CRISTALJAMA 2022
Effect of Aspirin vs Enoxaparin on Symptomatic Venous Thromboembolism in Patients Undergoing Hip or Knee Arthroplasty: The CRISTAL Randomized Trial.
Aspirin failed to show non-inferiority and was associated with a significantly higher rate of symptomatic VTE than enoxaparin, mainly driven by below-knee DVT. There was no significant difference in death or major bleeding.
Randomised trialPreventionHip arthroplasty
How long does a hip replacement lastLancet (London, England) 2019
How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up.
Pooled registry data suggested that just under 60% of hip replacements last 25 years; case series reported higher survival than registries, which are considered less prone to bias.
Systematic review / meta-analysisPrognosisHip arthroplasty
EPCAT IIIThe New England journal of medicine 2018
Aspirin or Rivaroxaban for VTE Prophylaxis after Hip or Knee Arthroplasty.
Aspirin was non-inferior to rivaroxaban for symptomatic VTE, with low event rates in both groups. There was no significant difference in major or clinically relevant bleeding.
Randomised trialPreventionHip arthroplasty
2018 PJI definition (ICM)The Journal of arthroplasty 2018
The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria.
Major criteria (two positive cultures of the same organism, or a sinus tract communicating with the joint) confirm infection, while a weighted minor-criteria score classifies cases as infected, inconclusive or not infected. The new definition outperformed the 2011 MSIS criteria.
Cohort studyDiagnosisHip arthroplasty
Posterior vs lateral approach meta-analysisAnnals of the Royal College of Surgeons of England 2015
A systematic review and meta-analysis of complications following the posterior and lateral surgical approaches to total hip arthroplasty.
The posterior approach significantly reduced Trendelenburg gait and stem malposition compared with the lateral approach, with non-significant trends towards less dislocation and heterotopic ossification; neither approach gave better function.
Systematic review / meta-analysisManagementHip arthroplasty
TXA in arthroplasty (Poeran)BMJ (Clinical research ed.) 2014
Tranexamic acid use and postoperative outcomes in patients undergoing total hip or knee arthroplasty in the United States: retrospective analysis of effectiveness and safety.
Tranexamic acid was associated with significantly lower transfusion rates, with no increase in thromboembolic events, acute renal failure or other complications.
Cohort studyManagementHip arthroplasty
NJR stemmed MoM failureLancet (London, England) 2012
Failure rates of stemmed metal-on-metal hip replacements: analysis of data from the National Joint Registry of England and Wales.
Stemmed metal-on-metal hips had significantly poorer survival than other bearings, with larger heads failing earlier, whereas larger heads improved survival for ceramic-on-ceramic bearings; younger women with large metal-on-metal heads had particularly high revision rates.
Registry studyPrognosisHip arthroplasty
Swedish register cemented vs uncementedActa orthopaedica 2010
Uncemented and cemented primary total hip arthroplasty in the Swedish Hip Arthroplasty Register.
Uncemented THA had significantly lower revision-free survival than cemented THA, mainly because of poorer uncemented cup performance; uncemented stems did better than cemented stems, though unrecognised intraoperative femoral fractures may cause early stem failure, and the commonest modern uncemented cups performed similarly to cemented cups.
Registry studyManagementHip arthroplasty
Operation of the centuryLancet (London, England) 2007
The operation of the century: total hip replacement.
Describes how THR transformed care of elderly arthritic patients, that both cemented and uncemented fixation can be durable, and how newer bearings, less invasive surgery and computer navigation aim to meet younger patients' demands, with cost-effectiveness governing future developments.
OtherManagementHip arthroplasty
Lewinnek safe zoneThe Journal of bone and joint surgery. American volume 1978
Dislocations after total hip-replacement arthroplasties.
Cups within about 15 degrees (plus or minus 10) of anteversion and 40 degrees (plus or minus 10) of inclination dislocated less often than those outside this 'safe zone'; increased anteversion was linked to anterior dislocation, and risk was highest early after surgery and in previously operated hips.
Cohort studyPreventionHip arthroplasty