- preoperative anticoagulants:
- consider use of cell saver;
- if patients have a medical condition that requires preoperative anticoagulants, then consider using press fit femoral and acetabular components;
- a prerequisite for cementing femoral stems, is the ability to obtain relative intramedullary canal hemostasis (which may not be possible w/ anticoagulation);
- avascular necrosis:
- note that there is some evidence that patients with AVN may have clotting abnormalities, and therefore these patients may require
more aggressive postoperative anticoagulation;
- reference:
- Total hip arthroplasty in patients with avascular necrosis of the hip. Follow-up observations on cementless and cemented operations.
- coxa vara
- dyplasia
- perthes dz
- SCFE
- protrusio:
- cerebral palsy:
- reference:
- The treatment of the painful hip in cerebral palsy by total hip replacement or hip arthrodesis.
- femoral neck fracture:
- references:
- Treatment of femoral neck fractures with total hip replacement versus cemented and noncemented hemiarthroplasty.
- Secondary total hip replacement after fractures of the femoral neck.
- Displaced subcapital fractures of the femur: a prospective randomized comparison of internal fixation, hemiarthroplasty and total hip replacement.
- Primary total hip replacement for displaced subcapital fractures of the femur.
- Treatment of acute femoral neck fractures with total hip arthroplasty.
- Total hip arthroplasty following failed internal fixation of hip fractures.
- converstion of hemiarthroplasty to THR:
- intertrochanteric frx
- references:
- Total hip arthroplasty for complications of intertrochanteric fracture. A technical note.
- Treatment of unstable intertrochanteric and subtrochanteric fractures in elderly patients. Primary bipolar arthroplasty compared with internal fixation.
- Hip Arthroplasty for Salvage of Failed Treatment of Intertrochanteric Hip Fractures.
- acetabular fracture:
- gaucher's disease
- reference:
- Total hip arthroplasty in Gaucher's disease. Long-term prognosis.
- juvenile rheumatoid arthritis:
- references:
- Total hip arthroplasty in juvenile rheumatoid arthritis. Two to eleven-year results.
- Total hip and knee arthroplasty in juvenile rheumatoid arthritis.
- Total hip arthroplasty in juvenile rheumatoid arthritis.
- rheumatoid arthritis:
- organ transplantation:
- total joint replacement following renal or liver transplantation carries a risk of joint infection of appoximately 19%;
- these patients will have a high relative mortality rate;
- cyclosporine A is associated w/ high risk of infection;
- references:
- Total joint arthroplasty for steroid-induced osteonecrosis in cardiac transplant patients.
- Total hip replacement in the renal transplant recipient.
- Total hip arthroplasty after renal transplantation. Long-term follow-up study and assessment of metabolic bone status.
- renal failure:
- patients receiving dialysis tend to develop early loosening;
- these patients may also be at especially high risk for infection;
- there is some evidence that press fit stems are less likely to develop a bacterial biofilm layer, and therefore will be less prone to infection;
- consider use of antibiotic impregnated cement;
- ref: Blood management experience: relationship between autologous blood donation and transfusion in orthopedic surgery.
- obese patient:
- references:
- Total Hip Arthroplasty without Cement in Obese Patients. A Minimum Two-Year Clinical and Radiographic Follow-up Study.
- A comparison of the perioperative morbidity in total joint arthroplasty in the obese and nonobese patient.
- previous pelvic irradiation:
- may be at higher risk of infection
- affects osteoblastic activity;
- damaging effects occur after 3000 centigray, and bone infarction can occur after 5000 centigray;
- radiographic changes in the femoral head include lytic and sclerotic patching, which can resemble a pagetoid or malignant lesion;
- associated with early loosening (40-50%) at 2 years;
- references:
- Septic arthritis of the hip joint in cervical cancer patients after radiotherapy: three case reports
- Septic arthritis of hip after radiotherapy for carcinoma of cervix
- Septic arthritis of the hip as a late complication of radiation therapy: a case report and review
- sickle cell anemia:
- these patients will require a careful assessment by a hematologist prior to surgery;
- in some cases, exchange transfusion will be indicated;
- reference:
- Total hip arthroplasty in patients who have sickle-cell hemoglobinopathy.
- systemic lupus erythematosus
- reference:
- Hip arthroplasty in patients with systemic lupus erythematosus.
- ankylosing spondylitis
- young patients:
- as reported by Sochart and Porter (1997), at 25 years survival of the femoral compartment was 75% to 89% (depending on the preoperative dx)
and the survival of the acetabular component was 58% to 79% depending on the preop dx;
- all of these patients underwent a formal Charnley type approach (trochanteric osteotomy w/ cemented acetabular and femoral components) and
all were less than 40 years old at the time of surgery;
- references:
- The long term results of Charnley low friction arthroplasty in young patients who have congenital dislocation, degenerative osteoarthritis, or rheumatoid arthritis.
- The fate of cemented total hip arthroplasty in young patients.
- Charnely total hip arthroplasty in patients less than fifty years old. A twenty to twenty five-year follow-up note.
- Results of primary total hip arthroplasty in young patients.
- Total hip arthroplasties in patients less than forty-five years old.
- Total hip replacement in patients younger than 30 years old - a five year follow up study.
- older patients:
- Total Hip Replacement in Patients Eighty Years of Age and Older
- simultaneous bilateral total hip arthroplasty:
- Salvati et al (1978) demonstrated that simultaneous bilateral total hip arthroplasty was no different than two
stage bilateral THA in terms of surgical technique, post-operative care, wound healing, or complications.
- in this study, the duration of anesthesia was greater than in a unilateral procedure by a factor less than two, but total
blood loss was about 1/3 more and the length of hospitalization was significantly longer;
- Agins, et al (1988) followed the first 122 consecutive patients having bilateral, cemented, simultaneous THA
for 9-15 years and felt that long-term clinical results for these patients are similar to those reported for unilateral procedures.
- the radiographic failure rate appeared to be greater in simultaneous bilateral hips performed for osteoarthritis, osteonecrosis, and rheumatoid arthritis.
- Ritter et al (1995) demonstrated success using a cementless bilateral THA technique.
- 92 patients with 184 THAs were followed for 24-77 months.
- HHS scores averaged 94.6. X-ray assessment demonstrated 70% of the femoral components were optimally fixed, 26% were stable, and 4% had failed.
- 96% of acetabular components were optimally fixed with only 6 failures.
- early weight bearing did not appear to adversely affect initial stability and long-term bony ingrowth.
- even patients with stage 1 (no treatment) and 2 (treated with cerclage wires) proximal femur fractures did not
appear to have compromised clinical results.
- patients s/p bilateral uncemented THA may WBAT with crutches or walker immediately post-op without compromise of outcome.
- similar to unilateral THA, failure of femoral and acetabular components was caused by undersizing and malposition.
- references
- Bilateral total hip-replacement arthroplasty in one stage.
- The nine- to fifteen-year follow-up of one-stage bilateral total hip arthroplasty.
- Single-stage, bilateral, cementless total hip arthroplasty.
- ankylosed hip: (see hip arthodesis)
- these patients may be at high risk for heterotopic ossification;
- in the report by Hamadouche M, et al, the authors report the long-term results of THR following a hip fusion;
- 45 consecutive total hip arthroplasties were performed in 45 patients from 1969 through 1993;
- ankylosis of the hip had been spontaneous in twenty patients and postoperative in twenty-five patients;
- mean duration of the ankylosis had been thirty-six years (range, three to sixty-five years);
- mean duration of follow-up was 8.5 years (range, five to twenty-one years);
- hip function was considered to be satisfactory for forty-one (91%) of the 45 patients;
- only factor that was predictive of the final functional result with regard to walking ability was the intraoperative status of the gluteal muscles;
- cumulative survival rate at eight years, with revision as the end point, was 96.7% (95% confidence interval, 90.2% to 100%);
- references:
- Total Hip Arthroplasty for the Treatment of Ankylosed Hips. A five to twenty one-year follow-up study.
- Joint replacement for ankylosed hips