Responsiveness of the Harris Hip Score and the SF-36: five years after total hip arthroplasty

Introduction Trabecular Titanium is an advanced cellular solid structure, composed of regular multiplanar hexagonal interconnected cells that mimic the morphology of the trabecular bone. This biomaterial demonstrated improved mechanical properties and enhanced osteoinduction and osteoconduction in several in vitro and in vivo studies. The aim of this study was to assess Trabecular Titanium osseointegration by measuring periacetabular changes in bone mineral density (BMD) with dual-emission X-ray absorptiometry (DEXA). Methods 89 patients (91 hips) underwent primary total hip arthroplasty (THA) with acetabular Trabecular Titanium cups. Clinical (Harris Hip Score (HHS), SF-36) and radiographic assessment were performed preoperatively, and postoperatively at 7 days and at 3, 6, 12 and 24 months. DEXA analysis was performed only postoperatively, using the BMD values measured at 7 days as baselines. Results After an initial decrease from baseline to 6 months, BMD increased and progressively stabilised in all 3 regions of interest (ROIs). Median (IQR) HHS and SF-36 increased from 48 (39-62) and 49 (37-62) preoperatively to 99 (96-100) and 86 (79-92) at 24 months, indicating a considerable improvement in terms of pain relief, functional recovery and quality of life. BMD patterns and radiographic evaluation showed evident signs of periacetabular bone remodelling and osseointegration; all cups were stable at the final follow-up without radiolucent lines, loosening or osteolysis. No revisions were performed. Conclusions After an initial reduction in periacetabular BMD, all 3 ROIs exhibited stabilisation or slight recovery. Although clinical outcomes and functional recovery proved satisfactory, longer follow-ups are necessary to assess this cup long-term survivorship.

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Influence of Training of Orthopaedic Surgeons on Clinical Outcome after Total Hip Arthroplasty in a High Volume Endoprosthetic Centre

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-0627-7586 ◽

2018 ◽

Vol 157 (01) ◽

pp. 48-53 ◽

Cited By ~ 1

Author(s):

Katrin Osmanski-Zenk ◽

Susanne Finze ◽

Robert Lenz ◽

Rainer Bader ◽

Wolfram Mittelmeier

Keyword(s):

Total Hip Arthroplasty ◽

Clinical Outcome ◽

Hip Arthroplasty ◽

High Volume ◽

Harris Hip Score ◽

Orthopaedic Surgeons ◽

Total Hip ◽

Sf 36 ◽

Euroqol 5D

Zusammenfassung Hintergrund Ziel der Studie ist die Überprüfung, ob sich die postoperative Ergebnisqualität und die Komplikationswahrscheinlichkeit hüftendoprothetischer Eingriffe signifikant bei Operateuren in Weiterbildung von denen der sog. Hauptoperateure im Rahmen der EndoCert-Struktur unterscheiden. Material und Methoden Eingeschlossen wurden 192 Patienten, die mit einer primären Hüftendoprothese versorgt wurden. Zur Evaluierung der Ergebnisqualität wurden präoperativ und 12 Monate postoperativ der Harris-Hip-Score, WOMAC, SF-36 und der EuroQol-5D abgefragt. Zudem wurden als Komplikationen die vom EndoCert-System definierten Qualitätsindikatoren erfasst. Ergebnisse Signifikante Verbesserungen der postoperativen Score-Werte in Abhängigkeit von der Qualifikation des verantwortlichen Operateurs konnten sowohl bei Senior-/Hauptoperateuren als auch bei Ärzten in Weiterbildung festgestellt werden. Sofern ein Operateur in Facharztweiterbildung von einem Senior-/Hauptoperateur assistiert wird, ist kein Anstieg des peri- und postoperativen Komplikationsrisikos zu verzeichnen. Dagegen ergeben sich signifikante Unterschiede hinsichtlich einer verlängerten OP-Dauer. Schlussfolgerung Durch die Umsetzung des EndoCert-Verfahrens wird sichergestellt, dass die postoperative Ergebnisqualität und die Komplikationswahrscheinlichkeit nach künstlichem Hüftgelenkersatz nicht von der Qualifikation des Erstoperateurs abhängig sind.

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Capsular resection versus capsular repair in direct anterior approach for total hip arthroplasty: a randomized controlled trial

The Bone & Joint Journal ◽

10.1302/0301-620x.103b2.bjj-2020-0529.r2 ◽

2021 ◽

Vol 103-B (2) ◽

pp. 321-328

Author(s):

Frans-Jozef Vandeputte ◽

Jens Vanbiervliet ◽

Cigdem Sarac ◽

Ronald Driesen ◽

Kristoff Corten

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Anterior Approach ◽

Direct Anterior Approach ◽

Harris Hip Score ◽

Anterior Capsule ◽

Total Hip ◽

Implant Positioning ◽

Sf 36 ◽

One Year

Aims Optimal exposure through the direct anterior approach (DAA) for total hip arthroplasty (THA) conducted on a regular operating theatre table is achieved with a standardized capsular releasing sequence in which the anterior capsule can be preserved or resected. We hypothesized that clinical outcomes and implant positioning would not be different in case a capsular sparing (CS) technique would be compared to capsular resection (CR). Methods In this prospective trial, 219 hips in 190 patients were randomized to either the CS (n = 104) or CR (n = 115) cohort. In the CS cohort, a medial based anterior flap was created and sutured back in place at the end of the procedure. The anterior capsule was resected in the CR cohort. Primary outcome was defined as the difference in patient-reported outcome measures (PROMs) after one year. PROMs (Harris Hip Score (HHS), Hip disability and Osteoarthritis Outcome Score (HOOS), and Short Form 36 Item Health Survey (SF-36)) were collected preoperatively and one year postoperatively. Radiological parameters were analyzed to assess implant positioning and implant ingrowth. Adverse events were monitored. Results At one year, there was no difference in HSS (p = 0.728), HOOS (Activity Daily Life, p = 0.347; Pain, p = 0.982; Quality of Life, p = 0.653; Sport, p = 0.994; Symptom, p = 0.459), or SF-36 (p = 0.338). Acetabular component inclination (p = 0.276) and anteversion (p = 0.392) as well as femoral component alignment (p = 0.351) were similar in both groups. There were no dislocations, readmissions, or reoperations in either group. The incidence of psoas tendinitis was six cases in the CS cohort (6%) and six cases in the CR cohort (5%) (p = 0.631). Conclusion No clinical differences were found between resection or preservation of the anterior capsule when performing a primary THA through the DAA on a regular theatre table. In case of limited visibility during the learning curve, it might be advisable to resect a part of the anterior capsule. Cite this article: Bone Joint J 2021;103-B(2):321–328.

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Relationship between self-reported and performance-based tests in assessment of patients with total hip arthroplasty

Hip International ◽

10.1177/1120700017752557 ◽

2018 ◽

Vol 28 (5) ◽

pp. 566-570 ◽

Cited By ~ 1

Author(s):

Nuray Elibol ◽

Bayram Unver ◽

Vasfi Karatosun ◽

Izge Gunal

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Harris Hip Score ◽

Performance Tests ◽

Walk Test ◽

Stand Test ◽

Total Hip ◽

Sit To Stand ◽

Sf 36 ◽

And Performance

Purpose: The aim of our study was to investigate the relationship between self-reported and performance-based tests in the assessment of patients with total hip arthroplasty (THA). Methods: Ninety four patients (35 males, 59 females) were included in the study with mean age 57.1 ± 14.6 years. Patients performed four performance tests (Timed “Up & Go” Test, Sit to Stand Test, Self-paced Walk Test and Stair Test) and two self-reported measurements (Harris Hip Score [HHS] and SF-36 [36-Item Short Form Health Survey]) were preferred to assess patients. Results: There were varying correlations between performance tests and subscales of the SF-36 including physical function, energy/fatigue, pain, general health. Strong correlation was found between HHS and Timed “Up and Go”( r = −0.59, p < 0.001), self-paced walk test ( r = −0.58, p < 0.001). Moderate correlation was found between HHS and sit to stand test ( r = −0.406, p < 0.001), stair test ( r = 0.32, p < 0.001). Conclusions: There were especially moderate-to-strong correlations between self-reported measurements and performance-based tests in the evaluation of patients with THA. Therefore, outcomes assessment after THA may include self-reported measurements or performance-based tests.

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Mid-term results of bilateral synchronous total hip arthroplasty for bony ankylosis in patients with ankylosing spondylitis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02258-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Lei Han ◽

Renfu Quan ◽

Zhenle Pei ◽

Guoping Cao ◽

Yungen Hu ◽

...

Keyword(s):

Ankylosing Spondylitis ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Harris Hip Score ◽

Heterotopic Bone ◽

Heterotopic Bone Formation ◽

Total Hip ◽

Vas Score ◽

Mid Term Results ◽

Bony Ankylosis

Abstract Background Total hip arthroplasty (THA) for bony ankylosis is technically challenging in patients with ankylosing spondylitis (AS). This study aimed to determine the mid-term results of bilateral synchronous THA for bony ankylosis in patients with AS. Methods Nineteen cases of bony ankylosis in patients with AS who received bilateral synchronous THA were included in this study (17 males and 2 females, mean age 49.2 years). Disease duration was 5–38 years (mean 18 years and 6 months). All patients received cementless THA. Intraoperative blood loss, visual analog scale (VAS) score, and complications were assessed. Harris hip scores evaluated the clinical effect. Results Patients were followed up for 62–98 months (mean 82.5 months). VAS score decreased from 7.42 ± 0.92 to 2.42 ± 0.83, Harris hip score improved from 21.8 ± 7.2 to 80.3 ± 6.5, and the flexion-extension range of the hip improved from 0 to 142.3 ± 6.2°. One patient with septum bronchiale had a fracture intraoperatively and was treated with wire strapping. One patient had a traction injury of the femoral nerve postoperatively and recovered 1 year after the operation. Loosening and subsidence were not observed in all patients. Heterotopic bone formation was noted in 3 patients. No complications such as joint dislocation, acute infection, and deep vein thrombosis were found. Conclusion Bilateral synchronous THA was effective for bony ankylosis of the hip in patients with AS because it improved patients’ quality of life and had satisfactory mid-term outcomes.

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Excellent Functional Outcome and Quality of Life after Primary Cementless Total Hip Arthroplasty (THA) Using an Enhanced Recovery Setup

Journal of Clinical Medicine ◽

10.3390/jcm10040621 ◽

2021 ◽

Vol 10 (4) ◽

pp. 621

Author(s):

Franziska Leiss ◽

Julia Sabrina Götz ◽

Günther Maderbacher ◽

Matthias Meyer ◽

Jan Reinhard ◽

...

Keyword(s):

Quality Of Life ◽

Patient Satisfaction ◽

Total Hip Arthroplasty ◽

Functional Outcome ◽

Hip Arthroplasty ◽

Enhanced Recovery ◽

Harris Hip Score ◽

Total Hip ◽

Cementless Total Hip Arthroplasty

Background: Total hip arthroplasty combined with the concept of enhanced recovery is of continued worldwide interest, as it is reported to improve early functional outcome and treatment quality without increasing complications. The aim of the study was to investigate functional outcome and quality of life 4 weeks and 12 months after cementless total hip arthroplasty in combination with an enhanced recovery concept. Methods: A total of 109 patients underwent primary cementless Total Hip Arthroplasty (THA) in an enhanced recovery concept and were retrospectively analyzed. After 4 weeks and 12 months, clinical examination was analyzed regarding function, pain and satisfaction; results were evaluated using Harris Hip score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), EQ-5D-5L, EQ-VAS and subjective patient-related outcome measures (PROMs). Preoperatively, HADS (Hospital Anxiety and Depression Scale) was collected. A correlation analysis of age, American Society of Anesthesiologists (ASA), HADS and comorbidities (diabetes mellitus, art. hypertension, cardiovascular disease) with WOMAC, Harris Hip score (HHS) and EQ-5D was performed. Results: Patients showed a significant improvement in Harris Hip score 4 weeks and 12 months postoperatively (p < 0.001). WOMAC total score, subscale pain, subscale stiffness and subscale function improved significantly from preoperative to 12 months postoperative (p < 0.001). EQ-5D showed a significant improvement preoperative to postoperative (p < 0.001). The influence of anxiety or depression (HADS-A or HADS-D) on functional outcome could not be determined. There was a high patient satisfaction postoperatively, and almost 100% of patients would choose enhanced recovery surgery again. Conclusion: Cementless THA with the concept of enhanced recovery improves early clinical function and quality of life. PROMs showed a continuous improvement over a follow-up of 12 months after surgery. PROMs can help patients and surgeons to modify expectations and improve patient satisfaction.

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A prospective randomised comparison of earlier function after total hip arthroplasty with a mini posterior approach or supercapsular percutaneously-assisted total hip approach: a gait analysis study

Hip International ◽

10.1177/11207000211018440 ◽

2021 ◽

pp. 112070002110184

Author(s):

Andrey A Korytkin ◽

Younes M El Moudni ◽

Yana S Novikova ◽

Kirill A Kovaldov ◽

Ekaterina A Morozova

Keyword(s):

Total Hip Arthroplasty ◽

Gait Analysis ◽

Hip Arthroplasty ◽

Posterior Approach ◽

Gait Velocity ◽

Harris Hip Score ◽

Kinematic Parameters ◽

Gait Patterns ◽

Total Hip

Background: The supercapsular percutaneously-assisted total hip (SuperPATH) approach is a muscle sparing surgical technique for total hip arthroplasty (THA). The literature reports good clinical and functional results of the SuperPATH technique in the short term. We aimed to compare early outcomes and gait analysis of THA using the mini posterior approach (MPA) and supercapsular percutaneously-assisted total hip (SuperPATH) approach. Methods: 44 patients who underwent THA, were randomly allocated to either MPA or SuperPATH. The data were then collected prospectively (preoperatively and postoperatively at 6 weeks). Plain anteroposterior radiographs of the pelvis and instrumental gait analysis were obtained. The visual analogue scale (VAS), Harris Hip Score (HHS) and Hip disability and Osteoarthritis Outcome Scores (HOOS) were used to assess functional and clinical outcomes. Results: No significant difference was found in patients’ surgical outcomes. Patients in the SuperPATH group had less pain according to the VAS score at follow-up than the MPA group ( p < 0.01). There was also a significant improvement in HHS and HOOS scores for all patients ( p < 0.001) with the SuperPATH group showing superior changes. The comparison of mean differences in gait velocity between preoperative and 6 weeks postoperative result, revealed improvement in the SuperPATH group over the MPA group ( p = 0.06). Limping was more persistent in the MPA group. Kinematic parameters demonstrated improved hip joint excursion slightly higher in the MPA group. There was no significant improvement in kinetic and kinematic parameters at different walking moments for all patients at 6 weeks compared to preoperative gait patterns. Conclusions: SuperPATH and MPA both show excellent results. This study reveals that the SuperPATH technique was associated with lower postoperative pain levels, and higher physical function and quality of life. Improved functional outcomes allowed earlier postoperative rehabilitation and faster recovery. Specific improvement in gait patterns were identified with nonsignificant differences between the 2 approaches at 6 weeks follow-up.

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Excellent Clinical and Radiographic Outcomes with Direct Superior Total Hip Arthroplasty with a Minimum of Two-Year Follow Up

Surgical Technology Online ◽

10.52198/21.sti.38.os1336 ◽

2021 ◽

Author(s):

Moritz Sharabianlou ◽

Prerna Arora ◽

Derek Amanatullah

Keyword(s):

Total Hip Arthroplasty ◽

Functional Recovery ◽

Hip Arthroplasty ◽

Case Series ◽

Harris Hip Score ◽

Timed Up And Go ◽

Total Hip ◽

Radiologic Evaluation ◽

Superior Approach

This study aims to establish the midterm safety and performance for the direct superior approach to minimally invasive surgery total hip arthroplasty (MIS-THA). We used a unicentric, single-surgeon, retrospective, consecutive case series analysis of the first 40 patients who received primary unilateral direct superior MIS-THA. Special attention was given to functional recovery by measuring Harris Hip Score (HHS) and timed-up-and-go (TUG) with a mean follow up of 2.2 ± 0.4 years. A radiologic evaluation was performed. HHS and TUG improved significantly at three months and one year (p < 0.001). All components were placed within the Lewinnek safe zone with no change position or signs of loosening at two years. With a minimum of two years of follow up, the direct superior approach appears to be safe without any obvious or consistent postoperative complications—clinically or radiographically—with excellent functional recovery. Additionally, our subgroup analysis supported no late learning curve effect.

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Patient- and Surgery-Related Factors that Affect Patient-Reported Outcomes after Total Hip Arthroplasty

Journal of Clinical Medicine ◽

10.3390/jcm7100358 ◽

2018 ◽

Vol 7 (10) ◽

pp. 358 ◽

Cited By ~ 2

Author(s):

Toshiyuki Kawai ◽

Masanao Kataoka ◽

Koji Goto ◽

Yutaka Kuroda ◽

Kazutaka So ◽

...

Keyword(s):

Regression Analysis ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Activity Score ◽

Harris Hip Score ◽

Related Factors ◽

Ucla Activity Score ◽

Factors Associated ◽

Total Hip ◽

Patient Reported

Patient-reported outcome measures (PROMs) are used to assess satisfaction after total hip arthroplasty (THA); however, the factors that determine these PROMs remain unclear. This study aimed to identify the patient- and surgery-related factors that affect patient satisfaction after THA as indicated by the Oxford Hip Score (OHS). One-hundred-and-twenty patients who underwent primary THA were included. Various patient-related factors, including clinical scores, and surgery-related factors were examined for potential correlations with the OHS at 3, 6, and 12 months post-THA. Univariate regression analysis showed that higher preoperative University of California Los Angeles (UCLA) activity score (p = 0.027) and better preoperative OHS (p = 0.0037) were correlated with better OHS at 3 months post-THA. At 6 months post-THA, the factors associated with better OHS were higher preoperative UCLA activity score (p = 0.039), better preoperative OHS (p = 0.0006), and use of a cemented stem (p = 0.0071). At 12 months post-THA, the factors associated with better OHS were higher preoperative UCLA activity score (p = 0.0075) and better preoperative OHS (p < 0.0001). Multivariate regression analysis showed that the factors significantly correlated with better OHS were female sex (p = 0.011 at 3 months post-THA), osteoarthritis (p = 0.043 at 6 months), higher preoperative OHS (p < 0.001 at 3 and 12 months, p = 0.018 at 6 months), higher preoperative Harris Hip Score (p = 0.001 at 3 months), higher preoperative UCLA activity score (p = 0.0075 at 3 months), and the use of a cemented femoral component (p = 0.012 at 6 months). Patient- and surgery-related factors affecting post-THA PROMs were identified, although the effect of these factors decreased over time.

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Changes in sexual activity of male patients with ankylosing spondylitis undergoing total hip arthroplasty

Hip International ◽

10.1177/1120700018796378 ◽

2018 ◽

Vol 29 (3) ◽

pp. 310-315 ◽

Cited By ~ 1

Author(s):

Jun Fu ◽

Xiang Li ◽

Kan Liu ◽

Jiying Chen ◽

Ming Ni ◽

...

Keyword(s):

Ankylosing Spondylitis ◽

Total Hip Arthroplasty ◽

Sexual Activity ◽

Hip Arthroplasty ◽

Harris Hip Score ◽

Clinical Parameters ◽

Total Hip ◽

Flexion Extension ◽

Before And After ◽

Male Patients

Introduction: Sexual activity is often an important component of life. To date, no studies have examined sexual activity before and after total hip arthroplasty (THA) in male patients with ankylosing spondylitis (AS). The purpose of the current study was to evaluate the effect of THA on sexual activity and to explore the most commonly reported and comfortable coital position for male AS patients with hip involvement. Methods: Data from 31 male AS patients who underwent THA for hip involvement were retrospectively reviewed. Information from the International Index of Erectile Function (IIEF), the Harris Hip Score (HHS) and other clinical parameters was collected and monitored over time. We compared the above-mentioned parameters before surgery and 2 years after surgery and analysed the correlation between changes on the IIEF and changes in clinical parameters. Results: The domain and total scores of the IIEF, except EF, were significantly higher after surgery than were those before surgery ( p < 0.05). There was a significant positive correlation between changes on the IIEF and improvement in flexion-extension range of motion (ROM), adduction-abduction ROM and HHS ( p < 0.05). Most patients (26/31, 83.9%) resumed sexual activity 5–12 weeks after surgery. The pre- and postoperative distributions of the most commonly reported and comfortable position were not significantly different (p > 0.05). Conclusions: Successful THA may improve sexual activity in male AS patients with hip involvement. Changes in hip ROM show the most significant correlation with improvement in sexual activity. Resumption of sexual activity occurs within 5–12 postoperative weeks.

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