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Garcia-Rey E, Saldaña L. Long-term results of total hip arthroplasty in severe congenital hip disease: A ten- to 20-year follow-up study. Orthop Traumatol Surg Res 2024; 110:103850. [PMID: 38428484 DOI: 10.1016/j.otsr.2024.103850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/20/2024] [Accepted: 02/23/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION The impact of bone deformities, previous surgeries, and the surgical technique in total hip arthroplasty (THA) for congenital dislocation of the hip (CDH) at a long-term has not been clearly defined yet. In this single-centre observational study we sought to assess patients undergoing THA due to osteoarthritis secondary to severe CDH with low or high dislocation ten- to 20-years after surgery. To determine this purpose, we assessed: (1) THA-related complications and reoperations; (2) the clinical outcome, patients' satisfaction and radiological results; and (3) the possible risk factors for reoperation with particular attention to the surgical technique and the influence of prior surgeries. HYPOTHESIS We hypothesized that an anatomical reconstruction of the hip would decrease the reoperations rates in patients undergoing THA with severe CDH. METHODS Seventy-five patients (85 hips) operated between 1999 and 2012 at our large tertiary hospital were analyzed. Fifty-six hips were diagnosed as low dislocation (group 1) and 29 hips as high dislocation (group 2). The existence of prior surgeries was frequent: group 1, pelvic osteotomies 6 hips, femoral osteotomies 7, tectoplasty (shelf) 6, resection arthroplasty 1 and lowering of the greater trochanter 1; group 2 included pelvic osteotomies 10 hips, femoral osteotomies 10, and a femoral lengthening 2. The number of additional procedures during THA was: group 1 (19/56 [34%]), acetabular roof bone autograft 8 hips, acetabular medial wall autograft 2, hardware removal 6, extended femoral osteotomy 2, and a femoral shortening 1; group 2 (20/29 [69%]), acetabular bone autograft 12 hips, medial autograft 1, hardware removal 1, extended femoral osteotomy 2, and a femoral shortening 4 hips. The clinical and the radiological analysis were compared in both groups for a minimum follow-up of ten years. Cox regression models were used to detect risk factors for reoperation. RESULTS Nine patients (13.8%) required reoperation for the following reasons: cup loosening (5 hips), periprosthetic femoral fracture (3) and stem loosening (1); seven had prior surgeries. The 12-year survival rate for reoperation for any reason was 96.3% (95% confidence interval [CI] 91.2-100) in group 1 and 75.7% (95% CI, 65.8-90.8) in group 2 (p=0.003). Patients with high dislocation (p=0.02, hazard ratio [HR]: 6.25, 95% CI, 1.26-30.9) and those with an acetabular component inclination placed out of the target zone between 35° and 50° (p=0.03, HR: 4.27, 95% CI, 1.13-16.1) had a higher risk of reoperation. DISCUSSION An optimal placement of the acetabular component decreased the reoperation rates in patients undergoing THA for severe CDH. Hips with high dislocation and the existence of prior surgery can affect THA implantation. LEVEL OF EVIDENCE III; retrospective; comparative.
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Affiliation(s)
- Eduardo Garcia-Rey
- Hôpital Universitario La Paz-Idi Paz, P Castellana 261, Madrid, Spain; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, CIBER-BBN, P° Castellana 261, 28046 Madrid, Spain.
| | - Laura Saldaña
- Hôpital Universitario La Paz-Idi Paz, P Castellana 261, Madrid, Spain; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, CIBER-BBN, P° Castellana 261, 28046 Madrid, Spain
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Zgouridou A, Kenanidis E, Potoupnis M, Tsiridis E. Global mapping of institutional and hospital-based (Level II-IV) arthroplasty registries: a scoping review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1219-1251. [PMID: 37768398 PMCID: PMC10858160 DOI: 10.1007/s00590-023-03691-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/13/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Four joint arthroplasty registries (JARs) levels exist based on the recorded data type. Level I JARs are national registries that record primary data. Hospital or institutional JARs (Level II-IV) document further data (patient-reported outcomes, demographic, radiographic). A worldwide list of Level II-IV JARs must be created to effectively assess and categorize these data. METHODS Our study is a systematic scoping review that followed the PRISMA guidelines and included 648 studies. Based on their publications, the study aimed to map the existing Level II-IV JARs worldwide. The secondary aim was to record their lifetime, publications' number and frequency and recognise differences with national JARs. RESULTS One hundred five Level II-IV JARs were identified. Forty-eight hospital-based, 45 institutional, and 12 regional JARs. Fifty JARs were found in America, 39 in Europe, nine in Asia, six in Oceania and one in Africa. They have published 485 cohorts, 91 case-series, 49 case-control, nine cross-sectional studies, eight registry protocols and six randomized trials. Most cohort studies were retrospective. Twenty-three per cent of papers studied patient-reported outcomes, 21.45% surgical complications, 13.73% postoperative clinical and 5.25% radiographic outcomes, and 11.88% were survival analyses. Forty-four JARs have published only one paper. Level I JARs primarily publish implant revision risk annual reports, while Level IV JARs collect comprehensive data to conduct retrospective cohort studies. CONCLUSIONS This is the first study mapping all Level II-IV JARs worldwide. Most JARs are found in Europe and America, reporting on retrospective cohorts, but only a few report on studies systematically.
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Affiliation(s)
- Aikaterini Zgouridou
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Eustathios Kenanidis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece.
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece.
| | - Michael Potoupnis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
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Penrose CT, George SZ, Bolognesi MP, Bhavsar NA, Horn ME. Do You PROMIS (Patient Reported Outcomes Measurement Information System)? Physical Function and Pain Interference Scores After Total Knee and Hip Arthroplasty. Arthroplast Today 2023; 23:101208. [PMID: 37745958 PMCID: PMC10517261 DOI: 10.1016/j.artd.2023.101208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 06/21/2023] [Accepted: 07/26/2023] [Indexed: 09/26/2023] Open
Abstract
Background Physical function and pain outcomes vary after arthroplasty. We investigated differences in postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) physical function (PF) and pain interference (PI) scores for patients undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA). We aimed to identify preoperative factors that predict postoperative PROMIS scores. Methods Patients who underwent TKA and THA from 2014-2020 were eligible. Preoperative variables including demographics, comorbidities, and pain scores were obtained from the medical record. Patients completed surveys measuring postoperative PF and PI. Descriptive statistics and separate linear regression models for each anatomical location were performed to examine factors predicting postoperative PROMIS PF and PI scores. Results Surveys were completed by 2411 patients (19.5% response rate). Unadjusted mean PF postoperative scores were 47.2 for TKA and 48.8 for THA. Preoperative predictors of lower PF included female sex; body mass index and comorbidities for TKA and THA; and age, tobacco use, and non-White race for THA. Mean PI scores were 47.9 for THA and 49.0 for TKA. Preoperative predictors of increased PI included non-White race and increased body mass index for TKA and THA; higher preoperative pain for TKA; and female sex and increased comorbidity for THA. Conclusions Postoperative PROMIS scores were similar for TKA and THA, with THA having slightly higher PF and lower PI scores. Regression models using preoperative variables showed similar performance for TKA compared with THA. These findings suggest areas for future development of clinical decision support tools.
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Affiliation(s)
- Colin T. Penrose
- Division of Adult Reconstruction, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Steven Z. George
- Department of Orthopaedic Surgery and Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Michael P. Bolognesi
- Division of Adult Reconstruction, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Nrupen A. Bhavsar
- Department of General Internal Medicine, Duke University, Durham, NC, USA
| | - Maggie E. Horn
- Division of Physical Therapy, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
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Harada T, Hamai S, Hara D, Fujita T, Okazawa K, Kozono N, Kawahara S, Yamaguchi R, Fujii M, Ikemura S, Motomura G, Nakashima Y. Reverse dynamics analysis of contact force and muscle activities during the golf swing after total hip arthroplasty. Sci Rep 2023; 13:8688. [PMID: 37248313 DOI: 10.1038/s41598-023-35484-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 05/18/2023] [Indexed: 05/31/2023] Open
Abstract
There are no reports on hip kinetics including contact forces and muscle activities during the golf swing after total hip arthroplasty (THA). The aim of this study was to identify the characteristics of three-dimensional dynamics during the golf swing. Ten unilateral primary THA patients participated in motion capture test of their driver golf swing. The driver swing produced approximately 20-30° of rotation in both lead and trail replaced hips. The mean hip contact forces (HCFs) of lead and trail replaced hips were 5.1 and 6.6 × body weight, respectively. Left and right THAs showed similar HCFs of lead and trail hips. More than 60% of the Percent maximum voluntary isometric contraction was found in bilateral iliopsoas muscles in all unilateral THA. Three factors [female sex, lower modified Harris Hip Score, and higher HCF of surgical side] were associated with the golf-related replacement hip pain. Golf is an admissible sport after THA because driver swings do not contribute excessive rotation or contact forces to hip prostheses. HCF could be reduced through swing adjustments, which may allow patients with golf-related replacement hip pain to develop a comfortable golf game free from pain.
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Affiliation(s)
- Tetsunari Harada
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
- Department of Medical-Engineering Collaboration for Healthy Longevity, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Daisuke Hara
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Tsutomu Fujita
- Department of Rehabilitation, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kazuya Okazawa
- Department of Rehabilitation, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Naoya Kozono
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shinya Kawahara
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Ryosuke Yamaguchi
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Masanori Fujii
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Saga University, 5-1-1 Nabeshima, Saga, 849-0937, Japan
| | - Satoshi Ikemura
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Goro Motomura
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Jang SJ, Fontana MA, Kunze KN, Anderson CG, Sculco TP, Mayman DJ, Jerabek SA, Vigdorchik JM, Sculco PK. An Interpretable Machine Learning Model for Predicting 10-Year Total Hip Arthroplasty Risk. J Arthroplasty 2023:S0883-5403(23)00336-4. [PMID: 37019312 DOI: 10.1016/j.arth.2023.03.087] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/20/2023] [Accepted: 03/25/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND As the demand for total hip arthroplasty (THA) rises, a predictive model for THA risk may aid patients and clinicians in augmenting shared decision-making. We aimed to develop and validate a model predicting THA within 10 years in patients using demographic, clinical, and deep learning (DL)-automated radiographic measurements. METHODS Patients enrolled in the Osteoarthritis Initiative were included. DL algorithms measuring osteoarthritis- and dysplasia-relevant parameters on baseline pelvis radiographs were developed. Demographic, clinical, and radiographic measurement variables were then used to train generalized additive models to predict THA within 10 years from baseline. A total of 4,796 patients were included (9,592 hips; 58% female; 230 THAs (2.4%)). Model performance using 1) baseline demographic and clinical variables 2) radiographic variables, and 3) all variables were compared. RESULTS Using 110 demographic and clinical variables, the model had a baseline area under the receiver operating curve (AUROC) of 0.68 and area under the precision recall curve (AUPRC) of 0.08. Using 26 DL-automated hip measurements, the AUROC was 0.77 and AUPRC was 0.22. Combining all variables, the model improved to an AUROC of 0.81 and AUPRC of 0.28. Three of the top five predictive features in the combined model were radiographic variables including minimum joint space along with hip pain and analgesic use. Partial dependency plots revealed predictive discontinuities for radiographic measurements consistent with literature thresholds of osteoarthritis progression and hip dysplasia. CONCLUSION A machine learning model predicting 10-year THA performed more accurately with DL radiographic measurements. The model weighted predictive variables in concordance with clinical THA-pathology assessments.
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Affiliation(s)
- Seong Jun Jang
- Weill Cornell College of Medicine, New York, NY, USA; Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
| | - Mark A Fontana
- Weill Cornell College of Medicine, New York, NY, USA; Center for Analytics, Modeling, and Performance, Hospital for Special Surgery, New York, NY, USA
| | - Kyle N Kunze
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | | | - Thomas P Sculco
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA; Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - David J Mayman
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA; Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Seth A Jerabek
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA; Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Jonathan M Vigdorchik
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA; Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Peter K Sculco
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA; Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
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Rhee I, Tirosh O, Ho A, Griffith A, Salehi L, Jensen A, Spiers L, Tran P. Do Certain Patient Cohorts Benefit from Different Surgical Approaches in Total Hip Arthroplasty? J Arthroplasty 2023:S0883-5403(23)00134-1. [PMID: 36813211 DOI: 10.1016/j.arth.2023.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/07/2023] [Accepted: 02/11/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Unfortunately, an important minority of total hip arthroplasty (THA) patients report unsatisfactory outcomes. We aimed to compare the patient reported outcome measures (PROMs) for three main THA approaches and evaluate the effect of sex and body mass index (BMI) on PROMs over a 10-year period. METHODS A total of 906 patients (535 women, mean BMI 30.7 (range, 15 to 58); 371 men, mean BMI 31.2 (range, 17 to 56)) who underwent primary THA by an anterior (AA)(312), lateral (LA)(211), or posterior (PA)(383) approach between 2009 and 2020 at a single institution were evaluated utilizing the Oxford Hip Score (OHS). PROMs were prospectively collected before surgery and routinely at 6 weeks, 6 months, as well as 1, 2, 5, and 10 years after surgery. RESULTS All three approaches resulted in significant postoperative OHS improvement. Overall, women experienced significantly lower OHS than men (p<0.01). A significant negative relationship between BMI and OHS was identified and this relationship was exacerbated with an AA (p<0.01). Women who had a BMI≤25, reported OHS with a difference greater than 5 points in favor of the AA, while women who had a BMI≥42 reported an OHS with a difference greater than 5 in favor of the LA. The BMI ranges were wider when comparing the anterior and posterior approaches, 22 to 46 for women and >50 for men. For men, an OHS difference greater than 5 was only seen with BMI≥45 in favor of the LA. CONCLUSION This study demonstrated that no single THA approach is superior than another, but rather that certain patient cohorts may benefit more from specific approaches. We suggest that women who have a BMI ≤ 25 should consider undergoing an anterior approach for THA, while for women who have a BMI ≥42 a lateral approach or for a BMI ≥46, a posterior approach is advised.
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Affiliation(s)
- Isaac Rhee
- Department of Orthopaedic Surgery, Western Health, Melbourne, VIC, Australia
| | - Oren Tirosh
- Department of Orthopaedic Surgery, Western Health, Melbourne, VIC, Australia; Swinburne University of Technology, Melbourne, VIC, Australia
| | - Andy Ho
- Department of Orthopaedic Surgery, Western Health, Melbourne, VIC, Australia
| | - Andrew Griffith
- Department of Orthopaedic Surgery, Western Health, Melbourne, VIC, Australia
| | - Lily Salehi
- Department of Orthopaedic Surgery, Western Health, Melbourne, VIC, Australia
| | - Amalie Jensen
- Department of Orthopaedic Surgery, Western Health, Melbourne, VIC, Australia
| | - Libby Spiers
- Department of Orthopaedic Surgery, Western Health, Melbourne, VIC, Australia
| | - Phong Tran
- Department of Orthopaedic Surgery, Western Health, Melbourne, VIC, Australia; Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Victoria University, St. Albans, VIC, Australia; Swinburne University of Technology, Melbourne, VIC, Australia.
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The Effect of Surgeon and Hospital Volume on Total Hip Arthroplasty Patient-Reported Outcome Measures: An American Joint Replacement Registry Study. J Am Acad Orthop Surg 2023; 31:205-211. [PMID: 36450013 DOI: 10.5435/jaaos-d-22-00525] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 10/08/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Some studies have shown lower morbidity and mortality rates with increased surgeon and hospital volumes after total hip arthroplasty (THA). This study sought to determine the relationship between surgeon and hospital volumes and patient-reported outcome measures after THA using American Joint Replacement Registry data. METHODS Using American Joint Replacement Registry data from 2012 to 2020, 4,447 primary, elective THAs with both preoperative and 1-year postoperative Hip Dysfunction and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR) scores were analyzed. This study was powered to detect the minimum clinically important difference (MCID). The main exposure variables were median annual surgeon and hospital volumes. Tertiles were formed based on the median annual number of THAs conducted: low-volume (1 to 42), medium-volume (42 to 96), and high-volume (≥96) surgeons and low-volume (1 to 201), medium-volume (201 to 392), and high-volume (≥392) hospitals. Mean preoperative and 1-year postoperative HOOS-JR scores were compared. RESULTS Preoperative HOOS-JR scores were significantly higher at high-volume hospitals than low-volume and medium-volume hospitals (49.66 ± 15.19 vs. 47.68 ± 15.09 and 48.34 ± 15.22, P < 0.001), although these differences were less than the MCID. At the 1-year follow-up, no difference was noted with no resultant MCID. Preoperative and 1-year HOOS-JR scores did not markedly vary with surgeon volume. In multivariate regression, low-volume and medium-volume surgeons and hospitals had similar odds of MCID achievement in HOOS-JR scores compared with high-volume surgeons and hospitals, respectively. CONCLUSION Using the HOOS-JR score as a validated patient-reported outcome measure, higher surgeon or hospital THA volume did not correlate with higher postoperative HOOS-JR scores or greater chances of MCID achievement in HOOS-JR scores compared with medium and lower volume surgeons and hospitals.
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Clinical and radiographic outcomes of primary total hip arthroplasty with the revelation hip system using density mapping. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:435-440. [PMID: 35092509 DOI: 10.1007/s00590-022-03210-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 01/10/2022] [Indexed: 10/19/2022]
Abstract
The Revelation Hip System is a cementless stem with a lateral flare concept. Stable fixation is achieved by fitting the stem to the medullary cavity of the proximal lateral femoral cortex. Patients who have undergone total hip arthroplasty using the Revelation Hip System show good postoperative clinical and radiographic outcomes. However, to the best of our knowledge, no study has reported the relationship between stem fitting and clinical or radiological outcomes after the surgery. In the present study, we investigated the relationship between stem fitting and clinical or radiological outcomes after total hip arthroplasty (THA) using the Revelation Hip System. In this study, 28 hips of 26 patients who were treated with the Revelation Hip System for osteoarthritis, osteonecrosis of the femoral head, rheumatoid arthritis, and rapidly destructive coxarthropathy and were followed up for > 5 y were enrolled. These patients were divided into two groups, including the rest fit group (11 hips, group R) and the control group (17 hips, group C), according to the results of the density mapping analysis. In group R, the lateral side of the stem fits on the medullary cavity of the proximal lateral femoral cortex, while in group C, the lateral side of the stem did not fit. Radiographic results showed no significant differences between the groups in terms of stem alignment, subsidence, and stress shielding around the cup. The incidence of stress shielding around the stem in zone 7 was not significant but tended to be higher in group R than in group C (p = 0.052). Clinical outcomes showed no significant differences between group R and group C in terms of the Harris hip score, the Japanese Orthopaedic Association (JOA) score, and the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) total score. However, pain complaints that were assessed by patient-reported outcomes using the 36-Item Short Form Health Survey (SF-36) bodily pain and vitality subscales and the JHEQ pain subscale were significantly higher in group R than in group C at the final follow-up. These results suggest that some patients had pain complaint even if the stems were inserted as per the concept after THA with the Revelation Hip System.Trial Registration911.
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Jacob MK, Reddy PK, Kuruvilla RS, John CV, Poonnoose PM, Oommen AT. Functional and clinical outcome with modified lateral approach total hip arthroplasty in stiff hips with ankylosing spondylitis. World J Orthop 2022; 13:714-724. [PMID: 36159621 PMCID: PMC9453278 DOI: 10.5312/wjo.v13.i8.714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/24/2022] [Accepted: 07/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Ankylosing spondylitis at total hip arthroplasty (THA) has significant hip stiffness with flexion deformity, restricted mobility, and function. Range of movement (ROM) improvement with good functional outcome is seen following THA in these hips. The modified Hardinge approach without abductor compromise is helpful in these stiff hips with associated flexion deformity.
AIM To assess improvement in ROM and functional outcomes with a modified lateral approach THA in ankylosing spondylitis with stiff hips.
METHODS A total of 69 hips that underwent THA with a modified Hardinge approach in 40 patients were evaluated at a mean follow-up of 38.33 mo. All individuals ambulated with weight-bearing as tolerated and ROM exercises from the 1st postoperative day. Modified Harris hip score and ROM were assessed during follow-up. Quality of life assessments using the 36-item and 12-item short form health surveys were done along with clinical and functional outcomes at follow-up. SPSS 22.0 was used for statistical analysis. The correlation of ROM and functional score change was performed using Pearson’s correlation coefficient.
RESULTS Sixty-nine hips with a significant decrease in ROM preoperatively with 32 clinically fused hips showed significant improvement in flexion range. The mean flexion in 69 hips improved from 29.35 ± 31.38 degrees to 102.17 ± 10.48 degrees. The mean difference of 72.82 with a P value < 0.0001 was significant. In total, 45 out of 69 hips had flexion deformity, with 13 hips having a deformity above 30 degrees. The flexion during the follow-up was below 90 degrees in 3 hips. Eleven hips had flexion of 90 degrees at follow-up, while the remaining 55 hips had flexion above 100 degrees. Modified Harris hip score improved from 17.03 ± 6.02 to 90.66 ± 7.23 (P value < 0.0001). The 36-item short form health survey at the follow-up indicated health status in 40 patients as excellent in 11, very good in 20, good in 5, fair in 3, and poor in 1. The mean mental health score was 84.10 ± 11.58. Pain relief was good in all 69 hips. Altogether, 28/40 patients (70%) had no pain, 9 patients (22%) had occasional pain, and 3 patients (8%) had mild to moderate pain with unusual activity. Heterotopic ossification was seen in 21 hips with Brooker class 1 in 14 hips.
CONCLUSION Modified Hardinge approach THA in ankylosing spondylitis with stiff hips with flexion deformity significantly improved ROM, Harris hip score, and quality of life indicated by the 36-item and 12-item short form health surveys.
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Affiliation(s)
- Mathew Kiran Jacob
- Unit 2, Department of Orthopaedics, Christian Medical College Hospital, Vellore 632004, India
| | - Pavan Kumar Reddy
- Unit 2, Department of Orthopaedics, Christian Medical College Hospital, Vellore 632004, India
| | - Roncy Savio Kuruvilla
- Unit 2, Department of Orthopaedics, Christian Medical College Hospital, Vellore 632004, India
| | | | | | - Anil Thomas Oommen
- Unit 2, Department of Orthopaedics, Christian Medical College Hospital, Vellore 632004, India
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Johnson AH, York J, Lashgari CJ, Petre BM, Turcotte JJ, Redziniak DE. Effects of Preexisting Depression and Anxiety on Postoperative Outcomes following Arthroscopic Rotator Cuff Repair. JSES Int 2022; 6:984-988. [PMID: 36353422 PMCID: PMC9637647 DOI: 10.1016/j.jseint.2022.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Rotator cuff repairs (RCRs) are one of the most commonly performed shoulder surgeries in the United States. Psychological health has been shown to influence postoperative outcomes in orthopedic procedures. The purpose of this study is to evaluate the relationship between depression and anxiety (DA) and psychotropic medication and postoperative outcomes following RCR. Methods A single institution retrospective observational cohort study of 816 patients undergoing arthroscopic RCR from January 2014 to October 2020 was conducted. Univariate statistics were used to assess differences in demographics, operative characteristics, and postoperative outcomes; multivariate analysis was used to evaluate risk factors for postoperative complications. Results Patients with DA were more likely to have a higher first (3.60 vs. 3.00, P = .004) and last (1.23 vs. 0.96, P = .042) postoperative pain scores, lower first (18.67 vs. 21.85, P = .008) and last (61.87 vs. 64.71, P = .014) Upper Extremity Functional Score (UEFS), more likely to experience an emergency department visit postoperatively (9.1 vs. 5.0%, P = .028), have a symptomatic recurrent tear (8.2 vs. 3.3%, P = .003), and persistent pain (4.3 vs. 1.2%, P = .011). After controlling for age, sex, body mass index, American Society of Anesthesiologists score, diabetes, smoking, coronary artery disease, asthma, hypertension, psychotropic medication and DA, having DA at the time of surgery was independently predictive of any complication (odds ratio, 2.033; P = .028) and persistent pain (odds ratio, 8.232; P ≤ .001). Patients with and without DA showed significant improvement in postoperative pain and UEFS from the first to the last measurement (P < .001). Conclusion DA is not a deterrent for RCR but targeted interventions may be needed to decrease the occurrence of complications.
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Oommen AT, Hariharan TD, Kandagaddala M, Chandy VJ, Poonnoose PM, Shankar AA. Spinopelvic Mobility Pattern and Acetabular Anteversion in Stiff Hips With Ankylosing Spondylitis After Total Hip Arthroplasty. Arthroplast Today 2022; 16:182-191. [PMID: 35774417 PMCID: PMC9237950 DOI: 10.1016/j.artd.2022.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 04/29/2022] [Accepted: 05/08/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Fused hips with spine stiffness in ankylosing spondylitis (AS) reduce spinopelvic mobility. We aimed to assess spinopelvic mobility pattern and acetabular anteversion in AS after total hip arthroplasty (THA). MATERIAL AND METHODS Ninety-four stiff hips in 58 AS individuals (mean age: 37.05) who underwent THA between 2012 and 2018 with a modified lateral approach were included. Twenty-three hips were fused, and 71 hips had mean flexion of 37.67°. Pelvic tilt, pelvic inclination, sacral slope (SS), and lumbar lordosis were correlated with THA, and functional outcomes were assessed at 34.6-month mean follow-up. RESULTS Thirty-seven had a stuck sitting pattern with stuck standing seen in 4 individuals. SS standing before and after THA were 25.08° and 27.30°. SS sitting was 8.99° compared to 16.80°. SS from sitting to standing was reduced (17.7°) in 17 individuals. Spine stiffness in extension was seen in 4 out of 37. Mean acetabular inclination after THA was 42.67°, and acetabular anteversion was 17.48°. Flexion after THA improved to mean 98.47°. Changes in SS from sitting to standing were correlated with THA (r-value: 0.93, P-value: .0001). The Harris Hip Score improved from 25.31 to 82.39 (P-value <.05), and the mean 12-item Short Form Survey at review was 52.18 and 59.55 (physical and mental components). The mean Western Ontario and Mc Master Universities Arthritis Index score was 17.56. CONCLUSIONS Spinopelvic mobility change was <10° after THA in AS, stuck sitting was seen in 37 of 58 (63.8%), and stuck standing was seen in 4 of 58 (6.9%), including spine stiffness in flexion or extension. Acetabular anteversion assessed was 17.48° (standard deviation: 4.41), with significant functional improvement. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Anil Thomas Oommen
- Department of Orthopaedics, Unit II, Christian Medical College Hospital, Vellore, Tamil Nadu, India
- Corresponding author. Department of Orthopaedics, Unit II, Christian Medical College Hospital, Scudder Road, Vellore, Tamil Nadu 632004, India. Tel.:+91 416 228 2081.
| | | | - Madhavi Kandagaddala
- Department of Radiology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | | | - Pradeep Mathew Poonnoose
- Department of Orthopaedics, Unit II, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - A. Arun Shankar
- Department of Orthopaedics, Unit II, Christian Medical College Hospital, Vellore, Tamil Nadu, India
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McEntee ML, Gandek B, Ware JE. Improving multimorbidity measurement using individualized disease-specific quality of life impact assessments: predictive validity of a new comorbidity index. Health Qual Life Outcomes 2022; 20:108. [PMID: 35820890 PMCID: PMC9277868 DOI: 10.1186/s12955-022-02016-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/25/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Interpretation of health-related quality of life (QOL) outcomes requires improved methods to control for the effects of multiple chronic conditions (MCC). This study systematically compared legacy and improved method effects of aggregating MCC on the accuracy of predictions of QOL outcomes. METHODS Online surveys administered generic physical (PCS) and mental (MCS) QOL outcome measures, the Charlson Comorbidity Index (CCI), an expanded chronic condition checklist (CCC), and individualized QOL Disease-specific Impact Scale (QDIS) ratings in a developmental sample (N = 5490) of US adults. Controlling for sociodemographic variables, regression models compared 12- and 35-condition checklists, mortality vs. population QOL-weighting, and population vs. individualized QOL weighting methods. Analyses were cross-validated in an independent sample (N = 1220) representing the adult general population. Models compared estimates of variance explained (adjusted R2) and model fit (AIC) for generic PCS and MCS across aggregation methods at baseline and nine-month follow-up. RESULTS In comparison with sociodemographic-only regression models (MCS R2 = 0.08, PCS = 0.09) and Charlson CCI models (MCS R2 = 0.12, PCS = 0.16), increased variance was accounted for using the 35-item CCC (MCS R2 = 0.22, PCS = 0.31), population MCS/PCS QOL weighting (R2 = 0.31-0.38, respectively) and individualized QDIS weighting (R2 = 0.33 & 0.42). Model R2 and fit were replicated upon cross-validation. CONCLUSIONS Physical and mental outcomes were more accurately predicted using an expanded MCC checklist, population QOL rather than mortality CCI weighting, and individualized rather than population QOL weighting for each reported condition. The 3-min combination of CCC and QDIS ratings (QDIS-MCC) warrant further testing for purposes of predicting and interpreting QOL outcomes affected by MCC.
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Affiliation(s)
- Mindy L McEntee
- College of Health Solutions, Arizona State University, 500 N. 3rd Street, Phoenix, AZ, 85004-0698, USA.
| | - Barbara Gandek
- University of Massachusetts Medical School, Worchester, MA, USA
- John Ware Research Group, Inc., Watertown, MA, USA
| | - John E Ware
- College of Health Solutions, Arizona State University, 500 N. 3rd Street, Phoenix, AZ, 85004-0698, USA
- University of Massachusetts Medical School, Worchester, MA, USA
- John Ware Research Group, Inc., Watertown, MA, USA
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Aggarwal A, Naylor JM, Adie S, Liu VK, Harris IA. Preoperative Factors and Patient-Reported Outcomes After Total Hip Arthroplasty: Multivariable Prediction Modeling. J Arthroplasty 2022; 37:714-720.e4. [PMID: 34990754 DOI: 10.1016/j.arth.2021.12.036] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/05/2021] [Accepted: 12/28/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Although total hip arthroplasty (THA) has been established as a cost-effective intervention, some patients experience ongoing pain and dissatisfaction. There is interest in predicting postoperative outcomes based on preoperative data, but the relative contribution of different preoperative factors is unclear. The study's aim was to develop multivariable prediction models for the assessment of patient-reported outcomes. METHOD Registry data on 1412 patients undergoing THA for osteoarthritis at two hospitals between 2013 and 2018 was used. Potential predictors included age, sex, body mass index, spoken language, education level, previous THA, American Society of Anaesthesiologists (ASA) score, lower back pain, depression/anxiety, other lower limb arthritis, number of other comorbidities, the preoperative expectation of pain and function, EuroQol Visual Analogue Scale (EQ-VAS) and preoperative OHS. Radiographic scores were also used: joint space narrowing (JSN), osteophytes, sclerosis, and an overall grade based on the Kellgren-Lawrence (KL) classification. Outcomes assessed were the patient-rated improvement, satisfaction, and OHS at six months. RESULTS JSN or overall KL scores were the most important predictors (P < .001) for all outcomes, with better radiographic scores associated with worse outcomes. Other predictors associated with poorer outcomes were lower back pain and lower expectation (predicting poor improvement), lower education and higher ASA (predicting lower satisfaction) and younger age, female sex, non-English speakers, lower preoperative EQ-VAS, lower education, back pain, and anxiety/depression (predicting lower OHS). CONCLUSION Preoperative radiological scores are an important predictor of patient-reported outcomes at six months postoperatively. Understanding the relative strengths and significance of different factors in predicting outcomes will help the clinician and patient decision-making for THA.
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Affiliation(s)
- Ashwin Aggarwal
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia; South Western Sydney Clinical School, Faculty of Medicine, UNSW Sydney, Liverpool, New South Wales, Australia
| | - Justine M Naylor
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia; South Western Sydney Clinical School, Faculty of Medicine, UNSW Sydney, Liverpool, New South Wales, Australia
| | - Sam Adie
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia; St George Hospital, New South Wales, Australia
| | | | - Ian A Harris
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia; South Western Sydney Clinical School, Faculty of Medicine, UNSW Sydney, Liverpool, New South Wales, Australia
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Implant positioning in total hip arthroplasty: influence of horizontal and vertical offset on functionality of prosthetic hip joint. INTERNATIONAL ORTHOPAEDICS 2022; 46:1501-1506. [PMID: 35288768 DOI: 10.1007/s00264-022-05364-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 03/01/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To analyze the effect of implant position measured in terms of offset on patient reported outcomes (PRO) following hip arthroplasty (THA). METHODS A total of 243 patients of the total hip replacement who had a one year follow-up were included in the study. Standard both hips radiograph was used to asses post-surgery implant position in terms of horizontal offset and vertical offset, and correlated with functional outcome which was evaluated as change in PRO. i.e., Harris hip score (HHS) post-op. With center of hip rotation as reference, horizontal offset was calculated as sum of distance, of centre, from proximal femoral shaft axis and a vertical line through ipsilateral teardrop, and vertical offset as limb length discrepancy. Post-op patients were classified into three groups depending on the measurement of horizontal offset of the operated hip. The patients having operated hip horizontal offset within 5 mm of the normal hip were grouped as restored offset (RO); those having shorter or higher offset by more than 5 mm compared to normal hip were labeled as decreased (DO) or increased offset (IO) group respectively. The groups were further subdivided into suboptimal and optimal function groups based on HHS, and among these groups, limb length discrepancy was evaluated. RESULTS Post follow-up mean HHS (78.23 ± 9.96) improved significantly in all three groups (p < 0.0001). The difference in post-operative HHS among DO, RO, and IO groups was significant, with their averages being 72.5 ± 4.7, 82.1 ± 6.5, and 75.2 ± 4.8 respectively (p = .01). Limb length discrepancy was significantly more common in patients with suboptimal functional scores in all three groups. CONCLUSION This study concluded that both horizontal offset and vertical offset should be reconstructed in patients operated with unilateral THR due to hip pathology, since both factor demonstrated a comparable additive effect on clinical outcome.
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Gazendam AM, Patel M, Ekhtiari S, Bali K, Wood TJ. Are Functional Outcomes of a Total Hip Arthroplasty Predictive of a Contralateral Total Hip Arthroplasty: A Retrospective Cohort Study. J Arthroplasty 2022; 37:298-302. [PMID: 34627955 DOI: 10.1016/j.arth.2021.09.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/22/2021] [Accepted: 09/29/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Current literature suggests that 8%-35% of patients undergoing total hip arthroplasty (THA) undergo a subsequent contralateral THA. This study aims to determine if functional outcomes after primary THA predict outcomes in the subsequent primary THA of the contralateral side. METHODS A retrospective cohort of patients undergoing staged bilateral primary THA was reviewed. The Oxford Hip Score (OHS) was utilized as the functional outcome measurement tool and was assessed preoperatively and at one year postoperatively. The minimal clinically important difference (MCID) was assessed. Based on the first-side THA one-year outcomes, the odds of maintaining an MCID, or not, for the second-side THA were determined. RESULTS The study cohort consisted of 551 patients and 1102 primary THAs. The average postoperative OHSs were similar after the first and second THA. Patients achieving the MCID with the first-side surgery were 2.6 times (95% confidence interval 1.0 to 6.64, P = .04) more likely to achieve the MCID for the second-side surgery than patients failing to reach the MCID for their first-side surgery. After the first THA, 29 (5.3%) patients failed to reach the predefined MCID for the OHS compared with 54 (9.8%) patients undergoing their second THA (odds ratio: 1.96 [95% confidence interval: 1.23 to 3.1], χ2 = 8.14, P = .005). CONCLUSIONS Functional outcomes after the first THA are predictive of functional outcomes of the second THA. Patients are more likely to achieve a clinically significant improvement after their first THA related to higher preoperative OHSs before the second THA.
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Affiliation(s)
- Aaron M Gazendam
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Mansi Patel
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Seper Ekhtiari
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Kamal Bali
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
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- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Thomas J Wood
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
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WIK TS, KLAKSVIK J, HUSBY OS, RASCH A, WINTHER SB. Patient-reported outcome after primary and aseptic revision hip arthroplasty: 1-year follow-up of 3,559 primary and 406 revision THAs in an institutional registry. Acta Orthop 2022; 93:132-137. [PMID: 34984475 PMCID: PMC8815322 DOI: 10.2340/17453674.2021.852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - Patient-reported outcomes (PROMs) after primary total hip arthroplasty (THA) and revision THA are important information in the preoperative shared decision-making process. We present 1-year results on pain, function, and quality of life following primary and revision THA. Patients and methods - From 2010 to 2018, 3,559 primary THA and 406 revision THAs were included in our institutional quality registry. PROMs were registered preoperatively, 3 months, and 1 year after surgery, numeric rating scale (0-10) for pain during mobilization and at rest, healthrelated quality of life (EQ-5D), and a hip-specific physical function score (HOOS-PS). 2 anchor questions were asked 1 year after surgery concerning joint function and willingness to go through surgery again. Results - There were statistically significant improvements in all PROMs at the 3-month follow-up in both groups. All PROMs improved more in the primary group relative to the revision group. 1 year after surgery, pain during mobilization was reduced with a mean change of 5.1 (SD 2.6) for primary THA and 2.9 (SD 3.0) for revision THA. 93% of primary THA patients reported both better function 1 year after surgery and that they would have gone through surgery again, compared with 78% and 79% in the revision THA group. Interpretation - Primary THA patients reported better function and more pain relief than the revision THA group 1 year after surgery. Pain during mobilization shows the most marked improvement in both groups, which is important preoperative information for patients.
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Affiliation(s)
- Tina S WIK
- Department of Orthopaedic Surgery, St Olavs hospital, Trondheim,Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology NTNU, Trondheim
| | - Jomar KLAKSVIK
- Department of Orthopaedic Surgery, St Olavs hospital, Trondheim
| | - Otto S HUSBY
- Department of Orthopaedic Surgery, St Olavs hospital, Trondheim,Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology NTNU, Trondheim
| | - Astrid RASCH
- Department of Clinical Services, St Olavs Hospital, Trondheim, Norway
| | - Siri B WINTHER
- Department of Orthopaedic Surgery, St Olavs hospital, Trondheim
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Preoperative Patient-Reported Outcomes Measurement Information System Global Health Scores Predict Patients Achieving the Minimal Clinically Important Difference in the Early Postoperative Time Period After Total Knee Arthroplasty. J Am Acad Orthop Surg 2021; 29:e1417-e1426. [PMID: 34061813 DOI: 10.5435/jaaos-d-20-01288] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/27/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The patient-specific factors influencing postoperative improvement after total knee arthroplasty (TKA) are important considerations for the surgeon and patient. The primary purpose of this study was to determine which patient demographic factors influence the postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health (GH) scores. In addition, we aimed to compare the prognostic utility of preoperative PROMIS-GH scores and the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR) in predicting postoperative improvement. METHODS This retrospective cohort study of a consecutive series of patients who underwent primary, unilateral TKA analyzed prospectively collected KOOS-JR and PROMIS-GH surveys. PROMIS-GH includes physical health (PH) and mental health scores. Patient demographic and presurgical characteristics were evaluated for prognostic capability in predicting postoperative improvement in the PROMIS scores and achievement of the minimal clinically important difference (MCID). Receiver operating characteristic curves were used to understand the prognostic thresholds of the preoperative PROMIS score and KOOS-JR for predicting MCID achievement. RESULTS A total of 872 patients were included. Although unadjusted analyses showed associations between patient demographic factors and PROMIS-PH scores, multivariable regression analysis for predictors of MCID achievement demonstrated that PROMIS-PH was the only significant preoperative variable. Receiver operating characteristic analysis revealed that the area under the curve of PROMIS-PH (0.70; 95% CI, 0.67 to 0.74) was less than that of the KOOS-JR (0.77; 95% CI, 0.73 to 0.81; P = 0.032). Sensitivity and specificity for achieving the MCID were maximized for preoperative PROMIS-PH scores of ≤ 38 (59% and 70%) and for preoperative KOOS-JR ≤ 51 (71% and 69%). CONCLUSIONS Preoperative KOOS-JR and PROMIS-PH scores predict clinically meaningful improvement after TKA. The KOOS-JR has greater prognostic utility in the early postoperative period. LEVEL OF EVIDENCE Level III, Prognostic Study.
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Zhang S, Chen JY, Pang HN, Lo NN, Yeo SJ, Liow MHL. Revision total hip arthroplasty is associated with poorer clinically meaningful improvements and patient satisfaction compared to primary total hip arthroplasty. J Orthop 2021; 28:96-100. [PMID: 34898927 DOI: 10.1016/j.jor.2021.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/13/2021] [Accepted: 11/17/2021] [Indexed: 12/30/2022] Open
Abstract
Purpose This study aims to compare PROM improvements and satisfaction rates between revision (rTHA) and primary total hip arthroplasty (pTHA). Methods 84 rTHAs were propensity-score matched to 168 pTHAs using patient demographics and preoperative PROMs. Multiple regression was used to evaluate differences in PROMs, minimal clinically important difference (MCID) attainment and patient satisfaction. Results Compared to pTHA patients, rTHA patients had poorer MCID attainment for OHS, WOMAC and SF-36 PCS and lower satisfaction rates at 2-years postoperatively (p < 0.05). Conclusion Patients undergoing rTHA are likely to have poorer outcomes and should be appropriately counselled to better manage their preoperative expectations. Level of evidence Level II.
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Affiliation(s)
- Siyuan Zhang
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Jerry Yongqiang Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Hee Nee Pang
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Ming Han Lincoln Liow
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
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Feingold JD, Swartwout EL, Roberts SA, Nwachukwu BU, Ranawat AS. Failure to Achieve Threshold Scores on Patient-Reported Outcome Measures Within 1 Year Has a Predictive Risk of Subsequent Hip Surgery Within 5 Years of Primary Hip Arthroscopy: A Case-Control Study. Orthop J Sports Med 2021; 9:23259671211053012. [PMID: 34805421 PMCID: PMC8600560 DOI: 10.1177/23259671211053012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 08/04/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Research has identified factors that influence achievement rates of threshold
scores on patient-reported outcome measures (PROMs) after hip arthroscopy.
However, little data exist on whether failure to achieve a threshold score
(minimal clinically important difference [MCID] or substantial clinical
benefit [SCB]) in the short term after hip arthroscopy predicts the risk of
future hip surgery. Purpose/Hypothesis: The purpose of this study was to determine if failure to achieve the MCID or
SCB on PROMs within 1 year of hip arthroscopy can be considered a risk
factor for repeat surgery within 5 years of primary hip arthroscopy. It was
hypothesized that failure to achieve threshold scores would increase the
risk of subsequent hip surgery. Study Design: Case-control study; Level of evidence, 3. Methods: A retrospective review of prospectively collected data was completed. Four
PROMs were collected preoperatively and within 1 year of hip arthroscopy:
modified Harris Hip Score, Hip Outcome Score–Activities of Daily Living, Hip
Outcome Score–Sports, and the 33-Item International Hip Outcome Tool. Results: Two cohorts were formed: (1) a study cohort (n = 88) composed of patients who
underwent repeat hip surgery within 5 years of hip arthroscopy and (2) a
control cohort (n = 288) composed of patients who did not require repeat hip
surgery. The study cohort had significantly (P < .001)
lower scores on all postoperative PROMs, and a significantly
(P < .001) smaller percentage of the study cohort
met the MCID and SCB. Multivariable regression analysis demonstrated that
not achieving the MCID or SCB on each of the PROMs is an independent risk
factor for repeat hip surgery. For every PROM in which a patient failed to
achieve the MCID, the odds of subsequent surgery increased by 1.68 (95% CI,
1.42-1.98; P < .001). For every PROM in which a patient
failed to achieve the SCB, the odds of subsequent surgery increased by 1.63
(95% CI, 1.35-1.97; P < .001). Conclusion: Failure to meet threshold scores on PROMs after hip arthroscopy was an
independent risk factor for subsequent hip surgery. This study establishes a
novel utility of PROMs and confirms the importance of these metrics in the
orthopaedic literature.
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Affiliation(s)
- Jacob D. Feingold
- Hospital for Special Surgery, New York, New York, USA
- Jacob D. Feingold, BS, Hospital for Special Surgery, 541 E 71st
Street, 3rd Floor, New York, NY 10021, USA (
)
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Amin T, Parr WC, Mobbs RJ. Opinion Piece: Patient-Specific Implants May Be the Next Big Thing in Spinal Surgery. J Pers Med 2021; 11:jpm11060498. [PMID: 34199467 PMCID: PMC8228233 DOI: 10.3390/jpm11060498] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/08/2021] [Accepted: 05/30/2021] [Indexed: 12/13/2022] Open
Abstract
The emergence of 3D-Printing technologies and subsequent medical applications have allowed for the development of Patient-specific implants (PSIs). There have been increasing reports of PSI application to spinal surgery over the last 5 years, including throughout the spine and to a range of pathologies, though largely for complex cases. Through a number of potential benefits, including improvements to the implant–bone interface and surgical workflow, PSIs aim to improve patient and surgical outcomes, as well as potentially provide new avenues for combating challenges routinely faced by spinal surgeons. However, obstacles to widespread acceptance and routine application include the lack of quality long-term data, research challenges and the practicalities of production and navigating the regulatory environment. While recognition of the significant potential of Spinal PSIs is evident in the literature, it is clear a number of key questions must be answered to inform future clinical and research practices. The spinal surgical community must selectively and ethically continue to offer PSIs to patients, simultaneously allowing for the necessary larger, comparative studies to be conducted, as well as continuing to provide optimal patient care, thereby ultimately determining the exact role of this technology and potentially improving outcomes.
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Affiliation(s)
- Tajrian Amin
- NeuroSpine Surgery Research Group (NSURG), Sydney 2000, Australia; (T.A.); (W.C.H.P.)
- Neuro Spine Clinic, Prince of Wales Private Hospital, Randwick 2031, Australia
- Faculty of Medicine, University of New South Wales (UNSW), Sydney 2000, Australia
| | - William C.H. Parr
- NeuroSpine Surgery Research Group (NSURG), Sydney 2000, Australia; (T.A.); (W.C.H.P.)
- Surgical and Orthopaedic Research Laboratories (SORL), Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Randwick 2031, Australia
- 3DMorphic Pty Ltd., Matraville 2036, Australia
| | - Ralph J. Mobbs
- NeuroSpine Surgery Research Group (NSURG), Sydney 2000, Australia; (T.A.); (W.C.H.P.)
- Neuro Spine Clinic, Prince of Wales Private Hospital, Randwick 2031, Australia
- Faculty of Medicine, University of New South Wales (UNSW), Sydney 2000, Australia
- Correspondence: ; Tel.: +61-(02)-9650-4766
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Katakam A, Bragdon CR, Chen AF, Melnic CM, Bedair HS. Elevated Body Mass Index Is a Risk Factor for Failure to Achieve the Knee Disability and Osteoarthritis Outcome Score-Physical Function Short Form Minimal Clinically Important Difference Following Total Knee Arthroplasty. J Arthroplasty 2021; 36:1626-1632. [PMID: 33419617 DOI: 10.1016/j.arth.2020.12.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/22/2020] [Accepted: 12/11/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The aims of this study are (1) to assess the association between body mass index (BMI) and failure to achieve the 1-year Knee Disability and Osteoarthritis Outcome Score-Physical Function Short Form (KOOS-PS) minimal clinically important difference (MCID) for total knee arthroplasty (TKA) patients and (2) to determine if there is a BMI threshold beyond which the risk of failing to achieve the MCID is significantly increased. METHODS A regional arthroplasty registry was queried for TKA patients from 2016 to 2019 with completion of preoperative and 1-year postoperative KOOS-PS. The MCID threshold was derived using a distribution-based approach. Demographic and patient-reported outcome measure variables were collected. BMI was analyzed continuously and categorically using cutoffs defined by the Centers for Disease Control and Prevention. The association between failure to achieve 1-year MCID and BMI was analyzed using multiple logistic regression. A BMI threshold was determined using the Youden index and receiver operating characteristic curve. RESULTS In total, 1059 TKAs were analyzed. BMI assessed continuously was significantly associated with failure to achieve the KOOS-PS MCID (odds ratio 1.03, 95% confidence interval 1.00-1.05, P = .025). Analysis of BMI categorically revealed that "overweight" (25-30 kg/m2), "obese class I" (30-35 kg/m2), "obese class II" (35-40 kg/m2), and "obese class III" (>40 kg/m2) patients faced 77%, 76%, 83%, and 106% greater risk, respectively, of failing to achieve the KOOS-PS MCID compared to "normal BMI" (<25 kg/m2) patients. CONCLUSION Elevated BMI was associated with an increased risk of failure to achieve the 1-year KOOS-PS MCID following TKA.
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Affiliation(s)
- Akhil Katakam
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA
| | - Charles R Bragdon
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Christopher M Melnic
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA
| | - Hany S Bedair
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA
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Galea VP, Rojanasopondist P, Connelly JW, Bragdon CR, Huddleston JI, Ingelsrud LH, Malchau H, Troelsen A. Changes in Patient Satisfaction Following Total Joint Arthroplasty. J Arthroplasty 2020; 35:32-38. [PMID: 31492454 DOI: 10.1016/j.arth.2019.08.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 08/03/2019] [Accepted: 08/06/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The primary aim is to identify the degree to which patient satisfaction with the outcome of total hip arthroplasty (THA) or total knee arthroplasty (TKA) changes between 1 and 3 years from the procedure. The secondary aim is to identify variables associated with satisfaction. METHODS Data were sourced from 2 prospective international, multicenter studies (919 THA and 450 TKA patients). Satisfaction was assessed by a 10-point numerical rating scale, at 1- and 3-year follow-up. Linear mixed-effects models were used to assess factors associated with satisfaction. RESULTS For the THA cohort, higher preoperative joint space width (odds ratio [OR] = 0.28; P = .004), pain from other joints (OR = 0.26; P = .033), and lower preoperative health state (OR = -0.02; P < .001) were associated with consistently lower levels of satisfaction. The model also showed that patients with preoperative anxiety/depression improved in satisfaction between 1 and 3 years (OR = -0.26; P = .031). For the TKA cohort, anterior (vs neutral or posterior) tibial component slope (OR = 0.90; P = .008), greater femoral component valgus angle (OR = 0.05; P = .012), less severe osteoarthritis (OR = -0.10; P < .001), and lower preoperative health state (OR = -0.02; P = .003) were associated with lower levels of satisfaction across the study period. In addition, patients with anterior tibial component slope improved in satisfaction level over time (OR = -0.33; P = .022). CONCLUSION Changes in satisfaction following THA and TKA are rare between 1- and 3-year follow-up. The findings of this study can be used to guide patient counseling preoperatively and to determine intervals of routine follow-up postoperatively.
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Affiliation(s)
- Vincent P Galea
- Harris Orthopaedic Laboratory, Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA
| | - Pakdee Rojanasopondist
- Harris Orthopaedic Laboratory, Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA
| | - James W Connelly
- Harris Orthopaedic Laboratory, Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA
| | - Charles R Bragdon
- Harris Orthopaedic Laboratory, Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA; Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA
| | - James I Huddleston
- Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood, CA
| | - Lina H Ingelsrud
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Henrik Malchau
- Harris Orthopaedic Laboratory, Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA; Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA
| | - Anders Troelsen
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
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CORR Insights®: What Preoperative Factors are Associated With Not Achieving a Minimum Clinically Important Difference After sTHA? Findings from an International Multicenter Study. Clin Orthop Relat Res 2019; 477:1313-1314. [PMID: 31136426 PMCID: PMC6554140 DOI: 10.1097/corr.0000000000000722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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