Comparison of Patient-Reported Outcomes of Total Hip Arthroplasty between a Neck-Preserving Short-Stem Implant and a Conventional Neck-Sacrificing Implant

2019 ◽  
Vol 03 (02) ◽  
pp. 078-085
Author(s):  
Stefany J. K. Malanka ◽  
Marius Dettmer ◽  
Amir Pourmoghaddam ◽  
Mitchell Veverka ◽  
Stefan W. Kreuzer
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Patient Reported Outcomes ◽  
Short Stem ◽  
Stem Design ◽  
Total Hip ◽  
Physiological Loading ◽  
Patient Reported ◽  
Age Cohort

AbstractFemoral neck-preserving short- (NPS) stem implants for total hip arthroplasty (THA) bear several advantages over longer-stem implants, such as native hip structure preservation and improved physiological loading. However, there still is a gap of knowledge regarding the potential benefits of a short-stem design over conventional neck-sacrificing stems in regards to patient-reported outcomes (PROs). The authors investigated the differences in PROs between a neck-sacrificing stem design and NPS stem design arthroplasty. They hypothesized that PROs of NPS stem THA would be higher in the medium-term in comparison to the neck-sacrificing implant system. Neck-sacrificing implant patients (n = 90, age 57 ± 7.9 years) and a matched (body mass index [BMI], age) cohort group of NPS implant patients (n = 105, age 55.2 ± 9.9 years) reported both preoperative and postoperative hip disability and osteoarthritis outcome scores (HOOS). Average follow-up was 413 ± 207 days (neck sacrificing implant) and 454 ± 226 days (NPS implant). The authors applied multivariate analysis of variance (MANOVA) and Mann–Whitney tests for statistical analyses. Significance levels were Holm–Bonferroni adjusted for multiple comparisons. HOOS Subscores increased significantly after surgery independent of implant type (p < 0.001). There was a significant time by surgery interaction (p = 0.02). Follow-up HOOS subscores were significantly higher in the NPS implant group: symptoms (p < 0.001), pain (p < 0.001), activities of daily living (ADL; p = 0.011), sports and recreation (p = 0.011), and quality of life (QOL; p = 0.007). While long-term studies are required for further investigation, evidence from the current study suggests that NPS implants may provide a significant benefit to primary THA patients, which could be due to physiological loading advantages or retention of bone tissue.

Importance of Retaining Sufficient Acetabular Depth: Successful 2-Year Outcomes of Hip Arthroscopy for Patients With Pincer Morphology as Compared With Matched Controls

2020 ◽  
Vol 48 (10) ◽  
pp. 2471-2480 ◽  
Author(s):  
Claudia R. Brick ◽  
Catherine J. Bacon ◽  
Matthew J. Brick
Keyword(s):  
Total Hip Arthroplasty ◽  
Femoroacetabular Impingement ◽  
Hip Arthroplasty ◽  
Hip Arthroscopy ◽  
Patient Reported Outcomes ◽  
Control Group ◽  
Total Hip ◽  
Patient Reported ◽  
Acetabular Overcoverage

Background: Patients with pincer-type femoroacetabular impingement are commonly treated with arthroscopic reduction of acetabular depth as measured by the lateral center-edge angle (LCEA). The optimal amount of rim reduction has not been established, although large resections may increase contact pressures through the hip. A recent publication demonstrated inferior surgical outcomes in patients with acetabular overcoverage as compared with normal acetabular coverage. Casual observation of our database suggested equivalent improvements, prompting a similar analysis. Purpose: To analyze patient-reported outcomes after hip arthroscopy for femoroacetabular impingement in patients with acetabular overcoverage who were matched with controls with normal coverage, as well as to analyze associations with reduction in LCEA. Study Design: Cohort study; Level of evidence, 3. Methods: Data were collected prospectively from patients with a minimum 2-year follow-up after receiving hip arthroscopy for femoroacetabular impingement by a single surgeon. Cases were reviewed to identify those with pincer-type morphology (LCEA >40°) and matched according to sex, age, chondral damage, and surgery date in a 1:1 ratio with controls with an LCEA of 25° to 40°. The surgical goal was to reduce the LCEA to the upper end of the normal range with minimal rim resection, usually 35° to 37°. Radiographic measurements of coverage, intraoperative findings, procedures, and patient-reported outcomes were recorded, including the 12-Item International Hip Outcome Tool, Non-arthritic Hip Score, Hip Disability and Osteoarthritis Outcome Score, visual analog scale for pain, rates of revision or reoperation, and conversion to total hip arthroplasty. Results: A total of 114 hips (93 patients) for the pincer group were matched 1:1 from 616 hips (541 patients) for the control group. The pincer group (mean ± SD age, 34.5 ± 12.2 years) did not differ in age, body mass index, or follow-up from controls. LCEA was reduced in both groups pre- to postoperatively: the pincer group from 44.0° ± 2.8° to 34.2° ± 3.5° and the controls from 32.9° ± 3.9° to 31.0° ± 3.0°. No differences in improvement were observed: iHOT-12 improved by 35.7 points in both groups ( P = .9 for analysis of variance interaction) and Nonarthritic Hip Score by 22.3 points ( P = .6). From all eligible surgical procedures, 2-year follow up rates were 2.5% and 2.6% for the pincer and control cohorts, respectively, and 1.2% and 0.3% for conversion to total hip arthroplasty. Conclusion: Arthroscopic management of acetabular overcoverage can achieve excellent results, equivalent to arthroscopy for other causes of symptomatic femoroacetabular impingement. A key finding was smaller rim resections producing a mean postoperative LCEA of 34.2° with a small standard deviation.

scholarly journals Primary stability of calcar-guided short-stem total hip arthroplasty in the treatment of osteonecrosis of the femoral head: migration analysis using EBRA-FCA

2020 ◽  
Vol 140 (12) ◽  
pp. 2091-2100
Author(s):  
Yama Afghanyar ◽  
Christoph Danckwardt ◽  
Miriam Schwieger ◽  
Uwe Felmeden ◽  
Philipp Drees ◽  
...  
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Migration Pattern ◽  
Short Stem ◽  
Stem Design ◽  
Total Hip ◽  
Migration Analysis ◽  
Short Stems

Abstract Introduction Osteonecrosis of the femoral head (ONFH) is a disabling condition that often results in secondary arthritis necessitating total hip arthroplasty (THA). Short-stem THA has constantly gained popularity. It remains controversial, whether ONFH represents a risk factor for failure after the implantation of short stems with pronounced metaphyseal anchorage. The potential spread of the osteonecrotic area and bone marrow edema into the metaphyseal bone might result in compromised stability. Early implant migration is considered predictive of subsequent aseptic loosening. The purpose of this study was a migration analysis of a modern, calcar-guided short-stem implant in patients with ONFH in a mid-term follow-up. Materials and methods This retrospective analysis investigated the migration pattern of 45 calcar-guided short stems in patients with ONFH, using Einzel-Bild-Roentgen-Analyse Femoral-Component-Analysis (EBRA-FCA). Influencing factors such as ARCO categories, age, gender, body weight and BMI were analyzed. Complications and adverse events were documented. Results At mid-term [48.1 months (SD 20.7 months)], mean axial migration was 1.56 mm (SD 1.77 mm). Mean migration rate stabilized after 2 years. No influence of ARCO categories, age and BMI was found. A tendency of increased axial migration was observed in male patients and in overweight patients. No revision surgeries had to be performed during follow-up. Conclusion The results indicate a migration pattern comparable to that of primary osteoarthritis patients with slight initial migration under full load followed by subsequent stabilization in the metaphyseal femur. The 100% survival rate at mid-term supports the usage of this short-stem design in patients with ONFH.

Patient-Reported Outcomes Can Be Used to Streamline Post-Total Hip Arthroplasty Follow-Up to High-Risk Patients

2017 ◽  
Vol 32 (11) ◽  
pp. 3319-3321
Author(s):  
Jie J. Yao ◽  
Hilal Maradit Kremers ◽  
Cathy D. Schleck ◽  
Dirk R. Larson ◽  
Jasvinder A. Singh ◽  
...  
Keyword(s):  
High Risk ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Patient Reported Outcomes ◽  
Total Hip ◽  
High Risk Patients ◽  
Patient Reported ◽  
Risk Patients

Three-year results of a polycarbonate urethane acetabular bearing in total hip arthroplasty

2019 ◽  
Vol 30 (3) ◽  
pp. 303-308
Author(s):  
Stefan Lazic ◽  
Catherine Kellett ◽  
Irrum Afzal ◽  
Rajan Mohan ◽  
Vijay Killampalli ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Patient Reported Outcomes ◽  
Prospective Observational Study ◽  
Total Hip ◽  
Polycarbonate Urethane ◽  
Patient Reported ◽  
Term Data

Background: Polycarbonate urethane (PCU) is a bearing surface with a lower modulus of elasticity than polyethylene or ceramic and is thought to more closely replicate the tribology of native hyaline cartilage. The purpose of this study was to determine the clinical outcomes with the use of PCU in elective total hip arthroplasty (THA). Methods: We carried out a prospective observational study in which 157 patients underwent elective THA with a metal-on-PCU hip system. Patients had radiographic follow-up at 6 months and 3 years after surgery. Oxford Hip Scores and EuroQol scores were obtained annually and Harris Hip Scores were obtained at 6 months and 3 years after surgery. Results: 180 hips were implanted, of which, 149 hips reached 3-year review with no revisions. There was an increase in Harris Hip Scores, Oxford Hip Scores and EuroQol scores ( p < 0.001). 12 patients (12 hips) reported painless hip squeaking. There were no dislocations and no other adverse events were reported. Conclusion: Our results showed satisfactory survivorship and improvements in patient reported outcomes with metal on PCU THA. Long-term data are still being collected to confirm these findings. We recommend further tribological research into the squeaking phenomenon we observed.

scholarly journals Imageless computer assisted navigation in ceramic-on-ceramic total hip arthroplasty vs. manual approach: a single-centre retrospective study

10.29007/9gpf ◽  
2019 ◽  
Author(s):  
John McLoughlin ◽  
Mo Mathew ◽  
Stephen Grant
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Patient Reported Outcomes ◽  
Statistical Significance ◽  
Computer Assisted ◽  
Total Hip ◽  
Patient Reported ◽  
Cup Positioning

Background: Acetabular cup positioning is vital to the long-term survivorship of total hip arthroplasty (THA). Malalignment has been linked to dislocation, wear and osteolysis. Although there are many studies demonstrating the reduction in variability of cup positioning with computer-assisted techniques, there are relatively few reporting long-term patient reported outcomes and revision rates. Aim: The aim of this study was to review whether those patients who underwent navigated THA had better long-term survivorship or better patient reported outcomes. Methods: We compared revision rates and Oxford hip scores of 152 THAs (47 navigated and 105 non-navigated) performed at a single site between 2003 and 2008, with a minimum follow-up of 10 years. Results: 9 of the non-navigated and none of the navigated hips were revised at 10 year follow-up (p=0.057). There were no observable differences in 10-year Oxford hip scores between the navigated and non-navigated hips, 44.82 and 43.38 respectively. Conclusion: With respect to the rate of revision, although statistical significance was not achieved, it can be shown from our data that there was a clinically significant reduction in revision rates with navigated vs. non-navigated techniques. More data with higher patient numbers in the navigated cohort may be required to validate the results of our study.

Outcomes after Total Hip Arthroplasty in Young Patients with Osteonecrosis of the Hip

2017 ◽  
Vol 27 (3) ◽  
pp. 286-292 ◽  
Author(s):  
Ishaan Swarup ◽  
Marisa Shields ◽  
Erik N. Mayer ◽  
Chelsea J. Hendow ◽  
Jayme C. Burket ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Patient Reported Outcomes ◽  
Young Patients ◽  
Implant Survival ◽  
Total Hip ◽  
Time Of Surgery ◽  
Patient Reported

Background Osteonecrosis of the hip is a clinical, radiographic, and pathologic entity that commonly affects young patients. This study evaluates long-term implant survival and patient-reported outcomes after primary total hip arthroplasty (THA) in patients with osteonecrosis aged 35 or younger. Methods A retrospective study with prospective follow-up was conducted at a major academic medical center. Chart review was performed to identify young THA patients with osteonecrosis, and follow-up surveys were conducted to determine implant survival and patient-reported outcomes. Kaplan-Meier survival analysis was performed to evaluate implant survival, and the hip disability and osteoarthritis outcome score (HOOS) was used to describe patient-reported outcomes. Results The study included 135 patients (204 THAs) with a mean time to follow-up of 14 years. In this group, 10-year implant survival was 86% and 20-year implant survival was 66%. Implant survival was longer in male patients (p = 0.02) and patients that were over the age of 25 at the time of surgery (p = 0.03). The mean HOOS scores at follow-up were 87 for pain, symptoms, and ADLs, and 77 for sports. All HOOS measures were lower in patients that underwent a revision THA, and HOOS-Pain and HOOS-Sport scores were lower in patients that were over the age of 25 at the time of surgery (p<0.05). Conclusions Young patients with osteonecrosis have good implant survival and long-term outcomes after THA. Patient factors and implant characteristics should be considered when predicting implant survival and outcomes after THA in young patients with osteonecrosis.

Does Hepatitis C Affect the Clinical and Patient-Reported Outcomes of Primary Total Hip Arthroplasty at Midterm Follow-Up?

2017 ◽  
Vol 32 (9) ◽  
pp. 2779-2782 ◽  
Author(s):  
Kimona Issa ◽  
Todd P. Pierce ◽  
Steven F. Harwin ◽  
Anthony J. Scillia ◽  
Vincent K. McInerney ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Patient Reported Outcomes ◽  
Total Hip ◽  
Patient Reported ◽  
Primary Total Hip Arthroplasty

Implant Survival and Clinical Outcomes of Total Hip Arthroplasty in Adolescent and Young Adult Patients

2021 ◽  
Author(s):  
Lauren Zeitlinger ◽  
Anthony Gemayel ◽  
Patrick Whitlock ◽  
Joel Sorger
Keyword(s):  
Young Adult ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Patient Reported Outcomes ◽  
Adult Patients ◽  
Total Hip ◽  
Patient Reported ◽  
Hip Disease ◽  
End Stage

AbstractTotal hip arthroplasty (THA) in pediatric patients is controversial with concern for high failure rates, and lack of promising outcomes as compared with the adult population. Increased survivorship of implants invites the potential for improved function and quality of life in young adults. Although THA is now an option for end-stage symptomatic hip disease in young patients, outcomes with contemporary techniques and implants have yet to be reported.Following the institutional review board approval, a retrospective chart review of 25 patients (29 hips) with end-stage hip disease at a single institution from 2010 to 2017 was performed. All patients underwent THA with noncemented, contemporary THA with highly cross-linked polyethene liners. Clinical, radiographic, and patient-reported outcomes were obtained including any postoperative complications, revisions, evidence of loosening or wear, and lastly, Western Ontario & McMaster Universities Osteoarthritis Index, Harris Hip Scores, Non-Arthritic Hip scores, and International Hip Outcome Tool. With a minimum follow-up duration of 2 years, there were no revisions or evidence of loosening or wear on follow-up radiographs. All patients underwent noncemented THA with metal or ceramic on highly cross-linked polyethylene liners. Six patients accounting for seven THAs completed patient-reported outcomes: two reporting excellent outcomes, four good outcomes, and one failed outcome. With advancing techniques and strategies, treatment options for hip pathology in the pediatric population are growing. We present favorable outcomes 2 years post-procedure, suggesting THA as a potential option for end-stage hip disease in pediatric and young adult patients.

scholarly journals Short-stem total hip arthroplasty is not associated with an earlier return to work compared to a straight-stem design

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Georg Hauer ◽  
Maria Smolle ◽  
Sabrina Zaussinger ◽  
Joerg Friesenbichler ◽  
Andreas Leithner ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Sick Leave ◽  
Return To Work ◽  
Hip Arthroplasty ◽  
Short Stem ◽  
Multivariate Linear Regression Analysis ◽  
Stem Design ◽  
Total Hip ◽  
Straight Stem ◽  
Significant Difference

AbstractReturn to work (RTW) has been specifically identified as a high priority in patients undergoing total hip arthroplasty (THA). This investigation sought to assess the effect of the stem design on patients’ RTW. Secondly, the study aimed to identify risk factors that lead to a delayed RTW. Questionnaires inquiring about RTW, employment history, educational level, type of work, physical demands and joint awareness were administered by post. Further data were collected from patients’ hospital records. 176 patients who underwent THA using a short-stem and 97 patients using a straight-stem design were compared. The median return to work time was 10 weeks [IQR 7–14 weeks], with no significant difference between the two groups (short stems vs. straight stems; 10 [IQR 7–14] vs. 11 [7.5–13.5] weeks; p = 0.693). In the multivariate linear regression analysis, self-employment vs. employee (p = 0.001), dimension of preoperative workload (p = 0.001), preoperative sick leave (p < 0.001), and hospital length of stay (LOS) (p < 0.001) independently affected the period until work was resumed. The Forgotten-Joint-Score-12 showed no significant difference between the two groups. The data show that the majority of THA patients can expect to resume work and stem design has no impact on RTW. Employees with preoperative sick leave, prolonged hospital LOS and low workload are at higher risk for a delayed RTW.

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