5-Year Clinical and Radiographic Results of the Direct Anterior Approach for Total Hip Arthroplasty Using a Collared Cementless Femoral Short-Stem Prosthesis

The aim of this study was to investigate the radiological and clinical outcome of the direct anterior approach (DAA) in total hip arthroplasty (THA) using a collared cementless femoral short-stem. This retrospective study included 124 patients with 135 THAs operated from 2014 to 2016 using a collared cementless triple tapered hydroxyapatite-coated femoral short-stem (AMIStem H Collared®, Medacta International, Castel San Pietro, Switzerland) implanted with a DAA. Follow-up was performed at three months, 12 months, and five years. Clinical outcome was assessed using the hip osteoarthritis outcome score (HOOS) and radiological analysis was done using conventional radiographs, which included evaluation of the femur morphology based on Dorr classification, of radiolucencies based on the Gruen zone classification and of stem subsidence. The mean age was 67.7 ± 11.3 years and the mean body mass index (BMI) was 27.4 ± 4.4 kg/m2. The stem survival rate at five years was 99.1% with one revision due to recurrent dislocations. Mean HOOS score improved from 40.9 ± 18.3 preoperatively to 81.5 ± 19.7 at three months, 89.3 ± 10.9 at 12 months, and 89.0 ± 14.0 at five years (all with p < 0.001). No significant correlations were found between age, femoral bone morphology, BMI and HOOS, and the appearance of relevant radiolucencies.

Reliability of hip joint position sense tests using a clinically applicable measurement tool in elderly participants with unilateral hip osteoarthritis

Hip joint proprioception is vital in maintaining posture and stability in elderly individuals. Examining hip joint position sense (JPS) using reliable tools is important in contemporary clinical practice. The objective of this study is to evaluate the intra-rater and inter-rater reliability of hip JPS tests using a clinically applicable measurement tool in elderly individuals with unilateral hip osteoarthritis (OA). Sixty-two individuals (mean age = 67.5 years) diagnosed with unilateral hip OA participated in this study. The JPS tests were evaluated using a digital inclinometer in hip flexion and abduction directions. The absolute difference between target and reproduced angle (repositioning error) in degrees was taken to measure JPS accuracy. The intraclass correlation coefficient (ICC (2.k), was used to assess the reliability. The Intra rater-reliability for hip JPS tests showed very good agreement in the lying position (hip flexion-ICC = 0.88–0.92; standard error of measurement (SEM) = 0.06–0.07, hip abduction-ICC = 0.89–0.91; SEM = 0.06–0.07) and good agreement in the standing position (hip flexion-ICC = 0.69–0.72; SEM = 0.07, hip abduction-ICC = 0.66–0.69; SEM = 0.06–0.08). Likewise, inter-rater reliability for hip JPS tests demonstrated very good agreement in the lying position (hip flexion-ICC = 0.87–0.89; SEM = 0.06–0.07, hip abduction-ICC = 0.87–0.91; SEM = 0.07) and good agreement in the standing position (hip flexion-ICC = 0.64–0.66; SEM = 0.08, hip abduction-ICC = 0.60–0.72; SEM = 0.06–0.09). The results support the use of hip JPS tests in clinical practice and should be incorporated in assessing and managing elderly participants with hip OA.

Global, regional, and national burdens of hip osteoarthritis from 1990 to 2019: estimates from the 2019 Global Burden of Disease Study

Background Hip osteoarthritis is a common disabling condition of the hip joint and is associated with a substantial health burden. We assessed the epidemiological patterns of hip osteoarthritis from 1990 to 2019 by sex, age, and socio-demographic index (SDI). Methods Age-standardized rates (ASRs) were obtained for the incidence and disability-adjusted life years (DALYs) of hip osteoarthritis from 1990 to 2019 for 21 regions, encompassing a total of 204 countries and territories. The estimated annual percentage changes (EAPCs) of ASRs were calculated to evaluate the trends in the incidence and DALYs of hip osteoarthritis over these 30 years. Results Globally, from 1990 to 2019, the age-standardized incidence rate (ASIR) of hip osteoarthritis increased from 17.02 per 100,000 persons to 18.70 per 100,000 persons, with an upward trend in the EAPC of 0.32 (0.29–0.34), whereas the age-standardized DALY rate increased from 11.54 per 100,000 persons to 12.57 per 100,000 persons, with an EAPC of 0.29 (0.27–0.32). In 2019, the EAPCs of the ASIR and age-standardized DALY rate of hip osteoarthritis were positively associated with the SDI of hip osteoarthritis. In 1990 and 2019, the incidence of hip osteoarthritis was unimodally distributed across different age groups, with a peak incidence in the 60–64-year-old age group, whereas the DALYs increased with age. Conclusions The incidence and DALYs of hip osteoarthritis have been increasing globally. The EAPCs of the ASIR and age-standardized DALY rate were particularly significant in developed regions and varied across nations and regions, indicating the urgent need for governments and medical institutions to increase the awareness regarding risk factors, consequences of hip osteoarthritis.

The Use of Scoring Hip Osteoarthritis with MRI as an Assessment Tool for Physiotherapeutic Treatment in Patients with Osteoarthritis of the Hip

Rehabilitation programs are considered effective at reducing the impact of osteoarthritis (OA) of the hip; however, studies using reliable measures related to OA biomarkers to assess the effects of rehabilitation are lacking. The objective of this study was to investigate whether an MRI-based (Magnetic Resonance Imaging-based), semi-quantitative system for an OA severity assessment is feasible for the evaluation of the structural changes in the joint observed during a long-term physiotherapy program in patients with hip OA. The study group consisted of 37 adult OA patients who participated in a 12-month physiotherapy program. The Scoring hip osteoarthritis with MRI (SHOMRI) system was used to evaluate the severity of structural changes related to hip OA. Hip disability and the osteoarthritis outcome score (HOOS) and the core set of performance-based tests recommended by Osteoarthritis Research Society International were used for functional assessment. SHOMRI showed excellent inter- and intra-rater agreement, proving to be a reliable method for the evaluation of hip abnormalities. At the 12-month follow-up no statistically significant changes were observed within the hip joint; however, a trend of structural progression was detected. There was a negative correlation between most of the SHOMRI and HOOS subscales at baseline and the 12-month follow-up. Although SHOMRI provides a reliable assessment of the hip joint in patients with OA it showed a limited value in detecting significant changes over time in the patients receiving physiotherapy over a 12-month period.

COMPARISON OF PSYCHOLOGICAL DIMENSIONS IN RURAL POPULATION WITH VARIOUS JOINT DEGENERATIVE ARTHRITIS

Background and Purpose:Osteoarthritis patients often suffer from anxiety which can affect the disease prognosis. This study is aimed at assessing the various psychological dimensions in different joint arthritic subjects of the rural population and finding the most common joint arthritis that can lead to anxiety in the rural population. Materials & methods: A total of 252 subjects satisfied the inclusion criteria and were recruited for the study after written informed consent and were asked to fill in the GPS online through Google forms. The “feelings” subscale assesses the patient’s psychological stress due to pain and disease. The psychological dimensions of sub-section feelings of GPS were analyzed by one-way ANOVA to assess whether there is a difference on average in the scores among the three groups at a [Formula: see text] significant level. Tukey HSD was used for post hoc pairwise comparisons. Results: One-way ANOVA results showed that there was no statistically significant difference between the groups for fear, level of anxiety, depression, stress, and fatigue. Tukey HSD post hoc comparison revealed that the results were statistically significant for fear ([Formula: see text], [Formula: see text]) and fatigue levels ([Formula: see text], [Formula: see text]). The Tukey HSD post hoc comparison for levels of anxiety, depression, and stress was not statistically significant. Conclusion: From this study, we conclude that anxiety, fatigue, and fear are highly prevalent in hip osteoarthritis. Anxiety is associated with all joint osteoarthritis and can result in poor quality of living. We recommend physicians to emphasize psychological dimensions and address them at an early stage in order to achieve a better prognosis in degenerative joint diseases.

Analysis of the factors determining the development of postoperative pain in patients after knee and hip replacement surgery

Chronic postoperative pain (POP) is a serious complication of total replacement (TR) of the knee (KJ) and hip (HJ) joints.Objective: to determine the factors associated with POP in patients after TR of KJ or HJ.Patients and methods. The study group consisted of 124 patients with knee osteoarthritis or hip osteoarthritis (age 63.6±9.9 years, 63% women and 37% men) who underwent TR of KJ or HJ. POP was defined as pain ≥40 mm on a numerical rating scale persistent for ≥3 months. Its presence was assessed after 3 and 6 months by telephone survey. Comparison of patients with POP and without it was carried out for a number of factors identified before surgery.Results and discussion. The incidence of POP was 27.4%. There was no difference in the incidence of POP in patients after TR of KJ or HJ: 28.1% and 26.9% (p=0.88). POP was statistically significantly associated with parameters such as higher body mass index (BMI); the intensity of pain at rest; general assessment of impairment; WOMAC index pain, stiffness and overall; severity of symptoms of neuropathic pain (PainDETECT); signs of depression and anxiety (HADS).The risk of POP was significantly higher (p<0.05) with BMI >30 kg/m2 (odds ratio, OR 2.755; 95% confidence interval, CI 1.053–7.206), rest pain ≥40 mm on a visual analog scale (OR 1.349; 95% CI 0.478–3.803), PainDETECT scores ≥13 (OR 3.598; 95% CI 1.048–12.36) and HADS depression ≥8 (OR 2.193; 95% CI 0.745–6.454), presence of ≥2 sources of pain (OR 6.996; 95% CI 2.358–20.756).Conclusion. It was found that the risk of POP after TR of KJ and HJ is higher in patients with overweight, severe preoperative pain, signs of neuropathic pain and depression, as well as in the presence of several sources of pain (except for the affected joint, that was replaced surgically).

No evidence that drugs reduce progression of osteoarthritis

Overview of: Yang W, Sun C, He SQ et al. The efficacy and safety of disease-modifying osteoarthritis drugs for knee and hip osteoarthritis-a systematic review and network meta-analysis. J Gen Intern Med. 2021;36:2085–93.