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George J, Taylor AJ, Schmalzried TP. Examining the "revisability" benefit of hip resurfacing arthroplasty. World J Orthop 2024; 15:554-559. [PMID: 38947266 PMCID: PMC11212540 DOI: 10.5312/wjo.v15.i6.554] [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: 01/31/2024] [Revised: 04/20/2024] [Accepted: 04/26/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Hip resurfacing arthroplasty (HRA) is an alternative to total hip arthroplasty (THA) that is typically reserved for young active patients because it preserves bone. However, the benefits of HRA only hold true if conversion THA after failed HRA provides acceptable outcomes. AIM To compare patient reported outcomes for conversion THA after HRA failure to primary THA. METHODS A retrospective review of 36 patients (37 hips) that underwent conversion THA for failed HRA between October 2006 and May 2019 by a single surgeon was performed. Patient reported outcomes [modified Harris Hip Score (mHHS), University of California Los Angeles (UCLA) activity score] were obtained via an email-based responder-anonymous survey. Outcomes were compared to normative data of a primary THA cohort with similar demographics. Subgroup analysis was performed comparing outcomes of conversion THA for adverse local tissue reaction (ALTR) vs all other causes for failure. RESULTS The study group had a lower mHHS than the control group (81.7 ± 13.8 vs 90.2 ± 11.6, P < 0.01); however, both groups had similar UCLA activity levels (7.5 ± 2.3 vs 7.2 ± 1.6, P = 0.51). Patients that underwent conversion for non-ATLR causes had similar mHHS (85.2 ± 11.5 vs 90.2 ± 11.6, P = 0.11) and higher UCLA activity levels (8.5 ± 1.8 vs 7.2 ± 1.6, P < 0.01) compared to the control group. Patients that underwent conversion for ATLR had worse mHHS (77.1 ± 14.5 vs 90.2 ± 11.6, P < 0.01) and UCLA activity levels (6.1 ± 2.3 vs 7.2 ± 1.6, P = 0.05) when compared to the control group. CONCLUSION Patient outcomes equivalent to primary THA can be achieved following HRA conversion to THA. However, inferior outcomes were demonstrated for ALTR-related HRA failure. Patient selection and perhaps further studies examining alternative HRA bearing surfaces should be considered.
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Affiliation(s)
- Jose George
- Department of Orthopedics, Harbor UCLA Medical Center, Torrance, CA 90509, United States
| | - Adam J Taylor
- Department of Orthopedics, Harbor UCLA Medical Center, Torrance, CA 90509, United States
| | - Thomas P Schmalzried
- Department of Orthopedics, Harbor UCLA Medical Center, Torrance, CA 90509, United States
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2
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LaValva SM, LeBrun DG, Canoles HG, Ren R, Padgett DE, Su EP. Clinical outcomes and return to dance after total hip arthroplasty or hip resurfacing in professional dancers. Bone Joint J 2024; 106-B:17-23. [PMID: 38425296 DOI: 10.1302/0301-620x.106b3.bjj-2023-0854.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Aims Professional dancers represent a unique patient population in the setting of hip arthroplasty, given the high degree of hip strength and mobility required by their profession. We sought to determine the clinical outcomes and ability to return to professional dance after total hip arthroplasty (THA) or hip resurfacing arthroplasty (HRA). Methods Active professional dancers who underwent primary THA or HRA at a single institution with minimum one-year follow-up were included in the study. Primary outcomes included the rate of return to professional dance, three patient-reported outcome measures (PROMs) (modified Harris Hip Score (mHHS), Hip disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR), and Lower Extremity Activity Scale (LEAS)), and postoperative complications. Results A total of 49 hips in 39 patients (mean age 56 years (SD 13); 80% female (n = 39)) were included. Mean follow-up was 4.9 years (SD 5.1). Of these 49 hips, 37 THAs and 12 HRAs were performed. In all, 96% of hips returned to professional dance activities postoperatively. With regard to PROMs, there were statistically significant improvements in mHHS, HOOS-JR, and LEAS from baseline to ≥ one year postoperatively. There were complications in 7/49 hips postoperatively (14%), five of which required revision surgery (10%). There were no revisions for instability after the index procedure. Two complications (5.4%) occurred in hips that underwent THA compared with five (42%) after HRA (p = 0.007), though the difference by procedure was not significantly different when including only contemporary implant designs (p = 0.334). Conclusion Active professional dancers experienced significant improvements in functional outcome scores after THA or HRA, with a 96% rate of return to professional dance. However, the revision rate at short- to mid-term follow-up highlights the challenges of performing hip arthroplasty in this demanding patient population. Further investigation is required to determine the results of THA versus HRA using contemporary implant designs in these patients.
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Affiliation(s)
- Scott M LaValva
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA
| | - Drake G LeBrun
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA
| | - Haley G Canoles
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA
| | - Renee Ren
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA
| | - Douglas E Padgett
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA
| | - Edwin P Su
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA
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3
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Alagha MA, Logishetty K, O’Hanlon C, Liddle AD, Cobb J. Three-Dimensional Preoperative Planning Software for Hip Resurfacing Arthroplasty. Bioengineering (Basel) 2023; 10:939. [PMID: 37627824 PMCID: PMC10451941 DOI: 10.3390/bioengineering10080939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/10/2023] [Accepted: 07/20/2023] [Indexed: 08/27/2023] Open
Abstract
Three-dimensional planning of hip arthroplasty is associated with better visualisation of anatomical landmarks and enhanced mapping for preoperative implant sizing, which can lead to a decrease in surgical time and complications. Despite the advantages of hip resurfacing arthroplasty (HRA), it is considered a technically challenging procedure and associated with inaccurate implant placement. This study aimed to examine the validity, reliability, and usability of preoperative 3D Hip Planner software for HRA. Fifty random cases of various hip osteoarthritis severity were planned twice by two junior trainees using the 3D Hip Planner within a one-month interval. Outcome measures included femoral/cup implant size, stem-shaft angle, and cup inclination angle, and were assessed by comparing outcomes from 2D and 3D planning. An adapted unified theory of acceptance and use of technology (UTAUT) survey was used for software usability. Bland-Altman plots between 3D and 2D planning for stem-shaft and inclination angles showed mean differences of 0.7 and -0.6, respectively (r = 0.93, p < 0.001). Stem-shaft and inclination angles showed inter-rater reliability biases of around -2° and 3°, respectively. Chi-square and Pearson's correlation for femoral implant size showed a significant association between the two assessors (r = 0.91, p < 0.001). The 3D test-retest coefficient of repeatability for stem-shaft and inclination angles were around ±2° and ±3°, respectively, with a strong significant association for femoral implant size (r = 0.98, p < 0.001). Survey analyses showed that 70-90% agreed that 3D planning improved expectancy in four domains. 3D hip planner appears to be valid and reliable in preoperative HRA and shows significant potential in optimising the quality and accuracy of surgical planning.
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Affiliation(s)
- M. Abdulhadi Alagha
- MSk Lab, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London W12 0BZ, UK
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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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Lass R, Bechler U, Springer B, Rueckl K, Hanreich C, Boettner F. Midterm results of the Birmingham hip resurfacing: a single-surgeon series. Arch Orthop Trauma Surg 2023; 143:1041-1048. [PMID: 35076766 DOI: 10.1007/s00402-021-04305-0] [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: 06/21/2021] [Accepted: 12/04/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Birmingham hip resurfacing (BHR) is readily used as alternative to total hip replacement in younger patients. The current study aims to compare outcomes in terms of adverse local tissue reactions (ALTR), elevated metal ion levels and survival rates between low-risk (femoral component size ≥ 48 mm) and high-risk (femoral component size < 48 mm) BHR patients at a minimum 5-year follow-up (FU). MATERIALS AND METHODS We report the minimum 5-year, single surgeon outcome results of 183 BHRs, performed between 2007 and 2012. 154 patients, 18 women (20 hips) and 136 men (163 hips) were included in the study. Patients were grouped in 149 low-risk cases (femoral component size ≥ 48 mm) and in 34 high-risk cases (18 female/12 male) patients with a femoral head size < 48 mm). RESULTS At a minimum of 5-years FU time, 91% of the patients were available for FU. The overall survival rate was 91.8%. There were five revisions (survival rate 96.6%) in the low-risk group and ten revisions (survival rate 70.6%) in the high-risk group. In the low-risk group, six patients (6.5%) showed elevated metal ion levels (> 7 μg/l), compared to five patients (20.8%) in the high risk-group (p = 0.03). CONCLUSION Including the surgeon's initial learning curve, the BHR shows very good mid-term survival rates in the low-risk group but should, as previously demonstrated, not be considered for patients with less than 48 mm femoral head size. LEVEL OF EVIDENCE Level III: retrospective cohort study.
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Affiliation(s)
- Richard Lass
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopedics and Traumatology, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Ulrich Bechler
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernhard Springer
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopedics and Traumatology, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Kilian Rueckl
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, 535 East 70th Street, New York, NY, 10021, USA
- Orthopedic Clinic König-Ludwig-Haus, University of Wuerzburg, Würzburg, Germany
| | - Carola Hanreich
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, 535 East 70th Street, New York, NY, 10021, USA
| | - Friedrich Boettner
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, 535 East 70th Street, New York, NY, 10021, USA.
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Hip resurfacing and posterior approach total hip arthroplasty have equivalent blood loss when tranexamic acid is used: a propensity score matched cohort analysis. Arch Orthop Trauma Surg 2022; 142:4055-4061. [PMID: 35001154 DOI: 10.1007/s00402-021-04272-6] [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: 07/30/2021] [Accepted: 11/19/2021] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Hip resurfacing (HR) requires a larger approach and soft tissue dissection and might therefore be associated with increased blood loss compared to total hip arthroplasty (THA). However, the effect of the adoption of tranexamic acid (TXA) in this setting is unknown. Therefore, the current study compares the blood loss and transfusion requirements between HR and posterior THA in patients receiving TXA. MATERIALS AND METHODS This retrospective cohort study included patients undergoing primary, unilateral THA or HR using a posterior approach between February 2016 and 2020 in which TXA was administered. THA and HR patients were propensity score matched using nearest neighbor greedy matching accounting for demographic, health and surgical variables. Postoperative hemoglobin (Hgb) levels and Hgb drop from preoperative to post-operative day (POD) 1 were compared using t-tests and associated risk factors were assessed using linear mixed modelling. RESULTS After matching, each cohort consisted of 1395 patients. Cohorts were similar regarding age, sex, BMI, and Charlson Comorbidity Index. No significant differences were found for Hgb levels on POD 1 (12.3 g/dl; p = 0.90) or Hgb drop (2.3 g/dl; p = 0.87). Duration of surgery was significantly longer for HR patients (82 vs 77 min; p < 0.01). Transfusion rate was 0.1% in both cohorts (p = 1.00). Hospital stay was significantly shorter for HR patients (1 vs 2 days; p < 0.01). CONCLUSION HR using a standard TXA regimen is not associated with greater perioperative blood loss than posterior THA and does not result in increased transfusion requirements. Both surgical procedures can be considered equally safe in terms of perioperative blood management when TXA is used.
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Kayani B, Baawa-Ameyaw J, Fontalis A, Tahmassebi J, Wardle N, Middleton R, Stephen A, Hutchinson J, Haddad FS. Oxidized zirconium versus cobalt-chrome femoral heads in total hip arthroplasty: a multicentre prospective randomized controlled trial with ten years' follow-up. Bone Joint J 2022; 104-B:833-843. [PMID: 35775177 DOI: 10.1302/0301-620x.104b7.bjj-2021-1673.r1] [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] [Indexed: 11/05/2022]
Abstract
AIMS This study reports the ten-year wear rates, incidence of osteolysis, clinical outcomes, and complications of a multicentre randomized controlled trial comparing oxidized zirconium (OxZr) versus cobalt-chrome (CoCr) femoral heads with ultra-high molecular weight polyethylene (UHMWPE) and highly cross-linked polyethylene (XLPE) liners in total hip arthroplasty (THA). METHODS Patients undergoing primary THA were recruited from four institutions and prospectively allocated to the following treatment groups: Group A, CoCr femoral head with XLPE liner; Group B, OxZr femoral head with XLPE liner; and Group C, OxZr femoral head with UHMWPE liner. All study patients and assessors recording outcomes were blinded to the treatment groups. The outcomes of 262 study patients were analyzed at ten years' follow-up. RESULTS Patients in Group C were associated with increased mean liner wear rates compared to patients in Group A (0.133 mm/yr (SD 0.21) vs 0.031 mm/yr (SD 0.07), respectively; p < 0.001) and Group B (0.133 mm/yr (SD 0.21) vs 0.022 mm/yr (SD 0.05), respectively; p < 0.001) at ten years' follow-up. Patients in Group C were also associated with increased risk of osteolysis and aseptic loosening requiring revision surgery, compared with patients in Group A (7/133 vs 0/133, respectively; p = 0.007) and Group B (7/133 vs 0/135, respectively; p = 0.007). There was a non-statistically significant trend towards increased mean liner wear rates in Group A compared with Group B (0.031 mm/yr (SD 0.07) vs 0.022 mm/yr (SD 0.05), respectively; p = 0.128). All three groups were statistically comparable preoperatively and at ten years' follow-up when measuring normalized Western Ontario and McMaster Universities Osteoarthritis Index (p = 0.410), 36-Item Short Form Health Survey (p = 0.465 mental, p = 0.713 physical), and pain scale scores (p = 0.451). CONCLUSION The use of UHMWPE was associated with progressively increased annual liner wear rates after THA compared to XLPE. At ten years' follow-up, the group receiving UHMWPE demonstrated an increased incidence of osteolysis and aseptic loosening requiring revision surgery compared to XLPE. Femoral heads composed of OxZr were associated with trend towards reduced wear rates compared to CoCr, but this did not reach statistical significance and did not translate to any differences in osteolysis, functional outcomes, or revision surgery between the two femoral head components. Cite this article: Bone Joint J 2022;104-B(7):833-843.
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Affiliation(s)
- Babar Kayani
- Department of Trauma and Orthopaedics, University College Hospital, London, UK
| | - Joanna Baawa-Ameyaw
- Department of Trauma and Orthopaedics, University College Hospital, London, UK
| | - Andreas Fontalis
- Department of Trauma and Orthopaedics, University College Hospital, London, UK
| | - Jenni Tahmassebi
- Department of Trauma and Orthopaedics, University College Hospital, London, UK
| | - Nick Wardle
- Colchester Hospital University Foundation Trust, Colchester, UK
| | - Robert Middleton
- Department of Trauma and Orthopaedics, Bournemouth University, Bournemouth, UK
| | | | | | - Fares S Haddad
- Department of Trauma and Orthopaedics, University College Hospital, London, UK
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Edwards TC, Guest B, Garner A, Logishetty K, Liddle AD, Cobb JP. The metabolic equivalent of task score : a useful metric for comparing high-functioning hip arthroplasty patients. Bone Joint Res 2022; 11:317-326. [PMID: 35604337 PMCID: PMC9130675 DOI: 10.1302/2046-3758.115.bjr-2021-0445.r1] [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] [Indexed: 11/05/2022] Open
Abstract
AIMS This study investigates the use of the metabolic equivalent of task (MET) score in a young hip arthroplasty population, and its ability to capture additional benefit beyond the ceiling effect of conventional patient-reported outcome measures. METHODS From our electronic database of 751 hip arthroplasty procedures, 221 patients were included. Patients were excluded if they had revision surgery, an alternative hip procedure, or incomplete data either preoperatively or at one-year follow-up. Included patients had a mean age of 59.4 years (SD 11.3) and 54.3% were male, incorporating 117 primary total hip and 104 hip resurfacing arthroplasty operations. Oxford Hip Score (OHS), EuroQol five-dimension questionnaire (EQ-5D), and the MET were recorded preoperatively and at one-year follow-up. The distribution was examined reporting the presence of ceiling and floor effects. Validity was assessed correlating the MET with the other scores using Spearman's rank correlation coefficient and determining responsiveness. A subgroup of 93 patients scoring 48/48 on the OHS were analyzed by age, sex, BMI, and preoperative MET using the other metrics to determine if differences could be established despite scoring identically on the OHS. RESULTS Postoperatively the OHS and EQ-5D demonstrate considerable negatively skewed distributions with ceiling effects of 41.6% and 53.8%, respectively. The MET was normally distributed postoperatively with no relevant ceiling effect. Weak-to-moderate significant correlations were found between the MET and the other two metrics. In the 48/48 subgroup, no differences were found comparing groups with the EQ-5D, however significantly higher mean MET scores were demonstrated for patients aged < 60 years (12.7 (SD 4.7) vs 10.6 (SD 2.4), p = 0.008), male patients (12.5 (SD 4.5) vs 10.8 (SD 2.8), p = 0.024), and those with preoperative MET scores > 6 (12.6 (SD 4.2) vs 11.0 (SD 3.3), p = 0.040). CONCLUSION The MET is normally distributed in patients following hip arthroplasty, recording levels of activity which are undetectable using the OHS. Cite this article: Bone Joint Res 2022;11(5):317-326.
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Affiliation(s)
- Thomas C Edwards
- MSk Lab, Imperial College London, Sir Michael Uren Biomedical Engineering Research Hub, London, UK
| | - Brogan Guest
- MSk Lab, Imperial College London, Sir Michael Uren Biomedical Engineering Research Hub, London, UK
| | - Amy Garner
- MSk Lab, Imperial College London, Sir Michael Uren Biomedical Engineering Research Hub, London, UK
| | - Kartik Logishetty
- MSk Lab, Imperial College London, Sir Michael Uren Biomedical Engineering Research Hub, London, UK
| | - Alexander D Liddle
- MSk Lab, Imperial College London, Sir Michael Uren Biomedical Engineering Research Hub, London, UK
| | - Justin P Cobb
- MSk Lab, Imperial College London, Sir Michael Uren Biomedical Engineering Research Hub, London, UK
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Mooiweer Y, Stevens M, van den Akker-Scheek I. Being active with a total hip or knee prosthesis: a systematic review into physical activity and sports recommendations and interventions to improve physical activity behavior. Eur Rev Aging Phys Act 2022; 19:7. [PMID: 35227191 PMCID: PMC8903715 DOI: 10.1186/s11556-022-00285-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 02/01/2022] [Indexed: 12/19/2022] Open
Abstract
Objectives Regular physical activity (PA) is considered important after total hip and knee arthroplasty (THA/TKA). Objective was to systematically assess literature on recommendations given by healthcare professionals to persons after THA and TKA and to provide an overview of existing interventions to stimulate PA and sports participation. Methods A systematic review with a narrative synthesis including articles published between January 1995 and January 2021 reporting on recommendations and interventions. The PubMed, Embase, CINAHL and PsycInfo databases were systematically searched for original articles reporting on physical activity and sports recommendations given by healthcare professionals to persons after THA and TKA, and articles reporting on interventions/programs to stimulate a physically active lifestyle after rehabilitation or explicitly defined as part of the rehabilitation. Methodological quality was assessed with the Mixed Methods Appraisal Tool (MMAT). The review was registered in Prospero (PROSPERO:CRD42020178556). Results Twenty-one articles reported on recommendations. Low-impact activities were allowed. Contact sports, most ball sports, and martial arts were not recommended. One study informed on whether health-enhancing PA recommendations were used to stimulate persons to become physically active. No studies included recommendations on sedentary behavior. Eleven studies reported on interventions. Interventions used guidance from a coach/physiotherapist; feedback on PA behavior from technology; and face-to-face, education, goal-setting, financial incentives and coaching/financial incentives combined, of which feedback and education seem to be most effective. For methodological quality, 18 out of 21 (86%) articles about recommendations and 7 out of 11 (64%) articles about interventions scored yes on more than half of the MMAT questions (0–5 score). Conclusion There is general agreement on what kind of sports activities can be recommended by healthcare professionals like orthopedic surgeons and physiotherapists. No attention is given to amount of PA. The same is true for limiting sedentary behavior. The number of interventions is limited and diverse, so no conclusions can be drawn. Interventions including provision of feedback about PA, seem to be effective and feasible. Supplementary Information The online version contains supplementary material available at 10.1186/s11556-022-00285-1.
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Affiliation(s)
- Yvet Mooiweer
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, P.O. BOX 30.001, 9700 RB, Groningen, The Netherlands
| | - Martin Stevens
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, P.O. BOX 30.001, 9700 RB, Groningen, The Netherlands.
| | - Inge van den Akker-Scheek
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, P.O. BOX 30.001, 9700 RB, Groningen, The Netherlands
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Khan ST, Robinson PG, MacDonald DJ, Murray AD, Murray IR, Macpherson GJ, Clement ND. Infographic: Total hip arthroplasty in golfers. Bone Jt Open 2022; 3:152-154. [PMID: 35172588 PMCID: PMC8886315 DOI: 10.1302/2633-1462.32.bjo-2022-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Shujaa T. Khan
- Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Patrick G. Robinson
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
- PGA European Tour Performance Institute, Virginia Water, UK
| | | | | | - Iain R. Murray
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Nick D. Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
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11
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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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12
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Wignadasan W, Mohamed A, Kayani B, Magan A, Plastow R, Haddad FS. Restarting elective orthopaedic surgery as COVID-19 lockdown restrictions are reduced : have patient perceptions towards surgery changed? Bone Jt Open 2021; 2:865-870. [PMID: 34666506 PMCID: PMC8559661 DOI: 10.1302/2633-1462.210.bjo-2021-0076.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aims The COVID-19 pandemic drastically affected elective orthopaedic services globally as routine orthopaedic activity was largely halted to combat this global threat. Our institution (University College London Hospital, UK) previously showed that during the first peak, a large proportion of patients were hesitant to be listed for their elective lower limb procedure. The aim of this study is to assess if there is a patient perception change towards having elective surgery now that we have passed the peak of the second wave of the pandemic. Methods This is a prospective study of 100 patients who were on the waiting list of a single surgeon for an elective hip or knee procedure. Baseline characteristics including age, American Society of Anesthesiologists (ASA) grade, COVID-19 risk, procedure type, and admission type were recorded. The primary outcome was patient consent to continue with their scheduled surgical procedure. Subgroup analysis was also conducted to define if any specific patient factors influenced decision to continue with surgery Results Overall, 88 patients (88%) were happy to continue with their scheduled procedure at the earliest opportunity. Patients with an ASA grade I were most likely to agree to surgery, followed by patients with ASA grades II, then those with grade III (93.3%, 88.7%, and 78.6% willingness, respectively). Patients waitlisted for an injection were least likely to consent to surgery, with just 73.7% agreeing. In all, there was a large increase in the proportion of patient willingness to continue with surgery compared to our initial study during the first wave of the pandemic. Conclusion As COVID-19 lockdown restrictions are lifted after the second peak of the pandemic, we are seeing greater willingness to continue with scheduled orthopaedic surgery, reinforcing a change in patient perception towards having elective surgery. However, we must continue with strict COVID-19 precautions in order to minimize viral transmission as we increase our elective orthopaedic services going forward. Cite this article: Bone Jt Open 2021;2(10):865–870.
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Affiliation(s)
- Warran Wignadasan
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Abdulrahman Mohamed
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Ahmed Magan
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK.,The Princess Grace Hospital, London, UK
| | | | - Fares S Haddad
- The Princess Grace Hospital, London, UK.,The Bone & Joint Journal, London, UK
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13
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Buckley A, Duffy P, Korley R. Downhill skiing following total knee arthroplasty: a survey of Alberta orthopedic surgeons. Can J Surg 2021; 64:E414-E418. [PMID: 34296812 PMCID: PMC8410469 DOI: 10.1503/cjs.009720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: In older adults facing knee arthroplasty, the ability to resume downhill skiing postoperatively is unclear. This study aimed to determine the perspectives of Alberta orthopedic surgeons and senior residents regarding downhill skiing after total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA). Methods: In May 2019, a Web-based survey was sent through the Alberta Orthopaedic Society to poll orthopedic surgeons performing arthroplasty and senior orthopedic residents (postgraduate year 4 or 5) in Alberta regarding the permissibility of downhill skiing after TKA or UKA. The survey also elicited information regarding under which conditions or restrictions, if any, surgeons would allow patients to return to downhill skiing, whether these recommendations were evidence based, and whether surgeons had seen complications from downhill skiing in their patients who had undergone knee arthroplasty. Results: Of the 41 respondents, 21 (51%) were full-time fellowship-trained orthopedic surgeons, 15 (37%) were specialists with some arthroplasty in their practice, and 5 (12%) were orthopedic residents. Ten of 40 respondents (25%) would allow unrestricted downhill skiing after TKA, and 1 (2%) would not allow any skiing at all. The remaining 29 (72%) indicated that they might allow downhill skiing under specific conditions, with the top 3 being limitations on speed and intensity (29 [71%]), return of full range of motion and strength in the operative knee (26 [63%]), and years of downhill ski experience (23 [56%]). Fourteen respondents (34%) would allow unrestricted downhill skiing after UKA, and 27 (66%) would allow skiing with the same top 3 conditions as for TKA. Thirty-two respondents (78%) reported that their decisions were not evidence based, and 35 (85%) had never seen complications from downhill skiing after TKA or UKA. Conclusion: Alberta orthopedic surgeons and senior residents are cautious regarding skiing after knee arthroplasty. The majority reported that their restrictions were not evidence based, which indicates the need for further investigation to develop an approach for surgeons to consistently and safely address return to downhill skiing after TKA or UKA.
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Affiliation(s)
- Andrew Buckley
- From the Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Paul Duffy
- From the Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Robert Korley
- From the Cumming School of Medicine, University of Calgary, Calgary, Alta
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14
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Abstract
AIMS Adverse local tissue reactions associated with abnormal wear considerably slowed down the general use of metal-on-metal (MoM) hip resurfacing arthroplasty (HRA), now limited to a few specialized centres. In this study, we provide the clinical results of 400 consecutive MoM HRAs implanted more than 20 years ago in one such centre. METHODS A total of 355 patients (400 hips) were treated with Conserve Plus HRA between November 1996 and November 2000. There were 96 female (27%) and 259 male patients (73%). Their mean age was 48.2 years (SD 10.9). The University of California, Los Angeles (UCLA) hip scores and 12-item Short Form Survey (SF-12) quality of life scores were reported. Survivorship was assessed using Kaplan-Meier analyses. RESULTS The mean follow-up was 16.5 years (0.1 to 24.0), including 34 patients (37 hips) who died. The mean UCLA hip scores were 9.3 (2 to 10), 9.1 (3 to 10), 9.0 (3 to 10), and 6.9 (2 to 10) for pain, walking, function, and activity, respectively. The mean SF-12 scores were 48.4 (16.0 to 62.1) for the physical component and 48.5 (10.5 to 66.5) for the mental component, and did not differ from those of the general population of the USA. A total of 60 hips in 55 patients were revised. Using revision for any indication as the endpoint, the Kaplan-Meier survivorship was 83.5% at 20 years. A diagnosis of developmental dysplasia (hazard ratio (HR) 2.199 (95% confidence interval (CI) 1.140 to 4.239); p = 0.019) and a low BMI (HR 0.931 (95% CI 0.873 to 0.994); p = 0.032) were risk factors for revision. Female sex was a risk factor only because of hip dysplasia and small component size. There were no cases of metal sensitivity associated with revision surgery. Radiological analysis showed persistent fixation in all but one hip. CONCLUSION The 83.5% 20-year survivorship of this initial series surpasses that of total hip arthroplasties in use 20 years ago in these young patients, suggesting satisfactory lifelong durability of the device for almost all of the remaining patients. Cite this article: Bone Joint J 2021;103-B(7 Supple B):25-32.
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Affiliation(s)
- Harlan C Amstutz
- Joint Replacement Institute, St Vincent Medical Center, Los Angeles, California, USA
| | - Michel Jean Le Duff
- Joint Replacement Institute, St Vincent Medical Center, Los Angeles, California, USA
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15
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Morse KW, Premkumar A, Zhu A, Morgenstern R, Su EP. Return to Sport After Hip Resurfacing Arthroplasty. Orthop J Sports Med 2021; 9:23259671211003521. [PMID: 33997077 PMCID: PMC8113959 DOI: 10.1177/23259671211003521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/15/2020] [Indexed: 11/17/2022] Open
Abstract
Background Femoroacetabular impingement and degenerative hip osteoarthritis (OA) affect athletes across a wide variety of sports. Hip resurfacing arthroplasty (HRA) has emerged as a surgical treatment for active individuals with end-stage hip OA to provide pain relief and allow return to high-impact activities. Return to professional sports after HRA has not been well characterized. Purpose/Hypothesis The aim of this study was to report on a series of elite athletes in a variety of sports who underwent HRA. We hypothesized that professional and elite-level athletes would be able to return to sports after HRA for end-stage hip OA. Study Design Case series; Level of evidence, 4. Methods A retrospective case series was conducted on professional athletes who underwent HRA at a single institution between 2007 and 2017. All surgeries were performed by a single surgeon using the posterolateral approach. Athletes' return to play and sport-specific performance statistics were obtained using self-reported and publicly available data sources. Athletes were matched to an age- and performance-based cohort to determine changes in performance-based metrics. Results Eight professional athletes were identified, including 2 baseball pitchers, 1 ice hockey defenseman, 1 foil fencer, 1 men's doubles tennis player, 1 basketball player, 1 ultramarathoner, and 1 Ironman triathlete. All 8 patients returned to sports; 6 of 8 (75%) patients were able to return for at least 1 full season at a professional level after surgery. There were no significant differences between performance statistics for athletes who returned to play and their preoperative performance measures for the years leading up to surgery or the age- and performance-matched cohort. Conclusion HRA remains a surgical alternative for end-stage hip OA in young, high-impact, active patients. While the primary goals of surgery are pain control and quality of life improvement, it is possible to return to elite-level sporting activity after HRA.
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Affiliation(s)
- Kyle W Morse
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Ajay Premkumar
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Andrew Zhu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Rachelle Morgenstern
- Department of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA
| | - Edwin P Su
- Department of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA
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16
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Clough EJ, Clough TM. Metal on metal hip resurfacing arthroplasty: Where are we now? J Orthop 2020; 23:123-127. [PMID: 33488008 DOI: 10.1016/j.jor.2020.12.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/27/2020] [Indexed: 12/15/2022] Open
Abstract
Metal on metal hip resurfacing arthroplasty (HRA) was introduced in an attempt to address potential limitations regarding return to sport, return to high functional activity and premature wear in young patients requiring standard total hip replacement (THR). Around 12% patients undergoing hip replacement surgery are under 55 years of age. By more closely mimicking natural anatomy, and having a metal on metal (MoM) bearing, it was hoped that HRA would address the issues. However, concern has emerged about early failure, high revision rates from local adverse reactions to metallic wear debris and potential systemic consequences of metal ion cardiotoxicity. In this article, we discuss the existing literature in the field, the current clinical evidence surrounding HRA, its indications, clinical outcomes, and risk factors for failure and conclude if it still has a role within orthopaedic hip surgery.
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Affiliation(s)
- E J Clough
- University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - T M Clough
- Wrightington Hospital, Hall Lane, Wigan, WN6 9EP, UK
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17
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Chang J, Wignadasan W, Kontoghiorghe C, Kayani B, Singh S, Plastow R, Magan A, Haddad F. Restarting elective orthopaedic services during the COVID-19 pandemic: Do patients want to have surgery? Bone Jt Open 2020; 1:267-271. [PMID: 33215113 DOI: 10.1302/2046-3758.16.bjo-2020-0057] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Aims As the peak of the COVID-19 pandemic passes, the challenge shifts to safe resumption of routine medical services, including elective orthopaedic surgery. Protocols including pre-operative self-isolation, COVID-19 testing, and surgery at a non-COVID-19 site have been developed to minimize risk of transmission. Despite this, it is likely that many patients will want to delay surgery for fear of contracting COVID-19. The aim of this study is to identify the number of patients who still want to proceed with planned elective orthopaedic surgery in this current environment. Methods This is a prospective, single surgeon study of 102 patients who were on the waiting list for an elective hip or knee procedure during the COVID-19 pandemic. Baseline characteristics including age, ASA grade, COVID-19 risk, procedure type, surgical priority, and admission type were recorded. The primary outcome was patient consent to continue with planned surgical care after resumption of elective orthopaedic services. Subgroup analysis was also performed to determine if any specific patient factors influenced the decision to proceed with surgery. Results Overall, 58 patients (56.8%) wanted to continue with planned surgical care at the earliest possibility. Patients classified as ASA I and ASA II were more likely to agree to surgery (60.5% and 60.0%, respectively) compared to ASA III and ASA IV patients (44.4% and 0.0%, respectively) (p = 0.01). In addition, patients undergoing soft tissue knee surgery were more likely to consent to surgery (90.0%) compared to patients undergoing primary hip arthroplasty (68.6%), primary knee arthroplasty (48.7%), revision hip or knee arthroplasty (0.0%), or hip and knee injections (43.8%) (p = 0.03). Conclusion Restarting elective orthopaedic services during the COVID-19 pandemic remains a significant challenge. Given the uncertain environment, it is unsurprising that only 56% of patients were prepared to continue with their planned surgical care upon resumption of elective services.Cite this article: Bone Joint Open 2020;1-6:267-271.
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Affiliation(s)
- Justin Chang
- Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Warran Wignadasan
- Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Christina Kontoghiorghe
- Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Babar Kayani
- Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Sandeep Singh
- Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ricci Plastow
- Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ahmed Magan
- Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Fares Haddad
- Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
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18
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Chang J, Wignadasan W, Kontoghiorghe C, Kayani B, Singh S, Plastow R, Magan A, Haddad F. Restarting elective orthopaedic services during the COVID-19 pandemic: Do patients want to have surgery? Bone Jt Open 2020. [PMID: 33215113 PMCID: PMC7659689 DOI: 10.1302/2633-1462.16.bjo-2020-0057] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Aims As the peak of the COVID-19 pandemic passes, the challenge shifts to safe resumption of routine medical services, including elective orthopaedic surgery. Protocols including pre-operative self-isolation, COVID-19 testing, and surgery at a non-COVID-19 site have been developed to minimize risk of transmission. Despite this, it is likely that many patients will want to delay surgery for fear of contracting COVID-19. The aim of this study is to identify the number of patients who still want to proceed with planned elective orthopaedic surgery in this current environment. Methods This is a prospective, single surgeon study of 102 patients who were on the waiting list for an elective hip or knee procedure during the COVID-19 pandemic. Baseline characteristics including age, ASA grade, COVID-19 risk, procedure type, surgical priority, and admission type were recorded. The primary outcome was patient consent to continue with planned surgical care after resumption of elective orthopaedic services. Subgroup analysis was also performed to determine if any specific patient factors influenced the decision to proceed with surgery. Results Overall, 58 patients (56.8%) wanted to continue with planned surgical care at the earliest possibility. Patients classified as ASA I and ASA II were more likely to agree to surgery (60.5% and 60.0%, respectively) compared to ASA III and ASA IV patients (44.4% and 0.0%, respectively) (p = 0.01). In addition, patients undergoing soft tissue knee surgery were more likely to consent to surgery (90.0%) compared to patients undergoing primary hip arthroplasty (68.6%), primary knee arthroplasty (48.7%), revision hip or knee arthroplasty (0.0%), or hip and knee injections (43.8%) (p = 0.03). Conclusion Restarting elective orthopaedic services during the COVID-19 pandemic remains a significant challenge. Given the uncertain environment, it is unsurprising that only 56% of patients were prepared to continue with their planned surgical care upon resumption of elective services. Cite this article: Bone Joint Open 2020;1-6:267–271.
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Affiliation(s)
- Justin Chang
- Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Warran Wignadasan
- Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Christina Kontoghiorghe
- Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Babar Kayani
- Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Sandeep Singh
- Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ricci Plastow
- Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ahmed Magan
- Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Fares Haddad
- Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
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19
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Affiliation(s)
- Fares S Haddad
- The Bone & Joint Journal, London, UK.,University College London Hospitals, The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, UK
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20
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Abstract
Aims Hip resurfacing arthroplasty (HRA) is typically indicated for young and active patients. Due to the longevity of arthroplasty, these patients are likely to undergo revision surgery during their lifetime. There is a paucity of information on the long-term outcome of revision surgeries performed after failed HRA. The aim of our study was to provide survivorship data as well as clinical scores after HRA revisions. Methods A total of 42 patients (43 hips) were revised after HRA at our centre to a variety of devices, including four HRA and 39 total hip arthroplasties (THAs). In addition to perioperative complications, University of California, Los Angeles (UCLA) hip scores and 12-Item Short-Form Health Survey questionnaire (SF-12) quality of life scores were collected at follow-up visits after the primary HRA and after revision surgery. Results The mean follow-up time after revision surgery was 8.3 years (0.3 to 19.1). The mean UCLA pain and function scores post-revision were comparable with the best scores achieved by the patients after the index HRA, but UCLA activity scores were lower after revision. SF-12 physical component scores were comparable between timepoints, but the mental component score decreased after revision. Six patients underwent unilateral re-revision surgery at a mean follow-up time of 7.8 years (0.3 to 13.7). Using the time to any re-revision as endpoint, the Kaplan-Meier survivorship was 85.3% at 13 years. Conclusion Patients undergoing revision after HRA can expect to achieve function and quality of life similar to their best after their primary surgery, while the risk of re-revision is low. Cite this article: Bone Joint J 2020;102-B(10):1289–1296.
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Affiliation(s)
- Harlan C. Amstutz
- The Joint Replacement Institute at St Vincent Medical Center, Los Angeles, California, USA
| | - Michel Le Duff
- The Joint Replacement Institute at St Vincent Medical Center, Los Angeles, California, USA
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21
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Bergiers S, Hothi H, Henckel J, Eskelinen A, Skinner J, Hart A. Does diametrical clearance influence the wear of Pinnacle hip implants? Bone Joint Res 2020; 9:515-523. [PMID: 32922759 PMCID: PMC7468555 DOI: 10.1302/2046-3758.98.bjr-2019-0195.r2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aims The optimum clearance between the bearing surfaces of hip arthroplasties is unknown. Theoretically, to minimize wear, it is understood that clearances must be low enough to maintain optimal contact pressure and fluid film lubrication, while being large enough to allow lubricant recovery and reduce contact patch size. This study aimed to identify the relationship between diametrical clearance and volumetric wear, through the analysis of retrieved components. Methods A total of 81 metal-on-metal Pinnacle hips paired with 12/14 stems were included in this study. Geometrical analysis was performed on each component, using coordinate and roundness measuring machines. The relationship between their as-manufactured diametrical clearance and volumetric wear was investigated. The Mann-Whitney U test and unpaired t-test were used, in addition to calculating the non-parametric Spearman's correlation coefficient, to statistically evaluate the acquired data. Results The hips in this study were found to have had a median unworn diametrical clearance of 90.31 μm (interquartile range (IQR) 77.59 to 97.40); 32% (n = 26) were found to have been below the manufacturing tolerance. There was no correlation found between clearance and bearing (rs = -0.0004, p = 0.997) or taper (rs = 0.0048, p = 0.966) wear rates. The wear performance of hips manufactured within and below these specifications was not significantly different (bearing: p = 0.395; taper: p = 0.653). Pinnacles manufactured from 2007 onwards had a greater prevalence of bearing clearance below tolerance (p = 0.004). Conclusion The diametrical clearance of Pinnacle hips did not influence their wear performance, even when below the manufacturing tolerance. The optimum clearance for minimizing hip implant wear remains unclear.Cite this article: Bone Joint Res 2020;9(8):515-523.
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Affiliation(s)
- Sean Bergiers
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, UK
| | - Harry Hothi
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, UK
| | - Johann Henckel
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, UK
| | | | - John Skinner
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, UK
| | - Alister Hart
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, UK
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22
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Chang JS, Wignadasan W, Pradhan R, Kontoghiorghe C, Kayani B, Haddad FS. Elective orthopaedic surgery with a designated COVID-19-free pathway results in low perioperative viral transmission rates. Bone Jt Open 2020; 1:562-567. [PMID: 33215155 PMCID: PMC7659660 DOI: 10.1302/2633-1462.19.bjo-2020-0110.r1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
AIMS The safe resumption of elective orthopaedic surgery following the peak of the COVID-19 pandemic remains a significant challenge. A number of institutions have developed a COVID-free pathway for elective surgery patients in order to minimize the risk of viral transmission. The aim of this study is to identify the perioperative viral transmission rate in elective orthopaedic patients following the restart of elective surgery. METHODS This is a prospective study of 121 patients who underwent elective orthopaedic procedures through a COVID-free pathway. All patients underwent a 14-day period of self-isolation, had a negative COVID-19 test within 72 hours of surgery, and underwent surgery at a COVID-free site. Baseline patient characteristics were recorded including age, American Society of Anaesthesiologists (ASA) grade, body mass index (BMI), procedure, and admission type. Patients were contacted 14 days following discharge to determine if they had had a positive COVID-19 test (COVID-confirmed) or developed symptoms consistent with COVID-19 (COVID-19-presumed). RESULTS The study included 74 females (61.2%) and 47 males (38.8%) with a mean age of 52.3 years ± 17.6 years (18 to 83 years). The ASA grade was grade I in 26 patients (21.5%), grade II in 70 patients (57.9%), grade III in 24 patients (19.8%), and grade IV in one patient (0.8%). A total of 18 patients (14.9%) had underlying cardiovascular disease, 17 (14.0%) had pulmonary disease, and eight (6.6%) had diabetes mellitus. No patients (0%) had a positive COVID-19 test in the postoperative period. One patient (0.8%) developed anosmia postoperatively without respiratory symptoms or a fever. The patient did not undergo a COVID-19 test and self-isolated for seven days. Her symptoms resolved within a few days. CONCLUSION The development of a COVID-free pathway for elective orthopaedic patients results in very low viral transmission rates. While both surgeons and patients should remain vigilant, elective surgery can be safely restarted using dedicated pathways and procedures.Cite this article: Bone Joint Open 2020;1-9:562-567.
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Affiliation(s)
- Justin S. Chang
- Department of Trauma and Orthopaedic Surgery, University College London, London, UK
| | - Warran Wignadasan
- Department of Trauma and Orthopaedic Surgery, University College London, London, UK
| | - Raj Pradhan
- Department of Trauma and Orthopaedic Surgery, University College London, London, UK
| | | | - Babar Kayani
- Department of Trauma and Orthopaedic Surgery, University College London, London, UK
- The Princess Grace Hospital, London, UK
| | - Fares S. Haddad
- Department of Trauma and Orthopaedic Surgery, University College London, London, UK
- The Princess Grace Hospital, London, UK
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23
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Johns WL, Sowers CB, Walley KC, Ross D, Thordarson DB, Jackson JB, Gonzalez TA. Return to Sports and Activity After Total Ankle Arthroplasty and Arthrodesis: A Systematic Review. Foot Ankle Int 2020; 41:916-929. [PMID: 32501110 DOI: 10.1177/1071100720927706] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is no consensus regarding participation in sports and recreational activities following total ankle replacement (TAR) and ankle arthrodesis (AA). This systematic review summarizes the evidence on return to sports and activity after operative management with either TAR or AA for ankle osteoarthritis (OA). METHODS A literature search of MEDLINE, EMBASE, CINAHL, and Cochrane Library databases was performed. Risk of bias of included studies was assessed using Methodological Index for Non-Randomized Studies (MINORS) criteria. Included studies reported sport and activity outcomes in patients undergoing TAR and AA, with primary outcomes being the percentage of sports participation and level of sports participation. RESULTS Twelve studies met inclusion criteria for analysis. There were 1270 ankle procedures, of which 923 TAR and 347 AA were performed. The mean reported patient age was 59.2 years and the mean BMI was 28 kg/m2. The mean follow-up was 43 months. Fifty-four percent of patients were active in sports preoperatively compared with 63.7% postoperatively. The mean preoperative activity participation rate was 41% in the TAR cohort, but it improved to 59% after TAR, whereas the preoperative activity participation rate of 73% was similar to the postoperative rate of 70% in the AA cohort. The most common sports in the TAR and AA groups were swimming, hiking, cycling, and skiing. CONCLUSION Participation in sports activity was nearly 10% improved after operative management of ankle OA with TAR and remains high after AA. The existing literature demonstrated a large improvement in pre- to postoperative activity levels after TAR, with minimal change in activity after AA; however, AA patients were more active at baseline. The most frequent postoperative sports activities after operative management of ankle OA were swimming, hiking, cycling, and skiing. Participation in high-impact sports such as tennis, soccer, and running was consistently limited after surgery. This review of the literature will allow patients and foot and ankle surgeons to set evidence-based goals and establish realistic expectations for postoperative physical activity after TAR and AA. LEVEL OF EVIDENCE Level III, systematic review.
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Affiliation(s)
- William L Johns
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Kempland C Walley
- Department of Orthopaedic Surgery, Penn State Hershey Bone and Joint Institute, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Daniel Ross
- School of Medicine, University of South Carolina, Columbia, SC, USA
| | | | | | - Tyler A Gonzalez
- School of Medicine, University of South Carolina, Columbia, SC, USA
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Amstutz HC, Le Duff MJ. Infographic: Effects of physical activity on long-term survivorship after metal-on-metal hip resurfacing arthroplasty. Bone Joint J 2019; 101-B:1184-1185. [PMID: 31564145 DOI: 10.1302/0301-620x.101b10.bjj-2019-1091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Harlan C Amstutz
- Joint Replacement Institute at St. Vincent Medical Center, Los Angeles, California, USA
| | - Michel J Le Duff
- Joint Replacement Institute at St. Vincent Medical Center, Los Angeles, California, USA
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