Introduction. Cephalomedullary nailing (CMN) is commonly used for unstable pertrochanteric fracture. CMN is relatively safe method although various complications can potentially occur needing revision surgery. Commonly used salvage procedures such as renailing, hemiarthroplasty, conservative treatment or total hip arthroplasty (THA) are viable alternatives. The aim was to investigate the rate of THA after CMN and evaluate the performance on conversion total hip arthroplasty (cTHA) after failure of CMN. Method. Collected data included patients from two orthopedic centers. Data consisted of all cTHAs after CMN between 2014-2020 and primary cementless THA operations between 2013-2023. Primary THA operations were treated as a control group where Oxford Hip Score (OHS) was the main compared variable. Result. From 2398 proximal femoral hip procedures 1667 CMN procedures were included. Altogether 46/1667 (2.8%) CMNs later received THA. Indications for THA after CMN failure were 13 (28.3%) cut-outs, nine (19.6%) cut-throughs, eight (17.4%) nail breakages, seven (15.2%) post traumatic arthrosis, seven (15.2%) nonunions, one (2.2%) malunion and one (2.2%) collum screw withdrawal. Mean (SD) time to complication after CMN operation is 5.9 (6.8) months. Mean (SD) time from nail procedure to THA was 10.4 (12.0) months. Total complication rate for cTHA after CMN was 17.4%. Reported complications were infection with seven (15.2%) cases and one (2.2%) nerve damage. Mean (SD) time to cTHA complication was 3.6 (6.1) months. One-sample T-test showed
Patients undergoing hip resurfacing arthroplasty (HRA) is typically reserved for highly active patients. Patient Reported Outcome Measures (PROMs) such as the Oxford Hip Score (OHS) are reported to have ceiling effects, which may limit physicians' ability to measure health gain in these patients. The Metabolic Equivalent of Task (MET) index is a validated compendium assigning energy expenditure to a wide range of activities; for example, a slow walk expends 2.9 kcal/kg/hour, golf expends 4.0 kcal/kg/hour, while moderate lacrosse typically expends 8.1 kcal/kg/hour. We hypothesized that for patients with high
Abstract. Objectives. Conventional approaches (including Tobit) do not accurately account for ceiling effects in PROMs nor give uncertainty estimates. Here, a classifier neural network was used to estimate postoperative PROMs prior to surgery and compared with conventional methods. The Oxford Knee Score (OKS) and the Oxford Hip Score (OHS) were estimated with separate models. Methods. English NJR data from 2009 to 2018 was used, with 278.655 knee and 249.634 hip replacements. For both OKS and
Reports of improved functional outcome of Metal on Metal Hip Resurfacing Arthroplasty (mHRA) to Total Hip Replacement needs to be balanced with concerns of metal ion release. By removing cobalt-chrome, cHRA reduces these risks. To the author's knowledge, there is no data available on functional outcomes of cHRA, therefore the aim of the study was to compare the function between cHRA patients and mHRA patients. 24 patients received a unilateral cHRA (H1, Embody) and was compared to 24 age and gender matched patients with a unilateral mHRA (BHR, Smith and Nephew). All patients completed the Oxford Hip Score (OHS)[T2] and underwent gait analysis on an instrumented treadmill before and at a mean of 74wks (+/− 10) for mHRA and 53wks (+/− 2) for cHRA post op. Walking trials started at 4km/h and increased in 0.5km/h increments until a top walking speed (TWS) was achieved. Vertical ground reaction forces (GRF) were recorded along with the symmetry index (SI). Spatiotemporal measures of gait were also recorded. Vertical GRF were captured for the entire normalised stance phase using statistical parametric mapping (SPM; CI = 95%). The gain in
Objectives. To define Patient Acceptable Symptom State (PASS) thresholds
for the Oxford hip score (OHS) and Oxford knee score (OKS) at mid-term
follow-up. Methods. In a prospective multicentre cohort study,
Aim. To investigate the validity of threshold values for the Oxford Hip and Knee Score (OHS and OKS) for treatment success 12 months after total knee or hip replacement. Methods. Questionnaires were administered to patients undergoing total hip (THA) or knee (TKA) replacement before and 12 months after surgery alongside questions assessing key accepted aspects of treatment success (satisfaction, pain relief, functional improvement) to form a composite criterion of success and assessed using receiver operator characteristic (ROC) analysis. Thresholds providing maximum sensitivity and specificity for predicting treatment success were determined for the total sample and subgroups defined by pre-surgery scores. Results. Data was available for 3203 THA and 2742 TKA patients. Applying the composite treatment success criterion, 52.7% of the TKA and 65.6% of the THA sample reported a successful treatment outcome. Accuracy for predicting treatment success was high for the
To validate the Modified Forgotten Joint Score (MFJS) as a new patient-reported outcome measure (PROM) in hip and knee arthroplasty against the UK's gold standard Oxford Hip and Knee Scores (OHS/OKS). The original Forgotten Joint Score was created by Behrend et al to assess post-op hip/knee arthroplasty patients. It is a new assessment tool devised to provide a greater discriminatory power, particularly in the well performing patients. It measures an appealing concept; the ability of a patient to forget about their artificial joint in everyday life. The original FJS was a 12-item questionnaire, which we have modified to 10-items to improve reliability and missing data. Postal questionnaires were sent out to 400 total hip/knee replacement (THR/TKR) patients who were 1–2 years post-op, along with the
Aim. To assess whether the Oxford Hip Score (OHS), is reflective of objectively assessed functional performance (timed up and go (TUG), 30 sec sit to stand (ST), 6 minute walk test (6MWT), stair climb performance (SCP), and gait speed (GS)) in patients undergoing total hip arthroplasty (THA). Methods. 50 patients undergoing THA were prospectively recruited after ethical approval. Demographics and objective physical performance were assessed (TUG, ST, 6MWT, SCP, GS), as was the
Aim. This study aimed to assess whether the severity of symptoms (assessed with the Oxford Hip Score (OHS)) can relate to the levels of mRNA expression of markers for muscle inflammation (tumour necrosis factor alpha (TNFα), interleukin 6 (IL-6)) in the proximal vastus lateralis (VL) of patients with severe OA undergoing THR. Methods. Following local research ethics approval and informed consent, 17 patients were prospectively recruited. Muscle biopsies were obtained from the proximal VL (accessed through the surgical wound) intraoperatively whilst the
Summary. Five year migration results of 49 large-head metal-metal (MoM) total hip arthroplasties show good implant stability and no association between implant migration and metal-ions levels, stem and cup position, or femoral bone mineral density. Introduction. The failure mechanism of metal-metal (MoM) total hip arthroplasty has been related to metal wear-debris and pseudotumor, but it is unknown whether implant fixation is affected by metal wear-debris. Patients and Methods. In July-August 2012 41 patients (10 women) at a mean age of 47 (23–63) years with a total of 49 MoM hip arthroplasties (ReCap Shell/M2a-Magnum head/Bi-Metric stem; Biomet Inc.) participated in a 5–7 year follow-up with blood tests (chrome and cobalt serum ions), questionnaires (Oxford Hip Score (OHS) and Harris Hip Score (HHS), measurement of cup and stem position and periprosthetic BMD. Further the patients had been followed with stereo-radiographs post-operative and at 1, 2 and 5 years for analysis of implant migration (Model-Based RSA 3.32). Results. 4 patients (6 hips) had elevated metal-ion levels (>7ug/l). The mean cup inclination was 45°(sd 6), the mean cup anteversion was 17°(sd7), and the mean stem anteversion was 19°(sd7). The difference between genders was statistically insignificant (p>0.09). At 5 years follow-up total translation (TT) for the stems (n=39 hips) was a mean 0.79mm (sd 0.53) and total rotation (TR) was a mean 1.99° (sd 1.53). Between 1–2 years there was no significant difference in mean TT (p=0.49)for the stems and between 2–5 years TT was mean 0.13 mm (sd 0.35) which was significant (p=0.03) but clinically very small and within the precision limits of the method. We found no significant migration along the 3 separate axes. There was no significant association between stem migration and metal ion levels >7ug/l (p=0.55), female gender (p=0.86), stem anteversion > 25° (p=0.29), T-scores < −1 (p=0.23), total
The link between squeaking and ceramic on ceramic (CoC) bearings has been widely reported in orthopaedic literature and is described as a hard bearing phenomenon. We aim to look at the incidence of noise in CoC bearings compared to Metal on Polyethylene (MoP) bearing, which have yet to be linked to squeaking. We developed a noise characterizing hip questionnaire and sent that along with the Oxford Hip Score (OHS) to 1000 patients; 3:2 ratio of CoC to MoP. 282 CoC patients and 227 MoP patients returned the questions: 509 patients in total. Our patient database provided details on femoral head size and the acetabular inclination angle, for each respondent. 47 (17%) of the CoC hip patients reported noise compared to 19 (8%) of the MoP hip patients (P=0.054). 9 CoC patients and 4 MoP patients reported squeaking, while clicking was the most frequent answer in both groups. 27% patients with noise reported avoiding recreational activities because of it. Patient's with noisy hips scored on average, 5 points worse in the
The aim of this study was to characterise noise associated with ceramic-on-ceramic total hip arthroplasty (THA). A questionnaire was constructed to assess noise associated with THA. 116 patients responded. All had ceramic-on-ceramic hybrid THA at Glasgow Royal Infirmary between 2005 and 2007 using a Trident prosthesis and Exeter stem. Oxford Hip Questionnaires (OHS) were also completed by the patients. 16.4% of respondents reported noise associated with their ceramic hip. The vast majority reported onset at least 1 year after implantation. The most common noise types were ‘clicking’ (47%) or ‘grinding’ (42%), while ‘squeaking’ was least frequently reported (11%). Noise was most commonly brought on by bending and during sit to stand movements. No correlation was identified between the incidence of noise and any patient specific factor or demographic variable. The mean
It is known that excessive varus alignment of the femoral stem in total hip replacement (THR) creates a sub-optimal biomechanical environment which is associated with increased rates of revision surgery and component wear. Little is known regarding the effect of femoral stem alignment on patient functional outcome. Methods. Retrospective study of primary THR patients at the RNOH. Alignment of the femoral stem component in-situ was measured subjectively by a consultant musculoskeletal radiologist in both coronal and sagittal planes using post-operative anterior-posterior and lateral pelvic radiographs. Each THR was grouped into valgus, minor-valgus, neutral, minor-varus or varus coronal plane alignment and posterior, minor-posterior, neutral, minor-anterior or anterior sagittal plane alignment. Patient reported functional outcome was assessed by Oxford Hip Score (OHS) and WOMAC questionnaires. Data analysed using a linear regression model. Results. 90 THRs were studied in 87 patients (55 Female). Mean age at THR=62 (22-86). Mean follow-up=17 months (11-39 months). Median OHS=16, WOMAC=8. Coronal plane alignment of the femoral stem was not associated with any change in
The Trident acetabular system is the second most common cementless cup implanted in the UK. Recent studies have shown that malseating of the liner can be as high as 16.4%. We felt this was very high and were prompted to review our series and early clinical outcomes. We reviewed 118 hips in 110 patients, implanted between from 2005-2007. We reviewed initial post operative X-rays using the technique described by Howcroft to identify malseating. The posterior approach was used in all cases. All cups were Trident PSL and all 85 Patients had OA, 10 RA, 8 AVN, 5 DDH, 3 OA post trauma, 2 Perthes, 2 Psoriatic Arthritis, 3 other. We only identified 3 malseated cups in 118 hips. 2 were in patients with OA secondary to trauma and 1 in primary OA. The rate of malseating for trainees operating was 5 % and only 1% when consultants were operating. There were no adverse events in these patients. No-one required revision. Oxford Hip Score (OHS) improved from 47 pre-op to 20 post op. This was compared to 47 and 22 in the correctly seated group (115 cases). Surprisingly the subgroup with the poorest
Exeter Trauma Stem (ETS) is one of the most common implants used for treating displaced intracapsular hip fractures in the UK. We previously performed a radiographic audit of these implants which showed good placement was difficult. This was in particular relation to leg length discrepancy (LLD). This study reviewed the clinical outcomes of these patients, in particular looking at the relation of leg length discrepancy to outcome. We performed a clinical review of patients at 3 months and 1 year post ETS for hip fracture. Oxford hip score (OHS), Trendelenberg test, Visual Analogue Score (VAS) and walking aids required were recorded. Leg length discrepancy was determined radiographically on initial post op X-ray. This was recorded as Even (+/− 5mm), 6-10mm Long and >10mm long. Seventy-two patients were reviewed at 3 months and 21 at 1 year. Mean VAS was 1.6. At 3 months 66% were Trendelenberg positive. Of those Trendelenberg positive at 3 months only 42% remained positive at 1 year. Mean
Background. Dissociation of the polyethylene liner is a known failure mechanism of the Harris Galante I and II uncemented acetabular components. The outcomes of revision surgery for this indication and the influence of time to diagnosis are not well described. Methods. We report a series of 29 cases revised due to this failure mechanism. Results. The median time from primary to revision surgery was 13 years. At a median of 4 years follow up, the mean
Background. Over 96% of primary total hip replacements (THR) recorded in the National Joint Registry (NJR) are performed through a posterior or lateral surgical approach. There is no high quality evidence available to support the use of one approach over the other in primary THR and even less evidence when the outcome of revision THR is considered. Methods. Questionnaires were sent to 267 patients who had revision hip replacements between January 2006 and March 2010 for aseptic loosening. They rated their pain from 0–10, and used the Self-Administered Patient Satisfaction Scale (SAPS), Oxford Hip Score (OHS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and Short form-12 (SF-12). Results. We performed 275 revision total hip replacements for aseptic loosening on patients in whom the primary operation details were available. Their mean age was 69 years (SD12) with 43% male and 57% right-sided procedures. 205 patients responded to our questionnaires (209/275 hips, 76%). Unfortunately 19 patients had died, 4 had dementia and 13 declined to participate. We were unable to contact a further 33.Grouping by approach, 20% (43/209) had primary and revision lateral approaches, 20% (43/209) had primary lateral and revision posterior and 60% (123/209) had both primary and revision via posterior approaches. The WOMAC and
Femoral stem varus has been associated with poorer results. We report the incidence of varus/valgus malalignment of the Exeter polished, double taper design in a multicentre prospective study. The surgical outcomes at a minimum of five year and complication rates are also reported. A multicentre prospective study of 987 total hip replacements was undertaken to investigate whether there is an association between surgical outcome and femoral stem malalignment. The primary outcome measure was the change in the Oxford hip score (OHS) at five years. Secondary outcomes included the rate of dislocation and revision. The incidence of varus and valgus malignment were 7.1% and 2.6% respectively. There was no significant difference in
Background. The position of the hip-joint centre of rotation (HJC) within the pelvis is known to influence functional outcome of total hip replacement (THR). Superior, lateral and posterior relocations of the HJC from anatomical position have been shown to be associated with greater joint reaction forces and a higher incidence of aseptic loosening. In biomechanical models, the maximum force, moment-generating capacity and the range of motion of the major hip muscle groups have been shown to be sensitive to HJC displacement. This clinical study investigated the effect of HJC displacement and acetabular cup inclination angle on functional performance in patients undergoing primary THR. Methods. Retrospective study of primary THR patients at the RNOH. HJC displacement from anatomical position in horizontal and vertical planes was measured relative to radiological landmarks using post-operative, calibrated, anterior-posterior pelvic radiographs. Acetabular cup inclination angle was measured relative to the inter-teardrop line. Maximum range of passive hip flexion, abduction, adduction, external and internal rotation were measured in clinic. Patient reported functional outcome was assessed by Oxford Hip Score (OHS) and WOMAC questionnaires. Data analysed using a linear regression model. Results. 109 THRs were studied in 104 patients (69 Female). Mean age at THR=63 years (22-88). Mean follow-up=17 months (11-39 months). Median OHS=16, WOMAC=8. Increasing vertical HJC displacement (in either superior or inferior direction) from anatomical position was associated with worsening