scholarly journals Patient- and Surgery-Related Factors that Affect Patient-Reported Outcomes after Total Hip Arthroplasty

2018 ◽  
Vol 7 (10) ◽  
pp. 358 ◽  
Author(s):  
Toshiyuki Kawai ◽  
Masanao Kataoka ◽  
Koji Goto ◽  
Yutaka Kuroda ◽  
Kazutaka So ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Activity Score ◽  
Harris Hip Score ◽  
Related Factors ◽  
Ucla Activity Score ◽  
Factors Associated ◽  
Total Hip ◽  
Patient Reported

Patient-reported outcome measures (PROMs) are used to assess satisfaction after total hip arthroplasty (THA); however, the factors that determine these PROMs remain unclear. This study aimed to identify the patient- and surgery-related factors that affect patient satisfaction after THA as indicated by the Oxford Hip Score (OHS). One-hundred-and-twenty patients who underwent primary THA were included. Various patient-related factors, including clinical scores, and surgery-related factors were examined for potential correlations with the OHS at 3, 6, and 12 months post-THA. Univariate regression analysis showed that higher preoperative University of California Los Angeles (UCLA) activity score (p = 0.027) and better preoperative OHS (p = 0.0037) were correlated with better OHS at 3 months post-THA. At 6 months post-THA, the factors associated with better OHS were higher preoperative UCLA activity score (p = 0.039), better preoperative OHS (p = 0.0006), and use of a cemented stem (p = 0.0071). At 12 months post-THA, the factors associated with better OHS were higher preoperative UCLA activity score (p = 0.0075) and better preoperative OHS (p < 0.0001). Multivariate regression analysis showed that the factors significantly correlated with better OHS were female sex (p = 0.011 at 3 months post-THA), osteoarthritis (p = 0.043 at 6 months), higher preoperative OHS (p < 0.001 at 3 and 12 months, p = 0.018 at 6 months), higher preoperative Harris Hip Score (p = 0.001 at 3 months), higher preoperative UCLA activity score (p = 0.0075 at 3 months), and the use of a cemented femoral component (p = 0.012 at 6 months). Patient- and surgery-related factors affecting post-THA PROMs were identified, although the effect of these factors decreased over time.

scholarly journals Preoperative Factors Predicting the Severity of BMD Loss Around the Implant after Total Hip Arthroplasty

2021 ◽  
Author(s):  
Akira Morita ◽  
Kobayashi Naomi ◽  
Hyonmin Choe ◽  
Taro Tezuka ◽  
Shota Higashihira ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Multivariate Regression ◽  
Harris Hip Score ◽  
Lateral Side ◽  
Mineral Density ◽  
Factors Associated ◽  
Total Hip ◽  
Preoperative Factors

Abstract BackgroundStress shielding after total hip arthroplasty (THA) leads to the loss of bone mineral density (BMD) around the femoral implants, particularly in the proximal area. BMD loss around the implant is likely to occur within 1 year after THA, but its severity depends on patient characteristics. This study evaluated preoperative factors associated with the severity of zone 7 BMD loss after THA.MethodsThis retrospective cohort study included 48 patients who underwent primary THA at our hospital from October 2011 to December 2015. All patients underwent implantation of a Zweymüller-type femoral component without any postoperative osteoporosis medications. The objective variable was change in zone 7 BMD after 1 year. Factors evaluated included age, body mass index (BMI), Japanese Orthopaedic Association (JOA) score, Harris Hip Score (HHS), Canal Flare Index (CFI), and lumbar BMD on the frontal and lateral sides. Factors associated with loss of zone 7 BMD were identified by univariate and multivariate regression analyses.ResultsUnivariate regression analysis showed that CFI (P=0.003) and preoperative lumbar BMD on the frontal (P=0.003) and lateral (P<0.001) sides were significantly correlated with loss of zone 7 BMD. Multivariate regression analysis showed that CFI (P=0.014) and lumbar BMD on the lateral side (P<0.001) were independently correlated with loss of zone 7 BMD.ConclusionLower preoperative lumbar BMD on the lateral side and lower CFI were significantly associated with zone 7 BMD loss after THA. Patients with these characteristics should be carefully monitored for severe BMD loss after THA.

Hip resurfacing arthroplasty and total hip arthroplasty in the same patient: which do they prefer?

2019 ◽  
pp. 112070001988292 ◽  
Author(s):  
Tyler E Calkins ◽  
Linda I Suleiman ◽  
Chris Culvern ◽  
Sulaiman Alazzawi ◽  
Gregory S Kazarian ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Hip Resurfacing ◽  
Contralateral Side ◽  
Harris Hip Score ◽  
Hip Resurfacing Arthroplasty ◽  
Total Hip ◽  
Resurfacing Arthroplasty ◽  
Patient Reported

Introduction: Hip resurfacing arthroplasty (HRA) is an alternative to conventional total hip arthroplasty (THA) with potential advantages of preserving femoral bone stock and the ability to participate in higher impact activities. This study compares outcomes, satisfaction and preference in patients who underwent HRA in 1 hip and THA on the contralateral side. Methods: 62 Patients with an HRA in 1 hip and a contralateral THA were retrospectively identified at 3 centres, consisting of 38 males and 24 females with 53 patients (85.5%) undergoing HRA first. A survey regarding satisfaction and preference for each procedure and outcome scores were obtained. Results: Patients were younger (51.5 vs. 56.6 years, p = 0.002) and had longer follow-up on the HRA hip (11.0 vs. 6.0 years, p < 0.001). HRA was associated with larger increase in Harris Hip Score from preoperative to final follow-up (35.8 vs. 30.6, p = 0.035). 18 Patients (29.0%) preferred HRA, 19 (30.6%) preferred THA and 25 (40.3%) had no preference ( p = 0.844). When asked what they would choose if they could only have 1 surgery again, 41 (66.1%, p < 0.001) picked HRA. Overall satisfaction ( p = 0.504), willingness to live with their HRA versus THA for the rest of their life ( p = 0.295) and recommendation to others ( p = 0.097) were similar. Conclusions: Although HRA is associated with risks related to metal-on-metal bearings, it showed greater increase in patient-reported outcomes and a small subjective preference amongst patients who have undergone both conventional and resurfacing arthroplasty.

The effect of femoral stem collar on implant migration and clinical outcomes following direct anterior approach total hip arthroplasty

2020 ◽  
Vol 102-B (12) ◽  
pp. 1654-1661
Author(s):  
Maxwell E. Perelgut ◽  
Jennifer S. Polus ◽  
Brent A. Lanting ◽  
Matthew G. Teeter
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Short Form ◽  
Femoral Stem ◽  
Ucla Activity Score ◽  
Total Hip ◽  
Implant Migration ◽  
Post Surgery ◽  
Stem Group ◽  
Patient Reported

Aims The direct anterior (DA) approach has been associated with rapid patient recovery after total hip arthroplasty (THA) but may be associated with more frequent femoral complications including implant loosening. The objective of this study was to determine whether the addition of a collar to the femoral stem affects implant migration, patient activity, and patient function following primary THA using the DA approach. Methods Patients were randomized to either a collared (n = 23) or collarless (n = 26) cementless femoral stem implanted using the DA approach. Canal fill ratio (CFR) was measured on the first postoperative radiographs. Patients underwent a supine radiostereometric analysis (RSA) exam postoperatively on the day of surgery and at two, four, six, 12, 26, and 52 weeks postoperatively. Patient-reported outcome measures (Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index, the 12-item Short Form Health Survey Mental and Physical Score, and University of California, Los Angeles (UCLA) Activity Score) were measured preoperatively and at each post-surgery clinic visit. Activity and function were also measured as the weekly average step count recorded by an activity tracker, and an instrumented timed up-and-go (TUG) test in clinic, respectively. Results Comparing the RSA between the day of surgery baseline exam to two weeks postoperatively, subsidence was significantly lower (mean difference 2.23 mm (SD 0.71), p = 0.023) with collared stems, though these patients had a greater CFR (p = 0.048). There was no difference (p = 0.426) in subsidence between stems from a two-week baseline through to one year postoperatively. There were no clinically relevant differences in PROMs; and there was no difference in the change in activity (p = 0.078) or the change in functional capacity (p = 0.664) between the collared stem group and the collarless stem group at any timepoint. Conclusion Presence of a collar on the femoral stem resulted in reduced subsidence during the first two postoperative weeks following primary THA using the DA approach. However, the clinical implications are unclear, and larger studies examining patient activity and outcomes are required. Cite this article: Bone Joint J 2020;102-B(12):1654–1661.

scholarly journals Primary labral reconstruction in patients with femoroacetabular impingement, irreparable labral tears and severe acetabular chondral defects decreases the risk of conversion to total hip arthroplasty: a pair-matched study

2019 ◽  
Vol 6 (3) ◽  
pp. 214-226 ◽  
Author(s):  
David R Maldonado ◽  
Cammille C Go ◽  
Joseph R Laseter ◽  
Ajay C Lall ◽  
Michael R Kopscik ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Femoroacetabular Impingement ◽  
Hip Arthroplasty ◽  
Matched Pair ◽  
Harris Hip Score ◽  
Total Hip ◽  
Labral Tears ◽  
Patient Reported ◽  
Outerbridge Grade ◽  
Tönnis Grade

Abstract In the presence of severe acetabular cartilage defects, the benefits of labral reconstruction (RECON) versus labral resection (RESEC) have not been determined. Prospectively collected data between October 2008 and December 2016 were retrospectively reviewed. Inclusion criteria were hip arthroscopy, acetabular Outerbridge grade III/IV, irreparable labral tears that underwent RECON or RESEC, and minimum 2-year postoperative measures for the modified Harris Hip Score, Non-Arthritic Hip Score, Hip Outcome Score–Sports Specific Subscale, International Hip Outcome Tool, Patient Satisfaction and Visual Analogue Scale for pain. Exclusion criteria included Tönnis grade &gt;1, previous hip conditions or previous ipsilateral hip surgeries. A 1:1 matched-pair analysis was performed based on age ±5 years, sex, body mass index ±5 kg/m2, Tönnis grade, acetabular microfracture, femoral Outerbridge grade (0 or I compared with II, III or IV). Relative risk (RR) and conversion rate to total hip arthroplasty (THA) were calculated. A total of 38 RECON hips were successfully matched. Both groups demonstrated significant improvements in patient-reported outcomes (PROs). THA conversion was 5.3% and 21.1% for the RECON and RESEC groups, respectively (P = 0.04). RECON was four times less likely to require THA conversion than the RESEC group (RR=4.0; 95% CI 0.91–17.63). In the setting of primary arthroscopic management of femoroacetabular impingement, irreparable labral tears and acetabular chondral lesions of Outerbridge III/IV, patients that underwent RECON and RESEC experienced significant improvement in PROs at minimum 2-year follow-up, and these functional scores were comparable when groups were matched. However, RR and rate to THA conversion were significantly higher in the RESEC group.

Anterior versus posterior approach total hip arthroplasty: patient-reported and functional outcomes in the early postoperative period

2019 ◽  
Vol 30 (6) ◽  
pp. 695-702 ◽  
Author(s):  
Alexander Martusiewicz ◽  
Dimitri Delagrammaticas ◽  
Ryan E Harold ◽  
Surabhi Bhatt ◽  
Matthew D Beal ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Length Of Stay ◽  
Physical Function ◽  
Hip Arthroplasty ◽  
Posterior Approach ◽  
Assistive Device ◽  
Harris Hip Score ◽  
Total Hip ◽  
Pain Scores ◽  
Patient Reported

Purpose: Direct anterior approach total hip arthroplasty (DA THA) has been reported to improve early outcomes compared to posterior approach THA up to 6 weeks postoperatively. Limited weekly outcomes data are available prior to 6 weeks. We evaluate outcomes including when patients first drive a car, leave home, and discontinue their assist device. Methods: Patients undergoing THA for primary osteoarthritis were prospectively enrolled. Outcomes data were collected preoperatively and postoperatively at weekly intervals for 6 weeks. Results: 111 patients (55 DA and 56 posterior approach) were enrolled. There was no significant difference ( p > 0.05) in pre-surgical Patient-Reported Outcomes Measurement Information System (PROMIS) scores or modified Harris Hip Score (mHHS). Postoperatively, the DA THA group had decreased length of stay ( p = 0.0002) and increased distance walked on postoperative day 1 and 2 ( p = 0.011, p = 0.0004). The DA group had lower pain scores ( p < 0.05) and required less day 1 and total narcotics ( p = 0.029, p = 0.01). The DA cohort had improved PROMIS Physical Function scores and mHHS up to 5 weeks postoperatively. DA patients discontinued their assistive device 8 days earlier ( p = 0.01), left home 3 days earlier ( p = 0.001), and drove a car 5 days earlier ( p = 0.01). Conclusions: Patients undergoing DA THA discontinued their assistive device, left their home, and drove a car sooner than posterior approach patients. We found improvement in physical function with DA, and it persisted up to 5 weeks postoperatively. Furthermore, DA patients had significantly shorter length of stay, improved mobilisation, decreased narcotic requirements and improved inpatient pain scores compared to posterior approach THA. Future randomised controlled study should be performed to minimise the biases inherent in this study methodology and confirm the results.

scholarly journals The usefulness of dual mobility cups in primary total hip arthroplasty patients at a risk of dislocation

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Nam Hoon Moon ◽  
Min Uk Do ◽  
Jung Shin Kim ◽  
Jae Seung Seo ◽  
Won Chul Shin
Keyword(s):  
Postoperative Complications ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Harris Hip Score ◽  
Dual Mobility ◽  
Total Hip ◽  
Early Results ◽  
Patient Reported ◽  
Primary Total Hip Arthroplasty

AbstractThis study aimed to evaluate the early results of primary total hip arthroplasty (THA) using dual mobility (DM) cups in patients at a risk of dislocation and compare them with that of fixed bearing (FB) THA. This retrospective study included patients who had undergone primary THA between January 2016 and December 2018 and were at a risk of dislocation. A propensity score-matched analysis was conducted for 63 THA procedures with vitamin-E infused highly cross-linked polyethylene (VEPE) DM bearing and 63 THA procedures performed with FB from the same manufacturer for a mean follow-up period of 3.1 and 3.5 years, respectively. The radiologic outcomes at the last follow-up and incidence of postoperative complications were evaluated and compared statistically between the two groups. The modified Harris hip score (mHHS) was used to assess patient-reported outcomes. Postoperative dislocation occurred in 4 cases (6.3%) in the FB group, but did not occur in the DM group (p = 0.042). There was no difference in the radiologic outcomes and postoperative complications between the two groups. The mHHS at the last follow-up showed satisfactory outcomes in both the groups (DM group, 90.5; FB group, 88.1), without a statistical difference between the groups. The early results of THA using VEPE DM bearing showed better outcomes than that of THA with FB for patients at a risk of dislocation. A longer follow-up period is recommended to assess the stability and overall outcomes.

scholarly journals Patient-reported outcomes after primary or revision total hip arthroplasty: A propensity score-matched Asian cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0252112
Author(s):  
Satoru Harada ◽  
Satoshi Hamai ◽  
Kyohei Shiomoto ◽  
Daisuke Hara ◽  
Masanori Fujii ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Propensity Score ◽  
Outcome Measures ◽  
Hip Arthroplasty ◽  
Activity Score ◽  
Revision Total Hip Arthroplasty ◽  
Ucla Activity Score ◽  
Patient Reported ◽  
Revision Tha ◽  
Asian Cohort

Background Few studies have compared patient-reported outcome measures (PROMs) between primary and revision total hip arthroplasty (THA). We investigated and compared PROMs between propensity score-matched primary and revision THA in an Asian cohort. Methods The Oxford Hip Score (OHS) and University of California-Los Angeles (UCLA) activity score, satisfaction score, and Short Form-12 Health Survey (SF-12) were compared between 110 primary and 110 revision THAs after propensity score matching. Multivariate analyses were performed to determine which factors, including patients’ demographics, indication for revision, and pre-operative PROMs, were associated with post-operative PROMs in the revision THA cohort. Results The revision THA cohort demonstrated significantly lower post-operative OHS, UCLA activity score, and satisfaction score (10% decrease on average) than those in the primary THA cohort (P < .05). The difference in SF-12 mental component summary measure (MCS) between the two cohorts was statistically insignificant (P = .24). In multivariate analysis for the revision THA cohort, lower post-operative UCLA activity score was significantly associated with higher BMI and lower pre-operative UCLA activity score (P < .05). Conclusion Revision THA was associated with a modest but significant decrease in physical PROMs as compared with primary THA. Pre-operative UCLA activity score significantly affected the post-operative physical outcome measures in the revision THA cohort. However, post-operative SF-12 MCS was comparable between the primary and revision THA cohorts.

The effect of conjoint tendon release on gait after direct anterior total hip arthroplasty

2018 ◽  
Vol 29 (6) ◽  
pp. 578-583
Author(s):  
Bryn O Zomar ◽  
Dianne Bryant ◽  
Susan Hunter ◽  
James L Howard ◽  
Brent A Lanting
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Proximal Femur ◽  
Gait Velocity ◽  
Harris Hip Score ◽  
Total Hip ◽  
Post Surgery ◽  
Patient Reported ◽  
Single Limb Support ◽  
Conjoint Tendon

Introduction: There has been considerable interest in the direct anterior (DA) approach to total hip arthroplasty (THA) recently. To facilitate exposure of the proximal femur it is sometimes necessary to release the conjoint tendon. Aim: To prospectively investigate whether release of the conjoint tendon has an impact on gait in the early postoperative period. Methods: We measured gait velocity, stride length, single-limb support and single-limb support symmetry preoperatively, at discharge from the hospital, and 2, 6 and 12 weeks and postoperatively. Participants also completed the Timed Up and Go and a series of questionnaires (WOMAC, SF-12, Harris Hip Score, and pain VAS) at each visit. Results: 36 participants undergoing a DA THA with a single surgeon were enrolled in this study. 22 participants had a release of the conjoint tendon during their surgery. We found no differences between the groups for any gait, patient-reported or surgical outcomes ( p < 0.05). There was a total of 3 complications reported in the release group, and 1 complication in the group that did not have a release. Conclusion: Although the conjoint tendon has an important role in the biomechanics of the hip, we found release of the conjoint tendon during the DA approach for THA to have no impact on gait or patient reported outcomes within 12 weeks post-surgery. Therefore, if the exposure of the proximal femur is limited, a low threshold for release of the conjoint tendon is recommended to improve visualisation.

Outcomes After Arthroscopic Hip Labral Reconstruction: A Systematic Review and Meta-analysis

2019 ◽  
Vol 48 (7) ◽  
pp. 1748-1755 ◽  
Author(s):  
Michael D. Rahl ◽  
Collin LaPorte ◽  
Gabrielle K. Steinl ◽  
Michaela O’Connor ◽  
T. Sean Lynch ◽  
...  
Keyword(s):  
Systematic Review ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Meta Analysis ◽  
Joint Disease ◽  
Harris Hip Score ◽  
Total Hip ◽  
Proper Patient Selection ◽  
Surgeon Experience ◽  
Patient Reported

Background: The acetabular labrum is critical to maintenance of hip stability and has been found to play a key role in preservation of the hip fluid seal. For irreparable labral damage, arthroscopic labral reconstruction is an evolving technique that has been shown to decrease hip pain and restore function. Purpose: To provide a comprehensive review of current literature for arthroscopic hip labral reconstruction, with a focus on determining if outcomes differ between autograft or allograft tissue. Study Design: Systematic review and meta-analysis. Methods: PubMed and Scopus online databases were searched with the key terms “hip,”“labrum,”“reconstruction,” and “graft” in varying combinations. Procedures performed, complications, failures, and functional outcome measures were included in this analysis. The inverse variance method was used to calculate pooled estimates and 95% CIs. Results: Eight studies with 537 hips were included. Mean age was 37.4 years (95% CI, 34.5-40.4 years), and mean follow-up time was 29 months (95% CI, 26-33 months). Survivorship after autograft reconstruction ranged from 75.7% to 100%, as compared with 86.3% to 90.0% in the allograft cohort. In the autograft cohort, failures included 0% to 13.2% conversion to total hip arthroplasty and 0% to 11.0% revision hip arthroscopy. Failures in the allograft cohort included 0% to 12.9% total hip arthroplasty conversion, 0% to 10.0% revision arthroscopy, and 0% to 0.8% open revision surgery. Based on 6 studies, the modified Harris Hip Score improved by a mean 29.0 points after labral reconstruction ( P < .0001). Conclusion: Arthroscopic hip labral reconstruction results in clinically significant improvements in patient-reported outcomes. Our analysis indicates that there are no significant differences in outcomes based on graft type alone. A number of factors may determine graft choice, including patient preference, surgeon experience, operative time, morbidity, and cost. Proper patient selection based on age and severity of degenerative joint disease will also optimize outcomes after labral reconstruction.

scholarly journals Preoperative factors predicting the severity of BMD loss around the implant after Total hip Arthroplasty

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Akira Morita ◽  
Naomi Kobayashi ◽  
Hyonmin Choe ◽  
Taro Tezuka ◽  
Shota Higashihira ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Multivariate Regression ◽  
Japanese Orthopaedic Association ◽  
Harris Hip Score ◽  
Lateral Side ◽  
Mineral Density ◽  
Total Hip ◽  
Preoperative Factors

Abstract Background Stress shielding after total hip arthroplasty (THA) leads to loss of bone mineral density (BMD) around the femoral implants, particularly in the proximal area. Loss of BMD around the implant is likely to occur within 1 year after THA; however, its severity depends on patient characteristics. This study evaluated preoperative factors correlated with the severity of zone 7 BMD loss after THA. Methods This retrospective cohort study included 48 patients who underwent primary THA from October 2011 to December 2015. All patients underwent implantation of a Zweymüller-type femoral component without any postoperative osteoporosis medications. The objective variable was a change in zone 7 BMD after 1 year. Factors evaluated included age, body mass index, Japanese Orthopaedic Association score, Harris Hip Score, Canal Flare Index (CFI), and lumbar BMD on the frontal and lateral sides. Univariate and multivariate regression analyses identified factors correlated with loss of zone 7 BMD. Results Univariate regression analysis identified CFI (P = 0.003) and preoperative lumbar BMD on the anterior-posterior (P = 0.003) and lateral (P < 0.001) sides as being correlated with loss of zone 7 BMD. Multivariate regression analysis identified CFI (P = 0.014) and lumbar BMD on the lateral side (P < 0.001) as being correlated independently with loss of zone 7 BMD. Conclusion Lower preoperative lumbar BMD on the lateral side and lower CFI were correlated with zone 7 BMD loss after THA. Patients with these characteristics should be monitored carefully for severe BMD loss after THA.

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