scholarly journals Uncemented total hip arthroplasty can be used safely in the elderly population

2021 ◽  
Vol 2 (5) ◽  
pp. 293-300
Author(s):  
Peter M. Lewis ◽  
Faiz J. Khan ◽  
Jacob R. Feathers ◽  
Michael H. Lewis ◽  
Keith H. Morris ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Best Practice ◽  
Age Groups ◽  
The Elderly ◽  
Patient Reported Outcome Measures ◽  
Meaningful Improvement ◽  
Total Hip ◽  
Uncemented Total Hip Arthroplasty ◽  
Patient Reported

Aims “Get It Right First Time” (GIRFT) and NHS England’s Best Practice Tariff (BPT) have published directives advising that patients over the ages of 65 (GIRFT) and 69 years (BPT) receiving total hip arthroplasty (THA) should receive cemented implants and have brought in financial penalties if this policy is not observed. Despite this, worldwide, uncemented component use has increased, a situation described as a ‘paradox’. GIRFT and BPT do, however, acknowledge more data are required to support this edict with current policies based on the National Joint Registry survivorship and implant costs. Methods This study compares THA outcomes for over 1,000 uncemented Corail/Pinnacle constructs used in all age groups/patient frailty, under one surgeon, with identical pre- and postoperative pathways over a nine-year period with mean follow-up of five years and two months (range: nine months to nine years and nine months). Implant information, survivorship, and regular postoperative Oxford Hip Scores (OHS) were collected and two comparisons undertaken: a comparison of those aged over 65 years with those 65 and under and a second comparison of those aged 70 years and over with those aged under 70. Results Overall revision rate was 1.3% (13/1,004). A greater number of revisions were undertaken in those aged over 65 years, but numbers were small and did not reach significance. The majority of revisions were implant-independent. Single component analysis revealed a 99.9% and 99.6% survival for the uncemented cup and femoral component, respectively. Mean patient-reported outcome measures (PROMs) improvement for all ages outperformed the national PROMs and a significantly greater proportion of those aged over 65/69 years reached and maintained a meaningful improvement in their OHS earlier than their younger counterparts (p < 0.05/0.01 respectively). Conclusion This study confirms that this uncemented THA system can be used safely and effectively in patient groups aged over 65 years and those over 69 years, with low complication and revision rates. Cite this article: Bone Jt Open 2021;2(5):293–300.

Can spinopelvic mobility be predicted in patients awaiting total hip arthroplasty?

2019 ◽  
Vol 101-B (8) ◽  
pp. 902-909 ◽  
Author(s):  
M. M. Innmann ◽  
C. Merle ◽  
T. Gotterbarm ◽  
V. Ewerbeck ◽  
P. E. Beaulé ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Patient Reported Outcome Measures ◽  
Screening Tools ◽  
Sacral Slope ◽  
Sitting Position ◽  
Total Hip ◽  
Patient Reported ◽  
Hip Flexion

Aims This study of patients with osteoarthritis (OA) of the hip aimed to: 1) characterize the contribution of the hip, spinopelvic complex, and lumbar spine when moving from the standing to the sitting position; 2) assess whether abnormal spinopelvic mobility is associated with worse symptoms; and 3) identify whether spinopelvic mobility can be predicted from static anatomical radiological parameters. Patients and Methods A total of 122 patients with end-stage OA of the hip awaiting total hip arthroplasty (THA) were prospectively studied. Patient-reported outcome measures (PROMs; Oxford Hip Score, Oswestry Disability Index, and Veterans RAND 12-Item Health Survey Score) and clinical data were collected. Sagittal spinopelvic mobility was calculated as the change from the standing to sitting position using the lumbar lordosis angle (LL), sacral slope (SS), pelvic tilt (PT), pelvic-femoral angle (PFA), and acetabular anteinclination (AI) from lateral radiographs. The interaction of the different parameters was assessed. PROMs were compared between patients with normal spinopelvic mobility (10° ≤ ∆PT ≤ 30°) or abnormal spinopelvic mobility (stiff: ∆PT < ± 10°; hypermobile: ∆PT > ± 30°). Multiple regression and receiver operating characteristic (ROC) curve analyses were used to test for possible predictors of spinopelvic mobility. Results Standing to sitting, the hip flexed by a mean of 57° (sd 17°), the pelvis tilted backwards by a mean of 20° (sd 12°), and the lumbar spine flexed by a mean of 20° (sd 14°); strong correlations were detected. There was no difference in PROMs between patients in the different spinopelvic mobility groups. Maximum hip flexion, standing PT, and standing AI were independent predictors of spinopelvic mobility (R2 = 0.42). The combined thresholds for standing was PT ≥ 13° and hip flexion ≥ 88° in the clinical examination, and had 90% sensitivity and 63% specificity of predicting spinopelvic stiffness, while SS ≥ 42° had 84% sensitivity and 67% specificity of predicting spinopelvic hypermobility. Conclusion The hip, on average, accounts for three-quarters of the standing-to-sitting movement, but there is great variation. Abnormal spinopelvic mobility cannot be screened with PROMs. However, clinical and standing radiological features can predict spinopelvic mobility with good enough accuracy, allowing them to be used as reliable screening tools. Cite this article: Bone Joint J 2019;101-B:902–909.

Back Pain and Its Effects on Early Patient-Reported Outcome Measures in Total Hip Arthroplasty

2020 ◽  
Vol 4 (04) ◽  
pp. 180-186
Author(s):  
Vivek Singh ◽  
Stephen Zak ◽  
David Yeroushalmi ◽  
Ran Schwarzkopf ◽  
Roy I. Davidovitch
Keyword(s):  
Back Pain ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Smoking Status ◽  
Demographic Data ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Chi Square ◽  
Total Hip ◽  
Patient Reported

AbstractThe success of total hip arthroplasty (THA) may be negatively impacted in those with back pain as evidenced by patient-reported outcome (PRO) scores. The goal of this study was to determine whether the hip–spine relationship, as it relates to the presence of preoperative back pain, affected THA outcomes, and PRO scores. We retrospectively reviewed 243 patients who underwent primary THA and completed the Hip disability and Osteoarthritis Outcome Score Junior (HOOS Jr.), back pain questionnaire, and the Forgotten Joint Score-12 (FJS-12) preoperatively and at 12-weeks postoperatively. Patients were separated into two cohorts: those with preoperative back pain and those who were back pain free. Analysis was performed using t-test and chi-square to determine differences in demographic data. Regression analysis was utilized to account for differences in demographic data. There were significant demographic differences, which included body mass index, American Society of Anesthesiologists, smoking status, and length of stay between the two cohorts. Patients with preoperative back pain had lower preoperative HOOS Jr. scores than their counterparts (44.93 vs. 55.2; p = 0.029). Additionally, the preoperative back pain free group reported better FJS-12 and HOOS Jr. scores at 12-weeks postoperatively (FJS-12:62.00 vs. 43.32, p < 0.0001; HOOS Jr.: 81.33 vs. 75.68, p = 0.029). Patients with preoperative back pain had lower preoperative PRO scores and overall experienced less postoperative satisfaction and greater disability than patients who were back pain free. However, these patients' preoperative to postoperative improvement in PRO scores (delta change) was greater than that of the back pain free patients. These results suggest that THA may alter the hip-spine mechanics and potentially provide a reprieve from back pain.

scholarly journals Uncemented total hip arthroplasty in the elderly

1999 ◽  
Vol 23 (6) ◽  
pp. 334-336 ◽  
Author(s):  
Ch. Konstantoulakis ◽  
G. Anastopoulos ◽  
A. Papaeliou ◽  
A. Tsoutsanis ◽  
A. Asimakopoulos
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
The Elderly ◽  
Total Hip ◽  
Uncemented Total Hip Arthroplasty

Ten-year survivorship of primary total hip arthroplasty in patients 30 years of age or younger

2018 ◽  
Vol 100-B (7) ◽  
pp. 867-874 ◽  
Author(s):  
C. A. Makarewich ◽  
M. B. Anderson ◽  
J. M. Gililland ◽  
C. E. Pelt ◽  
C. L. Peters
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Cox Regression ◽  
Revision Rate ◽  
Young Patients ◽  
Revision Arthroplasty ◽  
The Elderly ◽  
Total Hip ◽  
Patient Reported

Aims For this retrospective cohort study, patients aged ≤ 30 years (very young) who underwent total hip arthroplasty (THA) were compared with patients aged ≥ 60 years (elderly) to evaluate the rate of revision arthroplasty, implant survival, the indications for revision, the complications, and the patient-reported outcomes. Patients and Methods We retrospectively reviewed all patients who underwent primary THA between January 2000 and May 2015 from our institutional database. A total of 145 very young and 1359 elderly patients were reviewed. The mean follow-up was 5.3 years (1 to 18). Logistic generalized estimating equations were used to compare characteristics and the revision rate. Survival was evaluated using Kaplan–Meier curves and hazard rates were created using Cox regression. Results The overall revision rate was 11% (16/145) in the very young and 3.83% (52/1359) in the elderly groups (odds ratio (OR) 2.58, 95% confidence interval (CI) 1.43 to 4.63). After adjusting for the American Society of Anesthesiologists (ASA) score, gender, and a history of previous surgery in a time-to-event model, the risk of revision remained greater in the very young (adjusted hazard ratio (HR) 2.48, 95% CI 1.34 to 4.58). Survival at ten years was 82% (95% CI, 71 to 89) in the very young and 96% (95% CI, 94 to 97) in the elderly group (p < 0.001). The very young had a higher rate of revision for complications related to metal-on-metal (MoM) bearing surfaces (p < 0.001). At last follow-up, the very young group had higher levels of physical function (p = 0.002), lower levels of mental health (p = 0.001), and similar levels of pain (p = 0.670) compared with their elderly counterparts. Conclusion The overall revision rate was greater in very young THA patients. This was largely explained by the use of MoM bearings. Young patients with non-MoM bearings had high survivorship with similar complication profiles to patients aged ≥ 60 years. Cite this article: Bone Joint J 2018;100-B:867–74.

No clinically meaningful difference in 1-year patient-reported outcomes among major approaches for primary total hip arthroplasty

2021 ◽  
pp. 112070002199201
Author(s):  
◽  
James B Bircher ◽  
Atul F Kamath ◽  
Nicolas S Piuzzi ◽  
Wael K Barsoum ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Consecutive Series ◽  
Total Hip ◽  
Pain Scores ◽  
Significant Difference ◽  
Patient Reported ◽  
Primary Total Hip Arthroplasty

Background: Debate continues around the most effective surgical approach for primary total hip arthroplasty (THA). This study’s purpose was to compare 1-year patient-reported outcome measures (PROMs) of patients who underwent direct anterior (DA), transgluteal anterolateral (AL)/direct lateral (DL), and posterolateral (PL) approaches. Methods: A prospective consecutive series of primary THA for osteoarthritis ( n = 2,390) were performed at 5 sites within a single institution with standardised care pathways (20 surgeons). Patients were categorised by approach: DA ( n = 913; 38%), AL/DL ( n = 505; 21%), or PL ( n = 972; 41%). Primary outcomes were pain, function, and activity assessed by 1-year postoperative PROMs. Multivariable regression modeling was used to control for differences among the groups. Wald tests were performed to test the significance of select patient factors and simultaneous 95% confidence intervals were constructed. Results: At 1-year postoperative, PROMs were successfully collected from 1842 (77.1%) patients. Approach was a statistically significant factor for 1-year HOOS pain ( p = 0.002). Approach was not a significant factor for 1-year HOOS-PS ( p = 0.16) or 1-year UCLA activity ( p = 0.382). Pairwise comparisons showed no significant difference in 1-year HOOS pain scores between DA and PL approach ( p  > 0.05). AL/DL approach had lower (worse) pain scores than DA or PL approaches with differences in adjusted median score of 3.47 and 2.43, respectively ( p  < 0.05). Conclusions: Patients receiving the AL/DL approach had a small statistical difference in pain scores at 1 year, but no clinically meaningful differences in pain, activity, or function exist at 1-year postoperative.

No Clinically Meaningful Differences in 1-Year Patient-Reported Outcome Measures between Hip Resurfacing and Total Hip Arthroplasty: An Age-Matched Prospective Cohort Study

2021 ◽  
Author(s):  
Marcelo Siqueira ◽  
Keyword(s):  
Total Hip Arthroplasty ◽  
Outcome Measures ◽  
Hip Arthroplasty ◽  
Prospective Cohort ◽  
Patient Reported Outcome Measures ◽  
Hip Resurfacing ◽  
Patient Reported Outcome ◽  
Total Hip ◽  
Patient Reported

AbstractThis study compared patient-reported outcome measures (PROMs), readmissions, and reoperations between hip resurfacing (HR) and total hip arthroplasty (THA) in a matched prospective cohort. Between 2015 and 2017, 4,268 patients underwent HR or THA at a single institution. A prospective cohort of 2,147 patients were enrolled (707 HRs, 1,440 THAs). PROMs were collected at baseline and 1-year follow-up. Exclusion criteria: females (n = 2,008), inability/refusal to complete PROMs (n = 54), and diagnosis other than osteoarthritis (n = 59). Each HR patient was age-matched to a THA patient. Multivariate regression models were constructed to control for race, body mass index, education, smoking status, Charlson Comorbidity Index, mental health, and functional scores. A significance threshold was set at p = 0.017. A total of 707 HRs and 707 THAs were analyzed and 579 HRs (81.9%) and 490 THAs (69.3%) were followed up at 1 year. There was no statistically significant difference for Hip Injury and Osteoarthritis Outcomes Score (HOOS) Pain subscale (p = 0.129) and HOOS-Physical Function Shortform (HOOS-PS) (p = 0.03). HR had significantly higher median University of California in Los Angeles (UCLA) activity scores (p = 0.004). Ninety-day readmissions for HR and THAs were 1.8 and 3.5%, respectively (p = 0.06), and reoperations at 1 year were 1.2 and 2.3%, respectively (p = 0.24). For male patients, differences in medians for UCLA activity scores were 0.383 points, which were statistically significant but may not be clinically relevant. No differences exist in 90-day readmissions, reoperations, and HOOSpain and HOOS-PS scores. Because patients undergoing HR are advised to return to full activity at 1-year postoperative, follow-up is required. Metal ion levels were not obtained postoperatively for either group.

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