• Hip & pelvis
• /
• v.36 no.2
• /
• pp.108-119
• /
• 2024

Purpose: The incidence of deep vein thrombosis (DVT) following total hip arthroplasty (THA) without chemoprophylaxis could be as high as 50% in Caucasians. However, according to several subsequent studies, the incidence of venous thromboembolic events (VTE) in Asians was much lower. The routine use of chemoprophylaxis, which could potentially cause increased bleeding, infection, and wound complications, has been questioned in low-incidence populations. The objective of this study is to determine the incidence of VTE after primary THA without chemoprophylaxis in an Asian population using a fast-track rehabilitation protocol and to verify the safety profile for use of 'mechanical prophylaxis alone' in patients with standard risk of VTE. Materials and Methods: This is a retrospective cohort study of 542 Hong Kong Chinese patients who underwent primary THA without chemoprophylaxis. All patients received intermittent pneumatic compression and graduated compression stockings as mechanical prophylaxis. Multimodal pain management was applied in order to facilitate early mobilisation. Routine duplex ultrasonography was performed between the fourth and seventh postoperative day for detection of proximal DVT. Results: All patients were Chinese (mean age, 63.0±11.9 years). Six patients developed proximal DVT (incidence rate, 1.1%). None of the patients had symptomatic or fatal pulmonary embolism. Conclusion: The incidence of VTE after primary THA without chemical prophylaxis can be low in Asian populations when following a fast-track rehabilitation protocol. Mechanical prophylaxis alone can be regarded as a reasonably safe practice in terms of a balanced benefit-to-risk ratio for Asian patients with standard risk of VTE.

• Hip & pelvis
• /
• v.34 no.2
• /
• pp.106-114
• /
• 2022

Purpose: While initial fixation using a press-fit of the acetabular cup is critical for the durability of the component, restoration of the hip center is regarded as an attributable factor for implant survival and successful outcome. In protrusio acetabuli (PA), obtaining both restoration of the hip center and the press-fit of the acetabular cup simultaneously might be difficult during total hip arthroplasty (THA). We tested the hypothesis that use of a medialized cup, if press-fitted, will not result in compromise of the implant stability and outcome after cementless THA of PA. Materials and Methods: A total of 26 cementless THAs of 22 patients with PA were reviewed. During THA, press-fit of the cup was prioritized rather than hip center restoration. A press-fit was obtained in 24 hips. A pressfit could not be obtained in the two remaining hips; therefore, reinforcement acetabular components were used. Restoration of the hip center was achieved in 17 cups; 15 primary cups and two reinforcement components; it was medialized in nine cups. Implant stability and modified Harris hip score (mHHS) between the two groups were compared at a mean follow-up of 5.1 years (range, 2-16 years). Results: Twenty-six cups; 17 restored cups and nine medialized press-fitted cups, remained stable at the latest follow-up. A similar final mHHS was observed between the restored group and the medialized group (83.6±12.1 vs 83.8±10.4, P=0.786). Conclusion: Implant stability and favorable results were obtained by press-fitted cups, irrespective of hip center restoration. THA in PA patients showed promising clinical and radiological results.

• Hip & pelvis
• /
• v.34 no.2
• /
• pp.96-105
• /
• 2022

Purpose: Use of dual mobility (DM) articulations can reduce the risk of instability in both primary and revision total hip arthroplasty (THA). Knowledge regarding the impact of this design on patient-reported outcome measures (PROMs) is limited. This study aims to compare clinical outcomes between DM and fixed bearing (FB) prostheses following primary THA. Materials and Methods: All patients who underwent primary THA between 2011-2021 were reviewed retrospectively. Patients were separated into three cohorts: FB vs monoblock-D vs modular-DM. An evaluation of PROMs including HOOS, JR, and FJS-12, as well as discharge-disposition, 90-day readmissions, and revisions rates was performed. Propensity-score matching was performed to limit significant demographic differences, while ANOVA and chi-squared test were used for comparison of outcomes. Results: Of the 15,184 patients identified, 14,652 patients (96.5%) had a FB, 185 patients (1.2%) had a monoblock-DM, and 347 patients (2.3%) had a modular-DM prosthesis. After propensity-score matching, a total of 447 patients were matched comparison. There was no statistical difference in the 90-day readmission (P=0.584), revision rate (P=0.265), and 90-day readmission (P=0.365) and revision rate due to dislocation (P=0.365) between the cohorts. Discharge disposition was also non-significant (P=0.124). There was no statistical difference in FJS-12 scores at 3-months (P=0.820), 1-year (P=0.982), and 2-years (P=0.608) between the groups. Conclusion: DM bearings yield PROMs similar to those of FB implants in patients undergoing primary THA. Although DM implants are utilized more often in patients at higher-risk for instability, we suggest that similar patient satisfaction may be attained while achieving similar dislocation rates.

• Hip & pelvis
• /
• v.36 no.3
• /
• pp.204-210
• /
• 2024

Purpose: The purpose of this study was to determine whether the rates of (1) in-hospital lengths of stay (LOS), (2) readmissions, (3) medical complications, and (4) costs of care are higher for patients with depressive disorder (DD) undergoing primary total hip arthroplasty (THA) for treatment of femoral neck fractures (FNFs). Materials and Methods: A retrospective query of a national administrative claims database for patients undergoing primary THA from 2006 to 2014 was conducted. Patients with DD undergoing THA for treatment of FNF were 1:5 ratio propensity score matched to a cohort (DD=6,758, controls=33,708). Primary endpoints included LOS, 90-day medical complications, 90-day readmissions, and healthcare reimbursements. A P-value less than 0.05 was considered statistically significant. Results: Longer LOS were observed for patients with DD compared to those without DD (5.6 days vs. 5.4 days, P<0.001). Similar readmission rates (29.9% vs. 25.0%, odds ratio [OR] 1.03, P=0.281) were observed between groups. The odds of 90-day medical complications were higher for patients with DD compared to control subjects (60.6% vs. 21.4%, OR 1.57, P<0.0001). Within the 90-day episode of care interval, patients with a history of DD incurred significantly higher healthcare expenditures ($21,382 vs. $19,781, P<0.001). Conclusion: Our findings showed longer LOS, higher odds of 90-day medical complications, and higher healthcare expenditures within the 90-day episode of care following a primary THA for treatment of FNF for patients with DD compared to the matched cohort. Thus, accordingly, patients with DD should receive counseling prior to undergoing surgery.

• Earthquakes and Structures
• /
• v.22 no.6
• /
• pp.585-595
• /
• 2022

Using the nonlinear static procedures has become very common in seismic codes to achieve the nonlinear response of the structure during an earthquake. The capacity spectrum method (CSM) adopted in ATC-40 is considered as one of the most known and useful procedures. For this procedure the seismic demand can be approximated from the maximum deformation of an equivalent linear elastic Single-Degree-of-Freedom system (SDOF) that has an equivalent damping ratio and period by using an iterative procedure. Data from the results of this procedure are plotted in acceleration- displacement response spectrum (ADRS) format. Different improvements have been made in order to have more accurate results compared to the Non Linear Time History Analysis (NL-THA). A new procedure is presented in this paper where the iteration process shall not be required. This will be done by estimation the ductility demand response spectrum (DDRS) and the corresponding effective damping of the bilinear system based on a new parameter of control, called normalized yield strength coefficient (η), while retaining the attraction of graphical implementation of the improved procedure of the FEMA-440. The proposed procedure accuracy should be verified with the NL-THA analysis results as a first implementation. The comparison shows that the new procedure provided a good estimation of the nonlinear response of the structure compared with those obtained when using the NL-THA analysis.

• Proceedings of the KSME Conference
• /
• 2001.06c
• /
• pp.482-484
• /
• 2001

In orthopedics, hip arthroplasty is the operation that replaces damaged hip joint to artificial joint. In hip arthroplasty, quite better result can be achieved if robot is applied to machine cavity in bone, especially when cementless stem is used. So several kinds of robots were introduced for hip arthroplasty, but they used MRI, CT Scan, vision analysis and real time tracking of bone position for registration of robot. To overcome shortage of conventional robot surgery, gauge based registration method was proposed and small robot was designed. In this method, small robot is mounted on femur, and its position is determined by gauge registration method. Operation procedure was performed on model femur and result was analyzed. This robotic hip surgery system is expected to more adaptable in operation room.

• Proceedings of the Computational Structural Engineering Institute Conference
• /
• 1998.10a
• /
• pp.35-42
• /
• 1998

Response spectrum analysis method(RSA) rather than time history analysis method(THA) continues to e used by the profession for evaluating maximum dynamic responses of structures subjected to earthquake excitations. Nevertheless, this simple and practical method can cause significant errors in some cases with unproper modal combination method and so on. To obtain more exact responses based n RSA many studies have been carried out considering displacement of top story, base shear and overturning moment. The purpose of this study is to verify error characteristics in RSA with respect to various responses including displacement shear force and overturning moment of each story. It's shown that RSA appears to yield underestimated responses when compared to THA calculations. Also, errors involved in RSA computations grow with an increase in total number of stories.

• Hip & pelvis
• /
• v.34 no.3
• /
• pp.172-176
• /
• 2022

A 58-year-old-male patient presented with worsening pain and restricted movements of his right hip after undergoing multiple procedures for treatment of an inter-trochanteric fracture. Secondary arthrosis and an incorporated intramedullary fibular cortical bone graft which caused severe narrowing of the medullary canal were observed by imaging. Total hip arthroplasty (THA) using knee arthroscopic tools was performed for preparation of the severely narrowed femoral canal. A satisfactory clinical outcome was achieved and stable components were observed on radiographs at the 11-year follow-up. The technique described here may be considered when attempting to perform a conversion THA for preparation of a severely narrowed femoral canal using a fibular strut in order to minimize morbidity and prevent structural destabilization.

• Journal of the Korea Academia-Industrial cooperation Society
• /
• v.21 no.2
• /
• pp.322-327
• /
• 2020

An Armor Piercing Fin Stabilized Discarding Sabot (APFSDS), which penetrates and sabotages the target by physical energy, consists of a general penetrator using Depleted Uranium (DU) or Tungsten Heavy Alloy (THA) but THA is preferable because of manufacturing and environmental issues. On a THA penetrator, the penetration performance is determined mainly by self-sharpening depending on the hardness and toughness of materials. In particular, the tensile strength and impact strength work as key factors. The correlation coefficient for the penetration performance of the tensile strength was 0.721 and the impact strength was -0.599. The improved penetration performance by additional heat treatment was proven experimentally. Therefore, maintaining elongation over 9 % and tensile strength over 123 kg/㎟ is desirable, and the impact strength should be less than 6.8 kg·m/㎠ for good penetration performance.

• Journal of Korean Association for Spatial Structures
• /
• v.8 no.1
• /
• pp.57-67
• /
• 2008

In general, the response spectrum analysis(RSA) method is wifely used for seismic analysis of building structures, and the time history analysis(THA) is applied for computation of structural vibration caused by equipments, machines and moving loads, etc. However, compared with the RSA method, the THA method is very complex, difficult and time consuming. In this study, the maximum responses for the vertical vibration are calculated conveniently by the RSA method. At first, the process for the RSA in excitation is proposed, and the maximum modal responses are combined by CQC and SRSS methods. Also, the responses obtained by the two modal combination methods are compared to the responses by the THA. And the correlation coefficients for human activities is proposed, and the RSA responses obtained by used to the correlation coefficients are calculated. Finally, results of the proposed method are compared with those of the time history analysis and correlation coefficients should be considered for the RSA of floor structure subjected to group dynamic loads.