Feasibility and sustainability of working in different types of jobs after total hip arthroplasty: analysis of longitudinal data from two cohorts

ObjectivesTo investigate the rates of return to work and workability among working-age people following total hip arthroplasty (THA).MethodsParticipants from the Geneva Arthroplasty Registry and the Clinical Outcomes for Arthroplasty Study aged 18–64 years when they had primary THA and with at least 5 years’ follow-up were mailed a questionnaire 2017–2019. Information was collected about preoperative and post-THA employment along with exposure to physically demanding activities at work or in leisure. Patterns of change of job were explored. Survival analyses using Cox proportional hazard models were created to explore risk factors for having to stop work because of difficulties with the replaced hip.ResultsIn total, 825 returned a questionnaire (response 58%), 392 (48%) men, mean age 58 years, median follow-up 7.5 years post-THA. The majority (93%) of those who worked preoperatively returned to work, mostly in the same sector but higher rates of non-return (36%–41%) were seen among process, plant and machine operatives and workers in elementary occupations. 7% reported subsequently leaving work because of their replaced hip and the risk of this was strongly associated with: standing >4 hours/day (HR 3.81, 95% CI 1.62 to 8.96); kneeling/squatting (HR 3.32, 95% CI 1.46 to 7.55) and/or carrying/lifting ≥10 kg (HR 5.43, 95% CI 2.29 to 12.88).ConclusionsIt may be more difficult to return to some (particularly physically demanding) jobs post-THA than others. Rehabilitation may need to be targeted to these types of workers or it may be that redeployment or job change counselling are required.

Download Full-text

Safety of vitamin E-infused highwall liners for routine use in primary total hip arthroplasty: single centre, short-term follow-up of 1221 cases

Hip International ◽

10.1177/1120700020969644 ◽

2020 ◽

pp. 112070002096964

Author(s):

Kirill Gromov ◽

Nanna H Sillesen ◽

Thomas Kallemose ◽

Henrik Husted ◽

Henrik Malchau ◽

...

Keyword(s):

Patient Safety ◽

Vitamin E ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Single Centre ◽

Short Term ◽

Total Hip ◽

Arthroplasty Registry ◽

Primary Total Hip Arthroplasty

Background: Introduction of new implants should be monitored closely to capture any signs of compromising patient safety. Vitamin E infused highly-crosslinked polyethylene liners (VEPE) offer the potential for reduced wear. Highwall liners have been hypothesised to result in increased wear and potential liner fractures. The aim of this study was to determine the 3–7-year follow-up of highwall VEPE for primary total hip arthroplasty (THA), focusing on liner-related complications. Methods: We included 1221 consecutive THA operations from July 2010 to May 2014 with minimum follow-up of 3 (3.1–6.8) years Data collected included demographics, implant data, complications, reoperations, and deaths. Data were cross-referenced with the Danish Hip Arthroplasty Registry in order to ensure validity and completeness. Acetabular shell position was measured using Martell Hip Analysis Suite in a subgroup of 931 THAs. Results: Cumulative stem revision and shell revision at 3-year follow-up was 3.4% and 0.4% respectively. There were no revisions due to liner failure. Reason for revision included 11 dislocations, 15 soft-tissue revisions for infection, 44 stem revisions of which 34 were periprosthetic fractures and 13 shell revisions of which 6 were combined shell and stem revisions. Conclusion: Early follow-up of VEPE liners for primary THA have not shown any revisions associated with liner failure. Continued monitoring of new materials are necessary to capture any signs of compromised patient safety.

Download Full-text

Ceramic-on-Ceramic Bearing in Total Hip Arthroplasty Reduces the Risk for Revision for Periprosthetic Joint Infection Compared to Ceramic-on-Polyethylene: A Matched Analysis of 118,753 Cementless THA Based on the German Arthroplasty Registry

Journal of Clinical Medicine ◽

10.3390/jcm10061193 ◽

2021 ◽

Vol 10 (6) ◽

pp. 1193

Author(s):

Lisa Renner ◽

Carsten Perka ◽

Oliver Melsheimer ◽

Alexander Grimberg ◽

Volkmar Jansson ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Periprosthetic Joint Infection ◽

Science Studies ◽

Joint Infection ◽

Total Hip ◽

Arthroplasty Registry ◽

Matched Study ◽

Ceramic On Ceramic

Periprosthetic joint infection (PJI) is one of the most common complications in total hip arthroplasty (THA). The influence of bearing material on the risk of PJI remains unclear to date. This registry-based matched study investigates the role of bearing partners in primary cementless THA. Primary cementless THAs recorded in the German Arthroplasty Registry since 2012 with either a ceramic-on-ceramic (CoC) or ceramic-on-polyethylene (CoP) bearings were included in the analysis. Using propensity score matching (PSM) for age, sex, obesity, diabetes mellitus, Elixhauser comorbidity index, year of surgery and head size, we compared the risk for revision for PJI for CoC and CoP. Within the 115,538 THAs (87.1% CoP; 12.9% CoC), 977 revisions were performed due to PJI. There was a significantly higher risk for revision for PJI for CoP compared with CoC over the whole study period (p < 0.01) after 2:1 matching (CoP:CoC) with a hazard ratio of 1.41 (95% confidence interval (CI), 1.09 to 1.80) After 3 years, the risk for revision for PJI was 0.7% (CI 0.5–0.9%) for CoC and 0.9% (CI 0.8–1.1%) for CoP. The risk for revision for all other reasons except PJI did not significantly differ between the two groups over the whole study period (p = 0.4). Cementless THAs with CoC bearings were less likely to be revised because of infection in mid-term follow-up. In the future, registry-embedded studies focusing on long-term follow-up, including clinical data, as well as basic science studies, may give a deeper insight into the influence of the bearing partners.

Download Full-text

O29 Returning to, and staying in, work after total hip arthroplasty

Rheumatology ◽

10.1093/rheumatology/keab246.028 ◽

2021 ◽

Vol 60 (Supplement_1) ◽

Author(s):

Elena Zaballa ◽

E. Clare Harris ◽

Anne Lübbeke-Wolff ◽

Cyrus Cooper ◽

Nigel Arden ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Return To Work ◽

Hip Arthroplasty ◽

Postal Questionnaire ◽

Prolonged Standing ◽

Total Hip ◽

Occupational Activities ◽

Post Operation ◽

Cox Proportional Hazard Models

Abstract Background/Aims Total hip arthroplasty is increasingly offered at younger ages whilst simultaneously people are being encouraged to work to older ages. Ultimately, more people will expect to need to return to work post-THA. We explored the rates of return to work and the trajectories of remaining in work post-THA, with particular attention to the physical demands of the post-operative job. Methods Patients from the Geneva Hip Arthroplasty Registry and the Clinical Outcomes of Arthroplasty (COASt) study who underwent unilateral THA at least 5 years previously were identified. Participants were eligible if they were <65 years old at the time of the THA. A postal questionnaire was mailed to all eligible participants 2017-2019. Information was collected about demographics, relevant pre-operative and peri-operative factors, time to reach best function and leisure-time physical activities performed post-operation. For each job held post-operatively, participants provided information about the nature of physically-demanding exposures. Crude and adjusted estimates with their corresponding 95% confidence intervals (CI) were calculated using Cox proportional hazard models to estimate associations between occupational activities and risk of leaving a job due to difficulties with the replaced hip. Finally, mutually adjusted models were fitted with all the relevant covariates and the statistically significant occupational activities. Results Of the 1,453 eligible people, 817 (56%) returned the questionnaire. Post-operation 508 people returned to work (RTW) of whom: 446 were working at the time of the THA; 46 had stopped working pre-operatively; and 16 did not provide pre-operative work status. The median follow-up post-THA was 7.5 years (IQR 6.2 -12.1). Detailed occupational exposure information was available for 405 of the 508 who returned to work (203 men and 202 women). After adjusting for age at operation, sex, body mass index, time to reach best post-operative function, cohort and age at follow-up, reporting leaving a job because of problems with the replaced hip was strongly associated with: occupational standing > 4 hours/day (HR: 3.37, 95%CI 1.44-7.86), kneeling/squatting (HR: 95%CI 3.67, 1.61-8.40) and carrying/lifting> 10 kg (HR: 5.68, 95%CI 2.37-13.62) . Mutually adjusted models showed that the effect of lifting/carrying weights in excess of 10 kg remained statistically significant (p < 0.01). Conclusion These findings suggest that some jobs may be more difficult to manage post-THA, in particular if they involve prolonged standing, kneeling/squatting or lifting heavy weights. Subject to replication in other cohorts, these findings may be important to discuss with patients at the time of surgery and could imply a particular role for post-THA rehabilitation amongst people needing to RTW in physically-demanding jobs. Disclosure E. Zaballa: None. E. Harris: None. A. Lübbeke-Wolff: None. C. Cooper: None. N. Arden: None. G. Ntani: None. K. Walker-Bone: None.

Download Full-text

Small-head metal on metal total hip arthroplasty is associated with a high rate of complication and reoperation at mid-term follow-up

SAGE Open Medicine ◽

10.1177/20503121211014707 ◽

2021 ◽

Vol 9 ◽

pp. 205031212110147

Author(s):

Nobuhiko Sumiyoshi ◽

Kazuhiro Oinuma ◽

Yoko Miura

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Adverse Reactions ◽

Small Diameter ◽

High Rate ◽

Metal Debris ◽

Total Hip ◽

Metal On Metal ◽

Small Head

Background: Adverse reactions to metal debris are significant complications after metal-on-metal total hip arthroplasty. Recently, late appearances of adverse reactions to metal debris and subsequent need for reoperations have been reported with small-diameter head metal-on-metal devices. We retrospectively investigated mid-term clinical outcomes of small-head metal-on-metal total hip arthroplasty. Methods: We reviewed 159 hips in 139 patients who had a small-head metal-on-metal total hip arthroplasty (M2a Taper; Biomet, Warsaw, IN) with a minimum 5-year follow-up and documented postoperative complications. Results: Focal osteolysis in either the femur or acetabulum was observed in 12 hips (7.5%, 44 months after surgery on average), with pseudotumor observed in 8 hips (5%, 120 months after surgery on average). Four hips (2.5%) had dislocations (84 months after surgery on average) and six hips (3.8%, 122 months after surgery on average) underwent reoperation. Conclusion: Small-head metal-on-metal total hip arthroplasty is associated with a high degree of complications at mid-term follow-up period. Considering this, we discourage the use of metal-on-metal total hip arthroplasty regardless of head size.

Download Full-text

Long-term clinical and radiological outcome in patients with severe Legg-Calvé-Perthes disease after Chiari pelvic osteotomy: a mean of 14 years follow-up

Hip International ◽

10.1177/1120700020988150 ◽

2021 ◽

pp. 112070002098815

Author(s):

Dammerer Dietmar ◽

Braito Matthias ◽

Peter Ferlic ◽

Kaufmann Gerhard ◽

Juana Kosiol ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Joint ◽

Hip Arthroplasty ◽

Pelvic Osteotomy ◽

Perthes Disease ◽

Total Hip ◽

Joint Incongruence ◽

Chiari Pelvic Osteotomy

Introduction: The Chiari pelvic osteotomy (CPO) has been recommended as a salvage procedure to improve head coverage in case of hip joint incongruence in paediatric hip disease. In this study, we aimed to assess the long-term results of CPO for severe Legg-Calvé-Perthes disease (LCPD). Methods: A total of 39 patients who underwent a CPO at our department between 1995 and 2010 were prospectively followed both radiologically (Stulberg classification) and clinically (Harris Hip Score [HHS], conversion into total hip arthroplasty). In this study, we retrospectively reviewed the cases of 12 hips (12 patients, 3 girls, 8 left hips) treated by CPO for severe LCPD (Catterall grade 3 or 4) with hip joint incongruence. Mean follow-up was 14.0 (range 7.6–21.3) years. Results: Mean age at surgery was 10.2 (range 8.2–17.8) years. Additional femoral osteotomy was performed in 8 patients. A good radiological result (Stulberg I or II) was achieved in 2 patients, a fair result (Stulberg III) in 4 patients, and a poor outcome (Stulberg IV or V) in 6 patients. Mean postoperative HHS averaged 93 (range 65–100) points. An excellent functional outcome (HHS 90–100 points) was achieved in 9 patients. No patient underwent total hip arthroplasty during follow-up. Postoperative limb-length discrepancy was found in 3 patients. Conclusions: CPO for severe LCPD with hip joint incongruence resulted in good long-term clinical outcome in about ⅔ of our patients after a mean of 14 years. Our results suggest that CPO can still be considered as a salvage joint-conserving procedure in this selected group of younger patients.

Download Full-text

Letter to the editor regarding “Ceramic-on-ceramic articulation in press-fit total hip arthroplasty as a potential reason for early failure, what about the survivors: a ten year follow-up” by Loon et al.

International Orthopaedics ◽

10.1007/s00264-021-04996-5 ◽

2021 ◽

Author(s):

Weifeng Ji ◽

Jing Shen

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Early Failure ◽

Total Hip ◽

Press Fit ◽

Potential Reason ◽

Letter To The Editor ◽

Ceramic On Ceramic

Download Full-text

Total Hip Arthroplasty: Minimal Clinically Important Difference and Patient Acceptable Symptom State for the Forgotten Joint Score 12

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052267 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2267

Author(s):

Umile Giuseppe Longo ◽

Sergio De Salvatore ◽

Ilaria Piergentili ◽

Anna Indiveri ◽

Calogero Di Naro ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Validity And Reliability ◽

Total Hip ◽

Forgotten Joint Score ◽

Post Surgery ◽

Clinically Important Difference ◽

Patient Reported ◽

Patient Acceptable Symptom State

The Forgotten Joint Score-12 (FJS-12) is a valid patient-reported outcome measures (PROMs) used to assess prosthesis awareness during daily activities after total hip arthroplasty (THA). The minimum clinically important difference (MCID) can be defined as the smallest change or difference that is evaluated as beneficial and could change the patient’s clinical management. The patient acceptable symptom state (PASS) is considered the minimum PROMs cut-off value that corresponds to a patient’s satisfactory state of health. Despite the validity and reliability of the FJS-12 having been already demonstrated, the MCID and the PASS of this score have not previously been defined. Patients undergoing THA from January 2019 to October 2019 were assessed pre-operatively and six months post-surgery using the FJS-12, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Oxford Hip Score (OHS). Pre-operative and follow-up questionnaires were completed by 50 patients. Both distribution-based approaches and anchor approaches were used to estimate MCID. The aim of this paper was to assess the MCID and PASS values of FJS-12 after total hip replacement. The FJS-12 MCID from baseline to 6 months post-operative follow-up was 17.5. The PASS calculated ranged from 69.8 to 91.7.

Download Full-text