Thesis (doctoral)--Lund University, 1994. / Added t.p. with thesis statement inserted.

Thesis (M.S.)--Indiana University, 2002. / Includes bibliographical references (leaves 20-21).

This report presents a master thesis on 3D visualization for pre-operation planning of orthopedic surgery done for Sectra Medical Systems AB. The focus is on visualizing clinically relevant data for planning a Total Hip Replacement (THR). The thesis includes a pre-study and the implementation of a prototype using the Sectra IDS7 workstation.

Ce travail porte sur le comportement mécanique de la cupule acétabulaire de prothèse de hanche dans le milieu osseux. Un intérêt particulier est porté au développement d'une méthode d'analyse de signaux d'impacts visant à caractériser les propriétés biomécaniques de l'interface entre la cupule acétabulaire et l'os périacétabulaire. Dans un premier temps, l'insertion de la cupule par impacts reproductibles est étudiée expérimentalement. Il est démontré que les signaux de force des impacts sont sensibles aux conditions d'insertion de l'implant acétabulaire. Un modèle analytique empirique considérant une configuration poinçon plat est utilisé pour modéliser les conditions de contact entre l'os et l'implant. La stabilité de l'implant acétabulaire est ensuite évaluée dans différentes configurations osseuses. Une analyse des signaux d'impact permet d'estimer cette stabilité. Dans un deuxième temps, un marteau est instrumenté avec un capteur de force et utilisé pour enregistrer les signaux de force des impacts. La méthode d'analyse des signaux est adaptée et permet d'évaluer la stabilité primaire de l'implant acétabulaire. Pour permettre le transfert de l'approche vers une application clinique, une étude cadavérique est ensuite réalisée. Il est montré que la méthode est utile pour prévoir la stabilité primaire de la cupule acétabulaire dans des hanches cadavériques. Le troisième volet de cette thèse est composé d'études de simulation numérique pour mieux comprendre le comportement mécanique de la cupule acétabulaire. Un modèle est développé pour investiguer les procédés dynamiques ayant lieu lors de l'impaction de la cupule acétabulaire et pour estimer le potentiel de la méthode d'analyse d'impacts pour déterminer les conditions d'insertion de la cupule acétabulaire. Différentes conditions d'interférence et différentes vitesses d'impaction sont considérées. Il est montré que les signaux d'impacts sont sensibles à surface de contact entre l'os et l'implant. Un second modèle étudie l'influence des propriétés mécaniques de l'os périacétabulaire au comportement mécanique de la cupule / While hip arthroplasty has become a common surgical procedure, failures still happen due to inadequate mechanical behavior of the prosthesis. This work studies the behavior of the acetabular cup (AC) implant within bone tissue and develops an impact analysis method to assess its insertion conditions. In the first part, AC insertion within bovine bone tissue are performed using reproducible mass drops. The impact force signals are recorded and are shown to be sensitive to insertion conditions of the AC implant. An empirical analytical model considering a flat punch configuration to model the bone-implant contact conditions is used to understand the variations of the signals. The AC implant tangential stability is further evaluated for different bone cavity configurations. An impact signals analysis enables to assess the AC implant primary stability in vitro. In the second part, a hammeris instrumented with a force sensor and is used to record the impacts force signals. The impact signals analysis allows to evaluate the AC implant stability. In order to transfer the approach to a situation closer to the clinical application, tests are then realized with cadaveric hips. The method is found useful to predict the AC implant stability ex vivo. In the third part, finite element models are developed to improve the understanding of the AC implant mechanical behavior within bone tissue. A model investigates the dynamic processes occurring during the AC implant impaction. The impact signals analysis allows to evaluate the bone implant contact area. A second model studies the influence of the peri-implant anisotropic bone mechanical properties on the mechanical behavior of the AC implant. By coupling experimental and numerical approaches, this work provides new features concerning the mechanical processes responsible for the AC implant stability. Moreover, the feasibility of a medical device that could assess peroperatively the AC implant stability is proved

Introduction Alternative medicine has been employed in the treatment of several diseases. Listening to music after minor surgery has been beneficial regarding pain control. Aim The aim of this study was to determine the effect of music on intravenous patient-controlled (PCA) morphine consumption after hip or knee replacement. Methods This was an open label, randomized controlled trial. Forty (twenty per group) consecutive patients scheduled for arthroplasty were included. A standardized anaesthetic technique was used, consisting of propofol, sufentanil, rocuronium, and isoflurane. Postoperatively patients were allocated to one of two groups: Group M listened to music during the first 24 postoperative hours, while Group C did not listen to music. The PCA dose consisted of morphine 1.5 mg and droperidol 83.3 ìg with a lockout time on seven minutes. Rescue doses of morphine 15 ìg/kg intravenously every one-minute until the patient was pain free was administered by a nurse according to a visual descriptive pain score. Both groups received paracetamol 1 g intravenously six hourly. After 24 hours the total (PCA plus rescue) morphine dose was recorded. Morphine consumption in groups was analysed using the one-sided Student two-sample t test. The significance level was 0.05 and the power 0.95. Results Neither the PCA usage (p = 0.4138) nor the rescue doses of morphine (p = 0.9163) differed significantly between the groups. Conclusion Although a statistical difference could not be shown in this study, music during the postoperative period does offer a pleasant distraction from this overall undesirable experience. AFRIKAANS : Inleiding Alternatiewe medisyne word dikwels gebruik vir die hantering van verskeie siektetoestande. Daar is al aangetoon dat deur na musiek te luister voordelig is na geringer chirurgie ten opsigte van pynbeheer. Doel Die studie het ten doel gehad om die effek van musiek na heup- of knievervanging op intraveneuse pasiënt- beheerde morfienverbruik (PBA) te bepaal. Metodes Hierdie was ʼn enkel-blinde gerandomiseerde gekontroleerde studie. Veertig (twintig per groep) agtereenvolgende pasiënte geskeduleer vir gewrigsvervanging is by die studie ingesluit. ʼn Standaard narkosetegniek is gebruik, bestaande uit propofol, sufentaniel, rokuronium en isofluraan. Die pasiënte is postoperatief aan een van twee groepe toegedeel: Groep M het gedurende die eerste postoperatiewe 24 uur na musiek geluister terwyl Groep K nie na musiek geluister het nie. Die PBA-dosis het bestaan uit morfien 1.5 mg en droperidol 83.3 μg met ‘n uitsluitingstyd van sewe minute. Addisionele dosisse morfien is toegelaat. Dit is intraveneus deur die verpleegkundige volgens ʼn verbaal beskrewe pynskaal toegedien en het bestaan uit 15 μg/kg IV elke een minuut totdat die pasiënt volgens haar oordeel pynvry was. Beide groepe het ook sesuurliks parasetamol 1 g intraveneus ontvang. Vier en twintig uur na die operasie is die totale morfienverbruik (PBA plus bykomende dosisse) aangeteken. Die morfienverbruik in groepe is geanaliseer met behulp van die eenkantige tweesteekproef-t-toets. Die beduidenheidspeil was 0.05 en die onderskeidingsvermoë 0.90. Resultate Daar was tussen groepe geen beduidende verskil ten opsigte van die PBA (p = 0.4138) en die bykomende dosisse (p = 0.9613) morfien nie. Gevolgtrekking Alhoewel daar geen statisties beduidende verskil tussen groepe aangetoon is nie, bied musiek gedurende die postoperatiewe fase ʼn aangename afleiding van die andersins onaangename ondervinding. Copyright / Dissertation (MMed)--University of Pretoria, 2010. / Anaesthesiology / unrestricted

Le nombre de prothèses totales de hanche (PTH) posées en France est en forte augmentation en France depuis plusieurs années : +10% en 4 ans, avec plus de 100 000 poses en 2013. Cette augmentation est liée à la fois au vieillissement de la population et à l’élargissement de la patientèle implantée : les PTH sont posées chez des patients plus jeunes et actifs, et à l’autre extrême, chez des patients de plus en plus âgés, présentant davantage de comorbidités Le volume de pose de PTH, leurs caractéristiques, leur contexte de pose et la population implantée n’ont pas encore été décrits de manière exhaustive en France, contrairement aux pays disposant de registre d’arthroplastie (les pays nordiques et anglo-saxons). L'objectif de ma thèse était d'étudier quels sont les facteurs pronostics de la survie des PTH. La recherche portait sur les caractéristiques des implants, les caractéristiques des patients et les caractéristiques des séjours d’implantation. Les bases de données utilisées sont celles du SNIIRAM de 2006 à 2016, comprenant les remboursements de soins en ville (de 2006 à 2016) et à l’hôpital (de 2006 à 2015) des assurés affiliés à un régime obligatoire de l’assurance maladie. Environ 100 000 PTH sont implantées chaque année en France. La cohorte globale des patients porteurs de prothèse de hanche, implantée de 2006 à 2014 comprend environ un million de patients. Les études de cette thèse ont été conduites sur des cohortes de 100 000 à 300 000 patients, inclus de 2009 à 2012 et suivis jusqu’en 2013 à 2014.Ces études indiquent que les caractéristiques prothétiques, couple de frottement, mode d’ancrage, choix d’un col modulaire, sont associés à la survie de la PTH à court et moyen terme. Il en est de même pour les caractéristiques des patients, âge, sexe, diabète, ainsi que l’exposition à certains médicaments, dont les benzodiazépines. Les caractéristiques du centre dans lequel est implantée la prothèse, en particulier le volume d’activité du chirurgien implanteur, sont associées à la survie prothétique.L’utilisation des bases de données du PMSI permet une surveillance active des PTH et ont permis d’identifier à court terme certains facteurs de risque d’échec de la prothèse. Environ 100 000 patients sont implantés par PTH en France chaque année. La révision prothétique est une intervention à risques, avec des taux de complications per et post-opératoires plus élevés que pour la primo-implantation. Mieux comprendre les facteurs liés à l’échec de la PTH et agir en faveur de la survie prothétique sont donc des enjeux de santé publique. Nos travaux ont pour finalité de faire évoluer les pratiques et encourager les choix techniques les plus favorables pour la survie prothétique, de manière à contribuer à l’amélioration de la santé des patients. / More and more Total Hip Replacement (THR) are performed in France (PTH) these last decades ; a 10% increase in 4 years has been observed, with 100 000 implantations on 2013.This increase can is related to the ageing of the population as well as the expansion of the implanted population: on one side younger and more active patients are now implanted, and on the other side, older patients (more than 80), often with other comorbidities, are now implanted.Le number of implanted THR, their characteristics, the context of implantation et the characteristics of the implanted population in France have never been comprehensively described so far. Some data are available from international registries (from Nordic, British, North American coutries and Australia), but not in France. The aim of my PhD was to study which factors were associated with the THR survivorship. My research covered the characteristics of the implants, of the patients and of the implanting centers.The data we used were from the French National Health Insurance Information System, SNIIRAM (Système National d'Information Inter-Régimes de l'Assurance Maladie) from 2006 to 2016. About 100 000 THR are implanted annually in France; the total cohort of THR implanted patients between 2006 and 2014 comprises about a million subjects. The cohorts studied in my work comprises between 100 000 and 300 000 patients, included between 2009 and 2012 and followed until 2013 to 2014.These cohorts studies showed that the implants characteristics, bearing surface, cementation, choice of a modular neck are associated with the prosthetic survivorship at short and midterm follow-up. We found the same with the patients characteristics, age, sex, diabetes mellitus as well as exposure to drugs such as benzodiazepines. The characteristics if the implanting center are also associated to the prosthetic survivorship, more specifically the volume of activity of the surgeon who performed the hip arthroplasty.The PMSI data are a valuable tool to perform an active surveillance of THR survivorship and using them allowed us to identify several risk factors of revision at short to midterm follow-up. About 100 000 patients receive a THR annually in France and THR revision is a surgical operation far more complicated than primary implantation, with higher complications rate during and post-operation. Being able to identifiy the factors associated with THR revision and being able to take the measures improving the THR survivorship are indeed a major Public health challenges. Our work' purpose is to assess the current practices and to provide evidences to promote technical choices propitious to THR survivorship, to contribute to health quality improvement.

Includes bibliographical references / Background: Dislocation is one of the most common orthopaedic complications after primary total hip arthroplasty (THA). The reported dislocation rate in elective THR is 5 - 8%. This number increases up to 22% for THA done for neck of femur fractures. Larger femoral head sizes increase the head-neck ratio and range of motion before impingement, therefore reducing the dislocation rate. Due to the reported increase in dislocation for trauma, some surgeons prefer to do a hemi-arthroplasty or open reduction and internal fixation (ORIF). Methods: A retrospective review of all THA done for neck of femur fractures during 2006 - 2012 was undertaken at a large referral hospital. Records were reviewed for patient related and surgical risk factors. We excluded all pathological fractures, extra-capsular fractures and failed ORIF. Results: A total of 96 cases were identified as suitable for analysis. Average age at surgery was 73.2 years (range 30 - 81). Delay to surgery was 5.3 days (range 1 - 63). Average follow up period was 18.3 months (range 3 months - 4.3years). Four patients (4.3%) had a confirmed dislocation. The four patients who had confirmed dislocation had the following characteristics, 28 mm femoral head size, age over 60 years, 2 posterior approaches and 3 females, although not statistically significant. Conclusion: The outcomes of THR in patients with neck of femur fractures can be favourable and provide good long-term prosthesis survival. We report on low dislocation rate post total hip replacement for intra-capsular neck of femur fractures.

BACKGROUND: Tranexamic acid (TXA) has become highly utilized in total joint arthroplasties for its anti-fibrinolytic effect. Recently, intra-articular application of TXA has become popular for its avoidance of systemic distribution within the body. With a more direct application to the surgical site, there is interest to see if topical application will provide hemostasis without increasing rates of venous or arterial thrombotic events and infections. In particular, there is lack of published data describing the safety of TXA in patients who have a significant disposition towards thromboembolic events. METHODS: This study was a retrospective chart-review (RCR) to assess the safety and efficacy of intra-articular TXA (IA-TXA) in total knee and hip arthroplasty patients. IA-TXA 2g/50mL NS was administered to patients who were contraindicated for IV-TXA usage based on our hospital’s guidelines (history of VTE events, mitral or aortic valve replacement with additional risk factors for stroke, active cancer, genetic or acquired thrombophilia, significant cardiac disease, serum creatinine > 2.8 mg/dL). Primary efficacy outcomes were total blood loss on post-operative day 1 (POD1), overall perioperative blood loss, and changes in hemoglobin/hematocrit values over the hospital stay. Primary safety outcomes were the incidence of arterial or venous thrombosis and wound infections. The study compared patients who received IA-TXA (study group) to patients who did not receive TXA (control group). The study included TKA patients=156 (Control=72 Study=83), anterior THA patients=57 (Control=20 Study=37), and posterior THA patients=59 (Control=27 Study=32). RESULTS: TKA patients administered IA-TXA showed a significant decrease in POD1 blood loss compared to the control group [305.84 mL, p = 0.004]. Additionally, the control patients showed significantly lower levels of overall hematocrit than those who had received IA-TXA [0.9 units, p = 0.041]. However, IA-TXA did not cause a reduction in blood loss in either the anterior or posterior THA patients. No statistically significant differences existed between treatment and control groups for transfusion rates or post-operative complications (VTE events and infections). CONCLUSION: IA-TXA 2g/50mL is effective in reducing blood loss in TKA patients; however, further research is needed regarding IA-TXA use in THA patients. The lack of efficacy in THA may have been related to the dosage used, the volume instilled, the timing of administration, or technique of administration.

BACKGROUND: There has been an enormous rise in total joint arthroplasties (TJA) in the United States over the past several years. Researchers have documented the increase in healthcare costs associated with unplanned hospital readmissions among patients post-TJA, specifically total hip and total knee arthroplasties. Additionally, researchers have reported the burden that these costs place on the healthcare system, private payers and on patients and their caregivers. Social routines, quality of life and occupational functioning are often interrupted because of a patient’s unplanned hospital readmission after receiving a total hip or total knee arthroplasty. Investigators have identified the major causes of costly unexpected hospital readmissions among patients with a TJA; they include surgical site infections, blood clots, joint dislocations and periprosthetic fractures. The Occupational Therapy Practice Framework: Domain and Process describes the practice of occupational therapy as promoting health, well-being, and engagement in meaningful occupation. Nonetheless, there is limited literature in the occupational therapy field directed towards reducing hospital readmissions among patients with a total hip or knee arthroplasty, thus suggesting an area that is well-positioned for intervention development and testing. PURPOSE: This Occupational Therapy Doctoral Project entitled Teaching Intervention to Reduce Readmissions-Post Surgery (TIRR-PS) is a proposed program for an acute care hospital setting which: (a) described the problem of hospital readmissions among patients with a total hip or total knee arthroplasty, (b) investigated evidence and best practices for imparting knowledge and/or teaching skills to hospital administrators, healthcare professionals, occupational therapy staff, patients, and caregivers, (c) proposed an intervention based on empirically supported strategies and theoretical frameworks, (d) recommended activities to include as part of the program evaluation, the funding plan and the dissemination plan to promote this multi-level, multi-component pilot program. TIRR-PS will aim to reduce unplanned 30-day hospital readmissions and their associated healthcare costs. Unplanned readmissions are in part caused by inadequate education of hospital administrators, occupational therapy staff, patients, and caregivers. The TIRR-PS program will raise awareness about how to address common medical complication risks and promote the support of hospital administration for the education and skill building activities directed towards healthcare professionals with an emphasis on occupational therapy. CONCLUSION: TIRR-PS was designed for an acute care setting to reduce hospital readmission rates, to reduce healthcare costs, to improve patient quality of life, and to reduce the societal burden of unplanned hospital care. TIRR-PS is an innovative program designed to be comprehensive and to impart knowledge and skills to all relevant professionals in an acute care setting with a particular emphasis on the contribution of the OT profession. TIRR-PS, once evaluated, will provide a standardized, systematic approach to reducing unexpected hospitalizations post-TJA and shows promise for contributing to routine orthopaedic rehabilitative practice in acute care hospitals. This in turn will not only reduce healthcare costs, but will improve the post-surgery quality of life for patients with a recent total hip or total knee arthroplasty.

No description available.