scholarly journals Association of global sagittal deformity with functional disability two years after total hip arthroplasty

2021 ◽  
Author(s):  
Yoshinori Okamoto ◽  
Hitoshi Wakama ◽  
Tomohiro Okayoshi ◽  
Shuhei Otsuki ◽  
Masashi Neo
Keyword(s):  
Multivariate Analysis ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Functional Disability ◽  
Pelvic Incidence ◽  
Body Height ◽  
Total Hip ◽  
Significant Difference ◽  
Patient Reported ◽  
Sagittal Deformity

Abstract Introduction: The relationship between spinopelvic alignment and functional disability after total hip arthroplasty (THA) has not been fully elucidated despite the growing recognition of its importance on patient-reported outcome measures. We aimed to determine whether global sagittal deformity was associated with post-operative disability.Materials and methods: This prospective analysis was based on 208 THAs that were followed up for 2 years. The Hip Disability and Osteoarthritis Outcome Score-Joint Replacement (HOOS-JR) ranging from a scale of 0 (complete joint disability) to 100 (perfect joint health) was utilised to divide eligible patients into two groups with and without disability, using 70 as the threshold. Multivariate analysis was performed to evaluate the factors associated with disability. To identify the cut-off value of the parameters for predicting disability (HOOS-JR <70/100), we used the receiver-operating characteristic curve.Results: The disability (30 hips) and control (178 hips) groups showed a significant difference in body height (p = 0.020), pre-operative T1 pelvic angle divided by pelvic incidence (T1PA/PI) (p = 0.018), pelvic incidence minus lumbar lordosis (p = 0.027), post-operative HOOS-JR (p = 0.010), and satisfaction (p = 0.033). On multivariate analysis, the following factors were associated with persistent disability: T1PA/PI >0.2 (odds ratio [OR], 2.11; 95% confidence interval [CI], 1.19–4.14; p < 0.001) and height <148 cm (OR, 1.26; 95% CI, 1.09–1.48; p = 0.011). The cut-off value of pre-operative T1PA/PI was >0.19 with a sensitivity of 95% and specificity of 85%. Post-operative satisfaction (p < 0.001) and HOOS-JR (p = 0.023) differed between the two groups when the pre-operative cut-off value was chosen as 0.2.Conclusions: A T1PA/PI >0.2 was associated with greater disability after THA. Clinicians should be aware that patient-related factors, including global spinal deformities, particularly in patients with a short stature, can influence THA outcomes at 2 years postoperatively.

scholarly journals Association of global sagittal spinal deformity with functional disability two years after total hip arthroplasty

2021 ◽  
Author(s):  
Yoshinori Okamoto ◽  
Hitoshi Wakama ◽  
Tomohiro Okayoshi ◽  
Shuhei Otsuki ◽  
Masashi Neo
Keyword(s):  
Multivariate Analysis ◽  
Total Hip Arthroplasty ◽  
Short Stature ◽  
Hip Arthroplasty ◽  
Spinal Deformity ◽  
Functional Disability ◽  
Body Height ◽  
Harris Hip Score ◽  
Total Hip ◽  
Significant Difference

Abstract Background: The relationship between spinopelvic alignment and functional disability after total hip arthroplasty (THA) has not been fully elucidated despite the growing recognition of its importance on patient-reported outcome measures. Therefore, our aim was to assess the effect of global sagittal spinal deformity on post-operative disability.Methods: This prospective analysis was based on 208 cases of THA, with functional disability measured at a follow-up of 2 years. The Hip Disability and Osteoarthritis Outcome Score-Joint Replacement (HOOS-JR), ranging from a scale of 0 (complete joint disability) to 100 (perfect joint health), was used to divide eligible patients into two groups, namely with and without disability, using a score of 70 as the cut-off. The following factors were compared between the two groups using multivariate analysis: age, sex, body height, body mass index, spinopelvic parameters, and surgeon experience. To identify the cut-off value of the parameters for predicting disability (HOOS-JR <70/100), we used the receiver-operating characteristic curve.Results: The disability (30 hips) and control (178 hips) groups showed a significant difference in pre-operative body height (p = 0.020), T1 pelvic angle divided by pelvic incidence (T1PA/PI; p = 0.018), PI minus lumbar lordosis (p = 0.027), post-operative HOOS-JR (p = 0.010), patient satisfaction (p = 0.033), and the modified Harris Hip Score (p = 0.038). On multivariate analysis, the following factors were associated with persistent disability: T1PA/PI >0.2 (odds ratio [OR], 2.11; 95% confidence interval [CI], 1.19–4.14; p < 0.001) and height <148 cm equivalent to legal standards as short stature (OR, 1.26; 95% CI, 1.09–1.48; p = 0.011). The cut-off value of pre-operative T1PA/PI was >0.19, with a sensitivity of 95% and specificity of 85%. Post-operative satisfaction (p < 0.001), HOOS-JR (p = 0.023), and EuroQol 5-Dimension (p = 0.041) differed between the two groups when the pre-operative cut-off value was chosen as 0.2.Conclusions: A T1PA/PI >0.2 was associated with greater disability after THA. Clinicians should be aware that patient-related factors, including global spinal deformities, particularly in patients with a short stature, can influence THA outcomes at 2 years postoperatively.

scholarly journals Association of global sagittal spinal deformity with functional disability two years after total hip arthroplasty

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yoshinori Okamoto ◽  
Hitoshi Wakama ◽  
Tomohiro Okayoshi ◽  
Shuhei Otsuki ◽  
Masashi Neo
Keyword(s):  
Multivariate Analysis ◽  
Total Hip Arthroplasty ◽  
Short Stature ◽  
Hip Arthroplasty ◽  
Spinal Deformity ◽  
Functional Disability ◽  
Body Height ◽  
Harris Hip Score ◽  
Total Hip ◽  
Significant Difference

Abstract Background The relationship between spinopelvic alignment and functional disability after total hip arthroplasty (THA) has not been fully elucidated despite the growing recognition of its importance on patient-reported outcome measures. Therefore, our aim was to assess the effect of global sagittal spinal deformity on post-operative disability. Methods This analysis was based on 208 cases of THA, with functional disability measured at a follow-up of 2 years. The Hip Disability and Osteoarthritis Outcome Score-Joint Replacement (HOOS-JR), ranging from a scale of 0 (complete joint disability) to 100 (perfect joint health), was used to divide eligible patients into two groups, namely with and without disability, using a score of 70 as the cut-off. The following factors were compared between the two groups using multivariate analysis: age, sex, body height, body mass index, spinopelvic parameters, and surgeon experience. To identify the cut-off value of the parameters for predicting disability (HOOS-JR < 70/100), we used the receiver-operating characteristic curve. Results The disability (30 hips) and control (178 hips) groups showed a significant difference in pre-operative body height (p = 0.020), T1 pelvic angle divided by pelvic incidence (T1PA/PI; p = 0.018), PI minus lumbar lordosis (p = 0.027), post-operative HOOS-JR (p = 0.010), patient satisfaction (p = 0.033), and the modified Harris Hip Score (p = 0.038). On multivariate analysis, the following factors were associated with persistent disability: T1PA/PI > 0.2 (odds ratio [OR], 2.11; 95% confidence interval [CI], 1.19–4.14; p <  0.001) and height < 148 cm equivalent to legal standards as short stature (OR, 1.26; 95% CI, 1.09–1.48; p = 0.011). The cut-off value of pre-operative T1PA/PI was > 0.19, with a sensitivity of 95% and specificity of 85%. Post-operative satisfaction (p <  0.001), HOOS-JR (p = 0.023), and EuroQol 5-Dimension (p = 0.041) differed between the two groups when the pre-operative cut-off value was chosen as 0.2. Conclusions A T1PA/PI > 0.2 was associated with greater disability after THA. Clinicians should be aware that patient-related factors, including global spinal deformities, particularly in patients with a short stature, can influence THA outcomes at 2 years postoperatively.

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.

Does lumbar arthrodesis compromise outcome of total hip arthroplasty?

2018 ◽  
Vol 29 (5) ◽  
pp. 496-503 ◽  
Author(s):  
George Grammatopoulos ◽  
Kam Dhaliwal ◽  
Rajib Pradhan ◽  
Simon J M Parker ◽  
Karen Lynch ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Functional Outcome ◽  
Outcome Measures ◽  
Hip Arthroplasty ◽  
Patient Reported Outcome Measures ◽  
Single Centre ◽  
Prospective Data ◽  
Total Hip ◽  
Significant Difference ◽  
Patient Reported

Introduction:This matched cohort study aims to determine whether the presence of a spinal arthrodesis (SA) compromises outcome of total hip arthroplasty (THA) and whether the outcome is better if THA is performed before- (THA-1st) or after- SA (THA-2nd).Methods:This is a single centre, multi-surgeon, review of prospective data. Thirty-seven patients (47 hips) that had SA and 1° THA(s), formed the cases (26 THA-1st; 21 THA-2nd). Most cases had 1-level SA ( n = 24). Controls were patients without SA that had THA, over the same period matched for age, gender and prosthesis type. Outcome measures included complication-, revision- rates, Oxford-Hip- and Harris-Hip-Scores (OHS/HHS) (Δ: difference between pre- and post-operative scores). This is a single-centre, multi-surgeon, review of prospective data.Results:At a mean follow-up of 6 years, more complications were seen in cases of THA and SA compared with controls without SA (7 vs. 2) ( p = 0.03). Consequently, more cases were revised ( n = 4) compared with controls ( n = 0) ( p = 0.02). There were no differences in functional outcome between cases and controls ( p = 0.1–0.6). No differences in complications- (4/26 vs. 3/21; p = 1.00) or revision- rates (2/26 vs. 2/21; p = 1.00) were seen between THA-1stand THA-2ndGroups. The THA-1stGroup had higher pre- and post-operative OHS/HHS, compared to the THA-2ndGroup. However, no significant difference in ΔOHS (24 vs. 17) and ΔHHS (39 vs. 26) were seen between the THA-1stand THA-2ndGroups ( p = 0.1).Conclusions:Patients with THA and SA, had increased rates of revision; but no differences in patient-reported outcome measures (PROMs) were detected. Addressing the hip pathology first may be associated with improved functional outcome.

scholarly journals Posterior versus direct anterior approach in total hip arthroplasty: difference in patient-reported outcomes measured with the Forgotten Joint Score-12

SICOT-J ◽  
2018 ◽  
Vol 4 ◽  
pp. 54 ◽  
Author(s):  
Yu Ozaki ◽  
Tomonori Baba ◽  
Yasuhiro Homma ◽  
Hironori Ochi ◽  
Taiji Watari ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Patient Reported Outcomes ◽  
Direct Anterior Approach ◽  
Harris Hip Score ◽  
Total Hip ◽  
Forgotten Joint Score ◽  
Significant Difference ◽  
Patient Reported

Introduction: When the postoperative outcome of primary total hip arthroplasty (THA) was compared with the direct anterior approach (DAA) and the posterior approach (PA), there was no significant difference of the clinical outcome at 6 months to 1 year after surgery in many studies. This study was performed to compare the medium-term outcome of THA via the DAA or PA and clarify which approach achieves better quality of life (QOL). Methods: We investigated 61 hips receiving primary THA (30 via DAA and 31 via PA), using hip function scores such as the Harris Hip Score (HHS) and patient-reported outcomes such as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ), and the Forgotten Joint Score-12 (FJS). Results: The mean duration of postoperative follow-up was 36.8 months in the DAA group and 40.5 months in the PA group. There was no difference in preoperative or postoperative HHS between the two groups. Although there was no difference of postoperative WOMAC and JHEQ, the postoperative FJS-12 score was significantly higher in the DAA group than in the PA group (75.2 ± 15.9 versus 60.1 ± 24.4, p = 0.01). Conclusion: When forgetting the artificial joint in daily life is the target, better QOL can be achieved by performing THA via the DAA.

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.

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

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.

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.

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