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Streck LE, Chiu YF, Braun S, Mujaj A, Hanreich C, Boettner F. Activity Following Total Hip Arthroplasty: Which Patients Are Active, and Is Being Active Safe? J Clin Med 2023; 12:6482. [PMID: 37892620 PMCID: PMC10607190 DOI: 10.3390/jcm12206482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 09/24/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Younger and physically active patients demand a return to sport after total hip arthroplasty (THA). However, because of the risk of implant wear and loosening, high-impact activities are often not recommended. The current study evaluates predictive factors and revision rates in patients with higher activity levels. METHODS This retrospective study included 4152 hips in 3828 patients aged 45-75 that underwent primary THA for primary osteoarthritis between 2009 and 2019 with a minimum follow-up of 2 years. Pain and Lower Extremity Activity Scale (LEAS) were assessed before and 2 years after surgery. Activity was classified as low (LEAS 1-6), moderate (LEAS 7-13), or high (LEAS 14-18). RESULTS Pain and LEAS improved from preoperative to 2-years postoperative (p < 0.001). The activity level was low in 6.2%, moderate in 52.9%, and high in 40.9% of the patients. Younger age, lower BMI, ASA, and CCI, male sex, and higher preoperative LEAS correlated with higher activity at 2 years (p < 0.001). The predicted revision-free survival rates between the activity groups were better for more highly active patients (p < 0.001). CONCLUSIONS High physical activity 2 years following THA, with participating in sports like jogging several times a week, did not increase the risk of revision surgery. THA patients should not be prevented from a highly active lifestyle.
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Affiliation(s)
- Laura Elisa Streck
- Adult Reconstruction and Joint Replacement Department, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Yu-Fen Chiu
- Biostats Core, Research Administration, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Sebastian Braun
- Adult Reconstruction and Joint Replacement Department, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
- Center for Musculoskeletal Surgery, Charité Universitätsmedizin Berlin, Member of Freie Universität Berlin and Humboldt University Berlin, Chariteplatz 1, 10117 Berlin, Germany
| | - Anisa Mujaj
- Adult Reconstruction and Joint Replacement Department, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Carola Hanreich
- Adult Reconstruction and Joint Replacement Department, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
- Department for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Friedrich Boettner
- Adult Reconstruction and Joint Replacement Department, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
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Magan AA, Radhakrishnan GT, Kayani B, Ronca F, Khanduja V, Meek RMD, Haddad FS. Time for return to sport following total hip arthroplasty: a meta-analysis. Hip Int 2023; 33:221-230. [PMID: 34538122 DOI: 10.1177/11207000211041975] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Total Hip Arthroplasty (THA) is being increasingly undertaken in younger and more active patients, with many of these patients wanting to return to sport (RTS) after surgery. However, the percentage of patients RTS and time at which they are able to get back to sport following surgery remains unknown. The objective of this meta-analysis was to determine the time patients RTS after THA. METHODS A search was performed on PUBMED, MEDLINE, EMBASE, and the Cochrane Library for trials on THA and RTS, in the English language, published from the inception of the database to October 2020. All clinical trials reporting on to RTS following THA were included. Data relating to patient demographics, methodological quality, RTS, clinical outcomes and complications were recorded. The PRISMA guidelines were used to undertake this study. RESULTS The initial literature search identified 1720 studies. Of these, 11 studies with 2297 patients matched the inclusion criteria. 3 studies with 154 patients demonstrated an overall pooled proportion of 40.0% (95% CI, 32.5-47.9%) of patients RTS between 2 and 3 months after surgery. 4 studies with 242 patients demonstrated an overall pooled proportion of 76.9% (95% CI, 71.5-82.0) of patients RTS by 6 months after surgery. Pooled proportion analysis from 7 trials with 560 patients demonstrated 93.9% (95% CI, 82.7-99.5%) of patients RTS between 6 and 12 months after surgery. CONCLUSIONS Pooled proportion analysis showed increasingly more patients were able to RTS after THA over the first 1 year after surgery. There remains marked inter and intra-study variations in time for RTS but the pooled analysis shows that over 90% of patients were able to RTS at 6-12 months after THA. These finding will enable more informed discussions between patients and healthcare professionals about time for RTS following THA.
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Affiliation(s)
- Ahmed A Magan
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Ganan T Radhakrishnan
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Babar Kayani
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Flaminia Ronca
- Institute of Sports, Health and Exercise, University College Hospital, London, UK
| | - Vikas Khanduja
- Department of Trauma and Orthopaedic Surgery, Young Adult Hip Service, Addenbrooke's - Cambridge University Hospital, Cambridge, UK
| | - Robert M D Meek
- Department of Trauma and Orthopaedic surgery, Glasgow University, Glasgow, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK.,Institute of Sports, Health and Exercise, University College Hospital, London, UK
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Takahashi Y, Takahira N, Uchiyama K, Fukushima K, Moriya M, Shibuya M. Sports activity participation and subjective health status of patients after total hip arthroplasty via the anterolateral-supine approach: a case series study. BMC Musculoskelet Disord 2022; 23:943. [PMID: 36309642 PMCID: PMC9617043 DOI: 10.1186/s12891-022-05886-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 10/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background No reports have been published about participation in sports activity and subjective health status after total hip arthroplasty via the anterolateral approach in the supine position (ALS-THA) in Japanese patients. This study assessed sports activity participation and subjective health status, as well as factors potential associated with these variables, in patients who underwent ALS-THA. Methods Of 698 patients who underwent total hip arthroplasty at our institution between 2013 and 2018, questionnaires were sent to 355 patients under 80 years old who had undergone ALS-THA and 242 responded. Patients were asked about their subjective health status, participation in sports activity, the EuroQol 5-dimensions 5-level (EQ-5D-5L), the University of California Los Angeles (UCLA) activity scale score and the Forgotten Joint Score (FJS). Patient characteristics and hospitalization information were also collected. Patients’ subjective health status was categorized as “healthy” or “unhealthy”. Univariate and multivariate logistic regression analyses were performed to determine factors associated with participation in sports activity after ALS-THA and a “healthy” status. Results The pre- and postoperative sports activity participation rates were 54.0% and 57.8%, respectively. Most patients (76.8%, n = 182) were considered “healthy”. Age (P = .019) and UCLA activity score (P < .001) were significantly associated with sports activity after ALS-THA. FJS (P = .002) and EQ-5D-5L (P = .004) were significantly associated with a “healthy” status. Conclusion Patients participating in sports activity after ALS-THA are older and have higher UCLA activity scores and patients considered “healthy” have higher FJS and EQ-5D-5L scores. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05886-6.
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Haffer H, Bender A, Krump A, Hardt S, Winkler T, Damm P. Is Training With Gym Machines Safe After Hip Arthroplasty?—An In Vivo Load Investigation. Front Bioeng Biotechnol 2022; 10:857682. [PMID: 35402408 PMCID: PMC8989469 DOI: 10.3389/fbioe.2022.857682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/07/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Training with gym machines is one of the most popular physical activities after total hip arthroplasty (THA). However, to date, there are no evidence-based recommendations for physical activity after THA, worldwide. The aim of the study is to evaluate the in vivo hip joint loads during exercises on four widely used gym machines in order to provide a source for an evidence-based patient counselling for arthroplasty surgeons. Methods: The in vivo hip joint loads in seven patients (59.6 ± 6.4 years, 28.6 ± 2.1 kg/m2) with instrumented hip implants were assessed. The resulting force (Fres), bending moment (Mbend), and torsional moment (Mtors) were evaluated during the training on leg curl/leg extension machines (loads: 20, 30, and 40 kg), leg press machine [backrest: 10°, 30°, and 60°; load: 50, 75, and 100%BW (bodyweight)], and a rope pull machine (abduction/adduction/flexion/extension; each ipsi- and contralateral; load 10 kg). These loads were compared with the loads during walking on treadmill at 4 km/h (median peak values: Fres 303%BW, Mbend 4.25%BWm, and Mtors 2.70%BWm). Results: In each of the four performed exercises with a total of 23 different load conditions or exercise modes analyzed, a significantly lower or not different load was detected with respect to Fres, Mbend, and Mtors measured while walking with 4 km/h. Nevertheless, Fres and Mbend demonstrated a trend to increased loading during the ipsilateral monopod standing rope pull exercises hip flexion, extension, and abduction. Conclusion: Based on our investigation, we assume that the investigated gym machines and external loads can be considered mainly as low-impact sports (with some exceptions) and thus as safe physical activity after THA. Due to the fact that the examinations were conducted in the mean 17.4 months after THA, the applicability of the results to the immediate postoperative period is limited.
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Affiliation(s)
- Henryk Haffer
- Center for Musculoskeletal Surgery Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Alwina Bender
- Julius Wolff Institute, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Alexander Krump
- Julius Wolff Institute, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Sebastian Hardt
- Center for Musculoskeletal Surgery Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Tobias Winkler
- Center for Musculoskeletal Surgery Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Julius Wolff Institute, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Philipp Damm
- Julius Wolff Institute, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- *Correspondence: Philipp Damm,
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Bender A, Damm P, Hommel H, Duda GN. Overstretching Expectations May Endanger the Success of the “Millennium Surgery”. Front Bioeng Biotechnol 2022; 10:789629. [PMID: 35237570 PMCID: PMC8882767 DOI: 10.3389/fbioe.2022.789629] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/07/2022] [Indexed: 11/13/2022] Open
Abstract
Total hip arthroplasty (THA) is an extremely successful treatment strategy. Patient expectations, however, have increased; if not properly guided by surgeons, at present, patients expect next to pain-free restoration of the joint and a fast return to work and sports. While the revision rates after THA also increased in younger patients, knowledge on musculoskeletal loads still remains sparse, and the current recommendations on postoperative rehabilitation are based on expert opinions only. The aim of this study was to unravel biomechanical contact conditions in “working age” (<60 years, 53.5 ± 3.0 years) and “retirement age” (>60 years, 67.7 ± 8.6 years) patients during activities recommended post-THA. We hypothesized that working age patients would show substantially increased hip contact loads compared to older patients. The in vivo joint contact force (Fres) and torsion torque (Mtors), reflecting the main contact load situation, experienced during activities of daily living and sports activities were measured in a unique group of 16 patients with instrumented THA. We summarized patient activities and sports recommendations after THA mentioned within the literature using PubMed (without claim of completeness). The measurements showed that younger working age patients experienced significant (p = 0.050) increased Mtors (21.52 ± 9.11 Nm) than older retirement age patients (13.99 ± 7.89 Nm) by walking. Bowling, as a recommended low-impact sport, was associated with Fres of up to 5436 N and Mtors of up to 108 Nm in the working age group, which were higher than the Fres (5276 N) and Mtors (71 Nm) during high-impact soccer. Based on our results, age was proven to be a discriminator in joint loading, with working age patients presenting with increased loads compared to retirement age patients, already during daily activities. The current patient recommendations have led to further increased joint loadings. If THA cannot be delayed in a patient, we propose counselling patients on a carefully considered return to sports, focusing on low-impact activities, as indicated hereby. The findings from this work illustrate the need to provide critical feedback to patient expectations when returning to work and sports activities. Patients returning to more intensive sports activities should be carefully monitored and advised to avoid as much overloading as possible.
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Affiliation(s)
- Alwina Bender
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius-Wolff-Institute, Berlin, Germany
| | - Philipp Damm
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius-Wolff-Institute, Berlin, Germany
- *Correspondence: Philipp Damm,
| | - Hagen Hommel
- Department of Orthopaedics, Märkisch-Oderland Hospital, Brandenburg Medical School Theodor Fontane, Wriezen, Germany
| | - Georg N. Duda
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius-Wolff-Institute, Berlin, Germany
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Zimmerer A, Navas L, Kinkel S, Weiss S, Hauschild M, Miehlke W, Streit M. Recreational activity after cementless total hip arthroplasty in patients older than 75 years. Arch Orthop Trauma Surg 2022; 142:3059-3065. [PMID: 33938986 PMCID: PMC9522835 DOI: 10.1007/s00402-021-03896-y] [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: 01/07/2021] [Accepted: 04/03/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION This retrospective study aimed to compare activity levels before and at mid-term follow-up after primary cementless total hip arthroplasty (THA) in patients older than 75 years. MATERIALS AND METHODS A cohort of 79 patients with a mean age at surgery of 78 years (range 76-84 years) was evaluated 6.3 years (range 4-8 years) after cementless THA due to osteoarthritis and was followed up with a questionnaire to determine their activity level. Pre- and post-operative recreational activities were assessed at routine follow-up using the University of California, Los Angeles activity score, and the Schulthess Clinic sports and activity questionnaire. Post-operative health-related quality of life was measured using Veterans Rand 12-item survey (VR-12). RESULTS Six years after THA, 72% of preoperatively active patients had returned to activity. Comparing activity preoperatively (before the onset of symptoms) and 6 years after THA, the number of disciplines and session length has decreased significantly. A significant decline in high-impact activities was observed, while participation in low-impact activities significantly increased. CONCLUSION The majority of patients maintained a recreational activity level in the mid-term after primary cementless THA. However, a change in disciplines toward low-impact activities was observed.
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Affiliation(s)
- Alexander Zimmerer
- ARCUS Sportklinik, Rastatterstr. 17-19, 75179 Pforzheim, Germany ,Department of Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
| | - Luis Navas
- ARCUS Sportklinik, Rastatterstr. 17-19, 75179 Pforzheim, Germany
| | - Stefan Kinkel
- ARCUS Sportklinik, Rastatterstr. 17-19, 75179 Pforzheim, Germany
| | - Stefan Weiss
- ARCUS Sportklinik, Rastatterstr. 17-19, 75179 Pforzheim, Germany
| | | | - Wolfgang Miehlke
- ARCUS Sportklinik, Rastatterstr. 17-19, 75179 Pforzheim, Germany
| | - Marcus Streit
- ARCUS Sportklinik, Rastatterstr. 17-19, 75179 Pforzheim, Germany
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Mooiweer Y, van den Akker-Scheek I, Stevens M. Amount and type of physical activity and sports from one year forward after hip or knee arthroplasty-A systematic review. PLoS One 2021; 16:e0261784. [PMID: 34962967 PMCID: PMC8714096 DOI: 10.1371/journal.pone.0261784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/09/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION After rehabilitation following total hip or knee arthroplasty (THA/TKA), patients are advised to participate in physical activity (PA) and sports. However, profound insight into whether people adopt a physically active lifestyle is lacking. Aim is to gain insight into the performed amount and type of PA (including sports) and time spent sedentarily by persons after THA/TKA. METHODS A systematic review (PROSPERO: CRD42020178556). Pubmed, Cinahl, EMBASE and PsycInfo were systematically searched for articles reporting on amount of PA, and on the kind of activities performed between January 1995-January 2021. Quality of the articles was assessed with the adapted tool from Borghouts et al. RESULTS The search retrieved 5029 articles, leading to inclusion of 125 articles reporting data of 123 groups; 53 articles reported on subjects post-THA, 16 on post-hip-resurfacing arthroplasty, 40 on post-TKA, 15 on post-unicompartimental knee arthroplasty and 12 on a mix of arthroplasty types. With respect to quality assessment, 14 articles (11%) met three or fewer criteria, 29 (24%) met four, 32 (26%) met five, 42 (34%) met six, and 6 (5%) met seven out of the eight criteria. PA levels were comparable for THA and TKA, showing a low to moderately active population. Time spent was mostly of low intensity. Roughly 50% of -subjects met health-enhancing PA guidelines. They spent the largest part of their day sedentarily. Sports participation was relatively high (rates above 70%). Most participation was in low-impact sports at a recreational level. Roughly speaking, participants were engaged in sports 3 hours/week, consisting of about three 1-hour sessions. CONCLUSION Activity levels seem to be low; less than half of them seemed to perform the advised amount of PA following health-enhancing guidelines Sports participation levels were high. However, many articles were unclear about the definition of sports participation, which could have led to overestimation.
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Affiliation(s)
- Yvet Mooiweer
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Inge van den Akker-Scheek
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin Stevens
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Haffer H, Popovic S, Martin F, Hardt S, Winkler T, Damm P. In vivo loading on the hip joint in patients with total hip replacement performing gymnastics and aerobics exercises. Sci Rep 2021; 11:13395. [PMID: 34183711 PMCID: PMC8239021 DOI: 10.1038/s41598-021-92788-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/09/2021] [Indexed: 01/17/2023] Open
Abstract
A further increase in the number of total hip arthroplasty (THA) is predicted, in particular the number of young THA patients has raised and with it their demands. There is no standardized evidence-based rehabilitation program and no reliable guidelines for sports activities after THA. Stretching and strengthening gymnastics are routinely performed in rehabilitation and aerobics as a sport after THA. The aim of the investigation was to determine the in vivo force and moments acting on the hip prosthesis during gymnastics and aerobic exercises to provide a source for evidence-based recommendations. Hip joint loads were measured in six patients with instrumented hip implants. The resulting force FRes, bending moment MBend at the neck and torsional moment MTors at the stem were examined during seven strengthening (with two different resistance bands) and four stretching gymnastic exercises and seven aerobic exercises with and without an aerobic step board compared to the loads during the reference activity walking. The stretching and strengthening gymnastics exercises and the aerobic exercises with and without a board demonstrated in their median peak force and moments mostly lower or similar values compared to walking. Significantly increased loads were recorded for the flexor stretching exercise in monopod stand (Fres and MBend), the strengthening abduction exercise on the chair (MTors) and the strengthening flexion exercise with the stronger resistance band (MTors). We also found a significant increase in median peak values in aerobic exercises with a board for the "Basic Step" (ipsilateral started Fres and MTors; contralateral started MTors), "Kickstep ipsilateral started" (Fres and MTors) and "Over the Top contralateral started" (Fres). The in vivo loads in THA patients during frequently performed stretching, strengthening and aerobic exercises were demonstrated for the first time. It was proved that stretching gymnastic exercises are safe in terms of resulting force, bending and torque moments for THA patients, although an external assistance for stabilization may be considered. Strengthening gymnastics exercises are reliable in terms of Fres, MBend and MTors, but, based on our data, we recommend to adhere to the communicated specific postoperative restrictions and select the resistance bands with lower tension. Aerobic exercises without an aerobic board can be considered as reliable activity in terms of force and moments for THA patients. Aerobic exercises with a board are not recommended for the early postoperative period and in our opinion need to be adapted to the individual muscular and coordinative resources.
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Affiliation(s)
- Henryk Haffer
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Srdan Popovic
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
| | - Franziska Martin
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
| | - Sebastian Hardt
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Tobias Winkler
- Berlin-Institute of Health, Center for Regenerative Therapies, Center for Musculoskeletal Surgery, Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Philipp Damm
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany.
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Vu-Han T, Hardt S, Ascherl R, Gwinner C, Perka C. Recommendations for return to sports after total hip arthroplasty are becoming less restrictive as implants improve. Arch Orthop Trauma Surg 2021; 141:497-507. [PMID: 33258998 PMCID: PMC7899958 DOI: 10.1007/s00402-020-03691-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/11/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Total hip arthroplasty (THA) surgeries are expected to exponentially increase in the upcoming years, likely because of the overall broader indication of THAs. With these developments, an increasing number of younger (< 50 years) and active patients will receive surgical interventions, and expectations for an active lifestyle will accordingly increase. In addition, surgeons now have a growing array of techniques and implant materials to choose from. Despite these developments, evidence to provide the best standard-of-care to patients with high expectations for return to sports (RTS) is scarce and urgently needed. What recommendations do arthroplasty surgeons currently make to patients with high return to sports expectations, what factors may influence their recommendations and what surgical techniques and implant specifications are considered favorable in the treatment of patients with a more active lifestyle? This study was conducted to analyze the current recommendations, patient assessment, and patient counseling after THA to identify trends and relevant factors for surgical decision-making in patients with high-RTS expectations. MATERIAL AND METHODS We designed a questionnaire comprising five general items and 19 specific items that included 46 sub-items for hip arthroplasty and conducted a survey among 300 German surgeons specialized in arthroplasty at the German Arthroplasty Society (AE) to assess expert opinions, recommendations, surgical decision-making, and patient counseling for patients with high expectations for RTS after THA. RESULTS The majority of surgeons (81.9%) were in favor of RTS after THA. Risks associated with sports after THA were considered minimal (1%), with periprosthetic fractures ranking highest, followed by hip dislocation and polyethylene wear. Some surgical decision-making was influenced by high-RTS expectations in regard to implant fixation, stem type, femoral head diameter, and bearing-surface tribology. We observed an increasingly liberal counseling of patients for high-impact sports. CONCLUSION With the improvement of implants and surgical techniques, surgeons are more willing to encourage patients to adopt a more active lifestyle. However, the true long-term limitations need further investigation in future studies. LEVEL OF EVIDENCE 5 Expert opinions.
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Affiliation(s)
- T. Vu-Han
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin University Hospital, Chariteplatz 1, 10117 Berlin, Germany
| | - S. Hardt
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin University Hospital, Chariteplatz 1, 10117 Berlin, Germany
| | - R. Ascherl
- Department of Orthopaedic Surgery and Arthroplasty Nordoberpfalz AG, Krankenhaus Tirschenreuth, St.-Peter-Str. 31, 95643 Tirschenreuth, Germany
| | - C. Gwinner
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin University Hospital, Chariteplatz 1, 10117 Berlin, Germany
| | - C. Perka
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin University Hospital, Chariteplatz 1, 10117 Berlin, Germany
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Rochoy M, Six J, Favre J, Lagrange N, Lefebvre JM, Rollier JC, Girard J. Does hip or knee joint replacement decrease chances to complete an ultra-trail race? Study in participants at the Ultra-Trail du Mont Blanc®. Orthop Traumatol Surg Res 2020; 106:1539-1544. [PMID: 33191172 DOI: 10.1016/j.otsr.2020.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 07/01/2020] [Accepted: 07/21/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The number of patients with hip or knee joint replacements is increasing. Some of these patients want to practice sport, including in high-impact sports such as ultra-trails. Is the proportion of drop-out higher among runners after a hip or knee replacement? What are the symptoms of these patients? HYPOTHESIS Hip or knee joint replacements are associated with a higher drop-out rate during an ultra-trail. MATERIAL AND METHODS We conducted a monocentric retrospective epidemiological study. A questionnaire translated into French, English and Spanish were sent to all runners registered for one or more of the 5 races of the 2015 to 2017 Ultra-Trail du Mont-Blanc® (UTMB®) editions. There were no exclusion criteria. The drop-out rate of patients who responded to the questionnaire was calculated among patients with and without hip or knee joint replacement. Specific symptoms related to these joint replacements were identified before, during and after the race. RESULTS Out of the 24,855 participants having run at least one of the 3 editions, 2,469 responded. Some of them ran several races: these 2469 runners were on 3171 start lines and 2548 finish lines (drop-out rate of 19.6%). Among these 2469 runners, 18 had hip and/or knee replacement and were on 27 start lines and 17 finish lines (drop-out rate of 37%). The race was finished by 3 of the 6 runners with a total hip arthroplasty (THA), all of the 8 runners with a hip resurfacing arthroplasty (HRA) and 3 of the 4 runners with a total knee arthroplasty (TKA). Among runners with THA, pubalgia or groin pain was described by one of them before the race, 3 during the race and 2 after the race. Among runners with HRA, pygalgia or groin pain was described by 2 of them during the race. As for the TKA, there was no specific symptom. No answering runner had a unicompartmental knee prosthesis. DISCUSSION Running ultra-trail is possible after a hip or knee joint replacement. All of the 8 runners with HRA finished the race. We may remain cautious about the long-term survival of prostheses. LEVEL OF PROOF IV; monocentric retrospective epidemiological study.
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Affiliation(s)
- Michaël Rochoy
- University Lille, 59000 Lille, France; Département de médecine générale, faculté de médecine, 59000 Lille, France; Université de Lille, CHU Lille, ULR 2694 - METRICS, CERIM, General Practice Department, 59000 Lille, France.
| | - Julien Six
- University Lille, 59000 Lille, France; Département de médecine générale, faculté de médecine, 59000 Lille, France; Université de Lille, General Practice Department, 59000 Lille, France
| | - Jonathan Favre
- University Lille, 59000 Lille, France; Département de médecine générale, faculté de médecine, 59000 Lille, France; Université de Lille, General Practice Department, 59000 Lille, France
| | | | - Jean-Marc Lefebvre
- University Lille, 59000 Lille, France; Département de médecine générale, faculté de médecine, 59000 Lille, France; Université de Lille, General Practice Department, 59000 Lille, France
| | - Jean-Charles Rollier
- Arthrosport Argonay, Clinique d'Argonay Ramsay Générale de Santé, 685, route des Menthonnex, 74370 Argonay, France
| | - Julien Girard
- University Lille, 59000 Lille, France; Service d'orthopédie, hôpital Salengro, CHRU Lille, 59000 Lille, France
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Breuer R, Fiala R, Schrenk N, Tiefenboeck TM. Prospective Short-Term and Return-to-Sports Results of a Novel Uncemented Short-Stem Hip Prosthesis with Metaphyseal Anchorage. J Clin Med 2020; 9:jcm9061972. [PMID: 32599745 PMCID: PMC7356941 DOI: 10.3390/jcm9061972] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 06/19/2020] [Indexed: 11/16/2022] Open
Abstract
Short-stem hip prostheses were developed to treat active patients requiring total hip arthroplasty (THA). This study provides short-term data about a short-stem total hip arthroplasty system. Functional and radiological outcomes as well as return to sports and activity level were assessed. A series of 55 patients was primarily included. Data were available for 47 patients at an average follow-up of 38 ± 4.6 months. The back-to-sports analysis showed a 98% return-to-sports rate (46/47 patients). The average time for return to sports was 13 weeks (± 8) postoperatively. Five patients (10.6%) were more active postoperatively. The Harris Hip Score (HHS) improved from 34.8 (±9.4) preoperatively to 94.7 (±8.4, p ≤ 0.001) and the University of California, Los Angeles (UCLA) score improved from 4.5 (±1.8) to 6.9 (±1.9) (p ≤ 0.001). The High Activity Arthroplasty Score (HAAS) was 12 (±3.6) at 3-year follow-up. Pre- and postoperative UCLA and postoperative HHS and HAAS scores had a positive influence on the return-to-sports rate (p ≤ 0.05). The collection of radiographic data during all postoperative follow-ups showed no signs of radiolucent lines or bone fissures. The complication rate was at 5%. Short-stem systems are equaling conventional prostheses and offer benefits regarding soft tissue and bone stock preservation. Fast recovery and return to sports can be achieved.
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Affiliation(s)
- Robert Breuer
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria;
| | - Rainer Fiala
- Department of Orthopedics and Trauma Surgery, Sozialmedizinisches Zentrum Ost, 1220 Vienna, Austria;
| | - Nina Schrenk
- Department of Orthopedics, Klinikum Wels-Grieskirchen, 4600 Wels, Austria;
| | - Thomas M. Tiefenboeck
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria;
- Correspondence:
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12
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Batailler C, Rozinthe A, Mercier M, Bankhead C, Gaillard R, Lustig S. Return to Sport After Bilateral Single Stage Total Hip Arthroplasty Using the Direct Anterior Approach: A Case Control Study. J Arthroplasty 2019; 34:2972-2977. [PMID: 31326245 DOI: 10.1016/j.arth.2019.06.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/20/2019] [Accepted: 06/25/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) is currently performed on active patients with increasing functional demands. Single stage bilateral THA is indicated in younger patients in good general health. Our objective is to evaluate the return to sport (RTS) in patients who underwent bilateral single stage THA compared to unilateral THA. METHODS This retrospective case control study was conducted between 2013 and 2017. All patients who underwent bilateral single stage THA were included. The control group had unilateral THA performed and was matched based on age, body mass index, gender, and surgery date (2 controls for each bilateral case). All surgeries were performed by a single senior surgeon using the direct anterior approach. The University of California Los Angeles activity score was collected at the last follow-up. A questionnaire regarding RTS, motivation, and satisfaction was assessed. RESULTS Thirty-two patients were included in the study, of whom 21 were men. The average age was 60.7 ± 9.6 years, body mass index was 26 ± 4 kg/m2, and mean follow-up was 20.1 ± 11.6 months. Twenty-eight patients overall (87%) returned to sport after the procedure. Twenty-five of these (89%) returned to the same sport, and 17 (68%) participated at the same intensity. The average time to RTS was 4 ± 2.8 months. These results were at least as good as those after unilateral THA. The level of motivation of the patient was the only predictive factor for RTS (P < .001). CONCLUSION Bilateral single stage THA via a direct anterior approach allows for RTS and to a similar level in the majority of patients in whom this procedure is indicated. LEVEL OF EVIDENCE Comparative retrospective study, Level III.
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Affiliation(s)
- Cécile Batailler
- Orthopedic Surgery Department, Croix Rousse Hospital, Lyon, France
| | - Anouk Rozinthe
- Orthopedic Surgery Department, Croix Rousse Hospital, Lyon, France
| | - Marcelle Mercier
- Orthopedic Surgery Department, Croix Rousse Hospital, Lyon, France
| | | | - Romain Gaillard
- Orthopedic Surgery Department, Croix Rousse Hospital, Lyon, France
| | - Sébastien Lustig
- Orthopedic Surgery Department, Croix Rousse Hospital, Lyon, France
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13
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Hoorntje A, Janssen KY, Bolder SBT, Koenraadt KLM, Daams JG, Blankevoort L, Kerkhoffs GMMJ, Kuijer PPFM. The Effect of Total Hip Arthroplasty on Sports and Work Participation: A Systematic Review and Meta-Analysis. Sports Med 2019; 48:1695-1726. [PMID: 29691754 PMCID: PMC5999146 DOI: 10.1007/s40279-018-0924-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Total hip arthroplasty (THA) is a successful procedure to treat end-stage hip osteoarthritis. The procedure is increasingly performed in adults of working age, who often wish to return to sports (RTS) and return to work (RTW). However, a systematic overview of the evidence on RTS and RTW after THA is lacking. Objectives Our aim was to systematically review (1) the extent to which patients RTS and RTW after THA, including (2) the time to RTS and RTW. Methods We searched MEDLINE and Embase from inception until October 2017. Two authors screened and extracted the data, including study information, patient demographics, rehabilitation protocols and pre- and postoperative sports and work participation. Methodological quality was assessed using the Newcastle–Ottawa scale. Data on pre- and postoperative sports and work participation were pooled using descriptive statistics. Results A total of 37 studies were included, of which seven were prospective studies and 30 were retrospective studies. Methodological quality was high in 11 studies, moderate in 16 studies, and low in ten studies. RTS was reported in 14 studies. Mean RTS was 104% to the pre-surgery level and 82% to the pre-symptomatic sports level. Time to RTS varied from 16 to 28 weeks. RTW was reported in 23 studies; the mean was 69%. Time to RTW varied from 1 to 17 weeks. Conclusion A great majority of patients RTS and RTW after THA within a timeframe of 28 and 17 weeks, respectively. For the increasingly younger THA population, this is valuable information that can be used in the preoperative shared decision-making process. Electronic supplementary material The online version of this article (10.1007/s40279-018-0924-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alexander Hoorntje
- Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam Movement Sciences, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. .,Department of Orthopaedic Surgery, Foundation FORCE (Foundation for Orthopaedic Research Care and Education), Amphia Hospital, Molengracht 21, 4818 CK, Breda, The Netherlands. .,Academic Center for Evidence-Based Sports Medicine (ACES), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Kim Y Janssen
- Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam Movement Sciences, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Stefan B T Bolder
- Department of Orthopaedic Surgery, Foundation FORCE (Foundation for Orthopaedic Research Care and Education), Amphia Hospital, Molengracht 21, 4818 CK, Breda, The Netherlands
| | - Koen L M Koenraadt
- Department of Orthopaedic Surgery, Foundation FORCE (Foundation for Orthopaedic Research Care and Education), Amphia Hospital, Molengracht 21, 4818 CK, Breda, The Netherlands
| | - Joost G Daams
- Medical Library, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Leendert Blankevoort
- Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam Movement Sciences, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Academic Center for Evidence-Based Sports Medicine (ACES), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam Movement Sciences, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Academic Center for Evidence-Based Sports Medicine (ACES), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - P Paul F M Kuijer
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Acetabular Debonding: An Investigation of Porous Coating Delamination in Hip Resurfacing Arthroplasty. Adv Orthop 2018; 2018:5282167. [PMID: 30515334 PMCID: PMC6236702 DOI: 10.1155/2018/5282167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 10/01/2018] [Indexed: 11/21/2022] Open
Abstract
Background To date, there have been no published investigations on the cause of acetabular debonding, a rare failure phenomenon in metal-on-metal hip resurfacing where the acetabular porous coating delaminates from the implant while remaining well fixed to the pelvic bone. Purposes This study aims to summarize the current understanding of acetabular debonding and to investigate the discrepancy in rate of debonding between two implant systems. Patients and Methods To elucidate potential causes of debonding, we retrospectively analyzed a single-surgeon cohort of 839 hip resurfacing cases. Specifically, we compared rate of debonding and manufacturing processes between two implant systems. Results Group 1 experienced significantly more cases of debonding than Group 2 cases (4.0% versus 0.0%, p value<0.0001). Implant manufacturing processes differed in surface coating, heat treatment, postmanufacturing treatment, and apex thickness. Debonded implants were more likely to have missed RAIL guidelines (p=0.04). Conclusions We identified implant system, postoperative time, and acetabular component placement as variables contributing to rate of debonding. We recommend minimizing acetabular inclination angle according to RAIL guidelines. Further, we evaluated manufacturing differences between the two implant systems but did not have access to proprietary data to identify the cause of debonding. Both implants met ASTM standards, yet only the Group 1 implant debonded. This suggests the second implant had greater fatigue shear strength. Because the Group 2 implant achieved a more durable interface that did not debond, we suggest the ASTM F1160 standard for fatigue shear strength be increased to that achieved by its manufacturer. Level of Evidence II A retrospective evaluation of prospectively collected data.
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15
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Baumgarten KM, Chang PS, Dannenbring TM, Foley EK. Does total shoulder arthroplasty improve patients' activity levels? J Shoulder Elbow Surg 2018; 27:1987-1995. [PMID: 29804913 DOI: 10.1016/j.jse.2018.03.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/23/2018] [Accepted: 03/25/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total shoulder arthroplasty (TSA) decreases pain, improves range of motion, and increases strength. Whether these improvements translate to improvements in activity levels postoperatively remains unknown. The Shoulder Activity Level (SAL) is a valid and reliable outcomes survey that measures the patient's activity level. Currently, no studies have specifically examined the effect of TSA on SAL. METHODS A prospective collection of preoperative, patient-determined outcomes on patients undergoing TSA was compared with postoperative scores at a minimum of 2 years. These scores included the SAL, Western Ontario Osteoarthritis of the Shoulder Index (WOOS), American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment, Single Assessment Numeric Evaluation (SANE), and the Simple Shoulder Test (SST). Inclusion criteria were patients undergoing primary anatomic TSA or reverse TSA. RESULTS A mean follow-up of 3.7 years was available for 80 anatomic and 42 reverse TSAs. Anatomic TSAs had improvements from median preoperative scores to median postoperative scores for WOOS (34 to 89; P < .0001), ASES (30 to 87; P < .0001), SST (2 to 9; P < .0001), and SANE scores (23 to 90; P < .0001). The SAL improved from 7 to 8 but did not quite reach statistical significance (P = .07). Reverse TSAs had improvements from median preoperative scores to median postoperative scores for WOOS (31 to 83; P < .0001), ASES (29 to 82; P < .0001), SST (2 to 7; P < .0001), and SANE scores (20 to 85; P < .0001). The SAL improved from 4.5 to 6, but this did not reach statistical significance (P = .38). However, when anatomic and reverse TSAs were analyzed together, a statistically significant improvement was found postoperatively in the SAL (from 6 to 8; P = .006). CONCLUSIONS Anatomic TSA and reverse TSA improved activity levels. In addition, disease-specific and joint-specific quality of life scores all had statistically significant improvements. This study suggests that after shoulder arthroplasty patients in general have (1) significant improvements in their quality of life and (2) have small improvements in activity level. This study shows that most patients do not have to decrease their activity levels to diminish symptoms to an acceptable range.
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Affiliation(s)
- Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, SD, USA; University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA.
| | - Peter S Chang
- University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA
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16
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Hara D, Hamai S, Komiyama K, Motomura G, Shiomoto K, Nakashima Y. Sports Participation in Patients After Total Hip Arthroplasty vs Periacetabular Osteotomy: A Propensity Score-Matched Asian Cohort Study. J Arthroplasty 2018; 33:423-430. [PMID: 28947372 DOI: 10.1016/j.arth.2017.08.035] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 08/21/2017] [Accepted: 08/26/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND No studies have compared sports participation between total hip arthroplasty (THA) and periacetabular osteotomy (PAO) in matched Asian cohorts. We investigated sports participation and activity levels in Asian THA cohort, and compared them between THA and PAO cohorts. METHODS Multivariate analyses were applied to determine which factors were associated with postoperative sports participation and University of California-Los Angeles (UCLA) activity score in (1) 524 THA patients and (2) 487 acetabular dysplasia patients (295 THA patients and 192 PAO patients). In addition, postoperative sports participation and UCLA score were compared between 62 THA and 62 PAO patients after adjusting for baseline characteristics with propensity score matching. RESULTS Sports participation and UCLA score significantly increased after THA (P < .001 in both analyses). Preoperative sports participation was the factor most associated with both postoperative sports participation and UCLA score in both 524 THA patients and 487 acetabular dysplasia patients (P < .001 in all analyses). Multivariate analysis in 487 acetabular dysplasia patients demonstrated that THA, compared with PAO, was negatively associated with postoperative sports participation (P < .001), but not postoperative UCLA score (P = .22). THA patients showed significantly lower rate of postoperative sports participation (32.3% and 51.6%, respectively, P = .046), but not postoperative UCLA score (5.0 ± 1.6 and 5.2 ± 1.9, respectively, P = .47) compared with matched PAO patients. CONCLUSION THA significantly increased both sports participation and activity levels. Both multivariate and propensity score-matched analyses showed that postoperative activity levels were comparable between THA and PAO cohorts.
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Affiliation(s)
- Daisuke Hara
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keisuke Komiyama
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Goro Motomura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kyohei Shiomoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Panzram B, Bertlich I, Reiner T, Walker T, Hagmann S, Gotterbarm T. Cementless unicompartmental knee replacement allows early return to normal activity. BMC Musculoskelet Disord 2018; 19:18. [PMID: 29343231 PMCID: PMC5773134 DOI: 10.1186/s12891-017-1883-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 11/29/2017] [Indexed: 01/31/2023] Open
Abstract
Background Physical activity and regular participation in recreational sports gain importance in patients’ lifestyle after knee arthroplasty. Cementless unicompartimental Knee replacement with the Oxford System has been introduced into clinical routine. Currently there is no data reporting on the physical activity, return to sports rate and quality of live after medial cementless Oxford Unicompartimental Knee Replacement (OUKR). Methods This retrospective cohort study reports on the functional outcome of the first 27 consecutive patients (30 knees) that were consecutively treated with a cementless medial OUKR between 2007 and 2009 in our hospital. Physical activity and quality of life were measured using the Tegner-Score, the UCLA-Activity Score, the Schulthess Clinical Activity Questionnaire and the SF-36 Score. The patients’ satisfaction with the outcome was measured using a visual analogue scale. Results Mean age at surgery was 62.5 years. Patients showed a rapid recovery with 17 out of 27 patients returning to sports within 3 months, 24 within 6 months after surgery. The Return-to-activity-rate was 100%. 10 out of 27 patients showed a high activity level (UCLA ≥7 points) with a mean postoperative UCLA-Score of 6.1 points. Conclusions Patients recover rapidly after cementless OUKR with a return to sports rate of 100% and patients are able to participate in high impact sports disciplines.
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Affiliation(s)
- Benjamin Panzram
- Clinic of Orthopaedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Germany
| | - Ines Bertlich
- Clinic of Orthopaedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Germany
| | - Tobias Reiner
- Clinic of Orthopaedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Germany
| | - Tilman Walker
- Clinic of Orthopaedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Germany
| | - Sébastien Hagmann
- Clinic of Orthopaedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Germany
| | - Tobias Gotterbarm
- Clinic of Orthopaedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Germany.
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Gaillard EB, Gaillard MD, Gross TP. Interventions for Improving Hip Resurfacing Outcomes in Women: A High-Volume, Retrospective Study. J Arthroplasty 2017; 32:3404-3411. [PMID: 28750857 DOI: 10.1016/j.arth.2017.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/26/2017] [Accepted: 06/01/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Women seeking surgical intervention for their hip disorders will often find total hip arthroplasty (THA) presented as their only option. THA, when compared with hip resurfacing arthroplasty, removes substantially more bone-stock, limits range-of-motion, exhibits increased dislocation risk, and presents greater overall 10-year mortality rate. Despite these risks, most surgeons continue to select against women for hip resurfacing because registries notoriously report inferior survivorship when compared with men and THA. METHODS We investigated the reasons for why resurfacing arthroplasty devices survive poorly in women to develop interventions which might improve hip resurfacing outcomes in women. Using these findings, we developed a series of surgical interventions to treat the underlying issues. Herein, we compare 2 study groups: women who received hip resurfacings before (group 1) and after (group 2) these interventions. RESULTS Eight-year implant survivorship substantially improved from 89.6% for group 1 to 97.7% for group 2. Adverse wear-related failure, femoral component loosening, and acetabular component loosening were all significantly reduced in group 2, which we attribute to the implementation of our relative acetabular inclination limit guidelines, use of uncemented femoral fixation, and selection of the Tri-Spike acetabular component for supplemental fixation, respectively. Kaplan-Meier implant survivorship curves, grouped into 2-year time intervals, show that the disparity in failure rates between men and women is diminishing. CONCLUSION When experienced surgeons use refined and proper surgical technique, women show promise as excellent candidates for hip resurfacing as an alternative treatment for their debilitating hip conditions.
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Affiliation(s)
- Emily B Gaillard
- Midlands Orthopaedics & Neurosurgery Research Department, Columbia, South Carolina
| | - Melissa D Gaillard
- Midlands Orthopaedics & Neurosurgery Research Department, Columbia, South Carolina
| | - Thomas P Gross
- Midlands Orthopaedics & Neurosurgery Research Department, Columbia, South Carolina
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Smith TO, Dainty JR, MacGregor A. Trajectory of physical activity following total hip and knee arthroplasty: data from the English Longitudinal Study of Ageing (ELSA) cohort. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2017. [DOI: 10.1080/21679169.2017.1332683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Toby O. Smith
- School of Health Sciences, University of East Anglia, Norwich, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Jack R. Dainty
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Alex MacGregor
- Norwich Medical School, University of East Anglia, Norwich, UK
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Abstract
Epidemiologic data show that the number of middle aged (>40 yr) and elderly (>65 yr) individuals continues to increase steadily, creating an expanding need for sports medicine care. Management of injuries in this subset of patients is expanding well beyond sustaining a patient's ability to perform activities of daily living. In fact, many older individuals increasingly expect to maintain reasonably high activity levels throughout their lifespan as well as after musculoskeletal injury. While a number of the emerging physiologic benefits of physical activity in older patients have been outlined, no recent review has outlined the current best surgical techniques, rehabilitation protocols, and return-to-sport recommendations for older athletes after soft-tissue repair or reconstruction as well as joint replacement. The goal of orthopaedic care in the elderly patient is shifting from simple pain relief toward return to athletic activity.
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Affiliation(s)
- Steven F DeFroda
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, RI
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Gaillard MD, Gross TP. Metal-on-metal hip resurfacing in patients younger than 50 years: a retrospective analysis : 1285 cases, 12-year survivorship. J Orthop Surg Res 2017; 12:79. [PMID: 28578684 PMCID: PMC5455178 DOI: 10.1186/s13018-017-0579-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 05/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Nordic registry reports patients under 50 years old with total hip replacements realize only 83% 10-year implant survivorship. These results do not meet the 95% 10-year survivorship guideline posed by the UK's National Institute for Health and Care Excellence (NICE) in 2014. METHODS The purpose of this study is threefold: First, we evaluate if metal-on-metal hip resurfacing arthroplasty meets these high standards in younger patients. Next, we compare outcomes between age groups to determine if younger patients are at higher risk for revision or complication. Lastly, we assess how outcomes between sexes changed over time. From January 2001 to August 2013, a single surgeon performed 1285 metal-on-metal hip resurfacings in patients younger than 50 years old. We compared these to an older cohort matched by sex and BMI. RESULTS Kaplan-Meier implant survivorship was 96.5% at 10 years and 96.3% at 12 years; this did not differ from implant survivorship for older patients. Implant survivorship at 12 years was 98 and 93% for younger men and women, respectively; survivorship for women improved from 93 to 97% by using exclusively Biomet implants. There were four (0.3%) adverse wear-related failures, with no instances of wear or problematic ion levels since 2009. Activity scores improved from 5.4 ± 2.3 preoperatively to 7.6 ± 1.9 postoperatively (p < 0.0001), with 43% of patients reporting a UCLA activity score of 9 or 10. CONCLUSIONS Hip resurfacing exceeds the stricter 2014 NICE survivorship criteria independently in men and women even when performed on patients under 50 years old.
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Affiliation(s)
- Melissa D Gaillard
- Midlands Orthopaedics & Neurosurgery, 1910 Blanding Street, Columbia, SC, 29201, USA.
| | - Thomas P Gross
- Midlands Orthopaedics & Neurosurgery, 1910 Blanding Street, Columbia, SC, 29201, USA
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Primary Total Hip Arthroplasty: Equivalent Outcomes in Low and High Functioning Patients. J Am Acad Orthop Surg 2016; 24:814-822. [PMID: 27755263 DOI: 10.5435/jaaos-d-16-00361] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE Previous studies suggest that patients with poorer physical function prior to undergoing total hip arthroplasty (THA) have a lower postoperative functional outcome. We sought to determine if the preoperative level of function was predictive of the outcome in patients undergoing THA using modern perioperative protocols and surgical techniques. METHODS A prospective cohort study design evaluated the preoperative and 2-year postoperative health-related quality of life (HRQoL) scores of 200 patients who underwent THA. The cohort was divided into two groups according to the median preoperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical function scores. RESULTS Both high and low function groups had significant improvements in the HRQoL scores (P < 0.001). However, this improvement was substantially greater in the low function group, resulting in no difference in the HRQoL outcomes of the two groups at final follow-up. CONCLUSION This study contradicts the previously held belief that patients with worse function before THA do not do as well as those with less preoperative disability. LEVEL OF EVIDENCE Level II.
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