Femoroacetabular impingement (FAI) is commonly associated with early hip arthritis. We reviewed our series of 1300 hip resurfacing procedures. More than 90% of our male patients, with an average age of 53 years, had cam impingement lesions. In this condition, there are anterior femoral neck osteophytes, and a retroverted femoral head on a normally anteverted neck. It is postulated that FAI results in collision of the anterior neck of the femur against the rim of the acetabulum, causing damage to the acetabular labrum and articular cartilage, resulting in osteoarthritis. Early treatment of FAI involves arthroscopic or open removal of bone from the anterior femoral neck, as well as repair or removal of labral tears. However, once osteoarthritis has developed, hip replacement or hip resurfacing is indicated. Hip resurfacing can re-orient the head and re-shape the neck. This helps to restore normal biomechanics to the hip, eliminate FAI, and improve range of motion. Since many younger men with hip arthritis have FAI, and are also considered the best candidates for hip resurfacing, it is evident that resurfacing has a role in these patients.

Purpose: The current health care climate encourages an early discharge directly home. Efforts to increase efficiency and decrease length of stay require accurate pre-planning of patient discharge following total joint arthroplasty (TJA). The purpose of this study was to develop and evaluate an easily administered form to preoperatively predict patient discharge disposition following TJA.

Method: A form was generated by a multidisciplinary group of clinicians which identified a set of preoperative factors relevant to patient discharge including age, gender, body mass index, comorbidities, preoperative ambulatory status, projected postoperative weight bearing, home environment and location, and caregiver assistance. Data were collected from a retrospective review of 516 medical charts for patients that had undergone primary total knee arthroplasty (TKA) (n=103), revision TKA (n=104), bilateral TKA (n=102), primary total hip arthroplasty (THA) (n=106), and revision THA (n=101). A stepwise multinomial logistic regression model was used to identify predictors of discharge to a skilled nursing facility (SNF), rehabilitation facility, or home, using SPSS version 11.5 statistical software (SPSS Inc., Chicago, IL).

Results: Patients were more likely to be discharged to either a SNF or rehabilitation facility if they underwent bilateral TKA (p< 0.001); were female (p< 0.001), have their heart disease monitored (p=0.003); or are older (p< 0.001). Patients are more likely to be discharged home if preoperatively they are capable of independent ambulation in the community (p=0.014). Patients discharged to either a SNF or rehabilitation facility were not significantly different except patients undergoing bilateral TKA were more likely to be discharged to a rehabilitation facility (p< 0.001).

Conclusion: We identified factors associated with discharge to a SNF, rehabilitation facility, or home following elective joint replacement surgery. With further validation, this model may be a useful tool for preoperatively predicting a patient’s discharge disposition, which is valuable to the hospital, clinicians, patients, and families in efficiently preparing for postoperative care.

Purpose: There is a paucity of literature describing clinical outcomes following hip arthroscopy. Variables associated with short or prolonged recovery are undefined. This presents a challenge to surgeons in preoperatively communicating with patients about expectations after surgery. The goals of this study are to identify predictors of recovery and to develop models which will facilitate the proper counseling of patients prior to hip arthroscopy. In this study, we define a normal recovery after hip arthroscopy, determine the predictive values of preoperative and intraoperative variables for recovery and for progression to total hip arthroplasty (THA) after hip arthroscopy.

Method: A retrospective review of 216 individuals treated with hip arthroscopy at a tertiary medical center was conducted by a single reviewer. Univariate analysis was used to identify independent variables that correlated with prolonged or short recovery following hip arthroscopy and also on variables correlated with progression to THA. Binary logistic regression analysis was used to develop and test multivariate models for predicting prolonged recovery and progression to THA.

Results: Univariate analyses revealed multiple variables (spanning demographics, past medical history, radiographic findings, physical examination findings, and intraoperative findings) which were significantly (p≤0.05) correlated with prolonged recovery (13 significant predictors) and also with progression to THA (14 significant predictors). A multivariate predictive algorithm was generated using 5 significant predictors of prolonged recovery, which included Workman’s compensation involvement, female gender, use of pain medications, presence of a limp, and presence of a lateral labral tear. This algorithm was tested successfully using an independent sample of 25 individuals. Three multivariate predictors of progression to THA after hip arthroscopy were identified, including radiographic presence of arthritis, female gender and the presence of grade 4 chondral lesions, and a predictive algorithm was generated.

Conclusion: We generated and initially validated a multivariate algorithm to predict prolonged recovery following hip arthroscopy. If validated in larger sample, this model may allow a surgeon to appropriately counsel patients regarding expectations for recovery after hip arthroscopy.

Although conventional thinking and teaching have implicated weight and body mass index (BMI) in premature failure of total knee arthroplasty (TKA) there is scant evidence based confirmation of this belief. Furthermore, there is little knowledge regarding the precise effect of BMI on functional outcomes following TKA. We performed this study to assess the effect of weight on the longevity of TKA and on outcomes following TKA revision (TKAR).

186 consecutive subjects undergoing TKAR in a 17-center prospective cohort study, had data collected on weight (pounds), BMI and time elapsed between primary and revision surgery (T). The Physical Component Score (PCS) of the Short Form-36 (SF-36), the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index, and the Knee Society Score (KSS) were also collected preoperatively and at 6-month follow-up. Univariate, bivariate and multivariate statistical methods were used in the analysis.

The mean BMI and weight were 31.8 (54% of subjects had a BMI > 30) and 200 pounds (range 107–350) respectively. The distribution of both measures of excessive weight was close to normal. Average time between primary and revision procedures (T) was 7.3 years (range 6 months to 27 years). Using linear regression, T significantly decreased as weight (BMI) increased. Mean SF-36 PCS, WOMAC and KSS-Function scores were significantly improved 6 months after revision surgery. However, BMI and, in particular, weight were predictive of worse physical functional outcomes.

This study demonstrates the deleterious effect of weight on both the longevity of primary TKA as assessed at the time of revision and on functional outcomes following TKAR. Although further prospective data regarding this population is indicated, the current findings direct us towards better outcomes prediction for overweight patients and more effective counselling and appropriate management of these patients.