Symptomatic cobalt toxicity from a failed total
hip replacement is a rare but devastating complication. It has been reported
following revision of fractured ceramic components, as well as in
patients with failed metal-on-metal articulations. Potential clinical
findings include fatigue, weakness, hypothyroidism, cardiomyopathy,
polycythaemia, visual and hearing impairment, cognitive dysfunction,
and neuropathy. We report a case of an otherwise healthy 46-year-old
patient, who developed progressively worsening symptoms of cobalt
toxicity beginning approximately six months following synovectomy
and revision of a fractured ceramic-on-ceramic total hip replacement
to a metal-on-polyethylene bearing. The whole blood cobalt levels
peaked at 6521 µg/l. The patient died from cobalt-induced cardiomyopathy.
Implant retrieval analysis confirmed a loss of 28.3 g mass of the
cobalt–chromium femoral head as a result of severe abrasive wear
by ceramic particles embedded in the revision polyethylene liner.
Autopsy findings were consistent with heavy metal-induced cardiomyopathy. We recommend using new ceramics at revision to minimise the risk
of wear-related cobalt toxicity following breakage of ceramic components. Cite this article:
Periprosthetic joint infection (PJI) in total hip arthroplasty in the elderly may occur but has been subject to limited investigation. This study analyzed infection characteristics, surgical outcomes, and perioperative complications of octogenarians undergoing treatment for PJI in a single university-based institution. We identified 33 patients who underwent treatment for PJIs of the hip between January 2010 and December 2019 using our institutional joint registry. Mean age was 82 years (80 to 90), with 19 females (57%) and a mean BMI of 26 kg/m2 (17 to 41). Mean American Society of Anesthesiologists (ASA) grade was 3 (1 to 4) and mean Charlson Comorbidity Index was 6 (4 to 10). Leading pathogens included coagulase-negative Staphylococci (45%) and Aims
Methods
The Patient-Reported Outcomes Measurement Information System (PROMIS) has demonstrated faster administration, lower burden of data capture and reduced floor and ceiling effects compared to traditional Patient Reported Outcomes Measurements (PROMs). We investigated the suitability of PROMIS Mobility score in assessing physical function in the sequelae of childhood hip disease. In all, 266 adolscents (aged ≥ 12 years) and adults were identified with a prior diagnosis of childhood hip disease (either Perthes’ disease (n = 232 (87.2%)) or Slipped Capital Femoral Epiphysis (n = 34 (12.8%)) with a mean age of 27.73 years (SD 12.24). Participants completed the PROMIS Mobility Computer Adaptive Test, the Non-Arthritic Hip Score (NAHS), EuroQol five-dimension five-level questionnaire, and the Numeric Pain Rating Scale. We investigated the correlation between the PROMIS Mobility and other tools to assess use in this population and any clustering of outcome scores.Aims
Methods
To develop and externally validate a parsimonious statistical prediction model of 90-day mortality after elective total hip arthroplasty (THA), and to provide a web calculator for clinical usage. We included 53,099 patients with cemented THA due to osteoarthritis from the Swedish Hip Arthroplasty Registry for model derivation and internal validation, as well as 125,428 patients from England and Wales recorded in the National Joint Register for England, Wales, Northern Ireland, the Isle of Man, and the States of Guernsey (NJR) for external model validation. A model was developed using a bootstrap ranking procedure with a least absolute shrinkage and selection operator (LASSO) logistic regression model combined with piecewise linear regression. Discriminative ability was evaluated by the area under the receiver operating characteristic curve (AUC). Calibration belt plots were used to assess model calibration.Aims
Methods
Our aim was to examine the Elixhauser and Charlson comorbidity indices, based on administrative data available before surgery, and to establish their predictive value for mortality for patients who underwent hip arthroplasty in the management of a femoral neck fracture. We analyzed data from 42 354 patients from the Swedish Hip Arthroplasty Register between 2005 and 2012. Only the first operated hip was included for patients with bilateral arthroplasty. We obtained comorbidity data by linkage from the Swedish National Patient Register, as well as death dates from the national population register. We used univariable Cox regression models to predict mortality based on the comorbidity indices, as well as multivariable regression with age and gender. Predictive power was evaluated by a concordance index, ranging from 0.5 to 1 (with the higher value being the better predictive power). A concordance index less than 0.7 was considered poor. We used bootstrapping for internal validation of the results.Aims
Patients and Methods
Despite declining frequency of blood transfusion and electrolyte supplementation following total joint arthroplasty, postoperative blood analyses are still routinely ordered for these patients. This study aimed to determine the rate of blood transfusion and electrolyte restoration in arthroplasty patients treated with a perioperative blood conservation protocol and to identify risk factors that would predict the need for transfusion and electrolyte supplementation. Patients undergoing primary total joint arthroplasty of the hip or knee between July 2016 and February 2017 at a single institution were included in the study. Standard preoperative and postoperative laboratory data were collected and reviewed retrospectively. A uniform blood conservation programme was implemented for all patients. Need for blood transfusion or potassium supplementation was determined through a coordinated decision by the care team. Rates of transfusion and supplementation were observed, and patient risk factors were noted.Aims
Patients and Methods
Many case reports and small studies have suggested that cobalt
ions are a potential cause of cardiac complications, specifically
cardiomyopathy, after metal-on-metal (MoM) total hip arthroplasty
(THA). The impact of metal ions on the incidence of cardiac disease
after MoM THA has not been evaluated in large studies. The aim of
this study was to compare the rate of onset of new cardiac symptoms
in patients who have undergone MoM THA with those who have undergone
metal-on-polyethylene (MoP) THA. Data were extracted from the Standard Analytics Files database
for patients who underwent MoM THA between 2005 and 2012. Bearing
surface was selected using International Classification of Diseases
ninth revision codes. Patients with a minimum five-year follow-up
were selected. An age and gender-matched cohort of patients who underwent
MoP THA served as a comparison group. New diagnoses of cardiac disease
were collected during the follow-up period. Comorbidities and demographics
were identified and routine descriptive statistics were used.Aims
Patients and Methods
While an increasing amount of arthroplasty articles
report comorbidity measures, none have been validated for outcomes.
In this study, we compared commonly used International Classification
of Diseases-based comorbidity measures with re-operation rates after
total hip replacement (THR). Scores used included the Charlson,
the Royal College of Surgeons Charlson, and the Elixhauser comorbidity
score. We identified a nationwide cohort of 134 423 THRs from the
Swedish Hip Arthroplasty Register. Re-operations were registered
post-operatively for up to 12 years. The hazard ratio was estimated
by Cox’s proportional hazards regression, and we used C-statistics
to assess each measure’s ability to predict re-operation. Confounding
variables were age, gender, type of implant fixation, hospital category,
hospital implant volume and year of surgery. In the first two years only the Elixhauser score showed any significant
relationship with increased risk of re-operation, with increased
scores for both one to two and three or more comorbidities. However,
the predictive C-statistic in this period for the Elixhauser score
was poor (0.52). None of the measures proved to be of any value between
two and 12 years. They might be of value in large cohort or registry
studies, but not for the individual patient. Cite this article:
Fracture of a ceramic component in total hip
replacement is a rare but potentially catastrophic complication.
The incidence is likely to increase as the use of ceramics becomes
more widespread. We describe such a case, which illustrates how
inadequate initial management will lead to further morbidity and
require additional surgery. We present the case as a warning that
fracture of a ceramic component should be revised to another ceramic-on-ceramic
articulation in order to minimise the risk of further catastrophic
wear.
