Introduction

The patient's perspective is important in determining contemporary quality measures. Hip surgery may be much more disruptive on patient and family than many surgeons appreciate. We sought to investigate the character of the periacetabular osteotomy(PAO) experience from the patient's point of view. We hypothesized that interviewing this largely female population, treated in their very active years, would yield unique insights.

Aims

The aim of this study was to understand the experience of mature patients who undergo a periacetabular osteotomy (PAO), a major hip-preserving surgical procedure that treats symptomatic hip dysplasia by realigning the acetabulum. Our aim was to improve our understanding of how the operation affected the lives of patients and their families, with a long-term goal of improving their experience.

Aims. Periprosthetic proximal femoral fractures (PFFs) are a major complication after total hip arthroplasty (THA). Health status after PFF is not specifically investigated. The aim of this study is to evaluate the health status pattern over two years after sustaining a PFF. Methods. A cohort of patients with PFF after THA was derived from the Brabant Injury Outcomes Surveillance (BIOS) study. The BIOS study, a prospective, observational, multicentre follow-up cohort study, was conducted to obtain data by questionnaires pre-injury and at one week, and one, three, six, 12, and 24 months after trauma. Primary outcome measures were the EuroQol five-dimension three-level questionnaire (EQ-5D-3L), the Health Utility Index 2 (HUI2), and the Health Utility Index 3 (HUI3). Secondary outcome measures were general measurements such as duration of hospital stay and mortality. Results. A total of 70 patients with a PFF were included. EQ-5D utility scores were significantly lower on all timepoints except at six months’ follow-up compared to pre-injury. EuroQol visual analogue scale (EQ-VAS) scores at one month's follow-up were significantly lower compared to pre-injury. The percentage of reported problems at two years was higher for all dimensions except anxiety/depression when compared to pre-injury. The mean EQ-5D utility score was 0.26 higher in males compared to females (95% confidence interval (CI) 0.01 to 0.42; p = 0.003). The mean EQ-VAS score for males was 8.9 points higher when compared to females over all timepoints (95% CI 1.2 to 16.7; p = 0.027). Mortality was 10% after two years’ follow-up. Conclusion. PFF patients are a frail population with substantial functional impairment at baseline. Post-injury, they have a significant and clinically relevant lower health status two years after trauma when compared to pre-injury. Health status improves the most between one and three months after injury. Two years after PFF, more patients experience problems in mobility, self-care, usual activities, and pain/discomfort than pre-injury. Cite this article: Bone Joint J 2024;106-B(5):442–449

Studies have shown that 10–30% patients do not achieve optimal function outcomes after total hip replacement (THR). High quality randomised controlled trials (RCTs) evaluating the clinical and cost-effectiveness of techniques to improve functional outcomes after THR are lacking. We performed this study to evaluate the feasibility of a RCT comparing patient-reported functional outcomes after hybrid or fully cemented THR (ISRCTN11097021). Patients were recruited from two centres and randomised to receive either a fully cemented or hybrid THR. Data collection included Patient Reported Outcome Measures (PROMs), non-serious adverse events of special interest (AESI), serious adverse device effects (SADE) and NHS resource use. Qualitative interviews were undertaken to understand a) patient experiences of study processes and their reasons for taking part or not, and b) to understand surgeons’ perceptions of the study, factors affecting willingness to participate, and barriers to implementation of the future RCT findings. The target of 40 patients were successfully recruited for the feasibility RCT; the ratio of successful recruitment to eligible patients was 0.61 across both sites. Treatment crossovers occurred in four patients, all related to bone quality. Four patients were withdrawn due to not undergoing surgery within the study window because of the pandemic. Follow-up was 100% and PROMs were completed by all patients at all time points. The feasibility of conducting a within-trial cost-utility analysis was demonstrated. Interviews were conducted with 27 patients and 16 surgeons. Patients and surgeons generally found the study procedures acceptable and workable. Some declined participation because they did not want treatment allocated at random, or because blinding was off-putting. Surgeons’ perceptions of equipoise varied, and implementation of findings from the future RCT would need to recognise the ‘craft’ nature of surgery and the issue of training. We conclude that a full RCT with economic analysis will be both feasible and practicable, although mechanisms to safely implement potential changes to practice because of RCT findings may need consideration by the wider arthroplasty community

Although total hip arthroplasty (THA) is beneficial for many patients with hip osteoarthritis (OA), a subset of patients experience minimal benefit. It is therefore pertinent to understand the predictors of poor functional outcome to facilitate shared decision making. One such predictor is preoperative radiographic OA severity. The aim of this systematic review was to determine whether preoperative radiographic OA severity could predict postoperative patient-reported outcome measures (PROMs) and satisfaction rates after THA. This systematic review was conducted according to PRISMA guidelines, and the protocol published in PROSPERO (ID:Â CRD42023445918). A literature search was performed using Embase, MEDLINE and Cochrane Library databases. Demographics, radiographic OA severity, PROMs, satisfaction, and complications after THA were collected. A meta-analysis was performed, where appropriate, using a random-effects model. Of 631 identified articles, 12 were included in the final analysis (8,034 participants; mean age 65.2, 38.1% male, mean BMI 29.1 kg/m2). There were three key findings. Firstly, those with mild OA are less likely to achieve a meaningful clinical improvement in PROMs (odds ratio (OR) 0.50, 95% confidence interval (CI) 0.38, 0.65; p < 0.00001). Secondly, two studies indicates that postoperative patient satisfaction was lower in participants with mild OA. Thirdly, participants with mild arthritis experience less improvement in SF-36 physical functioning (mean difference (MD) -8.31, 95% CI -10.97, -5.64; p < 0.00001) and role physical (MD -5.59, 95% CI -8.40, -2.77; p < 0.0001), but showed higher improvement in general health (MD 1.68, 95% CI 0.31, 3.06; p = 0.02). Patients with mild OA, as determined radiographically, are less likely to achieve meaningful clinical improvements in PROMs and have lower postoperative satisfaction after THA. This information will improve collaborative decision-making in the preoperative period

Due to limitations of existing pharmacological therapies for the management of chronic pain in osteoarthritis (OA), surgical interventions remain a major component of current standard of care, with total joint replacements (TJRs) considered for people who have not responded adequately to conservative treatment. This study aimed to quantify the economic burden of moderate-to-severe chronic pain in patients with OA in England prior to TJR. A retrospective, longitudinal cohort design was employed using Clinical Practice Research Datalink GOLD primary care data linked to Hospital Episode Statistics secondary care data in England. Patients (age ≥18 years) with an existing OA diagnosis of any anatomical site (Read/ICD-10) were indexed (Dec-2009 to Nov-2017) on a moderate-to-severe pain event (which included TJR) occurring within an episode of chronic pain. 5-year TJR rates from indexing were assessed via Kaplan-Meier estimates. All-cause healthcare resource utilisation and direct medical costs were evaluated in the 1–12 and 13–24 months prior to the first TJR experienced after index. Statistical significance was assessed via paired t-tests. The study cohort comprised 5,931 eligible patients (57.9% aged ≥65 years, 59.2% female). 2,176 (36.7%) underwent TJR (knee: 54.4%; hip: 42.8%; other: 2.8%). The 5-year TJR rate was 45.4% (knee: 24.3%; hip: 17.5%; other: 6.8%). Patients experienced more general practitioner consultations in 1–12 months pre-TJR compared with 13–24 months pre-TJR (means: 12.13 vs. 9.61; p<0.0001), more outpatient visits (6.68 vs. 3.77; p<0.0001), more hospitalisations (0.74 vs. 0.62; p=0.0032), and more emergency department visits (0.29 vs. 0.25, p=0.0190). Total time (days) spent as an inpatient was higher in 1–12 months pre-TJR (1.86 vs. 1.07; p<0.0001). Mean total per-patient cost pre-TJR increased from £1,771 (13–24 months) to £2,621 (1–12 months) (p<0.0001). Resource-use and costs incurred were substantially greater in the 12 months immediately prior to TJR, compared with 13–24 months prior. Reasons for increased healthcare and economic burden in the pre-TJR period deserve further exploration as potential targets for efforts to improve patient experience and efficiency of care

Aims

Leg length discrepancy (LLD) is a common pre- and postoperative issue in total hip arthroplasty (THA) patients. The conventional technique for measuring LLD has historically been on a non-weightbearing anteroposterior pelvic radiograph; however, this does not capture many potential sources of LLD. The aim of this study was to determine if long-limb EOS radiology can provide a more reproducible and holistic measurement of LLD.

Aims

Periprosthetic hip-joint infection is a multifaceted and highly detrimental outcome for patients and clinicians. The incidence of prosthetic joint infection reported within two years of primary hip arthroplasty ranges from 0.8% to 2.1%. Costs of treatment are over five-times greater in people with periprosthetic hip joint infection than in those with no infection. Currently, there are no national evidence-based guidelines for treatment and management of this condition to guide clinical practice or to inform clinical study design. The aim of this study is to develop guidelines based on evidence from the six-year INFection and ORthopaedic Management (INFORM) research programme.

Aims

The Exeter V40 femoral stem is the most implanted stem in the National Joint Registry (NJR) for primary total hip arthroplasty (THA). In 2004, the 44/00/125 stem was released for use in ‘cement-in-cement’ revision cases. It has, however, been used ‘off-label’ as a primary stem when patient anatomy requires a smaller stem with a 44 mm offset. We aimed to investigate survival of this implant in comparison to others in the range when used in primary THAs recorded in the NJR.

Aims

The aims of this study were to validate the Forgotten Joint Score-12 (FJS-12) in the postoperative evaluation of periacetabular osteotomy (PAO), identify factors associated with joint awareness after PAO, and determine the FJS-12 threshold for patient-acceptable symptom state (PASS).

Aims

Custom triflange acetabular components (CTACs) play an important role in reconstructive orthopaedic surgery, particularly in revision total hip arthroplasty (rTHA) and pelvic tumour resection procedures. Accurate CTAC positioning is essential to successful surgical outcomes. While prior studies have explored CTAC positioning in rTHA, research focusing on tumour cases and implant flange positioning precision remains limited. Additionally, the impact of intraoperative navigation on positioning accuracy warrants further investigation. This study assesses CTAC positioning accuracy in tumour resection and rTHA cases, focusing on the differences between preoperative planning and postoperative implant positions.

Aims

This work aimed at answering the following research questions: 1) What is the rate of mechanical complications, nonunion and infection for head/neck femoral fractures, intertrochanteric fractures, and subtrochanteric fractures in the elderly USA population? and 2) Which factors influence adverse outcomes?

Aims

In this study, we aimed to visualize the spatial distribution characteristics of femoral head necrosis using a novel measurement method.

Introduction. Despite well-fixed implants, persistent pain following total hip arthroplasty (THA) remains a concern. Various surgical approaches have been advocated, yet whether patient-reported pain differs amongst techniques has not been investigated. This study's purposes were to determine differences in patient-reported pain based on surgical approach (direct anterior –DA versus posterolateral-PL) or PL approach incision length. Our hypothesis was that no differences in patient-reported pain would be present. Methods. A retrospective, IRB-approved investigation from 2 centers was performed. 7 fellowship trained arthroplasty surgeons (3 DA, 3 PL, 1 both) enrolled patients undergoing primary THA for non-inflammatory arthritis. PL approach patients were categorized based on incision length (6–8cm, 8–12cm, 12–15cm). Exclusion criteria were a prior hip surgery, revision procedure, or limited postoperative mobility. All THAs were performed using a cementless titanium, proximally coated, tapered femoral stem and hemispherical acetabular component. All patients had a minimum of 1-year clinical follow-up with radiographically well-fixed components. A pain-drawing questionnaire was administered in which patients identify the location and intensity of pain on an anatomic diagram. Independent Student's t-tests and Chi-square analyses were performed (p<0.05 = significant). Power analysis indicated 800 patients in each cohort would provide adequate power to detect a 4% difference in patient-reported pain (alpha = 0.05, beta = 0.80). Results. 1848 Patients (982 DA, 866 PL) were included. PL patients were younger (59.4 + 12.9 vs. 62.7 + 9.7; p<0.001) and had shorter follow-up (3.3 + 1.3 vs. 3.7 + 1.3 years; p<0.001) versus DA patients. There was no difference in postoperative UCLA score (6.0 + 1.9 vs. 6.0 + 2.0; p>0.9). PL patients reported increased moderate to severe trochanteric (21% vs. 14%; p<0.001) and groin pain (24% vs. 19%; p=0.004) than DA patients. There were no differences in anterior or lateral thigh, posterior thigh, low back, or buttock pain between the two cohorts (p=0.05–0.7). PL approach incision length did not impact the incidence or severity of patient-reported pain (p=0.3–0.7). Conclusion. When specifically queried, a significant proportion of patients experience persistent pain following THA via either a PL or DA approach. PL patients reported greater trochanteric and groin pain, although PL incision length did not impact the incidence or severity of patient-reported pain. Summary Statement. A significant proportion of patient experience persistent pain following THA, with an increased reporting of trochanteric and groin pain in those receiving a posterolateral versus anterior approach

Aims

The volume of ambulatory total hip arthroplasty (THA) procedures is increasing due to the emphasis on value-based care. The purpose of the study is to identify the causes for failed same-day discharge (SDD) and perioperative factors leading to failed SDD.

Aims

The aim of this study was to estimate time to arthroplasty among patients with hip and knee osteoarthritis (OA), and to identify factors at enrolment to first-line intervention that are prognostic for progression to surgery.

Background. It is not always clear why some patients experience recurrent dislocation following total hip arthroplasty (THA). In order to plan appropriate revision surgery for such patients, however, it is important to understand the specific biomechanical basis for the dislocation. We have developed a novel method to analyse the biomechanical profile of the THA, specifically to identify edge loading and prosthetic impingement, taking into account spinopelvic mobility. In this study we compare the results of this analysis in THA patients with and without recurrent dislocation. Methods. Post-operative CT scans and lateral standing and seated radiographs of 40 THA patients were performed, 20 of whom had experienced postoperative dislocation. The changes in pelvic and femoral positions on the lateral radiographs were measured between the standing and seated positions, and a 3D digital model was then generated to simulate the movement of the hip when rising from a chair for each patient. The path of the joint reaction force (JRF) across the acetabular bearing surface and the motion of the femoral neck relative to the acetabular margin were then calculated for this “sit-to-stand” movement, in order to identify where there was risk of edge loading or prosthetic impingement. Results. For every patient it was possible to model the path of the JRF and the femoral neck relative to the acetabular component. The analysis predicted either edge loading or prosthetic impingement in significantly more patients in the “dislocating” group compared to the “non-dislocating” group (figure 1). Conclusions. This method of biomechanical simulation may be able to identify edge loading and / or prosthetic impingement in THA patients who have experienced recurrent dislocation. This may be helpful in planning appropriate revision surgery. For any figures or tables, please contact the authors directly

Aims

The aim of this modified Delphi process was to create a structured Revision Hip Complexity Classification (RHCC) which can be used as a tool to help direct multidisciplinary team (MDT) discussions of complex cases in local or regional revision networks.

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?

Introduction. We investigated predictors of poor outcomes following metal-on-metal hip arthroplasty (MoMHA) revision surgery performed for adverse reactions to metal debris (ARMD), to help inform the revision threshold and type of reconstruction. Patients and Methods. A retrospective cohort study was performed involving 346 MoMHAs revised for histologically confirmed ARMD at two specialist centres (245=hip resurfacing, 101=total hip arthroplasty). Numerous preoperative (blood metal ions and imaging) and intraoperative (findings, and components removed/implanted) factors were used to predict poor outcomes. Poor outcomes were postoperative complications (including re-revisions), 90-day mortality, and poor Oxford Hip Scores (<27/48). Multivariable logistic regression models for predicting poor outcomes were developed using stepwise selection methods. Results. Cumulative implant survival rate seven-years after ARMD revision was 87.0% (95% CI=81.0%-91.2%). Poor outcomes occurred in 39% (n=135). Shorter time (under four-years) from primary to revision surgery (odds ratio (OR)=2.12, CI=1.00–4.46) was the only preoperative predictor of poor outcomes. Pre-revision metal ions and imaging did not influence outcomes. Single-component revisions increased the risk of poor outcomes (acetabular or femoral vs. all component revisions; OR=2.99, CI=1.50–5.97). Intraoperative factors reducing the risk of poor outcomes included the posterior approach (OR=0.22, CI=0.10–0.49), revision head sizes ≥36mm (vs. <36mm: OR=0.37, CI=0.18–0.77), ceramic-on-polyethylene (OR vs. ceramic-on-ceramic=0.30, CI=0.14–0.66) and metal-on-polyethylene revision bearings (OR vs. ceramic-on-ceramic=0.37, CI=0.17–0.83). Discussion. This large cohort study demonstrated 39% of patients experience poor outcomes following MoMHA revision for ARMD. This information will help surgeons when counselling patient's pre-revision about the expected prognosis. No threshold exists for recommending ARMD revision, therefore surgeons must make decisions on an individual case basis. However, surgeons can make intraoperative decisions that influence outcomes following ARMD revision. Conclusion. We recommend optimal outcomes following ARMD revision may be achieved if surgeons use the posterior approach, revise all MoMHA components, and use ≥36mm ceramic-on-polyethylene or metal-on-polyethylene articulations