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.

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 Total hip arthroplasty for high-riding hips: A retrospective analysis of 79 cases and proposal of a new classification

2020 ◽  
Vol 28 (2) ◽  
pp. 230949902092416
Author(s):  
İsmail Demirkale ◽  
Yüksel Uğur Yaradılmış ◽  
Ahmet Ateş ◽  
Murat Altay
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Classification System ◽  
Operating Time ◽  
Limb Length Discrepancy ◽  
Harris Hip Score ◽  
Level Of Evidence ◽  
Total Hip ◽  
Significant Difference ◽  
Functional Scores

Purpose: Total hip arthroplasty (THA) for high-riding hips is a complex procedure and the requirement for subtrochanteric osteotomy (STO) is an important decision that needs to be taken preoperatively. STO renders this complex surgery even more complicated and there are no guidelines to determine the STO requirement. In this study, the outcomes of THA for patients with high-riding hips were evaluated and a practical classification system is proposed to predict any osteotomy requirement. Methods: A retrospective evaluation was made of 79 hips of 76 patients who underwent THA for high-riding hip dysplasia. The amount of shortening in patients with STO and in patients without STO was compared. All patients were evaluated in respect of Harris hip score, operating time, erythrocyte suspension need, and actual limb length discrepancy. Preoperative radiographs were classified into four types according to the ratio of the distance between the lesser trochanter and the ischial tuberosity with pelvic height (LT-IT/P) to grade the degree of dislocation. Results: The mean follow-up was 30 ± 6.54 months. STO was applied to 47 (60%) hips and not to 32 (40%). There was no statistically significant difference between the groups in respect of the functional scores. STO prolonged the operating time and increased the need for blood transfusion ( p = 0.026, p < 0.001, respectively). When the LT-IT/P index was <0.19 (type 1), no additional surgical approach was required for reduction, at 0.19–0.29 (type 2), the head can be safely reduced with additional reduction methods, and when >0.3 (type 3), a shortening osteotomy will most likely be required. The rate of complications is increased if LT-IT/P is >0.4 (type 4). Conclusion: STO adjunct to THA increases the rate of complications. This practical classification system may guide the surgeon in the decision of whether an STO should be added to the procedure or not. Level of evidence: Level III, clinical trial

scholarly journals 32-mm ceramic-on-ceramic total hip arthroplasty versus 28-mm ceramic bearings: 5- to 15-year follow-up study

2018 ◽  
Vol 29 (1) ◽  
pp. 65-71 ◽  
Author(s):  
Yoshitoshi Higuchi ◽  
Taisuke Seki ◽  
Yukiharu Hasegawa ◽  
Yasuhiko Takegami ◽  
Daigo Morita ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Harris Hip Score ◽  
Total Hip ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Average Patient ◽  
The Mean ◽  
Ceramic On Ceramic

Introduction: This study aimed to compare the clinical and radiographic results of 28-mm ceramic-on-ceramic (CoC) total hip arthroplasty (THA) to those of 32-mm CoC during a 5- to 15-year follow-up period. Methods: 107 joints (95 women and 6 men) underwent 28-mm CoC, and 60 (49 women and 7 men) underwent 32-mm CoC. The average patient age at the time of surgery was 56.1 and 55.7 years in the 28-mm and 32-mm CoC groups, respectively. Clinical and radiologic measurements of all patients were analysed. Results: The mean preoperative Harris hip score (HHS) was similar in the 2 groups (28-mm, 58.9; and 32-mm, 58.5). However, at final follow-up, the mean HHS of the 32-mm CoC (91.8) was significantly better than that of the 28-mm CoC (88.2) ( p = 0.003), as were the ranges of motion (ROM) for flexion (98.3 ± 13.5° vs. 87.3 ± 19.3°, p < 0.001) and abduction (27.8 ± 14.9° vs. 22.1 ± 19.3°, p = 0.007). The mean wear rate was 0.0044 mm/year for the 28-mm CoC and 0.0044 mm/year for the 32-mm CoC. No ceramic fractures were found in the 2 groups. One joint in the 28-mm CoC (0.9%) required revision owing to progressive osteolysis. Kaplan-Meier survival at 10 years, with implant loosening or revision THA as the endpoint, was 98.3% for 28-mm CoC and 100% for 32-mm CoC ( p = 0.465). Conclusion: There was no significant difference in ceramic-related complications between the 2 groups. Our study demonstrated that the 32-mm and 28-mm CoC are safe and are associated with good clinical outcomes.

Total Hip Arthroplasty after Vascularized Fibular Grafting

2012 ◽  
Vol 2 (1) ◽  
pp. 12-17
Author(s):  
Thomas P Vail ◽  
Apostolos Dimitroulias ◽  
Jeff Hodrick ◽  
Rusty Brand ◽  
Nicholas Viens ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Acetabular Component ◽  
Hip Arthroplasty ◽  
Perioperative Complications ◽  
Harris Hip Score ◽  
Control Group ◽  
Total Hip ◽  
Uncemented Total Hip Arthroplasty ◽  
Significant Difference ◽  
Fibular Grafting

ABSTRACT Background Vascularized fibular grafting has been reported as a successful joint preserving surgery for patients with femoral head osteonecrosis. Few reports exist regarding the outcomes associated with total hip arthroplasty after failed vascularized fibular grafting. This study aims to highlight the early results and complications associated with this procedure. Materials and methods We retrospectively reviewed charts and radiographs of 30 patients (38 hips) who underwent conversion of prior vascularized fibular grafting to an uncemented total hip arthroplasty utilizing modern bearings (highly cross-linked polyethylene-on-metal or metal-on-metal). Mean follow-up was 41 months. A control group of 15 osteonecrosis patients (19 hips) was used who had a history of total hip arthroplasty without previous surgery. Outcome measures used were perioperative complications, clinical and radiological findings. Results The prior vascularized fibular grafting group had longer surgical times and more perioperative complications (calcar fracture and persistent wound drainage requiring early reoperation). In the prior vascularized fibular grafting group there were two cases requiring revision for aseptic loosening (one femoral and one acetabular component) and three cases of asymptomatic radiographic loosening (two femoral and one acetabular component). Furthermore, three patients reported symptoms of trochanteric bursitis. None of the above complications were seen in the control group. There was one dislocation in each group; and both were treated successfully with closed reduction. There was no significant difference between the two groups in the final postoperative Harris Hip Score (HHS). Conclusion Despite an increased complication rate, comparable clinical outcomes can be expected after conversion of vascularized fibular grafting to total hip arthroplasty. Dimitroulias A, Hodrick J, Brand R, Viens N, Attarian DE Vail TP, Bolognesi MP. Total Hip Arthroplasty after Vascularized Fibular Grafting. The Duke Orthop J 2012; 2(1):12-17.

scholarly journals Evaluation of results of primary cementless total hip arthroplasty in osteoarthritis

2017 ◽  
Vol 4 (2) ◽  
pp. 612
Author(s):  
Arshad Bashir ◽  
Qazi Manan ◽  
Faisal Younis Shah ◽  
Hayat Ahmad Khan ◽  
Mohammad Iqbal Wani ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Functional Disability ◽  
Tertiary Care ◽  
Hip Osteoarthritis ◽  
Harris Hip Score ◽  
Total Hip ◽  
Cementless Total Hip Arthroplasty ◽  
Radiographic Outcomes ◽  
Clinical And Radiological Outcome

Background: Total hip arthroplasty involves removal of diseased bone and soft tissue from both femoral and acetabular side and replacing it with mechanical components. It is one of the most successful surgical procedures. It relieves pain and functional disability experienced by patients with moderate to severe osteoarthritis of the hip, improving their quality of life. The success of THA is its ability to relieve the pain, while maintaining both mobility and stability of the joint. The purpose of this study was to evaluate the results of primary cementless total hip arthroplasty in patients with hip osteoarthritis.Methods: This study was done in a tertiary care teaching hospital. Thirty patients with hip osteoarthritis who were treated with cementless total hip arthroplasty were included in the study. This was a prospective study with a minimum of 12 months follow up (maximum of 25 months). The patients’ pre-operative and post-operative pain and functional status was compared using Harris hip score.Results: Excellent or good pain relief and function was obtained in 83.33% of cases. The mean total pre-operative Harris Hip Score was 32.93 which improved to 88.967 post-operatively. There was a statistically significant improvement in all parameters except absence of deformity. The most common complication was persistent anterior thigh pain that occurred in two patients.Conclusions: Our study suggests that the current generation of cementless implants provide satisfactory clinical and radiographic outcomes. Though the study was not free of complications, the overall clinical and radiological outcome showed encouraging results.

scholarly journals Early Postoperative Clinical Outcomes of Robotic Arm-Assisted Vs. Image-Based Navigated Total Hip Arthroplasty

2020 ◽  
Author(s):  
Nao Shibanuma ◽  
Kazunari Ishida ◽  
Tomoyuki Matsumoto ◽  
Koji Takayama ◽  
Yutaro Sanada ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Total Hip Arthroplasty ◽  
Clinical Outcomes ◽  
Hip Arthroplasty ◽  
Robotic Arm ◽  
Harris Hip Score ◽  
Surgical Time ◽  
Total Hip ◽  
Radiographic Parameters ◽  
Significant Difference

Abstract Background The purpose of this study was to compare the clinical outcomes of total hip arthroplasty (THA) using computer navigation systems (nTHA) and those of robotic arm-assisted THA (rTHA).Methods Thirty prospective subjects who underwent rTHA were clinically compared with 30 subjects who underwent nTHA. Clinical data (the surgical time, intraoperative blood loss, length of hospital stay, pain severity, number of days to independent walking, and Harris Hip Score (HHS) at discharge) and radiographic parameters (the inclination and anteversion angles) were statistically compared between the two groups. Results The surgical time, number of days to independent walking, and postoperative pain were significantly reduced in the rTHA group than in the nTHA group. The rTHA group showed a significantly higher postoperative HHS than did the nTHA group. No statistically significant difference was observed in radiographic parameters between the groups.Conclusion The surgical time, postoperative pain, and number of days to independent walking were significantly shorter, and the HHS at discharge was significantly higher in the rTHA group than in the nTHA group. Thus, as compared to nTHA, rTHA improved early clinical outcomes.

scholarly journals Conversion from a failed proximal femoral nail anti-rotation to a cemented or uncemented total hip arthroplasty device: a retrospective review of 198 hips with previous intertrochanteric femur fractures

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Weiguang Yu ◽  
Xiulan Han ◽  
Wenli Chen ◽  
Shuai Mao ◽  
Mingdong Zhao ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Complication Rate ◽  
Proximal Femoral Nail ◽  
Harris Hip Score ◽  
Elderly Individuals ◽  
Total Hip ◽  
Femoral Nail ◽  
Uncemented Total Hip Arthroplasty ◽  
Significant Difference

Abstract Background At present, it is unclear which device (uncemented or cemented total hip arthroplasty [UTA or CTA, respectively]) is more suitable for the conversion of a failed proximal femoral nail anti-rotation (PFNA). The aim of this review was to assess the outcomes of failed PFNAs converted to a UTA or CTA device in elderly individuals with intertrochanteric femoral fractures (IFFs). Methods Two hundred fifty-eight elderly individuals (258 hips) with IFFs who underwent a conversion to a UTA or CTA device following failed PFNAs during 2007–2017 were retrospectively identified from the China Southern Medical Centre (CSMC) database. The primary endpoint was the Harris Hip Score (HHS); secondary endpoint was the key orthopaedic complication rate. Results The median follow-up was 65 months (60–69 months). Significant distinctions were observed (87.26 ± 16.62 for UTA vs. 89.32 ± 16.08 for CTA, p = 0.021; 86.61 ± 12.24 for symptomatic UTA vs. 88.68 ± 13.30 for symptomatic CTA, p = 0.026). A significant difference in the overall key orthopaedic complication rate was detected (40.8% [40/98] vs. 19.0% [19/100], p = 0.001). Apparent distinctions were detected in terms of the rate of revision, loosening, and periprosthetic fracture (11.2% for UTA vs 3.0% for CTA, p = 0.025; 13.2% for UTA vs 5.0% for CTA, p = 0.043; 10.2% for UTA vs 3.0% for CTA, p = 0.041, respectively). Conclusion For elderly individuals with IFFs who suffered a failed PFNA, CTA devices may have a noteworthy advantage in regard to the revision rate and the rate of key orthopaedic complications compared with UTA devices, and CTA revision should be performed as soon as possible, regardless of whether these individuals have symptoms.

scholarly journals Does robotic-arm assisted total hip arthroplasty benefit short-term clinical outcomes? A pair match-controlled study

10.29007/455b ◽  
2018 ◽  
Author(s):  
Itay Perets ◽  
John Walsh ◽  
Brian Mu ◽  
Yosif Mansor ◽  
Leslie Yuen ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Clinical Outcomes ◽  
Hip Arthroplasty ◽  
Harris Hip Score ◽  
Controlled Study ◽  
Robotic Assistance ◽  
Short Term ◽  
Total Hip ◽  
Significant Difference

Recent advances have made robotic assistance a viable option in total hip arthroplasty (THA). However, the clinical outcomes of this procedure relative to THA without robotic assistance have yet to be reported. This study presents short-term outcomes of robotically assisted THA compared to a pair-matched control group of patients that underwent THA without robotic assistance.Data were prospectively collected on all THAs performed from July 2011 to January 2015. Patients were included if they underwent primary THA treating idiopathic osteoarthritis and were eligible for minimum two-year follow-up. Outcomes were measured using Harris Hip Score (HHS), the Forgotten Joint Score (FJS-12), pain on a visual analog scale (VAS), and satisfaction from 0-10. Patients that underwent THA with robotic assistance were matched 1:1 with THA patients without robotic assistance for age, sex, BMI, and approach.There were 85 patients in each study group. There were no significant differences in the demographic factors matched for. Both HHS and FJS-12 were significantly higher in the robotic assistance group at minimum two-year follow-up. VAS was lower in the robotic assistance group, but this was not statistically significant (p = 0.12). There was a not a significant difference in patient satisfaction. There was no significant difference in the rate of postoperative complications or subsequent revisions between groups.Robotically assisted THA is safe and may lead to superior short-term outcomes compared to THA without robotic assistance.

scholarly journals Poor outcomes for osteoporotic patients undergoing conversion total hip arthroplasty following prior failed dynamic hip screw fixation: a nationwide retrospective cohort study

2019 ◽  
Vol 47 (4) ◽  
pp. 1544-1554 ◽  
Author(s):  
Qian Xu ◽  
Jiajie Lai ◽  
Fan Zhang ◽  
Yangkai Xu ◽  
Fugui Zhu ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Dynamic Hip Screw ◽  
Harris Hip Score ◽  
Insurance Company ◽  
Total Hip ◽  
Asian Patients ◽  
Significant Difference ◽  
Hip Screw

Objectives This study was performed to compare the long-term clinical and radiological outcomes of conversion total hip arthroplasty (CTHA) following prior failed InterTan nail (IT) fixation or dynamic hip screw (DHS) fixation in Asian patients with osteoporotic intertrochanteric hip fractures (IHFs) and to clarify which implant tends to be more favourable for CTHA. Methods Records of consecutive Asian patients with osteoporosis who underwent conversion of failed primary unilateral IT or DHS fixation to THA from 2010 to 2013 were extracted from the comprehensive database of the China Pacific Insurance Company Ltd. All consecutive procedures were managed by high-volume surgeons. The primary endpoint was the clinical outcome. The secondary endpoint was the radiological outcome. Results In total, 447 Asian patients with osteoporotic IHFs (DHS, n = 223; IT, n = 224) were assessed during a median follow-up of 46 months (range, 39–53 months). The two groups showed a significant difference in the Harris hip score at final follow-up and in the orthopaedic complication rate (DHS, 20.2%; IT, 9.8%). Conclusion Conversion to THA following prior failed DHS fixation tends to be associated with poorer clinical and radiological outcomes in Asian patients with osteoporotic IHFs than that following prior failed IT fixation.

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