Aims. The influence of metabolic syndrome (MetS) on the outcome after hip and knee arthroplasty is debated. We aimed to investigate the change in patient-reported outcome measure (PROM) scores after hip and knee arthroplasty, comparing patients with and without MetS. Methods. From 1 May 2017 to 30 November 2019, a prospective cohort of 2,586 patients undergoing elective unilateral hip and knee arthroplasty was established in Denmark. Data from national registries and a local database were used to determine the presence of MetS. Patients’ scores on Oxford Hip Score (OHS) or Oxford Knee Score (OKS), EuroQol five-dimension five-level questionnaire (EQ-5D-5L), University of California, Los Angeles (UCLA) Activity Scale, and Forgotten Joint Score (FJS) at baseline, three, 12, and 24 months after surgery were collected. Primary outcome was the difference between groups from baseline to 12 months in OHS and OKS. Secondary outcomes were scores of OHS and OKS at three and 24 months and EQ-5D-5L, UCLA Activity Scale, and FJS at three, 12, and 24 months after surgery. Generalized linear mixed model was applied, adjusting for age, sex, Charlson Comorbidity Index, and smoking to present marginal mean and associated 95% CIs. Results. A total of 62.3% (1,611/2,586) of the cohort met the criteria for MetS. Both groups showed similar increase in mean OHS (MetS group 22.5 (95% CI 21.8 to 23.1), non-MetS group 22.1 (21.3 to 22.8); p = 0.477) and mean OKS (MetS group 18.0 (17.4 to 18.6), non-MetS group 17.8 (17.0 to 18.7); p = 0.722) at 12 months' follow-up. Between groups, similar improvements were seen for OHS and OKS at three and 24 months postoperatively and for the mean EQ-5D-5L, EuroQol-visual analogue scale (EQ-VAS), UCLA Activity Scale, and FJS at every timepoint. Conclusion. Patients meeting the criteria for MetS obtain the same improvement in PROM scores as individuals without MetS up to 24 months after hip and knee arthroplasty. This is important for the clinician to take into account when assessing and advising patients with MetS. Cite this article: Bone Joint J 2024;106-B(10):1074–1083

There is some evidence to suggest that outcomes of THA in patients with minimal radiographic osteoarthritis may not be associated with predictable outcomes. The aim of this study was to:. Assess the outcome of patients with hip pain who underwent THA with no or minimal radiographic signs of osteoarthritis,. Identify patient comorbidities and multiplanar imaging findings which are predictive of outcome,. Compare the outcome in these patients to the expected outcome of THA in hip OA. A retrospective review of 107 hips (102 patients, 90F:12M, median age 40.6, IQR 35.1–45.8 years, range 18–73) were included for analysis. Plain radiographs were evaluated using the Tonnis grading scale of hip OA. Outcome measures were all-cause revision; iHOT12; EQ-5D; Oxford Hip Score; UCLA Activity Scale; and whether THA had resulted in the patient's hip pain and function being Better/Same/Worse. The median Oxford Hip Score was 33.3 (IQR 13.9, range 13–48), and 36/107 (33.6%) hips achieved an OHS≥42. There was no association between primary hip diagnosis and post-operative PROMs. A total of 91 of the 102 patients (89.2%, 93 hips) reported that their hip pain and function was Better than prior to THA and would have the surgery again, 7 patients (6.8%, 10 hips) felt the Same, and 4 patients (3.9%, 4 hips) felt Worse and would not have the surgery again. Younger patients undergoing total hip arthroplasty with no or minimal radiographic osteoarthritis had lower postoperative Oxford Hip Scores than the general population; though most felt symptomatically better and knowing what they know now, would have surgery again. Those with chronic pain syndrome or hypermobility were likely to benefit less. Those with subchondral cysts or joint space narrowing on CT imaging were more likely to achieve higher functional scores and satisfaction

We aim to create a set of reference data of commonly used scoring systems in the normal population, and to compare these results with published postoperative scores for commonly performed knee operations. This was a questionnaire-based study and a total of 744 questionnaires were sent out, of which 494 replies were received. Six scoring systems were addressed: Lysholm and Oxford Knee Scores, Tegner and UCLA activity scales and Visual Analogue Scales (VAS) for both pain and function. Data was collected into groups based on age (20–29, 30–39, 40–49, 50–59, 60–69, 70–79, 80–89 years). The reference data obtained was then compared to published postoperative scores for knee arthroplasty and ACL reconstruction, to assess whether these patients did indeed return to “normal”. The mean scores for sequential age groups (described above) were as follows: Oxford Knee Score – 13, 13, 14, 14, 17, 15, 17; Lysholm Knee Score – 96, 95, 92, 89, 89, 89, 79; Tegener Activity Scale – 6, 5, 5, 4, 4, 3, 3; UCLA Activity Scale – 8, 7, 7, 7, 6, 6, 5; VAS pain – 5, 8, 10, 9, 14, 12, 20; VAS function 96, 95, 90, 90, 86, 84, 84. Symptom based scoring systems (Oxford Knee Score, Lysholm) were independent of age whereas activity scores (Tegner, UCLA) decreased with age. There was no significant difference detected between scores in different sexes in the same age group. Compared to published scores in an age-matched population following TKR, the data obtained showed that patients do not return to normal scores following arthroplasty. Following ACL reconstructive surgery, activity scores were higher than compared to the data obtained from our population. Data generated from this study can be used as reference data and can play an important role in interpreting post-intervention scores following knee surgery

AIM: To create a set of reference data of commonly used scoring systems in the normal population, and to compare these results with published postoperative scores for commonly performed knee operations. METHODS: This was a questionnaire-based study and a total of 657 questionnaires were sent out, of which 407 replies were received. A further 159 were excluded due to ongoing knee problems or previous knee surgery. Six scoring systems were addressed: Lysholm and Oxford Knee Scores, Tegner and UCLA activity scales and Visual Analogue Scales (VAS) for both pain and function. Data was collected into groups based on age (20–29, 30–39, 40–49, 50–59, 60–69, 70–79, 80–89 years). The reference data obtained was then compared to published postoperative scores for knee arthroplasty and ACL reconstruction, to assess whether these patients did indeed return to “normal”. RESULTS: The mean scores for sequential age groups (described above) were as follows: Oxford Knee Score – 13, 14, 14, 14, 17, 15, 19; Lysholm Knee Score – 95, 92, 92, 90, 88, 90, 79; Tegener Activity Scale – 5, 5, 5, 4, 4, 3, 3; UCLA Activity Scale – 9, 7, 7, 7, 6, 6, 5; VAS pain – 2, 9, 9, 9, 14, 12, 20; VAS function 97, 94, 92, 90, 86, 86, 83. Symptom based scoring systems (Oxford Knee Score, Lysholm) were independent of age. Activity scores (Tegner, UCLA) showed a statistically significant decrease with age. There was no significant difference detected between scores in different sexes in the same age group. Compared to published scores in an age-matched population following TKR, the data obtained showed that patients do not return to normal scores following arthroplasty. Following ACL reconstructive surgery, activity scores were higher than compared to the data obtained from our population. CONCLUSIONS: Data generated from this study can be used as reference data and can play an important role in interpreting post-intervention scores following knee surgery

Introduction and Aims: The importance in assessing clinical outcome is critical in evaluation of total hip replacement. There is now a sufficient body of evidence that activity level is correlated to wear of total hip replacement and wear to the longevity of that implant. The purpose of this study was, using the UCLA activity scale, to evaluate how activity relates to both health-related and disease-specific questionnaires. Method: One hundred and fifty-two patients who underwent primary hip arthroplasty filled out the health-related questionnaire – SF-12 survey, which has a mental and physical component – with an average score of 50 in the general population for each category. The same day they were clinically evaluated, using the UCLA and Harris hip scoring systems. All patients were evaluated by the same surgeon; at least two years post-surgery, with an average follow-up of 5.2 years. Patient average age at surgery was 52.4, with 66% male. To assess the strength of the relationship between SF-12, UCLA and Harris scores, linear regression analysis was used. Results: All individual UCLA scores were significantly correlated (p< 0.05) to SF-12 physical component, except for walking. When the single item UCLA activity score was added to Harris hip score, R squared raised from 0.43 to 0.53 in predicting quality of life. The single item Activity from the UCLA scoring system explained 38% of the variability in SF-12 physical component. With the linear regression analysis, all individual UCLA scores were independently significantly correlated (p< 0.05) to SF-12 physical component, except for walking. When the single item UCLA activity score was added to Harris hip score, R squared raised from 0.43 to 0.53 in predicting quality of life represented by the physical component of the SF-12. Conclusion: Our study has shown that the UCLA activity scale is not only important to assess wear of the bearing surface, but also provides additional information in assessing the clinical outcome of total hip replacement. The single item Activity from the UCLA scoring system explained 38% of the variability in SF-12 physical component and demonstrates the need to integrate activity in outcome measurements after hip arthroplasty

Abstract. Introduction. Changes in posterior tibial slope (PTS) and patellar height (PH) following proximal tibial osteotomies have been a recent focus for knee surgeons. Increased PTS and decreased PH following medial opening wedge high tibial osteotomy (MOWHTO) have been repeatedly reported in the literature. However, this has been disputed in more recent biomechanical studies. Methodology. A total of 62 cases who underwent MOWHTO were included. Surgery was performed using a dedicated step-by-step protocol focusing on the risks of unintentional slope changes. Clinically, all patients were evaluated preoperatively and at 2 years follow-up with the KOOS scores and UCLA physical activity scale. Preoperative and postoperative radiographic lower limb alignment parameters were measured on full-length lower limb radiographs, including (HKA), (MPTA), (mLDFA), proximal posterior tibial angle (PPTA), (JLCA) and(JLO). PH measurements were assessed on radiographs. Results. There was a significant change in the coronal plane alignment; the mMPTA changed from 84.38° to 90.39°, and the HKA changed from 172.19° to 180.15° (Both P < 0.0001). There was no significant change in the PTS as evidenced by a postoperative PPTA of 80.56 ° from a preoperative of 80.36°. And no significant change in the PH with all the indices; preoperative Caton Deschamps, Insall Salvati, and Schröter indices measured 0.95, 1.03, and 1.56, respectively. In comparison to postoperative measures of 0.93, 1.03, and 1.54, respectively. Conclusion. MOWHTO does not change the PTS or PH when accurate preoperative planning and precise intraoperative freehand technique are adopted. Involuntary modification of these anatomic parameters should be considered surgical errors

Introduction. Soft-tissue balancing methods in TKA have evolved from surgeon feel to digital load-sensing tools. Such techniques allow surgeons to assess the soft-tissue envelope after bone cuts, however, these approaches are ‘after-the-fact’ and require soft-tissue release or bony re-cuts to achieve final balance. Recently, a robotic ligament tensioning device has been deployed which characterizes the soft tissue envelope through a continuous range-of-motion after just the initial tibial cut, allowing for virtual femoral resection planning to achieve a targeted gap profile throughout the range of flexion (figure-1). This study reports the first early clinical results and patient reported outcomes (PROMs) associated with this new technique and compares the outcomes with registry data. Methods. Since November 2017, 314 patients were prospectively enrolled and underwent robotic-assisted TKA using this surgical technique (mean age: 66.2 ±8.1; females: 173; BMI: 31.4±5.3). KOOS/WOMAC, UCLA, and HSS-Patient Satisfaction scores were collected pre- and post-operatively. Three, six, and twelve-month assessments were completed by 202, 141, and 63 patients, respectively, and compared to registry data from the Shared Ortech Aggregated Repository (SOAR). SOAR is a TJA PROM repository run by Ortech, an independent clinical data collection entity, and it includes data from thousands of TKAs from a diverse cross-section of participating hospitals, teaching institutions and clinics across the United States and Canada who collect outcomes data. PROMs were compared using a two-tailed t-test for non-equal variance. Results. When comparing the baseline PROM scores, robotic patients had equivalent womac knee stiffness (p=0.58) and UCLA activity scale (p=0.38) scores but slightly higher womac knee pain (p=0.002) and functional scores (p=0.014, figure-2). While all scores improved over time, the rate of improvement was generally greater at 6 months than at three months when comparing the two groups, with statistically higher six-month scores in the robotic group for all categories (p<0.001). Overall patient satisfaction in the RB cohort was 90.3%, 95.0% and 91.8% at 3M, 6M and 1Y, respectively (figure-3). Average length of hospital stay was 1.6 days (±0.8). Surgical complications in this cohort included one infection four months post-op, 6 post-operative knee manipulations, one pulmonary embolism and one wound dehiscence from a fall. Discussion. We postulated that the ability to use gap data prospectively under known loading conditions throughout the knee range-of-motion would allow femoral cut planning that resulted in optimum balance with fewer releases and better long-term results. While the study group patients had slightly higher baseline knee pain and function than registry patients and showed similar net improvements at the three-month mark, study patients showed significantly better improvements in all areas between three months and six months compared to registry data. WOMAC stiffness and UCLA activity scores were equal between the two groups at baseline and significantly improved at three months and six months. Better ligament balance may have significantly contributed to these gains and to the high rates of satisfaction reported in the study patients compared to the historical literature. Limitations to this study include the small number of patients and the lack of a closely matched control group. For any figures or tables, please contact authors directly

Between July 2000 and December 2002, 263 consecutive patients across 5 surgical centers underwent to a revision surgery of a failed acetabular component in which TM acetabular components were used. There were 150 women and 113 men with a mean age of 69.5 years. The indication for acetabular revision was aseptic loosening in 186 cases (70.7%). Clinical evaluations were performed using the Harris hip score, the WOMAC and UCLA activity scale. Implant and screw position, polyethylene wear, radiolucent lines, gaps, and osteolysis were assessed. Preoperatively, acetabular bone deficiency was categorized using the classification of Paprosky et al. Statistical analysis was performed using nonparametric correlations. Standard life table was constructed, and the survival rate was calculated by means of Kaplan-Meier method. The overall mean follow-up was 73.6 months (range, 60–84 months), and no patient was lost to follow-up. The preoperative HHS rating improved from a mean of 43.6 ± 11.4 before revision, to a mean of 82.1 ± 10.7. None of the patients was re-revised for loosening. The cumulative prosthesis survival was 99.2% at 5 years. There was no correlation found between the various degrees of acetabular bony defect and the magnitude of clinical results (independent of pre-revision Paprosky grade). The use of component augments allowed us to minimize the volume of morsellized allograft used for defect repair. TM acetabular component demonstrates promising midterm results similar to those reported by other authors

Purpose: We report a series of 117 consecutive metal-on-metal Birmingham Hip Resurfacings in 105 patients with a minimum of 5 year follow up. Method: Patients were followed up both clinically and radiographically for a minimum of 5 years following implantation. Revision of either the femoral or acetabular component during the study period is defined as failure. Results: We followed up 114 of 117 hips (97%). We had 4 failures giving us survivorship at 5 years of 97% (95% confidence interval (CI) 94–100). The mean follow up was 72 months and the mean age at implantation 54.5 years old. The mean Oxford Hip Score fell from 41.6 preoperatively to 15.3 postoperatively (p< 0.0001). The mean Harris Hip Score at 5 year follow up was 96.4. The UCLA Activity Scale rose from 3.93 preoperatively to 7.54 postoperatively (p< 0.001). Radiographic analysis revealed neck thinning in 12 patients (10%) and we define a method of measuring this. The average stem shaft angle in our cohort was 130 degrees and the average cup angle was 36 degrees. Heterotropic ossification was present in 17 hips (15%). Conclusion: This study confirms that metal-on-metal resurfacing produces an excellent clinical and functional outcome in the younger patient who requires surgical intervention for hip disease. The results compare favourably with those from the originating centre and confirm that resurfacing is well suited for younger higher demand patients. It is the first study with a minimum 5 year follow up outside the originating centre

Introduction: We report the results of activity and functional outcome of matched pair analysis comparing hip resurfacing with total hip replacement with a minimum follow up of 22 months. Materials and Methods: 14 matched pairs were selected in terms of age (within 4 years), sex and diagnosis, of which 10 pairs were females and 4 pairs were males The mean age was 49.7(19 – 63). The Birmingham hip resurfacing was used in all patients in the resurfacing group and the Furlong HAC stem in all cases in the THR group with the CSF cup in most cases. The mean follow up in BHR group was 5.2 years (1.7 – 9.2) and 2.4 years (1.8 – 3.6) in THR group. Functional outcome was measured using Harris Hip score, WOMAC, SF 36 and the UCLA and Tegner activity scores. Results: The mean Harris Hip score, SF 36, WOMAC, UCLA and Tegner activity scores in the BHR group were 86.8, 77.3,49.7, 6.1 and 3.6 respectively. In the Furlong group the Harris Hip score, SF36, WOMAC, UCLA and Tegner activity scores were 82.9, 79.0,29.5, 5.6 and 3.2 respectively. There was no statistical difference in the mean scores between the two groups. With regard to functional activity, 21% of patients in both the groups scored 8 or more on the UCLA activity scale. 21% of patients in the BHR and 14% in the Furlong group scored 3 or more on the Tegner activity scale. Conclusion: In our study, hip resurfacing was not associated with a significant increase in activity level or functional outcome compared with total hip replacement

We report 114 of 117 (97% follow up) consecutive metal-on-metal hip resurfacings in 105 patients with a minimum of 5 years follow up implanted between October 1999 and May 2002. Revision of either the femoral or acetabular component during the study period is defined as failure. No other revisions have been performed or are impending. We had 4 failures giving us survivorship at 5 years of 97% (95% confidence interval (CI) 94 – 100). The mean follow up was 72 months and the mean age at implantation was 54.5 years old (Range 35 – 75). All patients were followed up clinically and radiographically. The mean Harris hip score at follow up was 96.4. The mean Oxford Hip Score fell from 41.6 preoperatively (Range 16 – 57) to 15.3 postoperatively (Range 12 – 49) p< 0.0001. The UCLA Activity Scale rose from 3.93 preoperatively (Range 1 – 10) to 7.54 postoperatively (Range 4 – 10) p< 0.001. Radiographic analysis revealed an average stem shaft angle of 130.6 degrees (Range 112 – 148) with average cup alignment of 36 degrees (Range 22 – 47). Neck thinning was present in 12 hips (10%) and we define a technique for measuring thinning. Heterotropic ossification was present in 17 hips and lucent lines around the femoral component in 10 hips. This study confirms that metal-on-metal resurfacing produces an excellent clinical and functional outcome in the younger patient who requires surgical intervention for hip disease. The results compare favourably with those from the originating centre and confirm that resurfacing is well suited for younger higher demand patients. It is the first study with a minimum 5 year follow up from outside the originating centre

Evidence has emerged that femoroacetabular impingement (FAI) may instigate early osteoarthritis of the hip and that symptomatic patients can be successfully treated by addressing the underlying pathomorphology. There is also an increasing body of evidence to support FAI as one major cause of hip and groin pain, decreased mobility and reduced performance in athletes. This study therefore aimed to investigate if professional athletes with FAI can resume to their sports after a surgical dislocation of the hip and continue their professional career up to a mid-term follow-up. We identified fifteen professional athletes (21 hips, all cam-type or mixed-type FAI, mean alpha-angles of 68°) who underwent a surgical hip dislocation for FAI treatment. Surgery was performed by the senior author in all cases. The patients were evaluated by postal survey at a mean of 47 months (range, 9–79) postoperatively. The evaluation inquired about the type and level of sports, subjective ratings, and clinical outcomes (Hip Outcome Score [HOS], SF-12, UCLA activity scale, FAI sports scale [FSS], VAS pain). At follow-up, 14 of the 15 patients (93%) were still professionally sports active. Twelve athletes maintained their levels and two were active in minor leagues. Eleven patients (75%) were satisfied with their hip surgery and their sports ability. Mean activity levels were 7.5 according to the self-developed FSS and 9.7 according to the UCLA scale, respectively. Mean scores of the HOS ADL and Sport subscales were 92.6 and 85.2, respectively. Mean scores of the SF-12 PCS and MCS were 50.7 and 56.1, respectively. Pain levels during sports were rated to be 2.0 according to the VAS. In conclusion, this study highlighted that professional athletes suffering from FAI can successfully return to professional sports after a surgical dislocation of the hip. All athletes except one (93%) could continue their professional career up to the follow-up four years after surgery. Clinical outcomes in terms of subjective ratings and scores were encouraging, nevertheless, longer-term follow-up has to show if results deteriorate with time considering the exhaustive joint use related to a professional sports career

Introduction: Preliminary results of the Birmingham Hip Resurfacing Arthroplasty were promising. The first series with minimum 5 year follow up was published in 2005 and came from the designing centre. Survivorship and functional results were good. This is the first series with a minimum 5 year follow up not from the designing centre. Methods: All patients who underwent BHR between the dates of October 1999 and May 2002 were included in the study. Results: We report 114 of 117 (97% follow up) consecutive metal-on-metal hip resurfacings in 105 patients with a minimum of 5 years follow up. Revision of either the femoral or acetabular component during the study period is defined as failure. We had 4 failures giving a survivorship at 5 years of 96.5% (95% confidence interval (CI) 93–100). The mean follow up was 72 months and the mean age at implantation was 54.5 years old (Range 35–75). All patients were followed up clinically and radiographically. The mean Harris hip score at follow up was 96.4. The mean Oxford Hip Score fell from 41.6 preoperatively (Range 16–57) to 15.3 postoperatively (Range 12–49) p< 0.0001. The UCLA Activity Scale rose from 3.93 preoperatively (Range 1–10) to 7.54 postoperatively (Range 4–10) p< 0.001. Radiographic analysis revealed an average stem shaft angle of 130.6 degrees (Range 112–148) with average cup alignment of 36 degrees (Range 22–47). Neck thinning was present in 16 hips (14%) and we define a technique for measuring thinning. Discussion: This study confirms that metal-on-metal resurfacing produces an excellent clinical and functional outcome in the younger patient who requires surgical intervention for hip disease. The results compare favourably with those from the originating centre and confirm that resurfacing is well suited for younger higher demand patients

The goal of this study was to develop and validate a short, evaluative self-report questionnaire for the clinical self-assessment of patients with hip osteoarthritis (OA). If used together with other self-report outcome tools (e.g. generic or physical activity measures), such a short joint-specific questionnaire could avoid an increased burden to the patients and decrease the risk of data loss. All items of the new score (Schulthess Hip Score, SHS) were generated solely on patient perceptions, for item removal we used the clinical severity-importance rating and inter-item correlation methods. The final score consisted of only five items. We then assessed the following metric properties of the SHS in 105 consecutive patients with symptomatic hip OA (mean age, 63.4 ± 11 years, 48 women) undergoing total hip arthroplasty (THA) in our clinic: proportion of evaluable questionnaires, reproducibility, internal consistency, concurrent validity, and responsiveness. 97% of the questionnaires were evaluable. Reproducibility of the SHS was excellent (intraclass correlation coefficient (ICC) 0.90; standard error of the measure (SEM) 6.4). Exploratory factor analysis indicated that all items loaded on only 1 factor which accounted for 69.4% of the total variance. Cronbach’s alpha was 0.88. Evidence of convergent validity was provided by moderate to high correlations with scores and subscales of the WOMAC (r = 0.58–0.78), Oxford Hip Score (r = 0.78), Harris Hip Score (r = 0.37), SF-12 physical component scale (r = 0.57), UCLA activity scale (r = 0.48), and Tegner score (r = 0.53). Evidence of divergent validity was provided by a lower correlation with the SF-12 mental component scale (r = 0.37). The SHS proved to be responsive with an effect size (ES) of 2.15 and a standard response mean (SRM) of 1.74 six months after THA. Taken together, the results of this study provide evidence to support the use of the five-item self-report SHS in patients with hip osteoarthritis. Considering the brevity of this score, it could be easily used together with other measures such as generic and physical activity assessment tools, without overburdening patients with an inordinate number of items and questions

Introduction: Metal-on-metal hip resurfacing arthroplasty (HRA) is currently recommended for younger, active patients with high expectations but information about outcomes is limited. Reports concentrate on wear, fracture rates and radiographic appearance, rather than function. Studies that report function do not describe rehabilitation protocols. This data is important to discussions about likely outcomes and restrictions prior to consent and to fully evaluate HRA. Methods: Consecutive Conserve HRA operations were reviewed 1 year post-surgery. Function was assessed using 3 validated questionnaires; the OHS (Oxford Hip Score), HOOS (Hip Disability and Osteoarthritis Outcome Score) and UCLA Activity Scale. Complications, pain, ROM, muscle strength, single leg stand, walking and stair climbing ability were recorded. Results: 125 HRA were reviewed (68 right, 57 left hips) in 120 patients (71 male, 49 female) of mean age 56 years. 86.7% recorded no complications, but 20% had pain at 3 months. The median OHS was 15, median UCLA 7 (active) and mean HOOS 82.78%. Operated hip flexors, extensors and abductors were weaker (p=0.000) and hip flexion ROM a mean 94.46 ± 12.71 (55–120) degrees. For 25% walking was limited, 7.6% needed a stick and 10% a stair rail. The OHS correlated with HOOS pain subscale (r=0.812, p=0.000), flexion ROM (r=0.426, p=0.000), hip extensor (r=0.359, p=0.000) and abductor (r=0.424, p=0.000) strength. Pain at 3 months correlated with the HOOS pain subscale (p=0.000, r= 0.503). Discussion: Although outcomes were generally good with few complications, high levels of function and activity 25% had poor outcomes; with pain, restricted hip flexion, decreased strength, limited walking and functional problems, particularly putting on socks. Pain present at 3 months was associated with pain and worse function at 1 year. It is postulated this sub-optimal recovery may be related to current rehabilitation protocols adopted from THA and not tailored to HRA

INTRODUCTION. Clinical trials have generally failed to demonstrate superior clinical effectiveness of minimally invasive surgical approaches for total knee arthroplasty (TKA). The hypothesis of the current study was that avoiding incision of the quadriceps tendon would result in a significantly faster recovery of ambulatory function after total knee arthroplasty, compared to a technique that incised the quadriceps tendon. METHODOLOGY. The MIKRO (Minimally Invasive Knee Replacement Outcomes) Study is a prospective, level 1 RCT that enrolled 128 patients with knee osteoarthritis who had failed non-operative treatment, and had decided to proceed with TKA. After skin incision, 64 patients each were randomized to either a subvastus (SV) or medial parapatellar arthrotomy (MPPA) approach. All surgeries were done with the same TKA implant, with anesthesia, post-operative analgesia, and physical therapy standardized for both groups. A Patient Diary methodology was used as the primary outcome measure for ambulatory function. During the first 8 weeks after TKA, a research assistant blinded to treatment assignment telephoned each patient and completed study forms that documented indoor and outdoor walking relative to use of ambulatory devices, as well as Knee Society Score (KSS) and the UCLA activity scale. The UCLA score and change in KSS from baseline at 4- and 12-week follow-up were used to begin the validation process for an Ambulatory Function Score (AFS) derived from diary indoor and outdoor scores. RESULTS. There was a trend for the SV group to report more independent ambulation than the MPPA group at week 1 after surgery, as indicated by self-reported AFS (p < .052). Both treatment groups demonstrated significant week to week AFS gains through 5 weeks, after which weekly changes were minimal. As expected, outdoor AFSs were initially slower to improve than indoor AFSs, but by 6 weeks the initial 20-pt difference was less than 10-pts. AFS scores were significantly correlated with UCLA scores across all 8 weeks. Knee Society Scores (KSS) at baseline were rarely correlated with AFS scores across the 8 weeks. However, 1-month and 3-month KSS scores were significantly correlated with AFS scores at p < .05 beginning with weeks 2 or 3 and through week 8. CONCLUSION. Avoiding incision of the quadriceps tendon during primary TKA resulted in a short-lived trend of quicker improvement in the AFS score in the SV TKA group versus the MPPA group. However, there appeared to be a similar rate of subsequent AFS improvement across the subsequent 8 weeks between the two groups. Preliminary results suggest a pattern of results – general improvement across 5–6 weeks that was maintained through the 8 weeks of evaluation, and significant correlations with UCLA and KSS scores after 2–3 weeks – that are consistent with the notion that the AFS is sensitive to change, and is variable depending on context (indoor vs. outdoor ambulation). Although related to UCLA and KSS scores, observed correlation magnitudes were not so high as to suggest that UCLA or KSS scores might be reasonable proxies for AFS

Aims

The primary outcome was investigating differences in wear, as measured by femoral head penetration, between cross-linked vitamin E-diffused polyethylene (vE-PE) and cross-linked polyethylene (XLPE) acetabular component liners and between 32 and 36 mm head sizes at the ten-year follow-up. Secondary outcomes included acetabular component migration and patient-reported outcome measures (PROMs) such as the EuroQol five-dimension questionnaire, 36-Item Short-Form Health Survey, Harris Hip Score, and University of California, Los Angeles Activity Scale (UCLA).

Aims

The primary aim of this study was to determine the rates of return to work (RTW) and sport (RTS) following a humeral shaft fracture. The secondary aim was to identify factors independently associated with failure to RTW or RTS.

Aims

The metabolic equivalent of task (MET) score examines patient performance in relation to energy expenditure before and after knee arthroplasty. This study assesses its use in a knee arthroplasty population in comparison with the widely used Oxford Knee Score (OKS) and EuroQol five-dimension index (EQ-5D), which are reported to be limited by ceiling effects.

Aims

Refobacin Bone Cement R and Palacos R + G bone cement were introduced to replace the original cement Refobacin Palacos R in 2005. Both cements were assumed to behave in a biomechanically similar fashion to the original cement. The primary aim of this study was to compare the migration of a polished triple-tapered femoral stem fixed with either Refobacin Bone Cement R or Palacos R + G bone cement. Repeated radiostereometric analysis was used to measure migration of the femoral head centre. The secondary aims were evaluation of cement mantle, stem positioning, and patient-reported outcome measures.