Conference

No abstract provided.

Reducing Length Of Stay After Total Hip And Knee Arthroplasty: Assessing Cost-Effectiveness, Caregiver Involvement And Surgical Approach, Bryn O. Zomar

Electronic Thesis and Dissertation Repository

Purpose

The overall purpose of this dissertation was to evaluate factors related to reducing length of stay after total hip and knee arthroplasty (THA and TKA).

Methods

Study 1 was a randomized controlled trial (RCT) to investigate the cost-effectiveness of outpatient THA compared to standard overnight stay. Study 2 was a prospective cohort study to assess patient- and caregiver-related factors and how they may relate to caregiver strain and level of assistance when caring for patients undergoing THA and TKA. Finally, Study 3 was a 2x2 factorial RCT to compare the trajectory of early functional recovery between the medial parapatellar …

A Protocol For A Randomized Controlled Trial Investigating The Safety And Cost-Effectiveness Of Outpatient Total Hip Arthroplasty, Bryn O. Zomar, Jacquelyn D. Marsh, Brent A. Lanting, Dianne M. Bryant

Bone and Joint Institute

© 2020 The Author(s). Background: A significant proportion of the overall cost of total hip arthroplasty (THA) results from the inpatient hospital stay following the procedure. Considering the substantial and increasing number of these procedures performed annually, shifting to an outpatient model of care where the patient is discharged home the same day as their surgery represents a potential for significant cost savings. The potential significant impact of an outpatient care model on constrained healthcare budgets and lack of high-quality evidence regarding its effectiveness warrants a rigorous comparative trial. The purpose of this prospective, randomized controlled trial is to evaluate …

Quantifying The Functional And Psychological Outcomes After Periprosthetic Femoral Fracture In Association With Total Hip Arthroplasty In Older Adults, Rifat Islam

Electronic Thesis and Dissertation Repository

This thesis evaluated the functional and psychological outcomes in older adults with a periprosthetic femoral fracture (PPF) after total hip arthroplasty. The first study was a retrospective chart review of 130 people who had PPF surgery to evaluate the functional and psychological outcomes and mortality rate at one-year post-PPF surgery. The second study assessed falls, mobility, balance, and lower extremity strength in ten people at 6-months to 4-years after PPF surgery. In Study 1, people had low scores on function and psychological well-being and the one-year mortality was 15.4%. Participants in Study 2 demonstrated slower gait, reduced mobility, balance and …

A Large-Scale Fifteen-Year Minimum Survivorship Of A Cementless Triple Tapered Femoral Stem, Evangelos Tyrpenou, Amir Khoshbin, Shoaib Mohammad, Emil H. Schemitsch, James P. Waddell, Amit Atrey

Bone and Joint Institute

© 2020 Elsevier Inc. Background: This study reports the long-term outcomes of a metaphyseal fit-and-fill cementless femoral component in total hip arthroplasty (THA) with a follow-up of 15-19 years. Methods: We conducted a retrospective review of 376 consecutive THAs (345 patients), using a triple tapered stem performed between 2000 and 2003 with a view to assessing survivorship and radiological and functional outcomes. Images were assessed for initial alignment, terminal osteolysis, or subsidence, while clinical outcomes were assessed using the St Michael's Hip Score. Results: Forty-five (11.9%) hips were lost to follow-up, 20 (5.31%) had died before our 15-year cutoff follow-up, …

Three Femoral Stem Designs Without Corrosion: A Review Of 2095 Stems, Douglas D.R. Naudie, Silvio Ndoja, Thomas J. Wood, Lyndsay E. Somerville, James L. Howard, Richard W. Mccalden, Steven J. Macdonald, Brent A. Lanting

Bone and Joint Institute

© 2020 Naudie et al. Introduction: Corrosion at the head–neck interface of modular components in total hip arthroplasty (THA) has been reported as a cause of failure of modern total hip replacement implants. While this method of failure has been well described, it remains poorly understood. The purpose of this study is to review the three most commonly used uncemented femoral stems at our institution over the last fifteen years and to correlate any established risk factors with rates of revision, particularly corrosion. Methods: We reviewed 2095 patients from March 2000 to September 2015 who underwent total hip arthroplasty with …

Implementation Of Outpatient Total Joint Arthroplasty In Canada: Where We Are And Where We Need To Go, Bryn O. Zomar, Shannon L. Sibbald, Doug Bickford, James L. Howard, Dianne M. Bryant, Jacquelyn D. Marsh, Brent A. Lanting

Bone and Joint Institute

© 2020 Zomar et al. Total joint arthroplasties (TJA) are successful procedures for the treatment of end-stage hip and knee arthritis. Length of stay in hospitals after these procedures has been steadily decreasing over time, with outpatient procedures (discharge on the same day as surgery) introduced in the US within the last 20 years. Reducing length of stay after TJA can provide cost savings. Centres in Canada have started to utilize outpatient TJA procedures, but we have identified some barriers that may have limited their implementation. We have summarized the current literature for outpatient TJA and discussed potential solutions for …

Comparison Of Functional And Patient-Reported Outcomes Between Direct Anterior And Lateral Surgical Approach One-Year After Total Hip Arthroplasty In A Canadian Population: A Cross-Sectional Study., Susan W. Hunter, Pavlos Bobos, Lyndsay Somerville, James Howard, Edward Vasarhelyi, Brent Lanting

Physical Therapy Publications

Background: From a clinical perspective, it is important to understand the outcomes that occur after total hip arthroplasty (THA) and do these vary with surgical approach. The objective of the study was to compare physical performance-based and patient-report outcomes between the Direct Anterior (DA) and Direct Lateral (DL) surgical approach at one-year after THA surgery.

Methods: We evaluated patients attending their one-year follow-up assessment after primary elective unilateral THA surgery for osteoarthritis of the hip. The Activities-specific Balance Confidence Scale, Falls Risk in Older People in a Community Setting, Timed Up and Go Test, 30-Second Chair Stand Test, Step Test, …

Collared Vs. Collarless Total Hip Arthroplasty In Both Direct Anterior And Direct Lateral Approach Surgery: A Prospective Cohort Comparison Study, Seb Heaven

Electronic Thesis and Dissertation Repository

Total hip arthroplasty (THA) is one of the most successful surgical procedures performed worldwide. Recent advances in implant technology and popularization of the muscle-sparing Direct Anterior (DA) approach to the hip has led to younger patients becoming candidates for hip arthroplasty surgery. Among the many considerations necessary for success in this patient population, implant design plays an important role in determining outcomes.

In this thesis, we prospectively evaluated patients who received a collared or collarless fully hydroxyapatite-coated femoral stem during THA with a standard RSA protocol to assess stem migration patterns following surgery.

Preliminary results indicate that collarless stems subside …

The Impact Of Free Radical Stabilization Techniques On In Vivo Property Changes In Highly Cross-Linked Polyethylene Acetabular Liners, Michael M. Decker .

Electronic Thesis and Dissertation Repository

Highly cross-linked polyethylene (HXLPE) was introduced into total hip arthroplasty (THA) to reduce long-term wear-related complications. However, HXLPE production and in vivo oxidation can alter mechanical behavior. Mechanical failure of HXLPE liners at the implant rim have been reported. The purpose of this thesis is to determine if thermal free radical stabilization techniques used in HXLPE production alter the mechanical properties, physical properties and oxidative stability of liner rims after extended in vivo time.

Retrieved remelted, single annealed and sequentially annealed HXLPE liner rims were mechanically tested using a validated microindentation technique. Oxidation and crystalline phase composition were measured. Results …

Assessing The Risk Of Falling In Adults One-Year After Total Hip Arthroplasty, William Janes

Electronic Thesis and Dissertation Repository

The purpose of this study was to examine falls prevalence, falls risk factors and knowledge of falls in individuals who have undergone a total hip arthroplasty. There were 135 patients examined at their one-year follow-up appointment for total hip arthroplasty. Our primary outcome, falls prevalence and falls circumstances, found a falls prevalence of 21.5% with identical circumstances to that of average community-dwelling older adults. Female sex, number of prescription medications and multiple joint replacements were found to be significantly associated with the occurrence of falls in the previous year. The Falls Risk for Older People in a Community Setting Questionnaire …

Cost Effectiveness Of Primary Total Hip Arthroplasty For Varying Levels Of Bmi, Karthikeyan E. Ponnusamy

Electronic Thesis and Dissertation Repository

The demand for hip arthroplasty is increasing rapidly due to a combination of an aging population as well as an increasing level of obesity in the country. The purpose of this study is to evaluate the risks and benefits of arthroplasty for patients of different obesity classes. The first two parts were to use a systematic review with meta-analysis and retrospective chart review to quantify the risks and benefits in different obesity classes. The third part was to perform a cost-effectiveness analysis to weight the balance between the two. We found that higher obesity classes are at higher risk of …

Mechanical Properties Of Retrieved Highly Cross-Linked Polyethylene Acetabular Liners In Total Hip Arthroplasty, Gurpreet Singh

Electronic Thesis and Dissertation Repository

Highly cross-linked polyethylene (HXLPE) has replaced the conventional ultra-high-molecular-weight-polyethylene (UHMWPE) as the gold standard bearing surface in total hip arthroplasty (THA) due to superior wear characteristics and survivorship. However, HXLPE has demonstrated poorer mechanical properties, in vivo oxidation, and concerns of rim fractures. The purpose of this project was to study the mechanical properties at the rim of retrieved HXLPE acetabular liners.

We developed a simple technique for measurement of hardness at the rim of irradiated, remelted, HXLPE liners of a specific design. The effect of shelf time on mechanical properties of retrieved liners was determined and showed no correlation …

Physical Activity Levels In Total Hip Arthroplasty Comparing The Direct Anterior Approach To The Direct Lateral Approach: A Prospective Cohort Study, Abdulaziz N. Aljurayyan

Electronic Thesis and Dissertation Repository

Total hip arthroplasty (THA) is a cost-effective surgical procedure to treat patients with end-stage hip arthritis with high patient satisfaction. Different surgical approaches to the hip have been used to successfully perform THA. However, the role of these surgical approaches on physical activity and early functional recovery in THA patients remains controversial.

In this thesis, we prospectively evaluated physical activity levels in patients with end-stage hip OA whom are undergoing elective THA. The primary focus was to evaluate the impact of different surgical approaches on physical activity levels as a measure of functional recovery in the immediate postoperative period.

Due …

Inpatient Versus Outpatient Total Hip Arthroplasty, Michael Pollock

Electronic Thesis and Dissertation Repository

We conducted a randomized controlled trial to evaluate patients undergoing a total hip arthroplasty (THA) who were discharged from the hospital either on the day of surgery (outpatient) or were admitted overnight following surgery (inpatient). Our primary outcome was the rate of serious adverse events during the first three months postoperatively. Secondary outcome measures included cost, patient satisfaction, functional outcomes, quality of life and pain. We found no statistically significant difference between the two groups in serious adverse events. We found that outpatient THA was less expensive from the perspectives of the hospital and ministry of health; but the difference …

A Prospective Cohort Study Investigating Functional Recovery In Patients With Osteoarthritis Following Total Hip Arthroplasty Using A Direct Anterior Versus Direct Lateral Surgical Approach, Bryn O. Zomar

Electronic Thesis and Dissertation Repository

We used a quasi-randomized cohort study to investigate whether there are differences in early functional recovery between patients who undergo total hip arthroplasty using a direct anterior (DA) or direct lateral (DL) surgical approach. We found significant differences in favour of the DA group for many functional outcomes including: gait velocity, stride length, operative limb single-limb support, single-limb support symmetry and time to complete the Timed Up and Go. Our primary outcome, gait velocity, was significantly greater in the DA group at discharge, two weeks and six weeks postoperative with adjusted mean differences of 0.12m/s, 0.15m/s and 0.17m/s respectively. There …

Surgical Approach In Total Hip Arthroplasty: Patient Outcomes And Impact On Costs, Stephen M. Petis

Electronic Thesis and Dissertation Repository

Total hip arthroplasty is often renowned as one of the most important surgical advances of the past century. Orthopaedic surgeons must choose a surgical approach to gain access to the hip joint in order to perform the reconstruction. There is debate in the literature as to which surgical approach optimizes patient outcomes, minimizes complications, and reduces costs to hospitals as a high volume procedure.

In the current studies, patient reported outcomes were compared at short-term follow-up using a prospective study design across the anterior, posterior, and lateral approach. A micro-costing method was used to acquire costs related to each procedure, …

Elderly Patients’ Ability To Recall Preoperative Health Status Six Weeks Following Total Hip Arthroplasty., Jacquelyn Marsh

Digitized Theses

We investigated patients’ ability to accurately recall their preoperative quality of life following hip replacement surgery. We randomized consecutive patients aged 55 years or older into two groups. At each assessment patients completed self-report questionnaires (group 1: 4-weeks preoperatively, day-of-surgery, 6-weeks and 3-months postoperatively, group 2: 6- weeks and 3 months postoperatively). At 6 weeks postoperatively, patients completed questionnaires based on their recollection of preoperative health status. 174 patients (mean age 71 years) participated. Agreement between actual and recalled data was excellent for disease-specific questionnaires (ICC range 0.86 to 0.88), and moderate for the generic health measures (ICC range 0.48 …