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
Periacetabular Osteotomy (PAO) has become the most important surgical procedure for patients with hip dysplasia, offering significant pain relief and improved joint function. This study focuses on recovery after PAO, specifically the return to sports (RTS) timeline, with the objective of identifying preoperative predictors to optimize patient outcomes. Our prospective, monocentric study from 2019 to 2023 included 698 hips from 606 patients undergoing PAO. Comprehensive preoperative data were collected, including demographic information, clinical assessments (Modified Harris Hip Score (mHHS), International Hip Outcome Tool-12 (iHot-12), Hip Disability and Osteoarthritis Outcome Score (HOOS), UCLA Activity Score) and psychological evaluations (Brief Symptom Inventory (BSI) and SF-36 Health Survey). Advanced logistic regression and machine learning techniques (R Core Team. (2016)) were employed to develop a predictive model.
Short stems have been developed to conserve bone stock, especially in younger populations undergoing a total hip arthroplasty (THA), and showed similar functional outcomes compared to conventional stems. Recent literature suggested that stem length might be an independent risk factor for acute periprosthetic femoral fracture in direct anterior THA (1) or with different short stem designs (2). The purpose of the present study was to compare the incidence of acute periprosthetic femoral fractures, between stems of the same manufacture (Taperloc microplasty vs Taperloc complete), which have the same stem characteristics, except for the stem length which is 35 mm shorter in Taperloc microplasty during posterior and lateral THA. Our institution's arthroplasty database was searched for all primary total hip arthroplasties utilizing short femoral stems performed between August 2016 and August 2023. Pre-operative X-rays for each case were analysed to characterize the proximal femoral geometry, specifically the canal bone ratio (CBR) and canal flare index (CFI). Data analysis was performed to identify risk factors for periprosthetic fractures. For the time period assessed, 2107 femoral stems (Taperloc Microplasty:1727, Taperloc complete: 380) were implanted. Females constituted 53% of the cohort. The average patient age was 70±11 years. The periprosthetic fracture rate was 0.94%, with 20 periprosthetic fractures (Taperloc Microplasty:17, Taperloc complete: 3) excluding 2 greater trochanteric fractures (1 at each group), identified at follow-up of three months. There was no significant difference between the periprosthetic fracture rates between the two stems (0.98% vs 0.79%, p>0.72) The
Background. The impact of a patient's activity level following total hip arthroplasty (THA) remains controversial, with some concerned about increased polyethylene wear, aseptic loosening and revisions. The purpose of this study is to report on implant survivorship and outcomes of high activity patients compared to low activity patients after THA with current polyethylene. Methods. A retrospective review identified 2002 patients (2532 hip) that underwent a primary THA with vitamin E infused highly crosslinked polyethylene liner and 2-year minimum follow-up or revision. Patients were divided in two groups based on their University of California Los Angeles (UCLA) activity level: Low activity (LA) (UCLA ≤5) and high activity (HA) (UCLA ≥ 6). Outcomes included Harris Hip Score, UCLA activity score, complications and reoperations.
Aims. Although good clinical outcomes have been reported for monolithic tapered, fluted, titanium stems (TFTS), early results showed high rates of subsidence. Advances in stem design may mitigate these concerns. This study reports on the use of a current monolithic TFTS for a variety of indications. Methods. A multi-institutional retrospective study of all consecutive total hip arthroplasty (THA) and revision total hip arthroplasty (rTHA) patients who received the monolithic TFTS was conducted. Surgery was performed by eight fellowship-trained arthroplasty surgeons at four institutions. A total of 157 hips in 153 patients at a mean follow-up of 11.6 months (SD7.8) were included. Mean patient age at the time of surgery was 67.4 years (SD 13.3) and mean body mass index (BMI) was 28.9 kg/m. 2. (SD 6.5). Outcomes included intraoperative complications, one-year all-cause re-revisions, and subsidence at postoperative time intervals (two weeks, six weeks, six months, nine months, and one year). Results. There were eight intraoperative complications (4.9%), six of which were intraoperative fractures; none occurred during stem insertion. Six hips (3.7%) underwent re-revision within one year; only one procedure involved removal of the prosthesis due to infection. Mean total subsidence at latest follow-up was 1.64 mm (SD 2.47). Overall, 17 of 144 stems (11.8%) on which measurements could be performed had >5 mm of subsidence, and 3/144 (2.1%) had >10 mm of subsidence within one year. A univariate regression analysis found that additional subsidence after three months was minimal. A
Aims. The main aims were to identify risk factors predictive of a radiolucent line (RLL) around the acetabular component with an interface bioactive bone cement (IBBC) technique in the first year after THA, and evaluate whether these risk factors influence the development of RLLs at five and ten years after THA. Methods. A retrospective review was undertaken of 980 primary cemented THAs in 876 patients using cemented acetabular components with the IBBC technique. The outcome variable was any RLLs that could be observed around the acetabular component at the first year after THA. Univariate analyses with univariate logistic regression and multivariate analyses with exact logistic regression were performed to identify risk factors for any RLLs based on radiological classification of hip osteoarthritis. Results. RLLs were detected in 27.2% of patients one year postoperatively. In
Obesity has previously been demonstrated to be an independent risk factor for increased complications following total hip (THA) and total knee arthroplasty (TKA). The purpose of this study was to compare the effects of obesity and BMI to determine whether the magnitude of the effect was similar for both procedures. We queried the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database to identify patients who underwent primary THA or TKA between 2010 and 2014. Patients were stratified by procedure and classified as non-obese, obese, or morbidly obese according to BMI. Thirty-day rates of wound complications, deep infection, total complications, and reoperation were compared using univariate and multivariate logistic regression analyses. We identified 64,648 patients who underwent THA and 97,137 patients who underwent TKA. Obese THA patients had significantly higher rates of wound complications (1.53% vs 0.96%), deep infection (0.31% vs 0.17%), reoperation rate (2.11% vs 1.02%), and total complications (5.22% vs. 4.63%) compared to TKA patients. Morbidly obese patients undergoing THA were also found to have significantly higher rates of wound complications (3.25% vs 1.52%), deep infection (0.84% vs 0.23%), reoperation rate (3.65% vs 1.60%), and total complications (7.36% vs. 5.57%).
Purpose. Obesity has previously been demonstrated to be an independent risk factor for increased complications following total hip (THA) and total knee arthroplasty (TKA). The purpose of this study was to compare the effects of obesity and BMI to determine whether the magnitude of the effect was similar for both procedures. Materials & Methods. We queried the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database to identify patients who underwent primary THA or TKA between 2010 and 2014. Patients were stratified by procedure and classified as non-obese, obese, or morbidly obese according to BMI. Thirty-day rates of wound complications, deep infection, total complications, and reoperation were compared using univariate and multivariate logistic regression analyses. Results. We identified 64,648 patients who underwent THA and 97,137 patients who underwent TKA. Obese THA patients had significantly higher rates of wound complications (1.53% vs 0.96%), deep infection (0.31% vs 0.17%), reoperation rate (2.11% vs 1.02%), and total complications (5.22% vs. 4.63%) compared to TKA patients. Morbidly obese patients undergoing THA were also found to have significantly higher rates of wound complications (3.25% vs 1.52%), deep infection (0.84% vs 0.23%), reoperation rate (3.65% vs 1.60%), and total complications (7.36% vs. 5.57%).
Aims. Accurate placement of the acetabular component is essential in
total hip arthroplasty (THA). The purpose of this study was to determine
if the ability to achieve inclination of the acetabular component
within the ‘safe-zone’ of 30° to 50° could be improved with the
use of an inclinometer. Patients and Methods. We reviewed 167 primary THAs performed by a single surgeon over
a period of 14 months. Procedures were performed at two institutions:
an inpatient hospital, where an inclinometer was used (inclinometer
group); and an ambulatory centre, where an inclinometer was not
used as it could not be adequately sterilized (control group). We excluded
47 patients with a body mass index (BMI) of > 40 kg/m. 2. ,
age of > 68 years, or a surgical indication other than osteoarthritis
whose treatment could not be undertaken in the ambulatory centre.
There were thus 120 patients in the study, 68 in the inclinometer
group and 52 in the control group. The inclination angles of the acetabular
component were measured from de-identified plain radiographs by
two blinded investigators who were not involved in the surgery.
The effect of the use of the inclinometer on the inclination angle
was determined using
Aims. The aim of this study was to compare the rate of perioperative
complications following aseptic revision total hip arthroplasty
(THA) in patients aged ≥ 80 years with that in those aged <
80
years, and to identify risk factors for the incidence of serious
adverse events in those aged ≥ 80 years using a large validated
national database. Patients and Methods. Patients who underwent aseptic revision THA were identified in
the 2005 to 2015 National Surgical Quality Improvement Program (NSQIP)
database and stratified into two age groups: those aged <
80
years and those aged ≥ 80 years. Preoperative and procedural characteristics
were compared.
Accurate placement of the acetabular component is essential in Total Hip Arthroplasty (THA). The purpose of this study is to determine if an analog spirit level can improve the surgeon's ability to achieve acetabular inclination within the “safe-zone” of 30 to 50 degrees. We reviewed 167 primary THAs performed by a single surgeon over 14 months. Procedures were performed at two facilities, an inpatient hospital where a spirit level was utilized and an ambulatory facility where it was not. We excluded 47 patients with a BMI>40, age>68 or a surgical indication other than osteoarthritis who were not candidates for the ambulatory center. Cup inclination angles were measured from de-identified plain radiographs by two blinded investigators not involved in the index procedures. The effect of level usage on inclination angle was determined using
Introduction. The changes in sagittal spino-pelvic balance from standing to sitting in patients with end-stage osteoarthritis (OA) of the hip remain poorly characterized. Our aim was to 1) investigate the contribution of sagittal spino-pelvic movement and hip flexion when moving from a standing to sitting posture in patients with hip OA; 2) determine the proportion of OA-patients with stiff, normal or hypermobile spino-pelvic mobility and 3) identify radiographic parameters correlating with spino-pelvic mobility. Methods. This prospective diagnostic cohort study followed 116 consecutive patients with end-stage osteoarthritis awaiting THR. All patients underwent preoperative standardized radiographs (lateral view) of the lumbar spine, pelvis and proximal femur using EOS© in standing position and with femurs parallel to the floor in order to achieve a 90°-seated position. Radiographic measurements performed included lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI) and pelvic-femoral-angle (PFA). The difference in PT between standing and seated allowed for patient classification based on spino-pelvic mobility into stiff (<±10°), normal (±10–30°), or hypermobile (>±30°). Results. From the standing to the sitting position, the pelvis tilted backwards by a mean of 19.1° (SD 12.8) and the hip was flexed by a mean of 56.6° (SD 17.2). Change in pelvic tilt correlated inversely with change in hip flexion (r=−0.68; P<0.01; r. 2. =0.47). Thirty-two patients (28%) had stiff, 68 (58%) normal and 16 (14%) hypermobile spino-pelvic mobility.
Introduction. Ascertaining the etiology of hip pain in young patients can be challenging. Osteoid osteoma about the hip has only been described in case reports and small case series in this sub-population. This study assessed the clinical course, radiologic findings, and treatment approaches in a large series of pediatric osteoid osteoma cases about the hip. Potential diagnostic and treatment pitfalls were identified. Methods. A single-center tertiary care departmental database was queried for all cases of osteoid osteoma seen between Jan 1, 2003 and December 31, 2015. Medical records were reviewed to identify those with lesions identified within or around the hip joint. Clinical, demographic, and radiologic data were analyzed. Results. Fifty children and adolescents (56% female, mean age 12.4 years, range 3–19 years) were identified with osteoid osteoma about the hip. The femoral neck was the most common lesion location (38%), and pain in the hip was the most common presenting chief complaint (60%). Night pain (90%) and symptom relief with NSAIDs (88%) were extremely common, though not universally reported. Sclerosis and/or cortical thickening was visible in 58% of radiographs, though a lucent nidus was visible in only 42%. Thirty patients (60%) underwent MRI, 27 of which were available for review, with focal peri-lesional edema as a universal finding. Amongst intracapsular lesions (n=17, 63%), common findings included medial retinacular thickening (33%), synovitis (45%) and effusion (76%). In the 43 patients (48%) who underwent CT, a diagnostic lucent nidus was a universal finding. Initial alternative diagnoses were recorded in 46% of cases, including, in order of decreasing frequency, femoro-acetabular impingement, minor trauma, hip synovitis, ‘growing pain’, stress fracture, and infection. Abnormal hip range of motion, positive impingement signs, and global synovitis on MRI scan were found to be associated with alternative diagnosis. On
Background. Structural bone allografts are an established treatment method for long-bone structural defects arising from such conditions as trauma, sarcoma, and osteolysis following total joint replacement. However, the quality of structural bone allografts is difficult to non-destructively assess prior to use. The functional lifetime of structural allografts depend on their ability to resist cyclic loading, which can lead to fracture even at stress levels well below the yield strength. Because allograft bone has limited capacity for remodeling, optimizing allograft selection for bone quality could decrease long-term fracture risk. Raman spectroscopy biomarkers can non-destructively assess the three primary components of bone (collagen, mineral, and water), and may predict the resistance of donor bone allografts to fracture from cyclic loads. The purpose of this study was to prospectively assess the ability of Raman biomarkers to predict number of cycles to fracture (“cyclic fatigue life”) of human allograft cortical bone. Methods. Twenty-one cortical bone specimens were from the mid-diaphysis of human donor bone tissue (bilateral femurs from 4 donors: 63M, 61M, 51F, 48F) obtained from the Musculoskeletal Transplant Foundation. Six Raman biomarkers were analyzed: collagen disorganization, type B carbonate substitution (a surrogate for mineral maturation), matrix mineralization, and 3 water compartments. Specimens underwent cyclic fatigue testing under fully reversed conditions at 35 and 45MPa (physiologically relevant stress levels for structural allografts). Specimens were tested to fracture or to 30 million cycles (“run-out”), simulating 15 years of moderate activity (i.e., 6000 steps per day).
Introduction. In the United States, cementless femoral fixation remains the dominant mode of fixation for femoral neck fractures, despite strong worldwide registry data that supports cemented fixation. The reason for this discrepancy remains unknown, controversial and often difficult to compare due to multiple variables. The purpose of this study was to evaluate a matched cohort of patients undergoing arthroplasty for femoral neck fractures and assess outcomes of revisions, periprosthetic fractures and mortality. Methods. This is an exact matched cohort study. Cemented fixation cases were exact matched to cementless fixation cases in a 1:1 fashion based on age, sex and Charlson Comorbidity Index (CCI). Outcome variables included: revision for periprosthetic fracture; all cause revision and mortality at any time point; all cause revision and mortality within 1-year and within 90-days. The primary independent variable was femoral fixation (cemented, cementless) and covariates included race (black, white, other), ethnicity (hispanic, non-hispanic), teaching status (minor, major, nonteaching) and bedsize (1–99, 100–399, >=400). Chi-square tests and multivariable logistic regression models were used for statistical analysis. Results. A total of 64,283 femoral neck fractures were evaluated. 17,138 cementless femoral stems were matched exactly to cemented femoral stems based on age, gender and Charleston comorbidity index (CCI). In the
The aims of this study were to determine the incidence and factors for developing periprosthetic joint infection (PJI) following hemiarthroplasty (HA) for hip fracture, and to evaluate treatment outcome and identify factors associated with treatment outcome. A retrospective review was performed of consecutive patients treated for HA PJI at a tertiary referral centre with a mean 4.5 years’ follow-up (1.6 weeks to 12.9 years). Surgeries performed included debridement, antibiotics, and implant retention (DAIR) and single-stage revision. The effect of different factors on developing infection and treatment outcome was determined.Aims
Methods
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). 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.Aims
Methods
There is evidence that morbidly obese patients have more intra- and postoperative complications and poorer outcomes when undergoing total hip arthroplasty (THA) with the direct anterior approach (DAA). The aim of this study was to determine the efficacy of DAA for THA, and compare the complications and outcomes of morbidly obese patients with nonobese patients. Morbidly obese patients (n = 86), with BMI ≥ 40 kg/m2 who underwent DAA THA at our institution between September 2010 and December 2017, were matched to 172 patients with BMI < 30 kg/m2. Data regarding demographics, set-up and operating time, blood loss, radiological assessment, Harris Hip Score (HHS), International Hip Outcome Tool (12-items), reoperation rate, and complications at two years postoperatively were retrospectively analyzed.Aims
Methods
The aim of our study was to investigate the effect of asymmetric crosslinked polyethylene liner use on the risk of revision of cementless and hybrid total hip arthroplasties (THAs). We undertook a registry study combining the National Joint Registry dataset with polyethylene manufacturing characteristics as supplied by the manufacturers. The primary endpoint was revision for any reason. We performed further analyses on other reasons including instability, aseptic loosening, wear, and liner dissociation. The primary analytic approach was Cox proportional hazard regression.Aims
Methods
Due to the opioid epidemic in the USA, our service progressively decreased the number of opioid tablets prescribed at discharge after primary hip (THA) and knee (TKA) arthroplasty. The goal of this study was to analyze the effect on total morphine milligram equivalents (MMEs) prescribed and post-discharge opioid repeat prescriptions. We retrospectively reviewed 19,428 patients undergoing a primary THA or TKA between 1 February 2016 and 31 December 2019. Two reductions in the number of opioid tablets prescribed at discharge were implemented over this time; as such, we analyzed three periods (P1, P2, and P3) with different routine discharge MME (750, 520, and 320 MMEs, respectively). We investigated 90-day refill rates, refill MMEs, and whether discharge MMEs were associated with represcribing in a multivariate model.Aims
Methods