Aims. This study aims to answer the following questions in patients with hip osteoarthritis (OA) who underwent total hip arthroplasty (THA): are patient-reported outcome measures (PROMs) affected by the location of the maximum severity of pain?; are PROMs affected by the presence of non-groin pain?; are PROMs affected by the severity of pain?; and are PROMs affected by the number of pain locations?. Methods. We reviewed 336 hips (305 patients) treated with THA for hip OA from December 2016 to November 2019 using pain location/severity questionnaires, modified Harris Hip Score (mHHS), Hip Outcome Score (HOS), international Hip Outcome Tool (iHOT-12) score, and radiological analysis. Descriptive statistics, analysis of covariance (ANCOVA), and Spearman partial correlation coefficients were used. Results. There was a significant difference in iHOT-12 scores between groups experiencing the most severe pain in the groin and the trochanter (p = 0.039). Additionally, more favourable mHHS scores were related to the presence of preoperative pain in trochanter (p = 0.049), lower back (p = 0.056), lateral thigh (p = 0.034), and posterior thigh (p = 0.005). Finally, the maximum severity of preoperative pain and number of pain locations had no significant relationship with PROMs (maximum severity: HHS: p = 0.928, HOS: p = 0.163, iHOT-12 p = 0.233; number of pain locations: HHS: p = 0.211; HOS: p = 0.801; iHOT-12: p = 0.112). Conclusion. Although there was a significant difference in iHOT-12 scores between patients with the most severe pain in the groin or trochanter, and the presence of pain in the trochanter, lower back, lateral thigh, or posterior thigh was related to higher mHHS scores, the majority of preoperative pain characteristics did not have a significant impact on outcomes. Therefore, a broad array of patients with hip OA might expect similar, favourable outcomes from THA notwithstanding preoperative pain characteristics. Cite this article: Bone Jt Open 2022;3(4):332–339

Purpose: The purpose of this study was to identify if preoperative pain scores predict postoperative pain and functional outcomes in patients following rotator cuff surgery and if a threshold where increased risk occurs could be established. Establishing a risk threshold may help identify patients who need increased follow-up or rehabilitation. Method: One hundred six subjects with rotator cuff pathology requiring operative intervention were prospectively followed. The pain subscale of the Shoulder Pain and Disability Index (SPADI) was used as an indicator of pre-operative pain. Postoperative function one year following surgery was determined using the Simple Shoulder Test (SST). Scores with 40% or more deficit (compared to age matched controls) were classified as poor outcomes. The relative risk (RR) of poor SST scores was calculated across different cutoffs for preoperative pain scores. Results: Having a high preoperative pain score was associated with a poor outcome following rotator cuff surgery at both the six month and one year followup. Preoperative pain scores did predict postoperative functional scores. As preoperative pain levels increased there was a higher risk of poor functional outcomes. The RR of having a poor SST at 1-year was 2.3, if preoperative pain score was greater than 35/50. Conclusion: The current study indicates that those patients with high preoperative pain scores (> 35/50 or > 70%) are more than twice as likely to have a poor outcome following rotator cuff surgery. This should inform patients and surgeons for postoperative expectations. Whether closer follow-up, pre-rehabilitation, more intensive postoperative rehabilitation or enhanced pain management can alter this prognosis warrants investigation

Background

Surgical intervention for hallux valgus and hallux rigidus is an option for patients presenting with severe pain and deformity. Literature suggest that patients with high Pain Catastrophisation Scores (PCS) have poorer outcomes in spinal and to a lesser extent in arthroplasty surgery. There is however very little evidence pertaining to foot and ankle surgery.

Aims. Total hip arthroplasty (THA) is a common procedure to address pain and enhance function in hip disorders such as osteoarthritis. Despite its success, postoperative patient recovery exhibits considerable heterogeneity. This study aimed to investigate whether patients follow distinct pain trajectories following THA and identify the patient characteristics linked to suboptimal trajectories. Methods. This retrospective cohort study analyzed THA patients at a large academic centre (NYU Langone Orthopedic Hospital, New York, USA) from January 2018 to January 2023, who completed the Patient-Reported Outcomes Measurement Information System (PROMIS) pain intensity questionnaires, collected preoperatively at one-, three-, six-, 12-, and 24-month follow-up times. Growth mixture modelling (GMM) was used to model the trajectories. Optimal model fit was determined by Bayesian information criterion (BIC), Vuong-Lo-Mendell-Rubin likelihood ratio test (VLMR-LRT), posterior probabilities, and entropy values. Association between trajectory groups and patient characteristics were measured by multinomial logistic regression using the three-step approach. Results. Among the 1,249 patients, a piecewise GMM model revealed three distinct pain trajectory groups: 56 patients (4.5%) in group 1; 1,144 patients (91.6%) in group 2; and 49 patients (3.9%) in group 3. Patients in group 2 experienced swift recovery post-THA and minimal preoperative pain. In contrast, groups 1 and 3 initiated with pronounced preoperative pain; however, only group 3 exhibited persistent long-term pain. Multinomial regression indicated African Americans were exceedingly likely to follow trajectory groups 1 (odds ratio (OR) 2.73) and 3 (OR 3.18). Additionally, odds of membership to group 3 increased by 12% for each BMI unit rise, by 19% for each added postoperative day, and by over four if discharged to rehabilitation services (OR 4.07). Conclusion. This study identified three distinct pain trajectories following THA, highlighting the role of individual patient factors in postoperative recovery. This emphasizes the importance of preoperatively addressing modifiable risk factors associated with suboptimal pain trajectories, particularly in at-risk patients. Cite this article: Bone Jt Open 2024;5(3):174–183

Indications for Unicompartmental Knee Arthroplasty (UKA) vary between units. Some authors have suggested, and many surgeons believe, that medial UKA should only be performed in patients who localise their pain to the medial joint line. This is despite research showing a poor correlation between patient-reported location of pain and radiological or operative findings in osteoarthritis. The aim of this study is to determine the effect of patient-reported pre-operative pain location and functional outcome of UKA at one and five years. Pre-operative pain location data were collected for 406 knees (380 patients) undergoing Oxford medial UKA. Oxford Knee Score, American Knee Society Scores and Tegner activity scale were recorded preoperatively and at follow-up. 272/406 (67%) had pure medial pain, 25/406 (6%) had pure anterior knee pain and 109/406 (27%) had mixed or generalised pain. None had pure lateral pain. The primary outcome interval is one year; 132/406 patients had attained five years by the time of analysis and their five year data is presented. At one and five years, each group had improved significantly by each measure (mean δOKS 15.6 (SD 8.9) at year one, 16.3 (9.3) at year five). There was no difference between the groups, nor between patients with and without anterior knee pain or isolated medial pain. We have found no correlation between preoperative pain location and outcome. We conclude that localised medial pain should not be a prerequisite to UKA and that it may be performed in patients with generalised or anterior knee pain

Introduction

It has been hypothesized that a unicompartmental knee arthroplasty (UKA) is more likely to be revised than a total knee (TKA) because conversion surgery to a primary TKA is available. The purpose of this study was to determine if there is a lower threshold for UKA revisions compared to TKA revisions based on Oxford Knee Scores and range of motion (ROM).

Introduction: Abnormal pain drawings have been shown in some studies to correlate well with psychological characteristics predicting poor outcome in spinal procedures. Our study evaluated whether pain drawings are a useful predictive tool for outcome following Intradiscal Electrothermal Therapy (IDET).

Method: 56 Patients underwent IDET for chronic discogenic lumbar pain as demonstrated by MRI and provocative discography. They were assessed pre and post operatively. Preoperatively patients were assessed by means of a questionnaire. Pain was measured using a visual analogue scale (VAS), a pain drawing was completed and demographic details and employment status were recorded. Post IDET patients were followed up by means of a postal questionnaire. The same details were recorded, in addition to which patients completed a Short Form 36 UK Version 1 and a subjective outcome assessment.

Pain drawings were classified as organic or non-organic according to the principle described by Mann et al.

Results: 46 (80.7%) patients were successfully followed up. Mean age was 41.2 years (Range 16–76), 27 were female and 19 male. 73.9% of pain drawings were classified as organic and 26.1% as non-organic. The pain diagram was a good predictive tool for outcome following IDET. Patients with “organic” pain drawings showed an improvement in mean pain VAS (Pre-6.7, Post 5.9), high patient satisfaction (Better 67.6%, Same 11.8%, Worse 20.6%), and higher physical component scores of the SF36 (Physical 64.1, Physical Role 45.6, Pain 54.0) compared to the “non-organic” group who demonstrated a deterioration in mean pain VAS (Pre-6.5, Post 8.2), low patient satisfaction (Better 8.3%, Same 58.3%, Worse 33.3%), and lower physical component scores of the SF36 (Physical 38.3, Physical Role 20.8, Pain 26.5).

Conclusion: We believe that our study demonstrates that a pre procedure pain diagram can be reliably used as a tool to predict outcome following IDET.

Aims. Better prediction of outcome after total hip arthroplasty (THA) is warranted. Systemic inflammation and central neuroinflammation are possibly involved in progression of osteoarthritis and pain. We explored whether inflammatory biomarkers in blood and cerebrospinal fluid (CSF) were associated with clinical outcome, and baseline pain or disability, 12 months after THA. Methods. A total of 50 patients from the Danish Pain Research Biobank (DANPAIN-Biobank) between January and June 2018 were included. Postoperative outcome was assessed as change in Oxford Hip Score (OHS) from baseline to 12 months after THA, pain was assessed on a numerical rating scale, and disability using the Pain Disability Index. Multiple regression models for each clinical outcome were included for biomarkers in blood and CSF, respectively, including age, sex, BMI, and Kellgren-Lawrence score. Results. Change in OHS was associated with blood concentrations of tumour necrosis factor (TNF), interleukin-8 (IL-8), interleukin-6 receptor (IL-6R), glycoprotein 130 (gp130), and IL-1β (R. 2. = 0.28, p = 0.006), but not with CSF biomarkers. Baseline pain was associated with blood concentrations of lymphotoxin alpha (LTα), TNFR1, TNFR2, and IL-6R (R. 2. = 0.37, p < 0.001) and CSF concentrations of TNFR1, TNFR2, IL-6, IL-6R, and IL-1Ra (R. 2. = 0.40, p = 0.001). Baseline disability was associated with blood concentrations of TNF, LTα, IL-8, IL-6, and IL-1α (R. 2. = 0.53, p < 0.001) and CSF concentrations of gp130, TNF, and IL-1β (R. 2. = 0.26, p = 0.002). Thus, preoperative systemic low-grade inflammation predicted 12-month postoperative outcome after THA, and was associated with preoperative pain and disability. Conclusion. This study highlights the importance of systemic inflammation in osteoarthritis, and presents a possible path for better patient selection for THA in the future. Preoperative central neuroinflammation was associated with preoperative pain and disability, but not change in OHS after THA. Cite this article: Bone Joint Res 2024;13(12):741–749

Total hip arthroplasty (THA) is often performed in symptomatic patients with developmental dysplasia of the hip (DDH) who do not qualify for periacetabular osteotomy (PAO). The impact of osteoarthritis (OA) severity on postoperative outcomes in DDH patients who undergo THA is not well described. We hypothesized that DDH patients who undergo THA with mild OA have slower initial recovery postoperatively, but similar one-year patient reported outcome measures (PROMs) when compared to DDH patients with severe OA. We performed a retrospective review at a single academic institution over a six-year period of patients with DDH who underwent primary THA and compared them to patients without DDH who underwent THA. Within the DDH cohort, we compared PROMs stratified by DDH severity and OA severity. Diagnosis of DDH was verified using radiographic lateral center edge angle (LCEA). Minimum one-year follow-up was required. PROMs were collected through one-year postoperatively. Logistic and linear regression models were used adjusting for age, sex, body mass index, and Charlson Comorbidity Index. 263 patients with DDH were compared to 1,225 THA patients without DDH. No significant differences were found in postoperative PROMs or revision rates (p=0.49). When stratified by DDH severity, patients with LCEA<10° had worse preoperative pain (p=0.01), mental health (p<0.01) and physical function (p=0.03) scores but no significant difference in postoperative PROMs. Within the DDH group, when stratified by OA severity, patients with Grade 3 Tonnis score had worse preoperative pain (p=0.04) but no significant difference in postoperative PROMs. Recovery curves in DDH patients based upon severity of DDH and OA were not significantly different at 2-weeks, 6-weeks and 1-year. DDH patients who have mild OA have similar recovery curves compared to those with severe OA. THA is reasonable in symptomatic DDH patients who have mild arthritis and do not qualify for PAO

Introduction. Autologous Matrix Induced Chondrogenesis (AMIC) for surgical treatment of osteochondral lesions of the talus (OCLT) has shown excellent clinical and radiological results at short term follow up two years after surgery. However, no mid-term follow up data is available. Aim. 1. To evaluate the clinical outcome after AMIC-aided reconstruction of osteochondral lesions of the talus at a minimum follow up time of five years. 2. To evaluate the morphology and quality of the regenerated cartilage by magnetic resonance imaging (MRI) at on at a minimum follow up time of five years. Methods. Seventeen patients prospectively underwent surgery receiving a AMIC-aided repair of OCLT consisting of debridement, autologous grafting, and sealing of the defect with a collagen scaffold (Chondro-Gide, Geistlich Surgery, Wolhusen, Switzerland). Clinical and radiological assessment was performed before and after a minimum of 60 months after surgery (average 78 months, range, 60–120). Clinical examination included the American Orthopaedic Foot & Ankle Society (AOFAS) ankle score and the Visual Analogue Scale (VAS). Radiological imaging consisted of MRI. The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score was applied. Results. The AOFAS ankle score improved significantly from a mean of 60 points preoperatively (range, 17–79) to 91 points (range, 70–100) postoperatively (p< 0.01). The preoperative pain score averaged a VAS of 5 (range, 2–8), improving to an average of 1.1 (range 0–8) (p< 0.01). The MOCART score for cartilage repair tissue on postoperative MRI averaged 71 points (range, 50–90). Conclusion. The AMIC-procedure is safe for the treatment of OCLT with overall good clinical and magnetic resonance imaging results at five years follow up

Abstract. Introduction. Osteotomy is recognised treatment for osteoarthritis of the knee. Evidence suggests favourable outcomes when compared to arthroplasty, for younger and more active individuals[1]. Double level osteotomy (DLO) is considered when a single level is insufficient to restore both joint line obliquity and adequate realignment[2]. This paper aims to establish the functional outcomes up to two years post operatively for patients undergoing DLO, using patient reported outcome measures (PROMs). Methodology. All patients who underwent a DLO at either Lister Hospital, Stevenage, or One Hatfield Hospital, Hertfordshire, between 1st January 2018 and 1st October 2020 were identified. DLO were performed by two specialist consultants, independently or in combination. PROMs including pain scores, health score, Oxford knee score (OKS) and knee injury and osteoarthritis outcome score (KOOS) were recorded pre-operatively and at six month, one and two year post operative intervals. Results. 24 patients underwent DLO; a medial opening wedge high tibial osteotomy and lateral closing wedge distal femoral osteotomy. The cohort comprised 21 males, 3 females with an average age of 54.09 (38–77) years. Preoperative pain scores graded from 0–10 improved from 6.86 to 2.0 at 2 years. OKS improved from 23.94 to 47.88, as did KOOS 43.55 to 87.51, over the same duration. Conclusion. DLO was associated with improvements in pain and functional outcomes, compared to pre-operative levels. In patients for whom arthroplasty may be unfavourable, this provides an alternative to non-operative management, the options for which are frequently exhausted early in the disease process

Background. Chronic pain after joint replacement is common, affecting approximately 10% of patients after total hip replacement (THR) and 20% of patients after total knee replacement (TKR). Heightened generalised sensitivity to nociceptive input could be a risk factor for the development of this pain. The primary aim of this study was to investigate whether preoperative widespread pain sensitivity was associated with chronic pain after joint replacement. Methods. Data were analysed from 254 patients receiving THR and 239 patients receiving. TKR. Pain was assessed preoperatively and at 12 months after surgery using the Western Ontario and McMaster Universities Osteoarthritis Pain Scale. Preoperative widespread pain sensitivity was assessed through measurement of pressure pain thresholds (PPTs) at the forearm using an algometer. Statistical analysis was conducted using linear regression and linear mixed models, and adjustments were made for confounding variables. Results. In both the THR and TKR cohort, lower PPTs (heightened widespread pain. sensitivity) were significantly associated with higher preoperative pain severity. Lower PPTs were also significantly associated with higher pain severity at 12 months after surgery in the THR cohort. However, PPTs were not associated with the change in pain severity from preoperative to 12 months postoperative in either the TKR or THR cohort. Conclusions. These findings suggest that although preoperative widespread pressure pain sensitivity is associated with pain severity before and after joint replacement, it is not a predictor of the amount of pain relief that patients gain from joint replacement surgery, independent of preoperative pain severity. Level of Evidence. 2. Approvals. The APEX trials were registered as an International Standardised Randomised Controlled Trial (96095682), approved by Southampton and South West Hampshire Research Ethics Committee(09/H0504/94) and all participants provided informed written consent

As treatments of knee osteoarthrosis are continually refined, increasingly sophisticated methods of evaluating their biomechanical function are required. Whilst TKA shows good preoperative pain relief and survivorship, functional outcomes are sub-optimal, and research focus has shifted towards their improvement. Restoration of physiological function is a common design goal that relies on clear, detailed descriptions of native biomechanics. Historical simplifications of true biomechanisms, for example sagittal plane approximation of knee kinematics, are becoming progressively less suitable for evaluation of new technologies. The patellar tendon moment arm (PTMA) is an example of such a metric of knee function that usefully informs design of knee arthroplasty but is not fully understood, in part due to limitations in its measurement. This research optimized PTMA measurement and identified the influence of knee size and sex on its variation. The PTMA about the instantaneous helical axis was calculated from optical tracked positional data. A fabricated knee model facilitated calculation optimization, comparing four data smoothing techniques (raw, Butterworth filtering, generalized cross-validated cubic spline-interpolation and combined filtering/interpolation). The PTMA was then measured for 24 fresh-frozen cadaveric knees, under physiologically based loading and extension rates. Sex differences in PTMA were assessed before and after size scaling. Large errors were measured for raw and interpolated-only techniques in the mid-range of extension, whilst both raw and filtered-only methods saw large inaccuracies at terminal extension and flexion. Combined filtering/interpolation enabled sub-mm PTMA calculation accuracy throughout the range of knee flexion, including at terminal extension/flexion (root-mean-squared error 0.2mm, max error 0.5mm) (Figure 1). Before scaling, mean PTMA throughout flexion was 46mm; mean, peak, and minimum PTMA values were larger in males, as was the PTMA at terminal flexion, the change in PTMA from terminal flexion to peak, and the change from peak to terminal extension (mean differences ranging from 5 to 10mm, p<0.05). Knee size was highly correlated with PTMA magnitude (r>0.8, p<0.001) (Figure 2). Scaling eliminated sex differences in PTMA magnitude, but peak PTMA occurred closer to terminal extension in females (female 15°, male 29°, p=0.01) (Figure 3). Improved measurement of the PTMA reveals previously undocumented characteristics that may help to improve the functional outcomes of knee arthroplasty. Knee size accounted for two-thirds of the variation in PTMA magnitude, but not the flexion angle at which peak PTMA occurred, which has implications for morphotype-specific arthroplasty and musculoskeletal models. The developed calculation framework is applicable both in vivo and vitro for accurate PTMA measurement and might be used to evaluate the relative performance of emerging technologies. For any figures or tables, please contact the authors directly

Background. The impact of a patient's activity level following total hip arthroplasty (THA) remains controversial, with some concerned about increased polyethylene wear, aseptic loosening and revisions. The purpose of this study is to report on implant survivorship and outcomes of high activity patients compared to low activity patients after THA with current polyethylene. Methods. A retrospective review identified 2002 patients (2532 hip) that underwent a primary THA with vitamin E infused highly crosslinked polyethylene liner and 2-year minimum follow-up or revision. Patients were divided in two groups based on their University of California Los Angeles (UCLA) activity level: Low activity (LA) (UCLA ≤5) and high activity (HA) (UCLA ≥ 6). Outcomes included Harris Hip Score, UCLA activity score, complications and reoperations. Multivariate nominal regression analysis was performed to evaluate the significance of postoperative activity level on survivorship while controlling for age, gender, preoperative pain, HHS and body mass index (BMI). Results. Mean follow-up was 4.5 years (range, 0.3 to 9.9 years). The LA group had significantly more female patients, were older, higher BMI and lower HHS pre-operatively (all with p<0.001). HA group had significantly higher improvements in HHS (p<0.001) and UCLA activity score (p<0.001). Aseptic revisions were performed in 2.1% of the LA group and in 0.4% hips of the HA group (p<0.001). Multivariate regression analysis found that a higher postoperative activity level remained a significant factor for improved aseptic survivorship with an OR of 4.9 (95% CI, 1.1 to 21.2, p=0.03). The aseptic 5-year survivorship was 99.6% for the HA group and 98% for the LA group (p<0.001). Conclusions. Higher activity level after primary THA did not increase the risk for midterm aseptic or all cause failure. Patient activity level after THA may not need to be limited with modern polyethylene

Aims

The aim of this study was to describe the prevalence and patterns of neuropathic pain over one year in a cohort of patients with chronic post-surgical pain at three months following total knee arthroplasty (TKA).

Cite this article: Bone Joint Res 2023;12(5):306–308.

Aims

To review the evidence and reach consensus on recommendations for follow-up after total hip and knee arthroplasty.

Aims

The incidence of limb fractures in patients living with HIV (PLWH) is increasing. However, due to their immunodeficiency status, the operation and rehabilitation of these patients present unique challenges. Currently, it is urgent to establish a standardized perioperative rehabilitation plan based on the concept of enhanced recovery after surgery (ERAS). This study aimed to validate the effectiveness of ERAS in the perioperative period of PLWH with limb fractures.

Aims

To map literature on prognostic factors related to outcomes of revision total knee arthroplasty (rTKA), to identify extensively studied factors and to guide future research into what domains need further exploration.

Aims

There are concerns regarding complications and longevity of total elbow arthroplasty (TEA) in young patients, and the few previous publications are mainly limited to reports on linked elbow devices. We investigated the clinical outcome of unlinked TEA for patients aged less than 50 years with rheumatoid arthritis (RA).