Improved Patient-Reported Quality of Life and Hip Function After Cementless 1-Stage Revision of Chronic Periprosthetic Hip Joint Infection

2019 ◽  
Vol 34 (11) ◽  
pp. 2763-2769.e1 ◽  
Author(s):  
Ninna Rysholt Poulsen ◽  
Inger Mechlenburg ◽  
Kjeld Søballe ◽  
Anders Troelsen ◽  
Jeppe Lange ◽  
...  
2017 ◽  
Vol 28 (4) ◽  
pp. 407-414 ◽  
Author(s):  
Ninna R. Poulsen ◽  
Inger Mechlenburg ◽  
Kjeld Søballe ◽  
Jeppe Lange

Introduction: Very limited information is available regarding patient-reported health-related quality of life (HRQoL) and hip function following treatment for chronic periprosthetic hip joint infection (PJI). Patient-reported outcome measures provide essential information to clinicians of the impact a treatment have on patient’s lives. The purpose of this study was to examine patient reported HRQoL and hip function after a completed re-implantation in a 2-stage revision. Method: 82 patients were identified retrospectively in the National Patient Register. 57 patients were alive and asked to complete the questionnaires EuroQol-5D (EQ-5D) and Oxford Hip Score (OHS) in November 2014. Results were compared to normative population data for EQ-5Dindex. Patients re-infected after a completed 2-stage revision were compared with not re-infected. Results: 45 patients completed the questionnaires. Mean time since re-implantation was 8.2 years (95% CI [confidence interval], 7.7-0.87). The EQ-5D index mean for the 2-stage group was 0.71 (0.64; 0.77) whereas the general population mean is 0.85 (0.84-0.85), p = 0.0004. The 2-stage revision patients scored significantly lower on every EQ-5D dimension. The re-infected group mean EQ-5D index score was significantly lower compared to the not re-infected group, p = 0.003. The EQ-VAS mean score was 58.2 (57.3-68.3) and the mean OHS for the group was 29.2 (25.4-33.0). Conclusions: Patients who undergo 2-stage revision after a PJI have lower scores on HRQoL than the general population. Patients who are re-infected following revision have a lower HRQoL score than patients not re-infected. Future research should focus on optimising patient-reported outcomes after treatment for PJI.


2020 ◽  
Author(s):  
Avi Marks ◽  
Mario Cortina-Borja ◽  
Dror Maor ◽  
Aresh Hashemi-Nejad ◽  
Andreas Roposch

Abstract Background: Osteonecrosis of the femoral head is a common complication in the treatment of developmental dysplasia of the hip (DDH). While functional outcomes of affected patients are good in childhood, it is not clear how they change during the transition to young adulthood. This study determined the relationship between osteonecrosis and hip function, physical function and health status in adolescents and young adults.Methods: We studied 181 patients with a mean age of 19.7 ± 3.8 years with and without osteonecrosis following an open or closed reduction (1995-2005). Patients completed patient-reported outcome measures in 2015/2016 to quantify hip function (maximum score 100); physical function (maximum score 100); and general health status (maximum score 1). We graded all radiographs for subtype of osteonecrosis (Bucholz-Ogden); acetabular dysplasia (centre-edge angle); subluxation (Shenton’s line); and osteoarthritis (Kellgren-Lawrence). Analyses were adjusted for the number of previous surgical procedures on the hip and for the severity of residual hip dysplasia.Results: In 149 patients (186 hips) with and without osteonecrosis, the mean differences (95% confidence interval) in hip function, physical function and quality of life were -4.7 (-10.26, 0.81), -1.03 (-9.29, 7.23) and 0.10 (-1.15, 1.18), respectively. Adjusted analyses stratified across types of osteonecrosis showed that only patients with Bucholz-Odgen grade III had reduced hip function (p<0.01) and physical function (p<0.05) but no difference in health-related quality of life when compared to no osteonecrosis. Conclusion: Osteonecrosis secondary to DDH is a relatively benign disorder in adolescents and young adulthood. Affected patients demonstrated minimal physical disability, a normal quality of life but reduced hip function.


2020 ◽  
Author(s):  
Avi Marks ◽  
Mario Cortina-Borja ◽  
Dror Maor ◽  
Aresh Hashemi-Nejad ◽  
Andreas Roposch

Abstract Background: Osteonecrosis of the femoral head is a common complication in the treatment of developmental dysplasia of the hip (DDH). While functional outcomes of affected patients are good in childhood, it is not clear how they change during the transition to young adulthood. This study determined the relationship between osteonecrosis and hip function, physical function and health status in adolescents and young adults.Methods: We performed a cross-sectional study of 169 patients with a mean age of 19.7 ± 3.8 years with and without osteonecrosis following an open or closed reduction (1995-2005). We also performed a separate longitudinal evaluation of an historical cohort of 54 patients with osteonecrosis, embedded in this sample. All completed patient-reported outcome measures in 2015/2016 to quantify hip function (maximum score 100); physical function (maximum score 100); and general health status (maximum score 1). We graded all radiographs for subtype of osteonecrosis (Bucholz-Ogden); acetabular dysplasia (centre-edge angle); subluxation (Shenton’s line); and osteoarthritis (Kellgren-Lawrence). Analyses were adjusted for the number of previous surgical procedures on the hip and for the severity of residual hip dysplasia.Results: In 149 patients (186 hips) with and without osteonecrosis, the mean differences (95% confidence interval) in hip function, physical function and quality of life were -4.7 (-10.26, 0.81), -1.03 (-9.29, 7.23) and 0.10 (-1.15, 1.18), respectively. Adjusted analyses stratified across types of osteonecrosis showed that only patients with Bucholz-Odgen grade III had reduced hip function (p<0.01) and physical function (p<0.05) but no difference in health-related quality of life when compared to no osteonecrosis. Conclusion: Osteonecrosis secondary to DDH is a relatively benign disorder in adolescents and young adulthood. Affected patients demonstrated minimal physical disability, a normal quality of life but reduced hip function.


2020 ◽  
Author(s):  
Avi Marks ◽  
Mario Cortina-Borja ◽  
Dror Maor ◽  
Aresh Hashemi-Nejad ◽  
Andreas Roposch

Abstract Background: Osteonecrosis of the femoral head is a common complication in the treatment of developmental dysplasia of the hip (DDH). While functional outcomes of affected patients are good in childhood, it is not clear how they change during the transition to young adulthood. This study determined the relationship between osteonecrosis and hip function, physical function and health status in adolescents and young adults.Methods: We studied 181 patients with a mean age of 19.7 ± 3.8 years with and without osteonecrosis following an open or closed reduction (1995-2005). Patients completed patient-reported outcome measures in 2015/2016 to quantify hip function (maximum score 100); physical function (maximum score 100); and general health status (maximum score 1). We graded all radiographs for subtype of osteonecrosis (Bucholz-Ogden); acetabular dysplasia (centre-edge angle); subluxation (Shenton’s line); and osteoarthritis (Kellgren-Lawrence). Analyses were adjusted for the number of previous surgical procedures on the hip and for the severity of residual hip dysplasia.Results: In 149 patients (186 hips) with and without osteonecrosis, the mean differences (95% confidence interval) in hip function, physical function and quality of life were -4.7 (-10.26, 0.81), -1.03 (-9.29, 7.23) and 0.10 (-1.15, 1.18), respectively. Adjusted analyses stratified across types of osteonecrosis showed that only patients with Bucholz-Odgen grade III had reduced hip function (p<0.01) and physical function (p<0.05) but no difference in health-related quality of life when compared to no osteonecrosis. Conclusion: Osteonecrosis secondary to DDH is a relatively benign disorder in adolescents and young adulthood. Affected patients demonstrated minimal physical disability, a normal quality of life but reduced hip function.


2020 ◽  
Vol 48 (6) ◽  
pp. 1416-1422 ◽  
Author(s):  
Ida Lindman ◽  
Axel Öhlin ◽  
Neel Desai ◽  
Kristian Samuelsson ◽  
Olufemi R. Ayeni ◽  
...  

Background: Femoroacetabular impingement syndrome (FAIS) is a common cause of hip pain and disability in athletes. Arthroscopic treatment for FAIS is well-established; however, the long-term results in elite athletes are limited. Purpose: To evaluate outcomes 5 years after arthroscopic treatment for FAIS in elite athletes. Study Design: Case series; Level of evidence, 4. Methods: Elite athletes undergoing arthroscopic treatment for FAIS with a minimum 5-year follow-up were included. They were prospectively followed up with patient-reported outcome measures. An elite athlete was defined as having a Hip Sports Activity Scale (HSAS) level of 7 or 8 before the onset of symptoms. Preoperatively and 5 years after surgery, all athletes completed a web-based questionnaire, including the Copenhagen Hip and Groin Outcome Score (comprising 6 subscales), the EQ-5D and EQ-VAS (European Quality of Life–5 Dimensions Questionnaire and European Quality of Life–Visual Analog Scale), iHOT-12 (International Hip Outcome Tool), a visual analog scale for hip function, and the HSAS. Moreover, patients reported their overall satisfaction with their hip function. Preoperative measurements were compared with the 5-year follow-up. Results: A total of 64 elite athletes (52 men, 12 women) with a mean ± SD age of 24 ± 6 years were included. On average, patients reported a statistically significant and clinically relevant improvement from preoperative patient-reported outcome measures to the 5-year follow-up ( P < .0003), Copenhagen Hip and Groin Outcome Score subscales (symptoms, 51.7 vs 71.9; pain, 61.0 vs 81.1; function of daily living, 67.1 vs 83.6; function in sports and recreation, 40.0 vs 71.5; participation in physical activity, 25.0 vs 67.4; hip and groin–related quality of life, 34.4 vs 68.0), EQ-5D (0.60 vs 0.83), EQ-VAS (66.1 vs 76.7), and iHOT-12 (40.0 vs 68.8). At the 5-year follow-up, 90.5% reported satisfaction with their overall hip function. In total, 54% still participated in competitive sports (HSAS, 5-8) at follow-up, while 77% had decreased their level. Older patients and patients with longer duration of symptoms reported a significantly lower level of sports activity (HSAS, 0-4; P < .009). Conclusion: Arthroscopic treatment for FAIS in elite athletes results in a statistically significant and clinically relevant improvement regarding symptoms, hip function, quality of life, and pain 5 years after surgery. Approximately half of the cohort was still in competitive sports at follow-up, yet 77% had decreased their level of sports. Nine of 10 patients were satisfied with their surgery.


2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Avi Marks ◽  
Mario Cortina-Borja ◽  
Dror Maor ◽  
Aresh Hashemi-Nejad ◽  
Andreas Roposch

Abstract Background Osteonecrosis of the femoral head is a common complication in the treatment of developmental dysplasia of the hip (DDH). While functional outcomes of affected patients are good in childhood, it is not clear how they change during the transition to young adulthood. This study determined the relationship between osteonecrosis and hip function, physical function and health status in adolescents and young adults. Methods We performed a cross-sectional study of 169 patients with a mean age of 19.7 ± 3.8 years with and without osteonecrosis following an open or closed reduction (1995–2005). We also performed a separate longitudinal evaluation of an historical cohort of 54 patients with osteonecrosis, embedded in this sample. All completed patient-reported outcome measures in 2015/2016 to quantify hip function (maximum score 100); physical function (maximum score 100); and general health status (maximum score 1). We graded all radiographs for subtype of osteonecrosis (Bucholz-Ogden); acetabular dysplasia (centre-edge angle); subluxation (Shenton’s line); and osteoarthritis (Kellgren-Lawrence). Analyses were adjusted for the number of previous surgical procedures on the hip and for the severity of residual hip dysplasia. Results In 149 patients (186 hips) with and without osteonecrosis, the mean differences (95% confidence interval) in hip function, physical function and quality of life were − 4.7 (− 10.26, 0.81), − 1.03 (− 9.29, 7.23) and 0.10 (− 1.15, 1.18), respectively. Adjusted analyses stratified across types of osteonecrosis showed that only patients with Bucholz-Odgen grade III had reduced hip function (p < 0.01) and physical function (p < 0.05) but no difference in health-related quality of life when compared to no osteonecrosis. Conclusion Osteonecrosis secondary to DDH is a relatively benign disorder in adolescents and young adulthood. Affected patients demonstrated minimal physical disability, a normal quality of life but reduced hip function.


2020 ◽  
Author(s):  
Andreas Roposch ◽  
Avi Marks ◽  
Dror Maor ◽  
Mario Cortina-Borja ◽  
Aresh Hashemi-Nejad

Abstract Background Osteonecrosis of the femoral epiphysis is a common complication in the treatment of developmental dysplasia of the hip (DDH). While functional outcomes of affected patients are good in childhood, it is not clear how they change during the transition to young adulthood. This study looks at determining the relationship between osteonecrosis of the femoral head and hip function, physical function and health status in adolescents and young adults treated for DDH.Methods We included 149 patients with a mean (and standard deviation) age of 19.7 (3.8) years with osteonecrosis following an open or closed reduction (1995–2005) and 32 age-matched patients without osteonecrosis. All patients completed valid and reliable patient-reported outcome measures in 2015/16 to quantify their hip function (maximum score 100); physical function (maximum score 100); and general health status (maximum score 1). We graded all radiographs for severity of osteonecrosis (Bucholz-Ogden); acetabular dysplasia (centre-edge angle); subluxation (Shenton’s line); and osteoarthritis (Kellgren-Lawrence). We determined the association between the patient-reported outcomes and radiographic severity of osteonecrosis using mixed-effects regression analysis adjusted for age and acetabular dysplasia at study assessment, and number of prior operations.Results In 149 patients (186 hips) with and without osteonecrosis, the mean differences (95% confidence interval) in hip function, physical function and quality of life were − 4.7 (-10.26, 0.81), -1.03 (-9.29, 7.23) and 0.10 (-1.15, 1.18), respectively. Adjusted analysis stratified across radiographic severity of osteonecrosis showed only patients with Bucholz grade III had significantly worse hip function (p < 0.01) and physical function (p < 0.05) but no difference in health-related quality of life when compared to no osteonecrosis.Conclusion Osteonecrosis secondary to DDH is a relatively benign disorder in young adulthood. Affected patients demonstrated minimal physical disability, a normal quality of life but reduced hip function.


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