8 of 12 Top Hip Papers of 2024 | Outcomes of Total Hip Arthroplasty in patients with EDS
Welcome back to my 12 Top Hip Papers series of miniblogs from 2024, where I walk you through what has been happening in the hip world over 2024. We are already at Day 8! If you missed day 7, you'll find a link at the bottom of this page to take you back.
For day 8 we'll be taking a look at a hip paper from 2024 that reported on outcomes of total hip arthroplasty (hip replacement) in those with hypermobile Ehlers Danlos Syndrome (hEDS). Really interesting stuff! Read on ...
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8 of 12 Top Hip Papers of 2024:Outcomes of Total Hip Arthroplasty in patients with Ehlers Danlos Syndrome1
Background:
- Hypermobile Ehlers Danlos Syndrome (hEDS) is a heritable connective tissue disorder that may impact on a wide range of bodily tissues and functions.
- Generalised joint hypermobility and effects on the musculoskeletal system are primary traits of hEDS.
- Those with hEDS often present with pain and instability in multiple joints, associated with their generalised joint laxity. Such joint laxity may present a post-operative risk for a prosthetic joint.
Study Aim:
- To compare rates of postoperative complications after primary Total Hip Arthroplasty (hip replacement) in patients who have EDS against matched controls.
What was done:
- A retrospective matched cohort study. Rates of complications following primary total hip arthroplasty in patients with and without Ehlers Danlos Syndrome were compared.
- Participants: Data from patients who underwent primary THA between 2009 and 2020, was extracted from a large database in Michigan, USA
- Matching: Propensity score matching was used to match patients who had EDS with patients who did not have EDS at a 1:4 ratio. Comorbidities were evenly distributed between the groups.
- EDS GROUP: n = 118; females: 88%; mean age: 56 years.
- CONTROL GROUP: n = 418; females: 85%; mean age: 55 years.
- Comparisons: Rates of medical and surgical complications at 90 days and 2 years were collected and compared.
Key Findings:
- At 90 days, the EDS group had significantly greater rates of hip dislocation than the control group.
- At 2 years, the EDS group had greater odds of dislocation, aseptic
loosening, and aseptic revision of the prosthesis (i.e., not related to infection).
Clinical Implications:
- Soft tissue laxity and reduced bone quality associated with EDS is the most likely explanation for significantly higher rates of dislocation and aseptic loosening after THA.
- Risk - benefit of THA for those with EDS should be considered when evaluating treatment options for advanced hip osteoarthritis.
- Surgeons may need to provide robust soft tissue and capsular repair, and closely consider choice of prosthesis, surgical approach, and post-operative precautions for those with EDS.
- Rehabilitation professionals should also consider the additional need for optimal health and function of capsular stabilisers pre and post THA, and additional precautions, even in the longer term.
Those with hEDS had higher rates of dislocation, mechanical loosening and aseptic revision after total hip replacement, likely due to soft tissue laxity and reduced bone quality. Patients with hEDS should be counselled about the risks of complications following total hip arthroplasty in those with their condition, and a risk-benefit analysis discussed within a shared decision making process.
When surgery is undertaken, the surgeon should pay close attention to robust soft tissue and capsular repair, and consider the choice of prosthesis, surgical approach, and post-operative precautions for those with EDS. Precautions are much more relaxed currently, then they were 10-20 years ago.
In those with generalised joint hypermobility, risk warnings and education regarding prevention of dislocation are still important, and not just for that typical 3 month period. Loosening of the prosthesis can occur over time in those with capsuloligamentous laxity, and dislocation risk remains elevated well after the normal healing period of the capsule.
Rehabilitation professionals should also consider the additional need for optimal health and function of the deep capsular stabilising muscles, both pre and post-operatively. The better the health of these tissues pre-operatively, the better the potential surgical repair. Check the operative notes for what the surgeon has cut and repaired. Work to optimise recovery of the capsular muscles, optimise control of movement/loading across the prosthesis, apply a slowly progressive functional strengthening program and allow additional time for recovery.
Like to learn more about hypermobility and the hip?
In Hip Academy, you will find a recorded masterclass on Hypermobility and the Hip - members only, where we discuss assessment and management of hip pain in the context of generalised or focal joint laxity, and hEDS or HSD. You will also find a comprehensive downloadable pdf resource detailing how to recognise hypermobile EDS and hypermobility spectrum disorders.
Join Hip Lovers and Hip Learners from all around the globe in Hip Academy and benefit from the extensive resources, live member masterclasses, Q & A sessions and Member Case Sharing.
I hope you enjoyed the infographic and key learnings from Day 8 of my 12 Top Hip Papers of 2024. There are 4 more papers to come, so keep an eye out, to see what other top papers and infographics I have prepared for you!
Missed paper 7? Click above to read it!
Paper 9 comes out tomorrow!
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