Feasibility and sustainability of working in different types of jobs after total hip arthroplasty: analysis of longitudinal data from two cohorts

ObjectivesTo investigate the rates of return to work and workability among working-age people following total hip arthroplasty (THA).MethodsParticipants from the Geneva Arthroplasty Registry and the Clinical Outcomes for Arthroplasty Study aged 18–64 years when they had primary THA and with at least 5 years’ follow-up were mailed a questionnaire 2017–2019. Information was collected about preoperative and post-THA employment along with exposure to physically demanding activities at work or in leisure. Patterns of change of job were explored. Survival analyses using Cox proportional hazard models were created to explore risk factors for having to stop work because of difficulties with the replaced hip.ResultsIn total, 825 returned a questionnaire (response 58%), 392 (48%) men, mean age 58 years, median follow-up 7.5 years post-THA. The majority (93%) of those who worked preoperatively returned to work, mostly in the same sector but higher rates of non-return (36%–41%) were seen among process, plant and machine operatives and workers in elementary occupations. 7% reported subsequently leaving work because of their replaced hip and the risk of this was strongly associated with: standing >4 hours/day (HR 3.81, 95% CI 1.62 to 8.96); kneeling/squatting (HR 3.32, 95% CI 1.46 to 7.55) and/or carrying/lifting ≥10 kg (HR 5.43, 95% CI 2.29 to 12.88).ConclusionsIt may be more difficult to return to some (particularly physically demanding) jobs post-THA than others. Rehabilitation may need to be targeted to these types of workers or it may be that redeployment or job change counselling are required.

Validation of the Swedish Version of Western Ontario Osteoarthritis of the Shoulder Index

BackgroundThe Western Ontario of the Shoulder index (WOOS) is a patient-reported, disease-specific instrument, designed to measure quality of life in patients with osteoarthritis of the shoulder. The Swedish Shoulder Arthroplasty Registry (SSAR) uses WOOS and EuroQoL 5-dimensions 3 levels (EQ-5D-3L) as patient reported outcome measures. The purpose of this study was to test the validity, responsiveness, and reliability of the Swedish translation of WOOS for patients with osteoarthritis of the shoulder.MethodsData was collected from three shoulder arthroplasty studies performed during 2005-2013, with 23, 21, and 19 patients respectively. Forms were collected preoperatively, and postoperatively between 12 and 24 months. WOOS and EQ-5D-3L were used in all three studies. Additionally, the Oxford Shoulder Score (OSS) (n=23) was used in one study, and the Constant-Murley score (CMS) (n=40) in two of the studies. Validity was analysed by calculating Pearson’s correlation coefficient (PCC). Cronbach’s alpha (CA) was used to estimate internal consistency and reliability. The responsiveness of WOOS was measured by calculating effect size and standardized response mean. To assess the performance of WOOS over time, we present repeated measures of WOOS in the registry over a 10-year period.ResultsThe validity analysis showed excellent correlations of WOOS to CMS, OSS and EQ-5D 3L, with Pearson’s correlation coefficient of 0.72, 0.83, and 0.62 respectively (P<0.001). There were adequate floor effects in the sport and lifestyle domains preoperatively, and adequate ceiling effects in all domains postoperatively. There were no floor effects and adequate ceiling effects for total WOOS. Analyzing reliability, Cronbach’s alpha was 0.95 for the pre- and postoperative WOOS scores combined. The analysis of responsiveness for WOOS showed an effect size of 2.52 and a standardized response mean of 1.43.The individual results measured by WOOS within the registry shows stable levels from 1 to 10 years.ConclusionThe Swedish translation of WOOS is valid, reliable, and responsive for use in a clinical setting for patients with glenohumeral osteoarthritis treated with shoulder arthroplasty, and we regard it as an appropriate instrument for use in the Swedish Shoulder Arthroplasty Registry.

Epidemiology of Hip And Knee Arthroplasty and Periprosthetic Joint Infection in Russian Federation

Background. Since there is no national arthroplasty registry in the Russian Federation, the exact number of arthroplasty operations performed is unknown. Aim of the study to evaluate the epidemiology of primary, revision hip and knee arthroplasty and periprosthetic joint infection in Russian Federation. Materials and Methods. The inquires were made to 85 subjects, 73 federal state budget institutions and 30 private hospitals. Results. Answers were received from 76 subjects of Russian Federation, 41 federal and 18 private hospitals. The studied indicators revealed to be pretty much heterogenic. The decrease of operations number from 20% to 40% in subjects of Russian Federation due to SARS-CoV-2 pandemic forced us to make no analysis for these 2020 indicators in Russian Federation generally. 147 061 primary hip and knee arthroplasties were performed in 2019 in Russian Federaion. 7 770 revison hip and knee arthroplasties were done. 6 606 cases of severe orthopaedic implant-assosiated infection were cured including 4 282 cases post hip and knee arthroplasties that constitutes 2,91 % from primary arthroplasties. Conclusions. The frequency of periprosthetic joint infection in Russian Federation correlates to the world data. High complexity for patients routing with implant-assosiated infection and strong demand for Federal Center of implant-assosiated orthopaedic infection are revealed.

Establishing an institutional reverse total shoulder arthroplasty registry

Background The number of implanted reverse total shoulder arthroplasties (RTSA) is increasing worldwide. To improve patient care, institutional and national arthroplasty registries are being established worldwide to record outcome data. This article aims to describe the setup of an RTSA database in a high-volume university orthopedic hospital. Methods All patients who received an RTSA at the authors’ tertiary referral hospital have been followed and individual datasets have been systematically recorded in a REDCap database since 2005. The data are captured longitudinally as a primary preoperative survey and as a regular or irregular postoperative follow-up. All baseline demographic data, patient history, surgical details, arthroplasty details, adverse events, and radiographic and clinical outcome scores (Constant–Murley score, Subjective Shoulder Value, range of motion) are recorded. Results A total of 1433 RTSA were implanted between January 2005 and December 2020. Of these, 1184 (83%) were primary implantations and 249 (17%) were secondary cases. The cohort had a mean age of 70 ± 10 years, was 39% male, and was classified ASA II in 59%. The lost to follow-up rate was 18% after 2 years, 22% after 5 years, and 53% after 10 years. The overall complication rate with 2 years minimum follow-up was 18% (156/854 shoulders) with reintervention in 10% (82/854 shoulders). Conclusion A well-managed institutional arthroplasty registry, including structured clinical and radiological follow-up assessments, offers the opportunity for high-quality long-term patient and arthroplasty outcome analysis. Such data are not only helpful for analyzing patient outcome and implant survival, but will be increasingly important to justify our daily clinical practice against different stakeholders in the various health care systems.

The influence of bearing surfaces on revisions due to dislocations in total hip arthroplasty

Introduction Recurrent dislocations are still the most frequent reason for revision in total hip arthroplasty (THA). The impact of bearing surfaces on dislocations is still controversial. We hypothesized that: (1) bearing surfaces influence the revisions due to dislocations; (2) ceramic-on-ceramic reduced the revisions for dislocations in adjusted models; (3) Delta-on-Delta bearings reduced the revisions for dislocations in comparison to surfaces with cross-linked polyethylene. Materials and methods The regional arthroplasty registry was enquired about bearing surfaces and revisions for dislocations and instability. Unadjusted and adjusted rates were provided, including sex, age (<65 years or ≥65 years), head diameter (≤28 mm or >28 mm; <36 mm or ≥36 mm) as variables. 44,065 THAs were included. Results The rate of revisions for dislocations was significantly lower in ceramic-on-ceramic and metal-on-metal bearings (unadjusted rates). After adjusting for age, sex, and head size (36 and 28 mm), hard-on-hard bearings were protective (p < 0.05): ceramic-on-ceramic had a lower risk of revisions due to dislocation than ceramic-on-polyethylene (HR 1.6, 95% CI 1.2–2.2 p = 0.0009). The rate of revisions for dislocation was similar in bearings with cross-linked polyethylene and Delta-on-Delta articulations, in unadjusted and adjusted models. Conclusion Bearings with conventional polyethylene were more predisposed to dislocations. Currently adopted bearings exerted no significant influence on revisions due to dislocations. These findings could be primarily related to wear, but due to the time distribution, soft tissue envelopes and surface tension may also play a role. Pre-clinical biomechanical evaluations and prospective matched cohort studies are required to draw definitive conclusions.

Eighty Percent Survival of Resurfacing Implants in the Knee After 10 Years: A Nationwide Cohort Study on 379 Procedures from the Danish Knee Arthroplasty Registry

Objective Focal cartilage injuries are debilitating and difficult to treat. Biological cartilage repair procedures are used for patients younger than 40 years, and knee arthroplasties are generally reserved for patients older than 60 years. Resurfacing implants are well suited for patients in this treatment gap. The objective was to investigate the 10-year survival of resurfacing implants in the Danish Knee Arthroplasty Registry. Design In this retrospective cohort study, patients treated with resurfacing implants were followed longitudinally in the Danish Knee Arthroplasty Registry from 1997 to 2020. The primary endpoint was revision surgery. The survival of the resurfacing implants was analyzed by Kaplan-Meier method. Results A total of 379 resurfacing implant procedures were retrieved from the Danish Knee Arthroplasty Registry. The mean age and weight of patients were 50 years (SD = 11) and 84 kg (SD = 17), respectively. The indications for surgery were as follows: secondary osteoarthritis (42%), primary osteoarthritis (32%), and osteochondral lesions (20%). Within the follow-up period, 70 (19%) of the implants were revised to arthroplasties. The 1-, 5-, and 10-year revision-free survival estimation was 0.95 (95% CI 0.93-0.97), 0.84 (95% CI 0.80-0.88), and 0.80 (95% CI 0.75-0.84), respectively. The median time to revision was 2 years. Conclusion The 10-year revision-free survival rate for resurfacing implants was 80%. Based on the revision rates, this treatment offers a viable alternative to biological cartilage repair methods in patients aged 40 to 60 years with focal cartilage pathology. Improved patient selection could further improve the implant survival rate. Further studies are needed to investigate this treatment method.

Secondary Patellar Resurfacing in TKA: A Combined Analysis of Registry Data and Biomechanical Testing

The German Arthroplasty registry (EPRD) has shown that different prosthesis systems have different rates of secondary patellar resurfacing: four years after implantation, the posterior-stabilized (PS) Vega prosthesis has a 3.2% risk of secondary patellar resurfacing compared to the cruciate-retaining (CR) Columbus prosthesis at 1.0% (both Aesculap AG, Tuttlingen, Germany). We hypothesized that PS implants have increased retropatellar pressure and a decreased retropatellar contact area compared to a CR design, which may lead to an increased likelihood of secondary patellar resurfacing. Eight fresh frozen specimens (cohort 1) were tested with an established knee rig. In addition, a possible influence of the registry-based patient collective (cohort 2) was investigated. No significant differences were found in patient data–cohort 2-(sex, age). A generally lower number of PS system cases is noteworthy. No significant increased patella pressure could be detected with the PS design, but a lower contact area was observed (cohort 1). Lower quadriceps force (100°–130° flexion), increased anterior movement of the tibia (rollback), greater external tilt of the patella, and increasing facet pressure in the Vega PS design indicate a multifactorial cause for a higher rate of secondary resurfacing which was found in the EPRD patient cohort and might be related to the PS’ principle function.