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

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.

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.

In endoprosthesis surgery there are typically a high percentage of implant defects, these can lead to failure of the whole prosthesis. One type of total hip replacement function loss is acetabular cup loosening from the pelvic bone. This disertation examines manufacture perturbations as one of the possible reasons for this kind of failure. Both dimension and geometry manufacturing perturbations of ceramic head and polyethylen cup were analyzed. We find that perturbations in the variables analysed here affect considered values of contact pressure and frictional moment. Furthermore, contact pressure and frictional moment are quantities affecting replacement success and durability. From obtained results it can be recommended to fit head and cup with a clearance of between 0 mm and 0.05 mm. It can not be recommend using interference type of fit because of strong deterioration of the contact conditions. Roundness perturbation of ceramic head should not exceed 0.025 mm.