Study suggests THR patients can skip hip precautions
Low-risk patients undergoing a total hip replacement (THR) with a posterior approach can skip the standard hip precautions currently recommended for post-surgical recovery, according to a new study conducted at Hospital for Special Surgery (HSS), in New York. Eliminating standard precautions in this population did not increase the risk of hip dislocation, according to the research presented at the annual meeting of the American Academy of Orthopaedic Surgeons. "The majority of patients we see are low risk; 90 percent of patients probably qualify for minimized precautions," said Peter Sculco, the study's lead author and an orthopedic surgeon specializing in hip and knee replacement at HSS. In the last 10 years, surgeons have started favoring the anterior approach (through the back of the hip) for THR over the posterior approach, because it doesn't involve standard hip precautions. Little data, however, backs the standard hip precautions recommended for the posterior approach. For a posterior approach, standard precautions are not flexing your hip past 90 degrees, not internally rotating your hip more than 10 degrees, using an elevated seat cushion at all times and a grabber for anything that is on the ground, and sleeping on your back for six weeks. In the new study, researchers retrospectively reviewed all patients undergoing a posterior primary uncemented THR from January 2014 to June 2016 at HSS. Surgeons had the choice to put patients on standard precautions or a pose avoidance protocol. A total of 1,311 patients met the inclusion criteria for the pose avoidance cohort, and the minimum follow-up was six weeks. Researchers then matched patients 1:1 in this group to a historical cohort of patients based on age, gender, and body mass index that were treated with standard posterior hip precautions. "Our results suggest that the standard postoperative precautions in patients undergoing [THR] through the posterior approach without known risk factors for instability are unnecessary," the researchers said. "We may find that precautions don't make sense for any of our patients, but we need to look at in a stepwise fashion."
Spine evaluation critical to reduce dislocations in revision THA
Hip replacement surgery is highly successful in restoring mobility, relieving pain and improving quality of life. Even though hip replacement is widely considered one of the most successful surgeries performed today, as with all surgical procedures, complications may occur. Some patients may require revision surgery many years later after the original implant wears out or if they experience hip dislocation. Previously, surgeons were unaware why certain hip replacement patients experience dislocations. However, recently a new assessment tool before revision hip replacement surgery has significantly reduced the rate of recurrent dislocations compared to a standard evaluation. The new tool was created by Jonathan Vigdorchik, and colleagues at Hospital for Special Surgery (HSS) and NYU Langone Orthopedic Hospital. Their study has been accepted for publication in a 2019 issue of The Bone & Joint Journal. "We were very surprised that the dislocation rate was only 3 percent for patients who received the new presurgical assessment compared to 16 percent for those who did not," said Vigdorchik, a hip and knee surgeon at HSS. The researchers also found that without this new evaluation method, 77 percent of inappropriately positioned hip implants would not have been identified. The new classification tool, called the Hip-Spine Classification in Revision Total Hip Arthroplasty (THA), allows surgeons to evaluate spinal function and mobility when planning revision surgery by analyzing a series of X-ray images of the spine and hip, taken from lying down, standing and sitting positions. The tool assigns a simple score to each patient's results: "1" for normal spine alignment or "2" for a loss of the normal curvature at the base of the spine called a flatback deformity; and "A" for normal spine mobility or "B" for a stiff spine. The score informs the approach for revision surgery.
Rti Surgical enrolls first patient in FORTE study
Deerfield, Ill.-based Rti Surgical Holdings Inc. enrolled the first patient in its Clinical Evaluation of Fortilink Interbody Fusion Device with Tetrafuse 3D Technology in Subjects with Degenerative Disc Disease (FORTE) study. FORTE is a prospective, multicenter postmarket evaluation of the safety and performance of the Fortilink-C, -TS, and -L Interbody Fusion (IBF) systems with Tetrafuse 3D Technology. The primary objective of the study is to assess radiographic evidence of cervical and lumbar fusion evaluated by an independent core laboratory at three-months post-surgery (Fortilink-C IBF system) or six-months post-surgery (Fortilink-TS and Fortilink-L IBF systems). "While PEEK implants are widely used, data suggest PEEK has minimal characteristics to enhance implant osseointegration," said Christopher Kepler, at the Rothman Orthopaedic Institute. "The porous Fortilink cages with Tetrafuse 3D technology have the potential to create a favorable environment for bone growth and are radiolucent. I look for the ongoing FORTE study to introduce surgeons to this product and demonstrate the advantages of Fortilink cages over other cage materials." The FORTE study will collect and evaluate real world data on adult subjects with degenerative disc disease (DDD) to explore pain reduction and procedural and long-term performance. The scope of the study is to evaluate 150 patients at up to 20 sites in the U.S. over the next 3.5 years, with evaluations post-procedurally over 24 months for the purposes of study data collection. All subjects are anticipated to be enrolled in Q1 2020. Tetrafuse 3D technology is manufactured under an exclusive license agreement with Oxford Performance Materials Inc., which grants Rti Surgical an exclusive license to its technology for spinal applications in the U.S.