The purpose of this modified Delphi study was to obtain consensus on wound closure (including best practices for each tissue layer of closure) and dressing management in total hip arthroplasty (THA), using an evidence-based approach.

The Delphi panel included 20 orthopedic surgeons from Europe and North America. Eighteen statements were identified (14 specific to THA and 4 relating to both THA and total knee arthroplasty) using a targeted literature review. Consensus was developed on the statements with up to three rounds of anonymous voting per topic. Panelists ranked their agreement with each statement on a five-point Likert scale. An a priori threshold of 75% was required for consensus.

In Round 1, 15 of 18 statements achieved consensus via a structured electronic questionnaire. In Round 2, the 3 statements that did not achieve consensus were revised during a virtual face to face meeting. An additional 2 statements were edited for clarity. In Round 3, the 5 revised statements achieved consensus via a structured electronic questionnaire. Wound closure related interventions that were recommended for use in THA included: 1) barbed sutures over non-barbed sutures (shorter closing times and overall cost savings); 2) subcuticular sutures over skin staples (lower risk of infections and higher patient preference); 3) mesh-adhesives over silver-impregnated dressings (lower rate of wound complications); 4) negative pressure wound therapy over other dressings (lower wound complications and reoperations and fewer dressing changes); 5) triclosan coated sutures (lower risk of surgical site infection).

Using a modified Delphi approach, a panel of 20 orthopedic surgeons achieved consensus on 18 statements pertaining to multi-layer wound closure and dressing management in THA. This study forms the basis for identifying critical evidence gaps within wound management to help reduce variability in outcomes during THA.

Introduction

The purpose of the study was to determine access to and, ability to use telemedicine technology in an adult hip and knee reconstruction patient population and we seek to understand these patients' perceived benefits, risks and preferences of telemedicine.

To assess clinical outcomes, metal ion levels, and periprosthetic femoral bone mineral density (BMD) in young, active patients receiving a modular dual mobility acetabulum and recently introduced titanium, proximally coated, tapered femoral stem design.

This was a prospective study of patients  65 years of age, with a BMI  35 kg/m², and UCLA activity score > 6 who received a modular cobalt chrome acetabular liner, highly cross-linked polyethylene mobile bearing, and cementless titanium femoral stem for their primary THA. Patients with a history of renal disease and metal hardware elsewhere in the body were excluded. All patients had a minimum of 2-year clinical follow-up.

Patient reported outcome measures, whole blood metal ion levels (ug/L), and periprosthetic femur BMD were measured at baseline and at 1- and 2-years postoperatively.

43 patients (30 male, 13 female; mean age 52.6 ± 6.5 years) were enrolled. Harris Hip Scores improved from 54.1 ± 20.5 to 91.2 ± 10.8 at 2 years postoperatively (p<0.001). All patients had radiographically well-fixed components, no patients have sustained an instability event, and no patients have required a return to the operating room or revision procedure.

Mean cobalt levels increased from 0.065 ± 0.03 ug/L preoperatively to 0.30 ± 0.51 at 1-year postoperatively (p=0.01), but decreased at 2 years postoperatively to 0.16 ± 0.23 (p=0.2) (Table 1). Four patients (9.3%) had a cobalt level outside the reference range (0.03 to 0.29ug/L) at 2 years postoperatively with values from 0.32 to 0.94. None were symptomatic

The mean femoral BMD ratio was maintained in Gruen zones 2 thru 7 at both 1- and 2-years postoperatively using this stem design (Table 2). At 2 years postoperatively, BMD in the medial calcar was 101.5% of the baseline value.

Use of a modular dual mobility prosthesis and cementless, tapered femoral stem has shown encouraging results in young, active patients undergoing primary THA. Elevation in mean cobalt levels and the presence of four patients outside the reference range at 2 years postoperatively demonstrates the necessity of continued surveillance in this cohort.

For any figures or tables, please contact authors directly: barrackr@wustl.edu

Surface replacement arthroplasty (SRA) has been proposed as a viable option for the treatment of osteoarthritis in young, active patients. Positive results of the Birmingham Hip Resurfacing (BHR) in select patient groups have been described in international series and registry data. We report 5–10 year U.S. follow-up for the BHR at our high volume institution.

314 patients (361 hips) between 2006–2011 underwent BHR at our institution and agreed to participate in research. Demographic features, modified Harris Hip Score, UCLA Activity Score, and satisfaction were recorded for patients with minimum 5-year follow-up (90%). Radiographs were evaluated for implant position and “at risk” signs. Complications, reoperations, and revisions were investigated.

Mean modified Harris Hip and UCLA scores significantly improved postoperatively to scores of 89.96 and 7.90 (p < 0.001), respectively. Kaplan-Meier estimated survival for all-cause revision was 96.7% [95% CI 94.7 – 98.7%] at 5 years and 91.5% [95% CI 85.3 – 97.6%] at 10 years. Estimated survival for aseptic revision in males less than 60 years old with a primary diagnosis of osteoarthritis was 99.5% [95% CI 98.7 – 100%] at 5 years and 98.8% [95% CI 97.0 – 100%] at 10 years. 14 patients required revision, including 5 revisions for adverse local tissue reaction.

Our study demonstrated excellent survivorship and clinical outcomes at 5–10 year follow up for the BHR. These results mirror other series and registry data published outside of the United States. Continued long-term follow-up and additional studies are necessary to validate the long-term safety and outcomes of the BHR, especially in young active arthroplasty patients.