Aims

The aim of this study was to determine whether total hip arthroplasty (THA) for chronic hip pain due to unilateral primary osteoarthritis (OA) has a beneficial effect on cognitive performance.

Objectives. The purpose of this study was to assess N-acetyl aspartate changes in the thalamus in patients with osteoarthritis of the hip using proton magnetic resonance spectroscopy. Methods. Nine patients with osteoarthritis of the hip (symptomatic group, nine women; mean age 61.4 years (48 to 78)) and nine healthy volunteers (control group, six men, three women; mean age 30.0 years (26 to 38)) underwent proton magnetic resonance spectroscopy to assess the changes of N-acetyl aspartate in the thalamus. . Results. The ratio of N-acetyl aspartate to creatine plus phosphocreatine in the thalamus contralateral to the symptomatic hip in patients with osteoarthritis of the hip was significantly lower than the ratio of N-acetyl aspartate to creatine plus phosphocreatine in the thalamus in the control group (1.611 (1.194 to 1.882) vs 1.355 (1.043 to 1.502), p < 0.001). And, a strong negative correlation was detected between the ratio of N-acetyl aspartate to creatine plus phosphocreatine in the thalamus contralateral to the symptomatic hip in patients with osteoarthritis of the hip and pain duration (r = -0.83, p = 0.018). Conclusions. We evaluated the ratio of N-acetyl aspartate to creatine plus phosphocreatine in the thalamus of patients with osteoarthritis of the hip by using proton magnetic resonance spectroscopy. We concluded that the ratio of N-acetyl aspartate to creatine plus phosphocreatine in the thalamus contralateral to the symptomatic hip in patients with osteoarthritis of the hip were significantly lower than those in the thalamus of the control group, and that pain duration was strongly related to the decrease of the ratio of N-acetyl aspartate to creatine plus phosphocreatine

Objective: We had performed bipolar hemi-arthroplasty for osteoarthritis of the hip, with the technique of ace-tabular reaming until 1991. We studied the long-term results of this procedure radiographically. Materials and methods: 62 patients (70 hips) were followed up for at least eight years after bipolar hemi-arthroplasty without cement. The diagnosis of all patients was osteoarthritis of the hip, which mainly came from dysplasia of the hip. The patients consisted of 13 men and 49 women. The average age at the operation was 43 years old (36–74 years old). The average duration of follow-up was 11 years (8–14 years). Smooth-surface press-fit type stem (Omnifit, Osteonics) was implanted for all cases. Focal osteolysis around component, the migration of the outer head and the subsidence of stem, were evaluated radiographically. By reviewing serial A-P radiographs, the first recognition of osteolysis and the extension of the lesion were researched. Results: The mean migration of the outer head was 3.0mm medially and 9.1mm superiorly. The mean subsidence of stem was 7.2mm at final follow-up. The ace-tabular focal osteolysis was identified in 31 hips (44 %) and was first recognized at average 3.1years(1–9years) postoperatively. The femoral focal osteolysis was identified in 33 hips (47%) and was first recognized at average 2.3 years (1–9years) postoperatively. After the first recognition of osteolysis, the lesion was progressively spreading, especially on femoral side. Conclusion: From these results, bipolar hemi-arthroplasty with the technique of acetabular reaming should not be indicated for osteoarthritis of the hip. This procedure causes osteolysis, which is progressive, and the migration of the outer head so often that it is difficult to preserve acetabular bone stock

Introduction: Ruptures of the glutaeus minimus tendon at the greater trochanter may be a reason for persisting pain after total hip replacement. The aim of this study was to investigate the frequency of the rupture of the glutaeus minimus tendon at the greater trochanter in patients with osteoarthritis of the hip. Patients and Methods: From May until August 2004, total hip joints were implanted in 67 conscutive patients with osteoarthritis of the hip joint. 54 of the operations were done with a standard Watson-Jones approach. 13 patients were operated with a minimal invasive approach without visualisation of the gluteaus minimus tendon. For the minimal invasive approach only patients with a normal appearance ot the X-ray of the greater trochanter were selected. The integrity of the insertion of the glutaeus minimus tendon was recorded during the operation with the Watson-Jones approach und compared to the X-ray findings. Results: There were 8 complete and 13 partial ruptures of the glutaeus minimus tendon in 54 patients with the Watson-Jones approach. The mean age of the patients with rupture was 75.0 years compared to 67.2 years of the patients without rupture.The Y-rays ot the hip in two planes showed osteophytes at the greater trochanter in 18 (86 %) with a ruptur and in no patient without a ruptur. The frequnece of a complete or partial rupture of the glutaeus minimus tendon was at least 31% in the 67 patients of this study. Conclusion: Ruptures of the glutaeus minimus tendon are common in patients with osteoarthritis o thi hip but it is unknown whether it is necessary to reinsert the tendon during the implantation of an artificial hip joint

Introduction The consequence of discongrency of the hip joint may be early, secondary osteoarthritis of the hip joint, that leads to important limits in movement abilities of an individual. The deficit of the femoral head coverage can be rather easily corrected, but only until the growth and maturation of the pelvis is completed. Redirection of the acetabular fragment can be performed by use of the periacetabular osteotomy according to Ganz. This type of the osteotomy is mainly used in the treatment of the acetabular displasia in patients with closed Y cartilage, but also in the treatment of the osteoarthritis of the hip joint. The Aim of the study was to present our early results of treatment of the patients with the secondary osteoarthritis of the hip joint by use of the periacetabular osteotomy according to Ganz. Material and Methods. Our material consisted of 64 patients, 72 hip joints, operated on between 1998–2004. 20 patients (24 hip joints) were selected from this group. In these 20 patients the indication for the treatment was not only the acetabular displasia, but also osteoarthritis of the hip joint. Our group consisted of 17 female and 3 male. In 4 cases the both hip joints were affected. The age of the patients was 26–44 years, average 34 years. The observation period was from 4 months to 6 years, average 2,5 years. The most important clinical symptom was the groin pain on the rest or while flexing the hip joint with internal rotation and adduction. The radiological symptoms in patients before the operation were: decentration, narrowing of the articular space, cysts beyond the sclerotic zone, fatigue fractures of the acetabular edge. Results. In all the patients, except of one, the pain disappeared. Abduction and internal rotation in the hip joint increased, but flexion decreased. The Wiberg’s angle increased from 10–15° to 25–40°, and the interior Wiberg’s angle from 10–0° to 15–20°. During follow up we observed remodeling of the cysts. The treatment was subjectively assessed by the patients as very good. Conclusion. The use of the periacetabular osteotomy occording to Ganz is the operation that corrects the hip joint. But in some cases of the osteoarthritis of the hip joint it allows to improve the quality of life and we hope may also delay the arthroplasty in the young age

Objectives. Sagittal alignment of the lumbosacral spine, and specifically pelvic incidence (PI), has been implicated in the development of spine pathology, but generally ignored with regards to diseases of the hip. We aimed to determine if increased PI is correlated with higher rates of hip osteoarthritis (HOA). The effect of PI on the development of knee osteoarthritis (KOA) was used as a negative control. Methods. We studied 400 well-preserved cadaveric skeletons ranging from 50 to 79 years of age at death. Each specimen’s OA of the hip and knee were graded using a previously described method. PI was measured from standardised lateral photographs of reconstructed pelvises. Multiple regression analysis was performed to determine the relationship between age and PI with HOA and KOA. Results. The mean age was 60.2 years (standard deviation (. sd. ) 8.1), and the mean PI was 46.7° (. sd. 10.7°). Multiple regression analysis demonstrated a significant correlation between increased PI and HOA (standardised beta = 0.103, p = 0.017). There was no correlation between PI and KOA (standardised beta = 0.003, p = 0.912). Conclusion. Higher PI in the younger individual may contribute to the development of HOA in later life. Cite this article: Dr J. J. Gebhart. Relationship between pelvic incidence and osteoarthritis of the hip. Bone Joint Res 2016;5:66–72. DOI: 10.1302/2046-3758.52.2000552

Rapidly progressive osteoarthritis of the hip (RPOH) is an unusual subset of osteoarthritis. It is characterized by rapid joint space loss, chondroly­sis, and sometimes marked femoral head and acetabular destruction as a late finding. The exact pathogenetic mechanism is unknown. Potential causes of RPOH include subchondral insufficiency fracture resulting from osteoporosis, increasing posterior pelvic tilt as a mechanical factor, and high serum levels of matrix metalloproteinase (MMP)-3 as biological factors. This study was aimed to identify some markers that associate with the destructive process of RPOH by analyzing the proposed pathological factors of the disease, MMP-3, pelvic tilt, and osteoporosis. Of female patients who visited our hospital with hip pain from 2012 through 2018, this study enrolled female patients with sufficient clinical records including the onset of hip pain, age and body mass index (BMI) at the onset, a series of radiographs during the period of >12 months from the onset of hip pain, and hematological data of MMP-3 and C-reactive protein (CRP). We found the hip joints of 31 patients meet the diagnostic criteria of RPOH, chondrolysis >two mm in one year, or 50% joint space narrowing in one year. Those patients were classified into two groups, 17 and 14 patients with and without subsequent femoral head destruction in one year shown by computed tomography, respectively. Serum MMP-3 and CRP were measured with blood samples within one year after the hip pain onset. The cortical thickness index (CTI) as an indicator of osteoporosis and pelvic tilt parameters were evaluated on the initial anteroposterior radiograph of the hip. These factors were statistically compared between the two groups. This study excluded male patients because RPOH occurs mainly in elderly females and the reference intervals of MMP-3 are different between males and females. There was no difference in age at onset or bone mass index between the RPOH patients with and without subsequent femoral head destruction. Serum levels of MMP-3 were significantly higher in the RPOH patients with the destruction (152.1 ± 108.9 ng/ml) than those without the destruction (66.8 ± 27.9 ng/ml) (P = 0.005 by Mann-Whitney test). We also found increased CRP in the patients with femoral head destruction (0.725 ± 1.44 mg/dl) compared with those without the destruction (0.178 ± 0.187 mg/dl) (P = 0.032 by Mann-Whitney test). No difference in the duration between the hip pain onset and the blood examination was found between the two groups. There was no significant difference in CTI or pelvic tilt between the two groups. The pathological condition that may increase serum MMP-3 and CRP could be involved in femoral head destruction after chondrolysis of the hip in patients with RPOH

Classification of osteoarthritis of the hip is fraught with difficulty Although different patterns of disease are recognised, there is no accepted classification or grading system. We aim to develop a classification system that reflects both the radiological changes, and the local disease process within the joint. After ethical permission and consent tissue was taken from 20 patients undergoing primary hip replacement surgery. Intra-operative tissue samples were taken from each patient and the steady state gene expression of several cytokines (TNF-α, IL1-β, IFN-γ, IL-6, RANKL and OPG) measured quantitatively using Taqman RT-PCR. Relative expression was calculated for each sample using standard curves and normalised to 18S expression. The technique was consistent with high correlations for repeated measures from the same tissue type (κ=0.99) and from different tissue types in the same joint (κ=0.92). Intra-observer (κ=0.93) and inter-observer (κ=0.89) reliability for the technique were also found to be high. Preoperative radiographs were scored by two independent observers and joint space narrowing, cysts, osteophytes and sclerosis noted in each of the DeLee-Charnley zones on the femoral and acetabular side. Based on these scores patients were then classified to either lytic or sclerotic type and subclassified into either hypertrophic or atrophic. Subgroup analysis of cytokine expression by radiographic type was performed. There were statically significant differences in expression of macrophage stimulating cytokines (IL-1γ and OPG) in the lytic group as compared to the sclerotic group (p< 0.05). Conversely, the sclerotic group expressed significantly higher levels of IL-6. Individuals with atrophic subtype demonstrated significantly higher levels of IL-1β and IL-6, but lower levels of IFN-γ. Our results demonstrate greatly differing patterns of disease within osteoarthritic hip joints. These changes are reflected in radiographic appearances of osteoarthritis. Our proposed classification system can be used grade and classify osteoarthritis in a manner that reflects the disease process

Introduction: Intra-articular injection (IAJ) with cortico-steroid and local anaesthetic has been used as both diagnostic and therapeutic intervention in osteoarthritis of the hip. Doubt remains about its efficacy in confirming the source of symptoms in patients with both hip and spinal arthritis. There are also concerns about the introduction of infection for patients undergoing surgery. Methods: All patients undergoing Hip IAJ for osteoarthritis within a 6-month period in 2007 were reviewed for three surgeons at one institution retrospectively. Data was collated and analysed using a set protocol allowing 18 months follow-up period. Results: 41 procedures (38 patients) had injections within the study period. Male: Female ratio was 17:24. Average age was 52 years. There were 54% right-sided procedures. 25/41 patients had full response to the injection. 80% were listed for surgery as a result (documented reasons in those not listed). 6/41 patients had a partial response to the injection – 66% were managed conservatively (due to co-morbidities elicited at review, or spinal pathology). 10/41 patients had no benefit – 3 were offered surgery (one after MRI confirmation, one after prolonged physiotherapy and one after discussion about diagnostic overlap). Hip replacement completely reduced symptoms in 19/21 (90%) and partially in 2/21 (10%) (1 had undergone a successful pre-operative IAJ). There were no deep infections in patients undergoing surgery after injection. 1 patient had a superficial infection (resolved at review). Discussion: Diagnostic IAJ can be of value in patients when there are concerns whether the origin of symptoms is truly ascribable to the hip. Patients where injections are successful go on to undergo successful surgery without an increased risk of infection

Aim: The purpose of this retrospective study was to evaluate the migration and survival of the femoral component following cementless total hip replacement in patients with osteonecrosis of the femoral head in comparison to patients with osteoarthritis of the hip. Methods: The study included 31 patients who underwent 35 cementless total hip replacements for advanced osteo-necrosis of the femoral head and 49 patients with 58 total hip arthroplasties for osteoarthritis. The migration analysis of the femoral component was performed with the Einzel-Roentgen-Bild-Analyse (EBRA). Results: The follow-up for the patients with osteonecrosis and osteoarthritis of the hip was 6.1 and 5.9 years. Five stems (15.2%) from the osteonecrosis and two stems (3.6%) from the osteoarthritis group were revised for aseptic loosening. The median stem subsidence in the patients with osteonecrosis and osteoarthritis was 1.7mm (95% CI, 1 to 3.5) and 0.65mm (95% CI, 0.5 to 0.8), respectively (p< 0.01). Survivorship analysis with stem revision as endpoint for failure showed in the osteonecrosis and osteoarthritis group of 74.5% (95% CI, 56.1% to 92.8%) and 96.4% (95% CI, 91.5% to 100%), respectively (p< 0.05). Conclusions: The signiþcant difference in the subsidence and survival of the femoral component in the patients with osteonecrosis and osteoarthritis of the hip indicates that the bone around the prostheses is obviously inßuenced by the osteonecrosis. Young patients diagnosed with osteonecrosis of the femoral head should be treated with the most conservative treatment to preserve the hip joint

Introduction Hip arthritis in the young has been a problem area in orthopaedics and thrust plate prosthesis (TPP) was developed as an option. TPP is an implant with fixation in proximal femur metaphysis transmitting hip forces to the resected neck. In young patients undergoing a hip replacement such prosthesis preserves proximal femoral bone stock, which is vital for a revision procedure. The purpose of the study was to evaluate the results of the Thrust Plate Prosthesis as a treatment option for osteoarthritis of the hip in young patients. Patients & Methods Of the fifty patients (63 hips) reviewed, 31 (62%) were males and 19 (38%) females. Pre-operative diagnosis included primary osteoarthritis (23), developmental dysplasia (8), avascular necrosis (7), Perthes (4), post-traumatic arthritis (3), rheumatoid arthritis (2), ankylosing spondylitis (1), psoriatic arthropathy (1) and slipped upper femoral epiphysis (1). All components were implanted uncemented with metal-on-metal articulation. The average follow-up was 4.04 years (range 12 months–8.5 years). Results The mean age of the patients was 42.3 years (range 21–57 years). The mean pre-operative Harris Hip Score was 41.9 (range 12–89) and at final follow-up 89.91 (range 41–100). In 25 hips with ≥ 5yr follow-up, the average HHS at final follow-up was 84.5 (range 50–100). Complications included dislocation (2), transient sciatic nerve palsy (1), discomfort from lateral strap (2), implantation of wrong femoral head (1), revision 3 (4.76%) and implant loosening (4) (6.35%). Conclusion The thrust plate prosthesis is a useful alternative in young patients with hip arthritis and the results are comparable with other uncemented hip replacements. The added advantage is preservation of the proximal femoral bone stock, which can prove useful in future revisions

Metal-on-metal resurfacing offers an alternative strategy to hip replacement in the young active patient with severe osteoarthritis of the hip. The aim of this study was to compare functional outcomes, failure rates and impending revisions in hybrid total hip arthroplasties (THAs) and Birmingham Hip Resurfacings (BHRs) in young active patients. We compared the 5-7 year clinical and radiological results of the metal-on-metal BHR with hybrid THA in two groups of 54 hips each, matched for sex, age, body mass index and activity. Function was excellent in both groups as measured by the Oxford hip score (median 13 in the BHRs and 14 in the THAs, p=0.14), but the resurfacings had higher UCLA activity scores (median 9 v 7, p=0.001) and better EuroQol quality of life scores (0.90 v 0.78, p=0.003). The THAs had a revision or intention to revise rate of 8% and the BHRs 6%. Both groups demonstrated impending failure on surrogate end-points. 12% of THAs had polyethylene wear and osteolysis under observation, and there was femoral component migration in 8% of resurfacings. Polyethylene wear was present in 48% of hybrid hips without osteolysis. Of the femoral components in the resurfacing group which had not migrated, 66% had radiological changes of unknown significance (classification proposed). In conclusion, the early to mid-term results of resurfacing with the BHR appear at least as good as those of hybrid THA. Only by longer term follow-up will we establish whether the change of practice recorded here represents a true advance

Metal-on-metal resurfacing offers an alternative strategy to hip replacement in the young active patient with severe osteoarthritis of the hip. The functional outcomes, failure rates and impending revisions in hybrid total hip arthroplasties (THAs) and Birmingham hip resurfacings (BHRs) were compared after 5–7 years. We studied the clinical and radiological results of the BHR with THA in two groups of 54 hips each, matched for sex, age, BMI and activity. Function was excellent in both groups as measured by the Oxford hip score (median 13 in the BHRs and 14 in the THAs, p=0.14), but the resurfacings had higher UCLA activity scores (median 9 v 7, p=0.001) and better EuroQol quality of life scores (0.90 v 0.78, p=0.003). The THAs had a revision or intention to revise rate of 8% and the BHRs 6%. Both groups demonstrated impending failure on surrogate end-points. 12% of THAs had polyethylene wear and osteolysis and there was femoral component migration in 8% of resurfacings. Polyethylene wear was present in 48% of hybrid hips without osteolysis. Of the femoral components in the resurfacing group which had not migrated, 66% had radiological changes of unknown significance. In conclusion, the early to mid-term results of resurfacing with the BHR appear at least as good as those of hybrid THA

Aims

The gluteus minimus (GMin) and gluteus medius (GMed) have unique structural and functional segments that may be affected to varying degrees, by end-stage osteoarthritis (OA) and normal ageing. We used data from patients with end-stage OA and matched healthy controls to 1) quantify the atrophy of the GMin and GMed in the two groups and 2) describe the distinct patterns of the fatty infiltration in the different segments of the GMin and GMed in the two groups.

Introduction: The purpose of this study is to evaluate the clinical and radiogra phic outcome of patients with secondary osteoarthritis of the hip, who underwent custom-made cementless THA. Methods: Between January 1994 and June 1997, 98 prim ary cementless custom-made THA’s were performed in 76 patients with secondary osteoarthritis and reviewed at mean 6 years follow-up (range: 4 – 7.5 years). Nine patients had a previous femoral osteotomy. There were 69 females and seven males. The mean age at operation was 54 years (40 – 73 years). Custom-made, 125 mm-long, titanium femoral components with blasted surface were fabricated based on the computerized tomography. Results: The mean Harris Hip Score improved from 43 to 95 points. 97 patients (99%) had more than 80 points for total score, and 2 patients (2%) had thigh pain at the latest follow-up. Radiographically, 86 hips (87%) showed obviously extensive bone ongrowth onto the middle part of the stem while 8 hips (9%) showed stable fibrous fixation. Four hips (4%) were unstable: more than 2 mm subsidence in 2 hips and more than 2 degrees varus migration in 2 hips. Of these 4 hips, 2 had intraoperative cracks of the poximal femur and 2 had varus positioning of the stem. Discussion and conclusion: Cementless THA has been advocated to enhance fit and fill of variable hip geometry. However, some clinical studies failed to show that custom implants significantly improve clinical success or implant longevity because their surface finish was not optimal. Custom-made titanium femoral components with blasted surface showed good clinical results. The reasons for radiolographical failures were because of intraoperative technical errors and these might be derived from 125 mm-long stem with maximum canal fill. A shorter stem may be an option because it may improve the feasibility of stem insertion and the distal fill

The management of osteoarthritis of the hip in young active patients has always been challenging. This can be made more difficult because of the longevity required of the prostheses used and the level of activity they must endure. The aim of this study was to compare the functional outcomes and activity levels following hip resurfacing and uncemented THA in young active patients matched for age, gender and activity levels. A retrospective review of 255 consecutive hip arthroplasties performed in a teaching hospital was carried out. From this series we identified 58 patients who had undergone uncemented THA (Group A) and 58 patients who underwent hip resurfacing (Group B), matched for age, gender and pre-operative activity level. The mean age of patients within Group A was 58.5 years (34–65) and in Group B was 57.9 years (43–68). Mean pre-operative University of California at Los Angeles (UCLA) score in Group A was 3.4 (1–7) and in Group B was 4.2 (1–8). The mean pre-operative Oxford Hip Score (OHS) was 46.1 (16–60) and 44.4 (31–57) in Groups A and B respectively. Mean follow-up period was five years (4–7 years). In the hip resurfacing group, the mean UCLA score improved from 4.2 (1–8) to 6.7 (3–10), while in the uncemented THA group this improved from 3.4 (1–7) to 5.8 (3–10). Similarly, the mean OHS improved from 44.4 (31–57) to 16.6 (12–31) in the hip resurfacing group and from 46.1 (16–60) to 18.8 (12–45) in the uncemented THA group. This study found no statistically significant difference in the levels of function (p= 0.82) or activity pursued (p= 0.60) after surgery between uncemented THA and hip resurfacing in a population of patients matched for age, gender and pre-operative activity levels. Although there was statistically significant improvement in UCLA and OHS within each group, it was found that no group was better than the other. This study has shown comparable outcomes with hip resurfacing and uncemented THA in terms of both functional outcomes and activity levels in a group of young active patients. The potential complications unique to hip resurfacing may be avoided by the use of uncemented THA. In addition, uncemented THA has a longer track record

Introduction: Rapidly destructive arthrosis of the hip (RDHD) is a rare and incompletely understood disorder with scarce literature about variations in natural history within a population. A series of cases from North Wales with rapid progressive joint destruction and extensive subchondral bone loss in the femoral head and acetabulum are presented.

Methods: A retrospective review of patients with a clinical profile and serial radiographs suggestive of a rapidly progressive hip disease was undertaken. This revealed 15 patients who met our criteria for RDHD. A retrospective analysis of clinical and radiographic records was performed. Radiographic findings mimicked those of other disorders such as septic arthritis, rheumatoid and seronegative arthritis, primary osteonecrosis with secondary osteoarthritis, or neuropathic osteoarthropathy, but none of the patients had clinical, pathologic, or laboratory evidence of these entities.

Results: Rapid progression of hip pain and disability was a consistent clinical feature. The average duration of symptoms was 1.4 years. Radiographs obtained at various intervals before surgery (average 14 months) in 15 patients documented rapid hip destruction, involvement being unilateral in 10 cases. All patients underwent total hip arthroplasty, and osteoarthritis was confirmed at pathologic examination. Histology of femoral heads failed to show the findings typical of primary osteonecrosis & no evidence of sepsis.

Discussion: The authors postulate that these cases represent an uncommon subset of osteoarthritis and regular review, both clinically and radiologically, are required to assess speed of progression and prevent rapid loss of bone stock without the surgeon being aware. These cases are unsuitable for being placed on long waiting list due to technical difficulties in delayed surgery and compromised outcome following surgery. The decisions about the need for surgery and the selection of cases should be made purely on clinical grounds and not on their rank in the waiting lists.(295)

The Covid-19 pandemic restricted access to elective arthroplasty theatres. Consequently, there was a staggering rise in waiting times for patients awaiting total hip arthroplasty (THA). Concomitantly, rapidly destructive osteoarthritis (RDOA) incidence also increased.

Two cohorts of patients were reviewed: patients undergoing primary THA, pre-pandemic (December 2017-December 2018) and patients with RDOA (ascertained by dual consultant review of pre-operative radiographs) undergoing THA after the pandemic started (March 2020 – March 2022). There were 236 primary THA cases in the pre-pandemic cohort. Out of the 632 primary THA cases post-pandemic, 186 cases (29%) had RDOA. Within this RDOA cohort, the pre-operative mean OHS, EQ5D3L and EQVAS (12.7, 10.5 and 57.6 respectively) were all poorer than in the pre-pandemic population (18.3, 9.4 and 66.7 respectively) (p<0.05). There was no significant difference between the RDOA and pre-pandemic cohort in Patient Reported Outcome Measures (PROMS) at 12 months, perhaps due to their ceiling effect.

Within the RDOA cohort, 7 cases required acetabular augments, 1 of which also required femoral shortening. The rate of intra-operative fracture, dislocation, infection, return to theatre, and revision were 2.2%, 2.7%, 4.3%, 3.8% and 2.2% respectively, greater than those reported in the literature. No fractures nor dislocations occurred in robot assisted arthroplasties.

With ever increasing waiting lists, RDOA prevalence will continue to rise. Increased surgical challenges and potential use of additional implants generated by its presence excludes these patients from waiting list initiative pathways, potentiating the complexity of the operative procedure. Going forwards, the economic burden and training implications must be considered.

During the last decade, outcome assessment in orthopaedic surgery has increasingly focused on patient self-report questionnaires. The Oxford Hip and Knee Scores (OHS and OKS) were developed for the self-assessment of pain and function in patients undergoing joint replacement surgery. These scores proved to be reliable, valid, and responsive to clinical change, however, no German version of these useful measures exists. We therefore cross-culturally adapted the OHS and OKS according to the recommended forward/backward translation protocol and assessed the following metric properties of the questionnaires in 105 (OHS) and 100 (OKS) consecutive patients undergoing total hip or knee replacement in our clinic: feasibility (percentage of fully completed questionnaires), reliability (intraclass correlation coefficients (ICC) and Bland and Altman’s limits of agreement), construct validity (correlation with the Western Ontario and McMaster Universities Index (WOMAC), Harris Hip Score (HHS), Knee Society Score (KSS), Activities of Daily Living Scale (ADLS), and Short Form (SF-)12), floor and ceiling effects, and internal consistency (Cronbach’s alpha, CA). We received 96.6% (OHS) and 91.9% (OKS) fully completed questionnaires. Reliability of both questionnaires was excellent (ICC > 0.90). Bland and Altman’s limits of agreement revealed no significant bias. Correlation coefficients with the other questionnaires ranged from −0.30 (SF-12 Mental Component Scale) to 0.82 (WOMAC) for the OHS, and from −0.22 (SF-12 Mental Component Scale) to −0.77 (ADLS) for the OKS. For both questionnaires, we observed no floor or ceiling effects. The internal consistency was good with a CA of 0.87 for the OHS and 0.83 for the OKS. In conclusion, the German versions of the OHS and OKS are reliable and valid questionnaires for the self-assessment of pain and function in German-speaking patients with hip or knee osteoarthritis. Considering the present results and the brevity of the measures, we recommend their use in the clinical routine.

Introduction. Nociceptive and neuropathic components both contribute to chronic pain. Since these components require different pain management strategies, correct pain diagnosis before and during treatment is important. Freynhagen et al. (2006) reported that they had developed and validated the pain-DETECT questionnaire (PD-Q) to detect neuropathic components in chronic low back pain patients. They also reported that 37% of unselected cohort of chronic LBP patients had predominantly neuropathic pain. However, the extent to which neuropathic components relate to the pathomechanism of pain deriving from osteoarthritis of hip joint remains unknown. The purpose of this study was to utilize PD-Q to investigate the relationship between neuropathic components and pain deriving from osteoarthritis of the hip joint. Methods. Between March and August 2010, 125 patients with osteoarthritis of hip joint completed PD-Qs about their pain. From this data set, we investigated whether or not the patients’ pain contained neuropathic components. Results. Only 6.4% of the patients had a score 19, indicating that a neuropathic component was likely (90%). Conversely, 79.2 % had a score 12, indicating that a neuropathic component was unlikely (15%). For the remaining 14.4% with an intermediate score (13–18), the presence of a neuropathic component remained uncertain. Conclusion. In this set of patients with osteoarthritis of hip joint, the PD-Q responses indicated that only a small percentage (6.4%) were likely to have a neuropathic component to their hip pain