The periacetabular osteotomy(PAO) is an effective common hip-preserving procedure to treat symptomatic acetabular dysplasia of the hip (DDH). The literature regarding truly long-term patient outcomes after PAO remains limited. We sought to evaluate our patient cohort treated by PAO 25 to 33 years ago to identify factors positively and negatively associated with durable therapeutic success. 219 dysplastic hips (183 patients) underwent PAO between August 1991 and December 1999 by a single surgeon. 164 hips in 134 patients were retrospectively evaluated at minimum of 25 years and maximum of 33 years post-operatively. Hips were evaluated using the pain subscale of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) postoperatively. Osteotomy failure was defined as
Pelvic osteotomies for hip dysplasia results can be variable and depend on the amount of preexisting arthritis. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) is a technique designed to measure early arthritis, and could be used to select hips that would benefit from a joint-preserving reconstructive procedure. Our objective was to investigate the role of preoperative dGEMRIC in predicting the success of PAO in patients 40 and above. We hypothesized that patients who failed had lower preoperative dGEMRIC index compared to those who did not. Following IRB approval, patients 40 or older who underwent PAO between 1990–2013 and had preoperative dGEMRIC scan and minimum follow-up of 4 years were identified. Patients with prior hip surgeries or any pathologies were removed leading to a total of 70 patients (Age: 44.2 ± 2.9 years old, BMI: 25.7 ± 4.5 Kg/m. 2. ). We only included the first hip undergoing PAO for those with bilateral PAO. Out of 70, 19 had failure defined by the need for total hip replacement or
Background. High complication rates and poor outcomes have been widely reported in patients undergoing revision of large head metal-on-metal arthroplasty. A previous study from our center showed high rates of dislocation, nerve injury, early cup loosening and pseudotumor recurrence. After noting these issues, we implemented the following changes in surgical protocol in all large head MOM revisions: 1. Use of highly porous shells in all cases 2. Use of largest femoral head possible 3. Low threshold for use of dual mobility and constrained liners when abductors affected or absent posterior capsule 4. Use of ceramic head with titanium sleeve in all cases 5. Partial resection of pseudotumor adjacent to sciatic and femoral nerves. Questions/purposes. The purpose of the present study is to compare the new surgical protocol above to our previously reported early complications in this group of patients. We specifically looked at (1) complications including reoperations; (2) radiologic outcomes; and (3) functional outcomes. Complication rates after (Group 1), and before (Group 2) modified surgical protocol were compared using Chi-square test, assuming statistical significance p<0.05. Results. Major complications occurred in 4 (8.3%) of 48 patients who had modified surgical technique, compared to 12 (38%) of 32 revisions prior to modification (p<0.05). Two hips of 48 (4.17%) endured dislocations in Group 1, compared to 9 of 32 (28%) in Group 2 (p<0.05). Four patients of 48 had repeat revision in Group 1: 2 for recurrence of pseudotumor, 1 for dislocation, and 1 for infection, compared to 6 patients who had 7 repeat revisions of 32 patients in Group 2: 3 for acetabular loosening, 3 for dislocation, and 1 for recurrence of pseudotumor (p=0.1). None of 48 revisions in Group 1 had acetabular loosening, compared to 4 of 32 in Group 2 (p=0.02). Two patients had nerve injury in Group 2, compared to none in Group 1 (p=0.16). The mean
This study compared the demographic, clinical and patient-reported outcomes after total hip replacement (THR) and Birmingham Hip Resurfacing (BHR) carried out by a single surgeon. Patients completed a questionnaire that included the WOMAC, SF-36 scores and comorbid medical conditions. Data were collected before operation and one year after. The outcome scores were adjusted for age, gender, comorbid conditions and, at one year, for the pre-operative scores. There were 214 patients with a THR and 132 with a BHR. Patients with a BHR were significantly younger (49 vs 67 years, p <
0.0001), more likely to be male (68% vs 42% of THR, p <
0.0001) and had fewer comorbid conditions (1.3 vs 2.0, p <
0.0001). Before operation there was no difference in WOMAC and SF-36 scores, except for function, in which patients awaiting THR were worse than those awaiting a BHR. At one year patients with a BHR reported significantly better
A prospective cohort of 222 patients who underwent revision hip replacement between April 2001 and March 2004 was evaluated to determine predictors of function, pain and activity level between one and two years post-operatively, and to define quality of life outcomes using validated patient reported outcome tools. Predictive models were developed and proportional odds regression analyses were performed to identify factors that predict quality of life outcomes at one and two years post-operatively. The dependent outcome variables were the Western Ontario and McMaster Osteoarthritis Index (WOMAC) function and pain scores, and University of California Los Angeles activity scores. The independent variables included patient demographics, operative factors, and objective quality of life parameters, including pre-operative WOMAC, and the Short Form-12 mental component score. There was a significant improvement (t-test, p <
0.001) in all patient quality of life scores. In the predictive model, factors predictive of improved function (original regression analyses, p <
0.05) included a higher pre-operative WOMAC function score (p <
0.001), age between 60 and 70 years (p <
0.037), male gender (p = 0.017), lower Charnley class (p <
0.001) and aseptic loosening being the indication for revision (p <
0.003). Using the
Introduction. Deaths due to overdose involving opioids have nearly quadrupled in USA in the last 20 years. Several published studies have shown that preoperative opioid use independently predicts perioperative complications in total joint arthroplasty. Our objectives were to (1) assess preoperative opioid consumption in patients undergoing total hip arthroplasty (THA) and (2) to determine how preoperative opioid use affects patient oriented outcomes (POO's) and hip scores before and after THA. Methods. 54 primary THA by a single surgeon were reviewed. A new patient questionnaire was administered to document preoperative opioid consumption (type, dosage and length of use); preoperatively and postoperatively POO's measurements [visual analog scale (VAS), QWB-7, SF-36, and WOMAC] and hip scores were recorded. Patients were stratified into two groups: (1) Opioid Users and (2) Non-Opioid Users. Oral morphine equivalents (OME) were calculated for opioid using patients using standard methodology. Results. 22.2% of the patients were using opioids prior to THA. Among these, 16.6% had tried more than 1 drug. Dosage was self-reported in 33.3% and length of usage only in 8.3%. Mean OME was 13.3mg (range: 6mg–32mg) among users. After adjusting for covariates (gender), opioid users reported worse significant outcomes before surgery for the SF-36 general health (69 vs 80.7; p=0.02), SF-36 role emotional (75.7 vs 99.1; p=0.002), and SF-36 mental health (64 vs 79.7; p=0.005). After surgery even though significant improvements were seen in both groups, opioid users reported significantly worse
The direct anterior (DA) approach has been associated with rapid patient recovery after total hip arthroplasty (THA) but may be associated with more frequent femoral complications including implant loosening. The objective of this study was to determine whether the addition of a collar to the femoral stem affects implant migration, patient activity, and patient function following primary THA using the DA approach. Patients were randomized to either a collared (n = 23) or collarless (n = 26) cementless femoral stem implanted using the DA approach. Canal fill ratio (CFR) was measured on the first postoperative radiographs. Patients underwent a supine radiostereometric analysis (RSA) exam postoperatively on the day of surgery and at two, four, six, 12, 26, and 52 weeks postoperatively. Patient-reported outcome measures (Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index, the 12-item Short Form Health Survey Mental and Physical Score, and University of California, Los Angeles (UCLA) Activity Score) were measured preoperatively and at each post-surgery clinic visit. Activity and function were also measured as the weekly average step count recorded by an activity tracker, and an instrumented timed up-and-go (TUG) test in clinic, respectively.Aims
Methods
To compare the in vivo long-term fixation achieved by two acetabular components with different porous ingrowth surfaces using radiostereometric analysis (RSA). This was a minimum ten-year follow-up of a prospective randomized trial of 62 hips with two different porous ingrowth acetabular components. RSA exams had previously been acquired through two years of follow-up. Patients returned for RSA examination at a minimum of ten years. In addition, radiological appearance of these acetabular components was analyzed, and patient-reported outcome measures (PROMs) obtained.Aims
Methods
It is not known whether change in patient-reported outcome measures (PROMs) over time can be predicted by factors present at surgery, or early follow-up. The aim of this study was to identify factors associated with changes in PROM status between two-year evaluation and medium-term follow-up. Patients undergoing Birmingham Hip Resurfacing completed the Veteran’s Rand 36 (VR-36), modified Harris Hip Score (mHHS), Tegner Activity Score, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at two years and a minimum of three years. A change in score was assessed against minimal clinically important difference (MCID) and patient-acceptable symptom state (PASS) thresholds. Binary logistic regression was used to assess the relationship between patient factors and deterioration in PASS status between follow-ups.Aims
Patients and Methods
Several factors have been implicated in unsatisfactory
results after total hip replacement (THR). We examined whether femoral
offset, as measured on digitised post-operative radiographs, was
associated with pain after THR. The routine post-operative radiographs
of 362 patients (230 women and 132 men, mean age 70.0 years (35.2
to 90.5)) who received primary unilateral THRs of varying designs
were measured after calibration. The femoral offset was calculated
using the known dimensions of the implants to control for femoral
rotation. Femoral offset was categorised into three groups: normal
offset (within 5 mm of the height-adjusted femoral offset), low
offset and high offset. We determined the associations to the absolute
final score and the improvement in the mean Western Ontario and
McMaster Universities osteoarthritis index (WOMAC) pain subscale
scores at three, six, 12 and 24 months, adjusting for confounding
variables. The amount of femoral offset was associated with the mean WOMAC
pain subscale score at all points of follow-up, with the low-offset
group reporting less WOMAC pain than the normal or high-offset groups
(six months: 7.01 ( Cite this article:
Reconstruction of the acetabulum after failed total hip arthroplasty
(THA) can be a surgical challenge in the presence of severe bone
loss. We report the long-term survival of a porous tantalum revision
acetabular component, its radiological appearance and quality of
life outcomes. We reviewed the results of 46 patients who had undergone revision
of a failed acetabular component with a Paprosky II or III bone
defect and reconstruction with a hemispherical, tantalum acetabular
component, supplementary screws and a cemented polyethylene liner.Aims
Patients and Methods
To investigate psychosocial and biomedical outcomes following
total hip replacement (THR) and to identify predictors of recovery
from THR. Patients with osteoarthritis (OA) on the waiting list for primary
THR in North West England were assessed pre-operatively and at six
and 12 months post-operatively to investigate psychosocial and biomedical
outcomes. Psychosocial outcomes were anxiety and depression, social
support and health-related quality of life (HRQoL). Biomedical outcomes
were pain, physical function and stiffness. The primary outcome
was the Short-Form 36 (SF-36) Health Survey Total Physical Function.
Potential predictors of outcome were age, sex, body mass index,
previous joint replacement, involvement in the decision for THR,
any comorbidities, any complications, type of medication, and pre-operative
ENRICHD Social Support Instrument score, Hospital Anxiety and Depression
scores and Western Ontario and McMaster Universities osteoarthritis index
score.Objectives
Methods
Polyethylene wear debris can cause osteolysis
and the failure of total hip arthroplasty. We present the five-year
wear rates of a highly cross-linked polyethylene (X3) bearing surface
when used in conjunction with a 36 mm ceramic femoral head. This was a prospective study of a cohort of 100 THAs in 93 patients.
Pain and activity scores were measured pre- and post-operatively.
Femoral head penetration was measured at two months, one year, two
years and at five years using validated edge-detecting software
(PolyWare Auto). At a mean of 5.08 years (3.93 to 6.01), 85 hips in 78 patients
were available for study. The mean age of these patients was 59.08
years (42 to 73, the mean age of males (n = 34) was 59.15 years,
and females (n = 44) was 59.02 years). All patients had significant
improvement in their functional scores (p <
0.001). The steady
state two-dimensional linear wear rate was 0.109 mm/year. The steady
state volumetric wear rate was 29.61 mm3/year. No significant
correlation was found between rate of wear and age (p = 0.34), acetabular
component size (p = 0.12) or clinical score (p = 0.74). Our study shows low steady state wear rates at five years in
X3 highly cross-linked polyethylene in conjunction with a 36 mm
ceramic femoral head. The linear wear rate was almost identical
to the osteolysis threshold of 0.1 mm/year recommended in the literature. Cite this article:
We carried out a clinical and radiological review of 103 cementless primary hip arthroplasties with a tapered rectangular grit-blasted titanium press-fit femoral component and a threaded conical titanium acetabular component at a mean follow-up of 14.4 years (10.2 to 17.1). The mean Harris hip score at the last follow-up was 89.2 (32 to 100). No early loosening and no fracture of the implant were found. One patient needed revision surgery because of a late deep infection. In 11 hips (10.7%), the reason for revision was progressive wear of the polyethylene liner. Exchange of the acetabular component because of aseptic loosening without detectable liner wear was carried out in three hips (2.9%). After 15 years the survivorship with aseptic loosening as the definition for failure was 95.6% for the acetabular component and 100% for the femoral component.