Introduction: Dual mobility implants have been successful in reducing postoperative hip dislocation but mid-term results of cup migration and polyethylene wear are missing in the literature.... Show moreIntroduction: Dual mobility implants have been successful in reducing postoperative hip dislocation but mid-term results of cup migration and polyethylene wear are missing in the literature. Therefore, we measured migration and wear at 5-year follow-up using radiostereometric analysis (RSA). Materials and methods: A cohort of 44 patients (mean age 73, 36 female) with heterogeneous indications for hip arthroplasty but all with a high risk of hip dislocation received total hip replacement (THA) with The Anatomic Dual Mobility X3 monoblock acetabular construct and a highly crosslinked polyethylene liner.RSA images and Oxford Hip Scores were obtained perioperatively and 1, 2, and 5 years postoperatively. Cup migration and polyethylene wear were calculated using RSA. Results: Mean 2-year proximal cup translation was 0.26 mm (95% CI 0.17; 0.36). Proximal cup translation was stable from 1- to 5-year follow-up. Mean 2-year cup inclination (z-rotation) was 0.23 degrees (95% CI - 0.22; 0.68) and was greater in patients with osteoporosis compared to patients without osteoporosis (p = 0.04). Using 1-year follow-up as baseline, the 3D polyethylene wear rate was 0.07 mm/year (0.05; 0.10).Oxford hip scores improved 19 (95% CI 14; 24) points from mean 21 (range 4; 39) at baseline, to 40 (9; 48) 2 years postoperatively. There were no progressive radiolucent lines > 1 mm. There was 1 revision for offset correction. Conclusions: Anatomic Dual Mobility monoblock cups were well-fixed, the polyethylene wear rate was low, and the clinical outcomes were good until 5-year follow-up suggesting good implant survival in patients of different age groups and with heterogeneous indications for THA. Show less
BACKGROUNDTwo-stage revision arthroplasty with an antibiotic-loaded spacer is the treatment of choice in chronically infected total hip arthroplasties. Interval spacers can be functional... Show moreBACKGROUNDTwo-stage revision arthroplasty with an antibiotic-loaded spacer is the treatment of choice in chronically infected total hip arthroplasties. Interval spacers can be functional articulating or prefabricated. Functional results of these spacers have scarcely been reported.AIMTo compare retrospectively the patient reported outcome and infection eradication rate after two-stage revision arthroplasty of the hip with the use of a functional articulating or prefabricated spacer.METHODSAll patients with two-stage revision of a hip prosthesis at our hospital between 2003 and 2016 were included in this retrospective cohort study. Patients were divided into two groups; patients treated with a functional articulating spacer or with a prefabricated spacer. Patients completed the Hip Osteoarthritis Outcome Score and the EQ-5D-3L (EQ-5D) and the EQ-5D quality of life thermometer (EQ-VAS) scores. Primary outcomes were patient reported outcome and infection eradication after two-stage revision. The results of both groups were compared to the patient acceptable symptom state for primary arthroplasty of the hip. Secondary outcomes were complications during spacer treatment and at final follow-up. Descriptive statistics, mean and range are used to represent the demographics of the patients. For numerical variables, students' t-tests were used to assess the level of significance for differences between the groups, with 95% confidence intervals; for binary outcome, we used Fisher's exact test.RESULTSWe consecutively treated 55 patients with a prefabricated spacer and 15 patients with a functional articulating spacer of the hip. The infection eradication rates for functional articulating and prefabricated spacers were 93% and 78%, respectively (P > 0.05). With respect to the functional outcome, the Hip Osteoarthritis Outcome Score (HOOS) and its subscores (all P < 0.01), the EQ-5D (P < 0.01) and the EQ-VAS scores (P < 0.05) were all significantly better for patients successfully treated with a functional articulating spacer. More patients in the functional articulating spacer group reached the patient acceptable symptom state for the HOOS pain, HOOS quality of life and EQ-VAS. The number of patients with a spacer dislocation was not significantly different for the functional articulating or prefabricated spacer group (P > 0.05). However, the number of dislocations per patient experiencing a dislocation was significantly higher for patients with a prefabricated spacer (P < 0.01).CONCLUSIONFunctional articulating spacers lead to improved patient reported functional outcome and less perioperative complications after two-stage revision arthroplasty of an infected total hip prosthesis, while maintaining a similar infection eradication rate compared to prefabricated spacers. Show less
We studied the prevention and treatment of prosthetic joint infections. This topic is of interest because the number of annually performed arthroplasty procedures is rising worldwide.Antibiotics... Show moreWe studied the prevention and treatment of prosthetic joint infections. This topic is of interest because the number of annually performed arthroplasty procedures is rising worldwide.Antibiotics are prophylactically administered to arthroplasty patients, but to date it remained unclear how many doses of prophylaxis provided the best protection. 90% of hospitals provide multiple doses, while 10% of hospitals administer a single dose prophylaxis.Our study shows that, with 242.179 included patients from the LROI database, there seems to be no difference in the risk of complete revision for infection between single dose and multiple dose prophylaxis.We have also evaluated several treatment options for two-stage revision of infected hip and knee prostheses.The use of a functional articulating antibiotic loaded spacer leads to a comparable infection eradication rate, improved patient reported outcome and less complications compared to a prefabricated standard spacer Show less
BACKGROUND Periprosthetic joint infections (PJIs) are frequently caused by coagulase-negative Staphylococci (CoNS), which is known to be a hard-to-treat microorganism. Antibiotic resistance among... Show moreBACKGROUND Periprosthetic joint infections (PJIs) are frequently caused by coagulase-negative Staphylococci (CoNS), which is known to be a hard-to-treat microorganism. Antibiotic resistance among causative pathogens of PJI is increasing. Two-stage revision is the favoured treatment for chronic CoNS infection of a hip or knee prosthesis. We hypothesised that the infection eradication rate of our treatment protocol for two-stage revision surgery for CoNS PJI of the hip and knee would be comparable to eradication rates described in the literature. AIM To evaluate the infection eradication rate of two-stage revision arthroplasty for PJI caused by CoNS. METHODS All patients treated with two-stage revision of a hip or knee prosthesis were retrospectively included. Patients with CoNS infection were included in the study, including polymicrobial cases. Primary outcome was infection eradication at final follow-up. RESULTS Forty-four patients were included in the study. Twenty-nine patients were treated for PJI of the hip and fifteen for PJI of the knee. At final follow-up after a mean of 37 mo, recurrent or persistent infection was present in eleven patients. CONCLUSION PJI with CoNS can be a difficult to treat infection due to increasing antibiotic resistance. Infection eradication rate of 70%-80% may be achieved. Show less
This thesis described the stepwise development and execution of a de-implementation strategy to reduce the use of the low-value blood salvage techniques and preoperative treatment with... Show moreThis thesis described the stepwise development and execution of a de-implementation strategy to reduce the use of the low-value blood salvage techniques and preoperative treatment with erythropoietin in primary elective hip and knee arthroplasty. The implementation model of Grol was used to develop de-implementation goals, to identify barriers that hinder de-implementation, to develop a de-implementation strategy and to execute and evaluate the developed de-implementation strategy. The intention of de-implementing low-value patient blood-management techniques was to reduce costs and improve the quality of healthcare. However, this thesis showed that a tailored de-implementation strategy is not necessarily successful. When evaluating the effects we found that in the group of hospitals that were exposed to the de-implementation strategy the reduction in blood salvage techniques and erythropoietin was comparable to the control group hospitals. We did found that the reduction in blood salvage techniques was associated with the increased use of local analgesic infiltration and the use of tranexamic acid, an antifibrinolytic drug to prevent excessive blood loss. We found that the substitution of low-value care might contribute to de-implementation of this low-value care. In future de-implementation efforts this can be used to improve the results. Show less
Hip replacements using a metal-on-metal (MoM) bearing surface were reintroduced with the promise of low wear rates and easy revision in case of the resurfacing design. Although initially mid-term... Show moreHip replacements using a metal-on-metal (MoM) bearing surface were reintroduced with the promise of low wear rates and easy revision in case of the resurfacing design. Although initially mid-term results were promising, local adverse soft tissure reactions to metal debris were detected around the year 2008. We studied the prevalence of these adverse reactions, known as pseudotumors, and analysed how well these could be identified with Metal Artefact Reducing Sequence Magnetic Resonance Imaging (MARS-MRI). We also studied the natural development of these pseudotumors and evaluated if measuring pseudotumor size in a clinical setting waa accurate. Based on metal ion analysis, symptoms and MARS-MRI scanning of a large cohort of MoM hip resurfacing patients, we proposed a treatment flow chart for these patients. Show less
