Aims. Young adults undergoing total hip arthroplasty (THA) largely have different indications for surgery, preoperative function, and postoperative goals compared to a standard patient group. The aim of our study was to describe young adult THA preoperative function and quality of life, and to assess postoperative satisfaction and compare this with functional outcome measures. Methods. A retrospective cohort analysis of young adults (aged < 50 years) undergoing THA between May 2018 and May 2023 in a single tertiary centre was undertaken. Median follow-up was 31 months (12 to 61). Oxford Hip Score (OHS) and focus group-designed questionnaires were distributed. Searches identified 244 cases in 225 patients. Those aged aged under 30 years represented 22.7% of the cohort. Developmental dysplasia of the hip (50; 45.5%) and Perthes’ disease (15; 13.6%) were the commonest indications for THA. Results. Preoperatively, of 110 patients, 19 (17.2%) were unable to work before THA, 57 (52%) required opioid analgesia, 51 (46.4%) were reliant upon walking aids, and 70 (63.6%) had sexual activity limited by their pathology. One patient required revision due to instability. Mean OHS was 39 (9 to 48). There was a significant difference between the OHS of cases where THA met expectation, compared with the OHS when it did not (satisfied: 86 (78.2%), OHS: 41.2 (36.1%) vs non-satisfied: 24 (21%), OHS: 31.6; p ≤ 0.001). Only one of the 83 patients (75.5%) who returned to premorbid levels of activity did so after 12 months. Conclusion. Satisfaction rates of THA in young adults is high, albeit lower than commonly quoted figures. Young adults awaiting THA have poor function with high requirements for mobility aids, analgesia, and difficulties in working and undertaking leisure activities. The OHS provided a useful insight into patient function and was predictive of satisfaction rates, although it did not address the specific demands of young adults undertaking THA. Function at one year postoperatively is a good indication of overall outcomes. Cite this article: Bone Jt Open 2024;5(4):304–311

Aims. The primary aim of this study was to compare the hip-specific functional outcome of robotic assisted total hip arthroplasty (rTHA) with manual total hip arthroplasty (mTHA) in patients with osteoarthritis (OA). Secondary aims were to compare general health improvement, patient satisfaction, and radiological component position and restoration of leg length between rTHA and mTHA. Methods. A total of 40 patients undergoing rTHA were propensity score matched to 80 patients undergoing mTHA for OA. Patients were matched for age, sex, and preoperative function. The Oxford Hip Score (OHS), Forgotten Joint Score (FJS), and EuroQol five-dimension questionnaire (EQ-5D) were collected pre- and postoperatively (mean 10 months (SD 2.2) in rTHA group and 12 months (SD 0.3) in mTHA group). In addition, patient satisfaction was collected postoperatively. Component accuracy was assessed using Lewinnek and Callanan safe zones, and restoration of leg length were assessed radiologically. Results. There were no significant differences in the preoperative demographics (p ≥ 0.781) or function (p ≥ 0.383) between the groups. The postoperative OHS (difference 2.5, 95% confidence interval (CI) 0.1 to 4.8; p = 0.038) and FJS (difference 21.1, 95% CI 10.7 to 31.5; p < 0.001) were significantly greater in the rTHA group when compared with the mTHA group. However, only the FJS was clinically significantly greater. There was no difference in the postoperative EQ-5D (difference 0.017, 95% CI -0.042 to 0.077; p = 0.562) between the two groups. No patients were dissatisfied in the rTHA group whereas six were dissatisfied in the mTHA group, but this was not significant (p = 0.176). rTHA was associated with an overall greater rate of component positioning in a safe zone (p ≤ 0.003) and restoration of leg length (p < 0.001). Conclusion. Patients undergoing rTHA had a greater hip-specific functional outcome when compared to mTHA, which may be related to improved component positioning and restoration of leg length. However, there was no difference in their postoperative generic health or rate of satisfaction. Cite this article: Bone Joint Res 2021;10(1):22–30

Introduction. Depression is a common co-morbidity in Total Hip Arthroplasty (THA). Chronic pain and depression influence one another. Postoperative outcomes and satisfaction rates are affected by depression. Objectives. The aim of the study was to determine the impact of pre-operative depression on patient functional outcomes and satisfaction rates after THA. A secondary objective was to assess potential change in the incidence of depression at mid-term post-operative follow-up. Study Design & Methods. We retrospectively reviewed 200 patients undergoing THA from 2015–2016 at a single academic institution.150 (75%) of patients were followed up at a minimum of 24 months. Patients pre-operative depression symptoms were assessed according to the Zung Self-reported depression score and the PHQ-9 scores. Functional scores, satisfaction rates, expectation rates and 30- and 90-day readmission rates were correlated with pre-operative and 2-year follow-up depression scores. Results. There were 103 females and 47 males with an average age of 60.1 years (22–89 years old). The Patient Health Questionnaire (PHQ-9) correlated with the Zung Self-reported depression scores. Overall, 73 patients (48.7%) were classified as being depressed pre-operatively. There were 48 (32.2%) with mild depression and 19 (12.8%) with marked depression. Females, HIV-infected and morbidly obese patients were more likely to be depressed. The mean pre-operative Harris Hip Score (HHS) was 35.95 (24–66) and Oxford Hip Score (OHS) 17.11 (0–48). The 30-day readmission rate was 2% and all patients were pre-operatively severely depressed. At a minimum of 2 years there was an improvement in Zung Self-Rating Depression Scale and PHQ-9 scores. Only 29 (18.8%) patients were depressed. There were 55 patients who progressed from depressed to non-depressed (p=0.00), while 11 patients (7.4%) became depressed after THA (p=0.00). The least improvement in both OHS and HHS was in the severely depressed group (p<0.05). The overall satisfaction rate was 89.7%. Depressed patient satisfaction rate was 86.9% with only 70.27% of the severely depressed group satisfied post-operatively. Age (>70) and BMI >40 correlated with dissatisfaction (p<0.05). Conclusions. There is a high prevalence of depression in THA. Incorporation of psychological management strategies may improve satisfaction rates and functional outcomes post-THA

In this study we evaluated whether pre-operative Western Ontario and McMaster Universities (WOMAC) osteoarthritis scores can predict satisfaction following total hip arthroplasty (THA). Prospective data for a cohort of patients undergoing THA from two large academic centres were collected, and pre-operative and one-year post-operative WOMAC scores and a 25-point satisfaction questionnaire were obtained for 446 patients. Satisfaction scores were dichotomised into either improvement or deterioration. Scatter plots and Spearman’s rank correlation coefficient were used to describe the association between pre-operative WOMAC and one-year post-operative WOMAC scores and patient satisfaction. Satisfaction was compared using receiver operating characteristic (ROC) analysis against pre-operative, post-operative and δ WOMAC scores. . We found no relationship between pre-operative WOMAC scores and one-year post-operative WOMAC or satisfaction scores, with Spearman’s rank correlation coefficients of 0.16 and –0.05, respectively. The ROC analysis showed areas under the curve (AUC) of 0.54 (pre-operative WOMAC), 0.67 (post-operative WOMAC) and 0.43 (δ WOMAC), respectively, for an improvement in satisfaction. . We conclude that the pre-operative WOMAC score does not predict the post-operative WOMAC score or patient satisfaction after THA, and that WOMAC scores can therefore not be used to prioritise patient care. Cite this article: Bone Joint J 2015;97-B:150–3

We compared patient satisfaction with surgeon satisfaction after total hip arthroplasty (THA) in a group of 193 patients (200 THAs, mean follow-up six years) using a visual analogue scale (VAS), and two objective and two subjective scoring systems. We also determined the survival rate with different endpoints. For the 121 hips available for clinical follow-up, we did not find a significant difference in satisfaction between patient and surgeon. In a subgroup with low patient satisfaction, the surgeon was more satisfied than the patient (p = 0.04). The correlation between the patient satisfaction VAS and the different subjective and objective scoring systems suggests that pain during activity is the most important factor for the patient. The survivorship at six years decreased from 96.6% to 83.7% if dissatisfaction (VAS > 20) was added to revision as an endpoint in the survival analysis. The patient satisfaction VAS provides additional information to evaluate the outcome of THA. We recommend the use of both subjective and objective scoring systems to evaluate the outcome of THA

Computer aided Total Hip Arthroplasty (THA) surgery is known to improve implantation precision, but clinical trials have failed to demonstrate an improvement in survivorship or patient reported outcome measures (PROMs). Our aim was to compare the risk of revision, PROMs and satisfaction rates between computer guided and THA implanted without computer guidance. We used the National Joint Registry dataset and linked PROMs data. Our sample included THAs implanted for osteoarthritis using cementless acetabular components from a single manufacturer (cementless and hybrid). An additional analysis was performed limiting the sample size to THAs using cementless stems (fully cementless). The primary endpoint was revision (of any component) for any reason. Kaplan Meier survivorship analysis and an adjusted Cox Proportional Hazards model were used. 41683 non computer guided, and 871 (2%) computer guided cases were included in our cementless and hybrid analysis. 943 revisions were recorded in the non-guided and 7 in the computer guided group (adjusted Log-rank test, p= 0.028). Cumulative revision rate at 10 years was 3.88% (95%CI: 3.59 – 4.18) and 1.06% (95%CI: 0.45 – 2.76) respectively. Cox Proportional Hazards adjusted HR: 0.45 (95%CI: 0.21 – 0.96, p=0.038). In the fully cementless group, cumulative revision rate at 10 years was 3.99% (95%CI: 3.62 – 4.38) and 1.20% (95%CI: 0.52 – 3.12) respectively. Cox Proportional Hazards adjusted HR: 0.47 (95%CI: 0.22 – 1.01, p=0.053). There was no statistically significant difference in the 6-month Oxford Hip Score, EQ-5D, EQ-VAS and success rates. Patient Satisfaction (single-item satisfaction outcome measure) was improved in the computer guided group but this finding was limited by a reduced number of responses. In this single manufacturer acetabular component analysis, the use of computer guided surgery was associated with a significant reduction in the early risk of revision. Causality cannot be inferred in view of the observational nature of the study, and further database and prospective studies are recommended to validate these findings

Introduction. The utility and yield of the current practice of routine screening of asymptomatic patients after primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) is unclear. The purpose of this prospective survey study was to determine the utility of the routine on year follow up visit primary THA and TKA. Methods. We prospectively enrolled all patients undergoing primary THA and TKA. At one-year follow-up, patients were asked to complete a survey that asked about satisfaction with the and if they thought the visit was worthwhile. Surgeons also completed a survey which asked if any intervention was done, if any problems were diagnosed/avoided, and if the visit was worthwhile. Data was analyzed and compared between patients and surgeons, and was also compared to the need for any additional interventions. Results. Between October 2017 and June 2018, 512 patients underwent primary THA or TKA. Of these, passive one-year follow-up was obtained in 195 (38%). The final cohort consisted of 195 patients; 102 THAs and 94 TKAs with mean follow-up of 378 days (range, 276–480 days). Patients reported a mean 4.64 rating when asked if the visit was worthwhile (5-point scale, 1=not worthwhile, 5=very worthwhile). No interventions were performed or ordered at 56.3% of visits. Physicians reported that complications were avoided because of the visit at 23.03% of visits and 66.8% of visits were worthwhile (yes/no). 49.44% of visits where no intervention was ordered were rated as worthwhile, whereas 90.3% of visits with interventions ordered were rated as worthwhile. Conclusions. Patients generally thought that their follow up visit was worthwhile, even when no intervention was ordered or issue was addressed. In the visits without any interventions, over half of physicians thought the visit was not worthwhile. Surgeons may consider restricting their one year postoperative visits to symptomatic patients only. For any tables or figures, please contact the authors directly

Aims. We assessed the long-term outcomes of a large cohort of patients who have undergone a periacetabular osteotomy (PAO), and sought to validate a patient satisfaction questionnaire for use in a PAO cohort. Methods. All patients who had undergone a PAO from July 1998 to February 2013 were surveyed, with several patient-reported outcome measures (PROMs) and radiological measurements of preoperative acetabular dysplasia and postoperative correction also recorded. Patients were asked to rate their level of satisfaction with their operation in achieving pain relief, restoration of activities of daily living, ability to perform recreational activity, and their overall level of satisfaction with the procedure. Results. A total of 143 PAOs were performed between 1998 and 2013. Of those, 90 postoperative surveys were returned. Only 65 patients (73 hips) had both pre- and postoperative radiographs available for measurement. The mean time to follow-up was 15 years (6.5 to 20). Most patients were female (91%), with a mean age of 26.4 years (14.9 to 48.3) at the time of their surgery. A statistically significant improvement in radiological correction was detected in all hips (p < 0.001). A total of 67 patients (92.3%) remained either very satisfied or satisfied with their PAO. The internal consistency of the patient satisfaction questionnaire, measured using Cronbach’s α, ranged from 0.89 to 0.94 indicating ‘good’ to ‘excellent’ reliability. Conclusion. Outcomes of importance to patients undergoing a PAO include several key domains: pain relief, improve activities of daily living, and improve recreational ability. Our study demonstrates high rates of long-term patient satisfaction in all domains, and found the patient satisfaction questionnaire to be a valid and reliable instrument for use in this cohort. Cite this article: Bone Jt Open 2023;4(12):964–969

Aims. The aim of this study was to evaluate the suitability of the tapered cone stem in total hip arthroplasty (THA) in patients with excessive femoral anteversion and after femoral osteotomy. Methods. We included patients who underwent THA using Wagner Cone due to proximal femur anatomical abnormalities between August 2014 and January 2019 at a single institution. We investigated implant survival time using the endpoint of dislocation and revision, and compared the prevalence of prosthetic impingements between the Wagner Cone, a tapered cone stem, and the Taperloc, a tapered wedge stem, through simulation. We also collected Oxford Hip Score (OHS), visual analogue scale (VAS) satisfaction, and VAS pain by postal survey in August 2023 and explored variables associated with those scores. Results. Of the 58 patients (62 hips), two (two hips) presented with dislocation or reoperation, and Kaplan-Meier analysis indicated a five-year survival rate of 96.7% (95% CI 92.4 to 100). Mean stem anteversion was 35.2° (SD 18.2°) for the Taperloc stem and 29.8° (SD 7.9°) for the Wagner Cone stem; mean reduction from Taperloc to Wagner Cone was 5.4° (SD 18.8°). Overall, 55 hips (52 patients) were simulated, and the prevalence of prosthetic impingement was lower for the Wagner Cone (5.5%, 3/55) compared with the Taperloc (20.0%, 11/55) stem, with an odds ratio of 0.20 (p = 0.038). Among the 33 respondents to the postal survey (36 hips), the mean scores were VAS pain 10.9, VAS satisfaction 86.9, and OHS 44.7. A multivariable analysis revealed that reduction of stem anteversion from Taperloc to Wagner Cone was more favourable for VAS pain (p = 0.029) and VAS satisfaction (p = 0.002). Conclusion. The mid-term survival rate for THA using the Wagner Cone stem was high, which may be supported by a reduction in prosthetic impingement. The reduction in excessive stem anteversion by using a tapered cone stem was associated with reduced pain and increased patient satisfaction. Cite this article: Bone Jt Open 2024;5(10):858–867

Aims. Psychological status may be an important predictor of outcome after periacetabular osteotomy (PAO). The aim of this study was to investigate the influence of psychological distress on postoperative health-related quality of life, joint function, self-assessed pain, and sports ability in patients undergoing PAO. Methods. In all, 202 consecutive patients who underwent PAO for developmental dysplasia of the hip (DDH) at our institution from 2015 to 2017 were included and followed up at 63 months (SD 10) postoperatively. Of these, 101 with complete data sets entered final analysis. Patients were assessed by questionnaire. Psychological status was measured by Brief Symptom Inventory (BSI-18), health-related quality of life was raised with 36-Item Short Form Survey (SF-36), hip functionality was measured by the short version 0f the International Hip Outcome Tool (iHOT-12), Subjective Hip Value (SHV), and Hip Disability and Outcome Score (HOS). Surgery satisfaction and pain were assessed. Dependent variables (endpoints) were postoperative quality of life (SF-36, HOS quality of life (QoL)), joint function (iHOT-12, SHV, HOS), patient satisfaction, and pain. Psychological distress was assessed by the Global Severity Index (GSI), somatization (BSI Soma), depression (BSI Depr), and anxiety (BSI Anx). Influence of psychological status was assessed by means of univariate and multiple multivariate regression analysis. Results. In multiple multivariate regression, postoperative GSI, BSI Soma, and BSI Depr had a negative effect on postoperative SF-36 (e -2.07, -3.05, and -2.67, respectively; p < 0.001), iHOT-12 (e -1.35 and -4.65, respectively; p < 0.001), SHV (e -1.20 and -2.71, respectively; p < 0.001), HOS QoL (e -2.09 and -4.79, respectively; p < 0.001), HOS Function (e -1.00 and -3.94, respectively; p < 0.001), and HOS Sport (e -1.44 and -5.29, respectively; p < 0.001), and had an effect on postoperative pain (e 0.13 and 0.37, respectively; p < 0.001). Conclusion. Psychological distress, depression, and somatization disorders affect health-related quality of life, perceived joint function, and sports ability. Pain perception is significantly increased by somatization. However, patient satisfaction with surgery is not affected. Cite this article: Bone Jt Open 2023;4(10):758–765

Aims. Although periacetabular osteotomies are widely used for the treatment of symptomatic dysplastic hips, long-term surgical outcomes and patient-reported outcome measures (PROMs) are still unclear. Accordingly, we assessed hip survival and PROMs at 20 years after transpositional osteotomy of the acetabulum (TOA). Methods. A total of 172 hips in 159 patients who underwent TOA were followed up at a mean of 21.02 years (16.6 to 24.6) postoperatively. Kaplan-Meier analysis was used to assess survivorship with an endpoint of total hip arthroplasty (THA). PROMs included the visual analogue scale (VAS) Satisfaction, VAS Pain, Oxford Hip Score (OHS), and Forgotten Joint Score-12 (FJS-12). Thresholds for favourable outcomes for OHS (≥ 42) and FJS-12 (≥ 51) were obtained using the receiver operating characteristic curve with VAS Satisfaction ≥ 50 and VAS Pain < 20 as anchors. Results. THA was performed on 37 hips (21.5%) by the latest follow-up. Kaplan-Meier analysis indicated that the hip survival rate at 20 years was 79.7% (95% confidence interval (CI) 73.7 to 86.3). Multivariate analysis showed that preoperative Tönnis grade significantly influenced hip survival. Tönnis grades 0, 1, and 2 were associated with 20-year survival rates of 93.3% (95% CI 84.8 to 100), 86.7% (95% CI 79.8 to 94.3), and 54.8% (95% CI 41.5 to 72.3), respectively. More than 60% of the patients exhibited favourable PROMs. An advanced Tönnis grade at the latest follow-up and a higher BMI were both significantly associated with unfavourable OHS, but not with other PROMs. Conclusion. This study demonstrated the durability of TOA for hips with Tönnis grades 0 to 1 at 20 years. While the presence of advanced osteoarthritis and higher BMI was associated with lower hip functions (OHS), it was not necessarily associated with worse patient satisfaction and joint awareness. Cite this article: Bone Joint J 2022;104-B(7):767–774

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). Methods. Data from 686 patients (882 hips) with hip dysplasia who underwent transposition osteotomy of the acetabulum, a type of PAO, between 1998 and 2019 were reviewed. After screening the study included 442 patients (582 hips; response rate, 78%). Patients who completed a study questionnaire consisting of the visual analogue scale (VAS) for pain and satisfaction, FJS-12, and Hip disability and Osteoarthritis Outcome Score (HOOS) were included. The ceiling effects, internal consistency, convergent validity, and PASS thresholds of FJS-12 were investigated. Results. The median follow-up was 12 years (interquartile range 7 to 16). The ceiling effect of FJS-12 was 7.2%, the lowest of all the measures examined. FJS-12 correlated with all HOOS subscales (ρ = 0.72 to 0.77, p < 0.001) and pain and satisfaction-VAS (ρ = -0.63 and 0.56, p < 0.001), suggesting good convergent validity. Cronbach’s α was 0.95 for the FJS-12, which indicated excellent internal consistency. The median FJS-12 score for preoperative Tönnis grade 0 hips (60 points) was higher than that for grade 1 (51 points) or 2 (46 points). When PASS was defined as pain-VAS < 21 and satisfaction-VAS ≥ 77, the FJS-12 threshold that maximized the sensitivity and specificity for detecting PASS was 50 points (area under the curve (AUC) = 0.85). Conclusion. Our results suggest that FJS-12 is a valid and reliable assessment tool for patients undergoing PAO, and the threshold of 50 points may be useful to determine patient satisfaction following PAO in clinical settings. Further investigation of the factors influencing postoperative joint awareness may enable improved prediction of treatment efficacy and informed decision-making regarding the indication of PAO. Cite this article: Bone Joint J 2023;105-B(7):760–767

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

Aims. The aim of this study was to identify the minimal clinically important difference (MCID), minimal important change (MIC), minimal detectable change (MDC), and patient-acceptable symptom state (PASS) in the Forgotten Joint Score (FJS) according to patient satisfaction six months following total hip arthroplasty (THA) in a UK population. Methods. During a one-year period, 461 patients underwent a primary THA and completed preoperative and six-month FJS, with a mean age of 67.2 years (22 to 93). At six months, patient satisfaction was recorded as very satisfied, satisfied, neutral, dissatisfied, or very dissatisfied. The difference between patients recording neutral (n = 31) and satisfied (n = 101) was used to define the MCID. MIC for a cohort was defined as the change in the FJS for those patients declaring their outcome as satisfied, whereas receiver operating characteristic curve analysis was used to determine the MIC for an individual and the PASS. Distribution-based methodology was used to calculate the MDC. Results. Using satisfaction as the anchor, the MCID for the FJS was 8.1 (95% confidence interval (CI) 3.7 to 15.9; p = 0.040), which was affirmed when adjusting for confounding. The MIC for the FJS for a cohort of patients was 17.7 (95% CI 13.7 to 21.7) and for an individual patient was 18. The MDC90 for the FJS was eight, meaning that 90% of patients scoring more than this will have experienced a real change that is beyond measurement error. The PASS threshold for the FJS was defined as 29. Conclusion. The MCID and MIC can be used respectively to assess whether there is a clinical difference between two groups, or whether a cohort or patient has had a meaningful change in their FJS. Both values were greater than measurement error (MDC90), suggesting a real change. The PASS threshold for the postoperative FJS can be used as a marker of achieving patient satisfaction following THA. Cite this article: Bone Joint J 2021;103-B(12):1759–1765

In this RCT the primary aim was to assess whether a short (125mm) Exeter V40 stem offered an equivalent hip specific function compared to the standard (150mm) stem when used for cemented total hip arthroplasty (THA). Secondary aims were to evaluate health-related quality of life (HRQoL), patient satisfaction, stem height and alignment, radiographic loosening, and complications between the two stems. A prospective multicentre double-blind randomised control trial was conducted. During a 15-month period, 220 patients undergoing THA were randomised to either a standard (n=110) or short (n=110) stem Exeter. There were no significant (p≥0.065) differences in preoperative variables between the groups. Functional outcomes and radiographic assessment were undertaken at 1- and 2-years. There were no differences (p=0.428) in hip specific function according to the Oxford hip score at 1-year (primary endpoint) or at 2-years (p=0.767) between the groups. The short stem group had greater varus angulation (0.9 degrees, p=0.003) when compared to the standard group and were more likely (odds ratio 2.42, p=0.002) to have varus stem alignment beyond one standard deviation from the mean. There were no significant (p≥0.083) differences in the Forgotten joint scores, EuroQol-5-Dimension, EuroQol-VAS, Short form 12, patient satisfaction, complications, stem height or radiolucent zones at 1 or 2-years between the groups. The Exeter short stem offers equivalent hip specific function, HRQoL, patient satisfaction, and limb length when compared to the standard stem at 2-years post-operation. However, the short stem was associated with a greater rate of varus malalignment which may influence future implant survival

Injury of the lateral femoral cutaneous nerve (LFCN) is one of the known complications after periacetabular osteotomy (PAO) using anterior approach. We previously reported that the incidence of LFCN injury was 48% at 1 year after PAO. However, there was no study examining the sequential changes of LFCN injury status. In this study, we performed a prospective over 3-year follow-up study as to the incidence of LFCN injury as well as its clinical outcomes. This study included 40 consecutive hips in 40 patients (3 males and 37 females) who underwent PAO from May 2016 to July 2018. The mean age at surgery was 36.7 years (17 to 60). The mean observation period was 47.3 months (36 to 69). The incidence and severity of LFCN injury was evaluated, while clinical scores, including the Harris Hip Score (HHS), Short-Form 36 Health Survey (SF-36), and Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ), were also investigated. At 3 years after PAO, LFCN injury was observed in 13 of 40 (33%) patients, in which 7 patients who had a symptom at 1 year have completely recovered. There was no significant difference in the HHS and SF-36 between patients with and without LFCN injury at 3 years. Regarding the JHEQ, a significant difference was recognized in the patient satisfaction and mental score between patients with and without LFCN injury, but there were no significant differences in the other clinical scores. The incidence of LFCN injury gradually decreased to 33% at 3 years after CPO. LFCN injury did not influence the clinician-reported outcome, while it had a negative impact on patient satisfaction and mental score based on the patient-reported outcome

We report the impact of implementing a new short-stay hip and knee arthroplasty pathway in a National Health Service (NHS) hospital. This was enacted due to existing concerns with a long length of stay (LOS) and reduced elective operating capacity each winter due to emergency bed pressures. The overnight introduction of this pathway was aimed to reduce LOS, alleviate bed pressures, minimise readmission rates and generate financial savings, all combining to facilitate full elective activity during the winter. We conducted a prospective study at a regional tertiary arthroplasty centre. The new pathway was introduced across the service overnight. It includes rigorous preoperative optimisation, specific anaesthetic protocols and uniform changes in surgical practice to allow a focus on early mobilization and discharge on the day of surgery where possible. Data collection spanned 17 months, including the initial six months post implementation of the short-stay pathway. LOS data was collected for the full period and data was compared pre- and post-implementation of the new pathway. Patient satisfaction and 30-day readmission data were also collected. There was an immediate and significant decrease in median LOS from 4 days pre-implementation to 1 day post-implementation. Patient satisfaction was high, and the 30-day readmission rate was unchanged (5.95%), with no readmissions directly related to decreased inpatient stay. Financial analyses revealed substantial cost savings due to reduced LOS and the elimination of routine post-operative blood tests, estimated at over £1.6m per year. Elective activity over winter was significantly higher (79%) than in the same time period in the previous year. An acute introduction of a carefully planned and coordinated short-stay hip and knee pathway is safe, cost-effective and popular with patients, but also contributes to increased efficiency in the delivery of elective healthcare in the context of increasing demand and financial constraints in the NHS

Most hip replacements are performed in an in-patient setting; however, there has been a shift in recent years in Canada towards doing more on an outpatient basis. In 2021–2022, 15.6% of hip replacements were performed as day surgeries compared to 0.7% in 2018–2019. This analysis will assess patient reported outcome measures of patients who had inpatient versus outpatient hip replacement surgery between 2018 and 2021. We analysed a retrospective sample of 4917 adult patients who had an elective primary unilateral hip replacement. Preoperative and three-month postoperative PROMs were completed - the Oxford Hip Score, EQD5L and patient satisfaction with the outcome were recorded. Patients who had an outpatient procedure were matched 1:1 with patients who are admitted to hospital for surgery based on age, sex and pre-COVID versus the COVID (March 15, 2020 as the start). Preoperative PROMs and Charlson Comorbidity Index were collected. T-tests and chi-square tests were used to assess the differences. The inpatient group on average was older, female and had a lower preoperative PROMs score and more comorbidities than the outpatient group. With cohort matching the sample consisted of 1244 patients. The inpatient and outpatient groups have similar Oxford scores, postoperative EQ-5D-5L scores and the proportion satisfied with their surgical results. The Oxford postoperative score was slightly higher in the outpatient group compared to the inpatient group; however, this is not clinically significant. We observed that outpatient protocols have no difference in patient satisfaction, self-reported functional outcomes and self-reported health-related quality of life three months after a hip replacement. Day surgery protocols represented potential solution to the challenges caused by the expected increase in demand for hip replacements. Our results demonstrated that patients do well clinically with day surgery procedures and there does not appear to be any detrimental effect on PROMs

The results of total hip arthroplasty (THA) revisions to correct leg length discrepancy (LLD) are not clear, with only two former limited series (< 25 patients). Therefore, we conducted a retrospective study of THA revisions for LLD to determine: 1) the change in LLD, 2) the function outcomes and whether obtaining equal leg lengths influenced function, 3) the complication and survival rates. This multicenter study included 57 patients: 42 THA revisions for limb shortening and 15 revisions for limb lengthening. LLD was measured on conventional radiographs and EOS. The Oxford-12 and FJS outcome scores were collected and the number of patients achieving the Oxford-12 MCID. The revisions were carried out a mean of 2.8 years after the index THA. The median LLD decreased from 7.5 mm (IQR: [5;12]) to 1 mm (IQR: [0.5;2.5]) at follow-up (p=0.0002). Overall, 55 of 57 patients (96%) had < 5 mm LLD at follow-up and 12 patients (21%) had equal leg lengths. The complication rate was 25%: 12 mechanical complications (8 periprosthetic femoral fractures, 2 stem loosening and 1 cup loosening, 1 dislocation) and 1 periprosthetic infection. The patient satisfaction was high with a median FJS of 79.2/100 and 77% of patients reached the Oxford-12 MCID. Lengthening procedures had significantly worst function than shortening (38% vs 91% of patients achieving the Oxford-12 MCID (p=0.0004)). Survivorship was 85% (95% CI: 77.9 – 92.5) at 2 years and 77% (95% CI: 66.3 – 87.1) at 4.6 years when using re-revision for any reason as the endpoint. When LLD after THA does not respond to conservative management, revision THA should be considered. Although revision THA for LLD improved medium-term functional outcomes with a high patient satisfaction rate, especially for shortening procedures, the complication rate was high, particularly related to periprosthetic femoral fracture

Aims. The primary aim of this trial was to compare the subsidence of two similar hydroxyapatite-coated titanium femoral components from different manufacturers. Secondary aims were to compare rotational migration (anteversion/retroversion and varus/valgus tilt) and patient-reported outcome measures between both femoral components. Methods. Patients were randomized to receive one of the two femoral components (Avenir or Corail) during their primary total hip arthroplasty between August 2018 and September 2020. Radiostereometric analysis examinations at six, 12, and 24 months were used to assess the migration of each implanted femoral component compared to a baseline assessment. Patient-reported outcome measures were also recorded for these same timepoints. Overall, 50 patients were enrolled (62% male (n = 31), with a mean age of 65.7 years (SD 7.3), and mean BMI of 30.2 kg/m. 2. (SD 5.2)). Results. The two-year subsidence was similar for Avenir (-0.018 mm (95% confidence interval (CI) -0.053 to 0.018) and Corail (0.000 mm (95% CI -0.027 to 0.026; p = 0.428). Both anteversion/retroversion (Avenir 0.139° (95% CI -0.204 to 0.481°); Corail -0.196° (95% CI -0.445 to 0.053°; p = 0.110) and varus/valgus tilt (Avenir -0.024° (95% CI -0.077 to 0.028); Corail -0.049° (95% CI -0.098 to 0.000°; p = 0.473) were not statistically significantly different. After two years, patients reported similar improvements in EuroQol five-dimension five-level health questionnaire (Avenir 0.22 (SD 0.2); Corail 0.22 (SD 0.18); p = 0.965) and other outcomes scores. Patient satisfaction on a five-point Likert scale was also similar between both groups after two years (Avenir 1.38 (SD 0.88); Corail 1.33 (SD 0.57); p = 0.846). Conclusion. The performance of both femoral components was similar in terms of stability and patient outcomes. Cite this article: Bone Joint J 2023;105-B(10):1045–1051