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. 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.Aims
Methods
The aims of this study were to evaluate the incidence of reoperation (all cause and specifically for periprosthetic femoral fracture (PFF)) and mortality, and associated risk factors, following a hemiarthroplasty incorporating a cemented collarless polished taper slip stem (PTS) for management of an intracapsular hip fracture. This retrospective study included hip fracture patients aged 50 years and older treated with Exeter (PTS) bipolar hemiarthroplasty between 2019 and 2022. Patient demographics, place of domicile, fracture type, delirium status, American Society of Anesthesiologists (ASA) grade, length of stay, and mortality were collected. Reoperation and mortality were recorded up to a median follow-up of 29.5 months (interquartile range 12 to 51.4). Cox regression was performed to evaluate independent risk factors associated with reoperation and mortality.Aims
Methods
This study aimed to determine whether lateral femoral wall thickness (LWT) < 20.5 mm was associated with increased revision risk of intertrochanteric fracture (ITF) of the hip following sliding hip screw (SHS) fixation when the medial calcar was intact. Additionally, the study assessed the association between LWT and patient mortality. This retrospective study included ITF patients aged 50 years and over treated with SHS fixation between 2019 and 2021 at a major trauma centre. Demographic information, fracture type, delirium status, American Society of Anesthesiologists grade, and length of stay were collected. LWT and tip apex distance were measured. Revision surgery and mortality were recorded at a mean follow-up of 19.5 months (1.6 to 48). Cox regression was performed to evaluate independent risk factors associated with revision surgery and mortality.Aims
Methods
The primary aim of our study was to assess the influence of age on hip-specific outcome following total hip arthroplasty (THA). Secondary aims were to assess health-related quality of life (HRQoL) and level of activity according to age. A prospective cohort study was conducted. All patients were fitted with an Exeter stem with a 32 mm head on highly cross-linked polyethylene (X3RimFit) cemented acetabulum. Patients were recruited into three age groups: < 65 years, 65 to 74 years, and ≥ 75 years, and assessed preoperatively and at three, 12, 24, and 60 months postoperatively. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Harris Hip Score (HHS), and Hip disability and Osteoarthritis Outcome Score (HOOS), were used to assess hip-specific outcome. EuroQol five-dimension five-level questionnaire (EQ-5D-5L) and 36-Item Short Form Survey (SF-36) scores were used to assess HRQoL. The Lower Extremity Activity Scale (LEAS) and Timed Up and Go (TUG) were used to assess level of activity.Aims
Methods
The aim of this study was to estimate time to arthroplasty among patients with hip and knee osteoarthritis (OA), and to identify factors at enrolment to first-line intervention that are prognostic for progression to surgery. In this longitudinal register-based observational study, we identified 72,069 patients with hip and knee OA in the Better Management of Patients with Osteoarthritis Register (BOA), who were referred for first-line OA intervention, between May 2008 and December 2016. Patients were followed until the first primary arthroplasty surgery before 31 December 2016, stratified into a hip and a knee OA cohort. Data were analyzed with Kaplan-Meier and multivariable-adjusted Cox regression.Aims
Methods
This study aims to assess the feasibility of conducting a pragmatic, multicentre randomized controlled trial (RCT) to test the clinical and cost-effectiveness of an informal caregiver training programme to support the recovery of people following hip fracture surgery. This will be a mixed-methods feasibility RCT, recruiting 60 patients following hip fracture surgery and their informal caregivers. Patients will be randomized to usual NHS care, versus usual NHS care plus a caregiver-patient dyad training programme (HIP HELPER). This programme will comprise of three, one-hour, one-to-one training sessions for the patient and caregiver, delivered by a nurse, physiotherapist, or occupational therapist. Training will be delivered in the hospital setting pre-patient discharge. It will include practical skills for rehabilitation such as: transfers and walking; recovery goal setting and expectations; pacing and stress management techniques; and introduction to the HIP HELPER Caregiver Workbook, which provides information on recovery, exercises, worksheets, and goal-setting plans to facilitate a ‘good’ recovery. After discharge, patients and caregivers will be supported in delivering rehabilitation through three telephone coaching sessions. Data, collected at baseline and four months post-randomization, will include: screening logs, intervention logs, fidelity checklists, quality assurance monitoring visit data, and clinical outcomes assessing quality of life, physical, emotional, adverse events, and resource use outcomes. The acceptability of the study intervention and RCT design will be explored through qualitative methods with 20 participants (patients and informal caregivers) and 12 health professionals.Aims
Methods
The aim of this study was to determine whether total hip arthroplasty (THA) for chronic hip pain due to unilateral primary osteoarthritis (OA) has a beneficial effect on cognitive performance. A prospective cohort study was conducted with 101 patients with end-stage hip OA scheduled for THA (mean age 67.4 years (SD 9.5), 51.5% female (n = 52)). Patients were assessed at baseline as well as after three and months. Primary outcome was cognitive performance measured by d2 Test of Attention at six months, Trail Making Test (TMT), FAS-test, Rivermead Behavioural Memory Test (RBMT; story recall subtest), and Rey-Osterrieth Complex Figure Test (ROCF). The improvement of cognitive performance was analyzed using repeated measures analysis of variance.Aims
Methods
The purpose of this study was to determine the access to and ability to use telemedicine technology in adult patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA), and to determine associations with the socioeconomic characteristics of the patients, including age, sex, race, and education. We also sought to understand the patients’ perceived benefits, risks, and preferences when dealing with telemedicine. We performed a cross-sectional survey involving patients awaiting primary THA and TKA by one of six surgeons at a single academic institution. Patients were included and called for a telephone-administered survey if their surgery was scheduled to be between 23 March and 2 June 2020, and were aged > 18 years.Aims
Methods
The aim of this study was to compare the rate of mortality and
causes of death in Korean patients who undergo surgery for a fracture
of the hip, up to 11 years after the injury, with a control group
from the general population. National cohort data from Korean Health Insurance Review and
Assessment Service – National Sample Cohort were used. A ratio of
1:4 matched patients with a fracture who underwent surgery (3383,
fracture group) between 2003 and 2012, and controls (13 532) were
included. The matches were processed for age, gender, income, and
region of residence. We also undertook analyses of subgroups according
to age and gender. The mean follow-up was 4.45 years (1 to 11).Aims
Materials and Methods
Large ceramic femoral heads offer several advantages
that are potentially advantageous to patients undergoing both primary
and revision total hip replacement. Many high-quality studies have
demonstrated the benefit of large femoral heads in reducing post-operative instability.
Ceramic femoral heads may also offer an advantage in reducing polyethylene wear
that has been reported Cite this article: Bone Joint J 2013;95-B, Supple A:63–6.
We report the clinical and radiological outcomes
of a series of contemporary cementless ceramic-on-ceramic total hip
replacements (THRs) at ten years in patients aged ≤ 55 years of
age. Pre- and post-operative activity levels are described. A total
of 120 consecutive ceramic cementless THRs were performed at a single
centre in 110 patients from 1997 to 1999. The mean age of the patients
at operation was 45 years (20 to 55). At ten years, four patients
had died and six were lost to follow-up, comprising ten hips. The
mean post-operative Harris hip score was 94.7 (55 to 100). Radiological
analysis was undertaken in 90 available THRs of the surviving 106
hips at final review: all had evidence of stable bony ingrowth,
with no cases of osteolysis. Wear was undetectable. There were four
revisions. The survival for both components with revision for any
cause as an endpoint was 96.5% (95% confidence interval 94.5 to
98.7). The mean modified University of California, Los Angeles activity
level rose from a mean of 6.4 (4 to 10) pre-operatively to 9.0 (6
to 10) at the ten-year post-operative period. Alumina ceramic-on-ceramic bearings in cementless primary THR
in this series have resulted in good clinical and radiological outcomes
with undetectable rates of wear and excellent function in the demanding
younger patient group at ten years. Cite this article:
We report the survival at five years of 144 consecutive metal-on-metal resurfacings of the hip implanted between August 1997 and May 1998. Failure was defined as revision of either the acetabular or femoral component for any reason during the study period. The survival at the end of five years was 98% overall and 99% for aseptic revisions only. The mean age of the patients at implantation was 52.1 years. Three femoral components failed during the first two years, two were infected and one fractured. A single stage revision was carried out in each case. No other revisions were performed or are impending. No patients were lost to follow-up. Four died from unrelated causes during the study period. This study confirms that hip resurfacing using a metal-on-metal bearing of known provenance can provide a solution in the medium term for the younger more active adult who requires surgical intervention for hip disease.
The benefit of arthroscopy of the hip in the
treatment of femoroacetabular impingement (FAI) in terms of quality
of life (QoL) has not been reported. We prospectively collected
data on 612 patients (257 women (42%) and 355 men (58%)) with a
mean age at the time of surgery of 36.7 years (14 to 75) who underwent
arthroscopy of the hip for FAI under the care of a single surgeon.
The minimum follow-up was one year (mean 3.2 years (1 to 7)). The
responses to the modified Harris hip score were translated using
the Rosser Index Matrix in order to provide a QoL score. The mean
QoL score increased from 0.946 (-1.486 to 0.995) to 0.974 (0.7 to
1) at one year after surgery (p <
0.001). The mean QoL score
in men was significantly higher than in women, both before and one
year after surgery (both p <
0.001). However, the mean change
in the QoL score was not statistically different between men and
women (0.02 (-0.21 to 0.27) and 0.04 (-0.16 to 0.87), respectively;
p = 0.12). Linear regression analysis revealed that the significant predictors
of a change in QoL score were pre-operative QoL score (p <
0.001)
and gender (p = 0.04). The lower the pre-operative score, the higher
the gain in QoL post-operatively (ρ = -0.66; p <
0.001). One
year after surgery the QoL scores in the 612 patients had improved
in 469 (76.6%), remained unchanged in 88 (14.4%) and had deteriorated
in 55 (9.0%).
We analysed which pre-operative factors could be used to predict the length of in-patient stay following unilateral primary total hip replacement undertaken for osteoarthritis. Data were collected prospectively from 2302 patients undergoing primary total hip replacement over a nine-year period. The relationships between the various pre-operative factors and length of stay were studied separately using either Student’s t-test or Pearson’s correlation, and then subjected to multiple linear regression analysis. The mean length of stay was 8.1 days (median 7; 3 to 58). After adjusting for the effects of other pre-operative factors, younger age, male gender, higher combined Harris hip function and activity score, higher general health perception dimension of the Short-Form 36 score, and non-steroidal anti-inflammatory drug use were all found to be significantly associated with a reduced length of stay.
We have studied the natural history of a first episode of dislocation after primary total hip replacement (THR) to clarify the incidence of recurrent dislocation, the need for subsequent revision and the quality of life of these patients. Over a six-year period, 99 patients (101 hips) presented with a first dislocation of a primary THR. A total of 61 hips (60.4%) had dislocated more than once. After a minimum follow-up of one year, seven patients had died. Of the remaining 94 hips (92 patients), 47 underwent a revision for instability and one awaits operation (51% in total). Of these, seven re-dislocated and four needed further surgery. The quality of life of the patients was studied using the Oxford Hip Score and the EuroQol-5 Dimension (EQ-5D) questionnaire. A control group of patients who had not dislocated was also studied. At a mean follow-up of 4.5 years (1 to 20), the mean Oxford Hip Score was 26.7 (15 to 47) after one episode of dislocation, 27.2 (12 to 45) after recurrent dislocation, 34.5 (12 to 54) after successful revision surgery, 42 (29 to 55) after failed revision surgery and 17.4 (12 to 32) in the control group. The EuroQol-5 dimension questionnaire revealed more health problems in patients undergoing revision surgery.
Patients considered suitable for total hip resurfacing arthroplasty often have bilateral disease. The peri-operative complications, transfusion requirements, hospital stay, outcome and costs in patients undergoing one-stage bilateral total hip resurfacing were compared with a group of patients undergoing a two-stage procedure. A total of 92 patients were included in the study, of which 37 (40%) had a one-stage and 55 (60%) had a two-stage resurfacing. There were no significant differences in age, gender, or American Society of Anaesthesiologists grade between the groups (p = 0.31, p = 0.23, p = 0.13, respectively). There were three systemic complications in the one-stage group (8.1%) and one in the two-stage group (1.8% of patients; 0.9% of procedures). There was no significant difference in the complication rate (p = 0.72) or the transfusion requirements (p = 0.32) between the two groups. The one-stage group had a reduced total hospital stay of five days (95% confidence interval 4.0 to 6.9; p <
0.001), reduced length of time to completion of all surgery of five months (95% confidence interval 2.6 to 8.3; p <
0.001), and the reduced cost was 35% less than that of a two-stage procedure. However, the total anaesthetic time was significantly longer for the one-stage group (p <
0.001; 95% confidence interval 31 to 52). This study demonstrates that consideration should be given to one-stage surgery for patients with bilateral symptomatic disease suitable for metal-on-metal hip resurfacing. A one-stage procedure appears to have benefits for both the patient and the hospital without additional complications.
