The primary objective of this study was to determine if surgical treatment for spinal stenosis is comparable to total hip and knee arthroplasty in improving patients’ self-reported quality of life. An age, sex and time of surgery matched cohort of patients who had undergone elective primary one-two level spinal decompression (n=90) with (n=26 /90) or without fusion for spinal stenosis (n=40 with degenerative spondylolisthesis) and elective primary total hip (n=90) and knee (n = 90) arthroplasty for osteoarthritis were compared. The primary outcome measure was the preoperative and two year postoperative Medical Outcomes Study Short Form-36 (SF-36) questionnaire.

There was no significant difference in the mean pre-operative Physical Component Summary (PCS) / Mental Component Summary between groups [Spine −32/43; Hip − 30/45; Knee 31/46 (p > 0.5)]. With the exception of the knee MCS (p=0.2), postoperative scores were significantly improved for all groups [Spine −40/53; Hip − 43/51; Knee 39/48 (p < 0.001)]. Overall the hip surgery had the great impact on PCS and the spine surgery on MCS.

Studies have shown the significant impact on overall patient quality of life and cost-effectiveness of primary total joint arthroplasty. The results of this unique study show that surgical intervention for spinal stenosis has a similar positive effect at two year follow up. This study provides data that supports the need advocacy regarding waiting time initiatives and surgical resources for the treatment of patients with symptomatic spinal stenosis with a similar demographic to those with primary OA of the hip or knee.

Sixty-two consecutive primary total hip arthroplasties were prospectively randomized to receive either hydroxyapatite coated (thirty-five hips) or nonhydroxy-apatite coated (twenty-seven hips) femoral prostheses. At a minimum eleven-year followup fifty-one hips (forty-four patients) were evaluated. Only one femoral stem had been revised (secondary to traumatic periprosthetic fracture). Radiographs were available for thirty-nine hips. None of these femoral stems were loose. Harris Hip scores were evaluated for thirty-six unrevised hips and did not differ significantly between the two groups. There appears to be no significant advantage to hydroxyapatite coating for this femoral prosthesis at an average follow-up of thirteen years.

There are a paucity of long term randomized controlled trials on results of hydroxapatite coating of femoral prostheses. The purpose of this study was to update the results of a prospective randomized study of a proximally pourous coated, tapered titanium femoral component with and without hydroxyapatite coating.

Sixty-two consecutive primary total hip arthroplasties done by one surgeon in fifty-five patients were prospectively randomized to receive either hydroxyapatite coated (thirty-five hips) or nonhydroxyapatite coated (twenty-seven hips) femoral prostheses. At a minimum eleven year followup, three hips (three patients) were lost to followup, and a further eight patients had expired (eight hips). The remaining surviving cohort of fifty-one hips (forty-four patients) were evaluated clinically, including Harris Hip Scores, and radiographically.

At an average of thirteen years followup, only one femoral stem had been revised (secondary to traumatic periprosthetic fracture), that being in the hydroxyapatite group. There were eight acetabular revisions in the hydroxyapatite group (thirty-four percent) and four acetabular revisions in the nonhydroxyapatite group (sixteen percent). Radiographs were available for thirty-nine hips. None of these femoral stems were loose. Harris Hip scores were evaluated for thirty-six unrevised hips and did not differ significantly between the two groups.

Using endpoints of femoral revision, radiographic loosening, and Harris Hip Scores there appears to be no significant advantage to hydroxyapatite coating for this femoral prosthesis at an average follow-up of thirteen years.

Funding: Biomet, Warsaw IN

This study (n=126, mean age=68.8 years, males=62) evaluated pre-operative WOMAC pain and physical function, age, gender, general health status, revision severity classification, number of revisions, comorbidity and unilateral vs. bilateral surgery as predictors of WOMAC pain and physical function at twenty-four months post revision hip arthroplasty. Pain improved from 9.3 to 3.6 and physical function improved from 35.4 to 17.1. No factors were predictive of patient function. Decreased pain was predicted by less pain pre surgery (p=0.01) and being male (p=0.04).

To determine if pre-operative WOMAC pain and physical function, age, gender, general health status (SF-36), revision severity classification, number of revisions, comorbidity and unilateral vs. bilateral surgery are predictive of WOMAC pain and physical function at twenty-four months post revision hip arthroplasty.

Physical function at twenty-four months is not independently predicted by the pre-treatment factors evaluated in this study. Male patients with less pain pre surgery and little comorbidity have less pain post surgery.

With the exception of pre-treatment pain, the pre-treatment factors tested in this study provide minimal guidance in identifying factors that might be modified to enhance patient outcome.

This prospective cohort study included one hundred and twenty-six patients (mean age=68.8 years, males: females=62:64) who had revision for other than infection or peri-prosthetic fracture. On average from pre-surgery to twenty-four months post-surgery, WOMAC pain improved 9.3 to 3.6 and physical function improved from 35.4 to 17.1. In univariate analysis (t-test, p< 0.05), males tended to have better function (19.6 vs. 14.7) and reported less pain (4.4 vs. 2.8). No other factors were significant in univariate analysis. None of the a priori factors noted above were independently predictive of patient function at twenty-four months in the multivariate model (F=2.06, p=0.04, R²=0.16). Decreased pain with activity at twenty-four months independently was predicted by having less pain pre surgery (p=0.01), being male (p=0.04) and having fewer comorbidities (p=0.07) in the multi-variate model (F=2.9. p=0.004, R²=0.21).

Funding: This work was supported by a grant from The Arthritis Society