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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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Spranz D, Müller LM, Trefzer R, Hetto P, Innmann M, Renkawitz T, Walker T, Reiner T. Elevated Blood Tantalum Concentrations in Patients Following Reconstruction of Severe Acetabular Defects in Total Hip Arthroplasty Using Modular Tantalum Augments in Combination With Uncemented Tantalum Cups. J Arthroplasty 2024:S0883-5403(24)00540-0. [PMID: 38823519 DOI: 10.1016/j.arth.2024.05.068] [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: 01/31/2024] [Revised: 05/21/2024] [Accepted: 05/23/2024] [Indexed: 06/03/2024] Open
Abstract
INTRODUCTION The reconstruction of acetabular defects in total hip arthroplasty (THA) can be challenging. An option to treat uncontained acetabular defects is to use modular tantalum augments in combination with cementless press-fit cups. However, modularity is associated with an increased risk of debonding and mechanical failure. In addition, metal wear particles can be released due to micromotions at the implant interface. Clinical data on the long-term results of this treatment strategy is limited. The purposes of this study were: (1) to evaluate the clinical and radiological outcome of complex THA using modular trabecular metal augments and uncemented revision cups; (2) to investigate the blood tantalum concentrations in these patients at mid-term (mean 4.5 year) follow-up; and (3) to report complications and mechanisms of failure related to this procedure. MATERIALS AND METHODS In this single-center study, we retrospectively reviewed data from a consecutive cohort of 27 patients who underwent complex acetabular defect reconstruction using a modular tantalum acetabular augment in combination with an uncemented tantalum cup. We evaluated the implant survival, and the radiological and clinical outcomes after a mean follow-up of 4.5 years (SD 2.1; range 2.5 to 10.6 years) using patient-reported outcome scores (PROMs). Blood samples were analyzed regarding tantalum concentration and compared with a control group. RESULTS The cumulative survival rate at 4.5 years with the endpoint "revision of the acetabular component for aseptic loosening" was 94.4% (95% confidence interval (CI) 71.6 to 99.2) and 82.9% (95 % CI 60.5 to 93.3) for the endpoint "revision for any reason." The PROMs improved significantly up to the latest follow-up, and radiographic data showed no signs of loosening or implant migration. Median blood tantalum concentrations were significantly higher in the study group (0.15 μg/L) compared to the control group (0.002 μg/L) (P < 0.001). CONCLUSIONS This study demonstrated acceptable clinical and radiological results of cementless revision THA using modular trabecular metal implants for the reconstruction of large acetabular defects. Tantalum concentrations were significantly higher in patients who had tantalum implants compared to the control group, however, the systemic and local effects of an increased tantalum exposure are not yet fully understood and have to be further investigated.
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Affiliation(s)
- David Spranz
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstraße 200 a, 69118 Heidelberg, Germany
| | - Lisa-Marie Müller
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstraße 200 a, 69118 Heidelberg, Germany
| | - Raphael Trefzer
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstraße 200 a, 69118 Heidelberg, Germany
| | - Pit Hetto
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstraße 200 a, 69118 Heidelberg, Germany
| | - Moritz Innmann
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstraße 200 a, 69118 Heidelberg, Germany
| | - Tobias Renkawitz
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstraße 200 a, 69118 Heidelberg, Germany
| | - Tilman Walker
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstraße 200 a, 69118 Heidelberg, Germany
| | - Tobias Reiner
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstraße 200 a, 69118 Heidelberg, Germany.
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Piovan G, De Berardinis L, Screpis D, Senarighi M, Povegliano L, Natali S, Gigante AP, Zorzi C. Metal-backed or all-poly tibial components: which are better for medial unicompartmental knee arthroplasty? A propensity-score-matching retrospective study at the 5-year follow-up. J Orthop Traumatol 2024; 25:24. [PMID: 38704499 PMCID: PMC11069491 DOI: 10.1186/s10195-024-00765-3] [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: 12/27/2023] [Accepted: 04/04/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND This retrospective medium-term follow-up study compares the outcomes of medial fixed-bearing unicompartmental knee arthroplasty (mUKA) using a cemented metal-backed (MB) or an all-polyethylene (AP) tibial component. MATERIALS AND METHODS The database of our institution was mined for primary mUKA patients implanted with an MB or an AP tibial component (the MB-UKA and AP-UKA groups, respectively) from 2015 to 2018. We compared patient demographics, patient-reported outcome measures (PROMs), and motion analysis data obtained with the Riablo™ system (CoRehab, Trento, Italy). We conducted propensity-score-matching (PSM) analysis (1:1) using multiple variables. RESULTS PSM analysis yielded 77 pairs of MB-UKA and AP-UKA patients. At 5 years, the physical component summary (PCS) score was 52.4 ± 8.3 in MB-UKA and 48.2 ± 8.3 in AP-UKA patients (p < 0.001). The Forgotten Joint Score (FJS-12) was 82.9 ± 18.8 in MB-UKAs and 73.4 ± 22.5 in AP-UKAs (p = 0.015). Tibial pain was reported by 7.8% of the MB-UKA and 35.1% of the AP-UKA patients (p < 0.001). Static postural sway was, respectively, 3.9 ± 2.1 cm and 5.4 ± 2.3 (p = 0.0002), and gait symmetry was, respectively, 92.7% ± 3.7 cm and 90.4% ± 5.4 cm (p = 0.006). Patient satisfaction was 9.2 ± 0.8 in the MB-UKA and 8.3 ± 2.0 in the AP-UKA group (p < 0.003). CONCLUSIONS MB-UKA patients experienced significantly better 5-year static sway and gait symmetry outcomes than AP-UKA patients. Although the PROMs of the two groups overlapped, MB-UKA patients had a lower incidence of tibial pain, better FJS-12 and PCS scores, and were more satisfied.
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Affiliation(s)
- Gianluca Piovan
- Department of Orthopaedics, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar Di Valpolicella, Italy
| | - Luca De Berardinis
- Clinical Orthopaedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica Delle Marche, Via Tronto, 10/a, 60126, Ancona, AN, Italy.
| | - Daniele Screpis
- Department of Orthopaedics, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar Di Valpolicella, Italy
| | - Marco Senarighi
- Clinical Orthopaedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica Delle Marche, Via Tronto, 10/a, 60126, Ancona, AN, Italy
| | - Lorenzo Povegliano
- Department of Orthopaedics, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar Di Valpolicella, Italy
| | - Simone Natali
- Department of Orthopaedics, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar Di Valpolicella, Italy
| | - Antonio Pompilio Gigante
- Clinical Orthopaedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica Delle Marche, Via Tronto, 10/a, 60126, Ancona, AN, Italy
| | - Claudio Zorzi
- Department of Orthopaedics, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar Di Valpolicella, Italy
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Wallace DT, Ohly NE, Allen DJ, Baines J. Long-term Outcomes of Revision Total Hip Arthroplasty Using a Modular Fluted Conical Femoral Stem. J Arthroplasty 2024; 39:1048-1053. [PMID: 37871856 DOI: 10.1016/j.arth.2023.10.031] [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: 05/26/2023] [Revised: 10/10/2023] [Accepted: 10/14/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND This study presents minimum 6-year follow-up data on the survival and satisfaction of an uncemented modular revision femoral system, following on from our previously published earlier results. METHODS We retrospectively reviewed all revision hip arthroplasties performed at our institution between January 2005 and October 2012, using a single modular femoral revision system. Patient-reported outcomes were collected (satisfaction score and Oxford Hip Score). Preoperative and postoperative radiographs were reviewed for stem subsidence, and Kaplan-Meier analysis was performed for survival. A total of 115 femoral revisions were performed in 106 patients. RESULTS All-cause survival was 82% (95% confidence interval 74 to 91%) at 10.8 years, and 96% (95% confidence interval 90 to 100%) excluding septic failure. Of the 19 cases requiring reoperation, 16 were for infection, 2 for aseptic loosening, and 1 for mechanical failure. At final follow-up, 88.5% of patients were "satisfied" or "very satisfied". CONCLUSIONS This study showed excellent clinical results of a commonly used revision hip stem with at least 10 years follow-up. Satisfaction rates were high, with few aseptic failures. Stem subsidence was more common in revisions for infection, but did not correlate with lower satisfaction scores.
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Affiliation(s)
- David T Wallace
- Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, Scotland
| | - Nicholas E Ohly
- Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, Scotland
| | - David J Allen
- Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, Scotland
| | - Joe Baines
- Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, Scotland
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Omran K, Waren D, Schwarzkopf R. Postoperative pain trajectories in total hip arthroplasty. Bone Jt Open 2024; 5:174-183. [PMID: 38442745 PMCID: PMC10914419 DOI: 10.1302/2633-1462.53.bjo-2023-0181.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
Aims Total hip arthroplasty (THA) is a common procedure to address pain and enhance function in hip disorders such as osteoarthritis. Despite its success, postoperative patient recovery exhibits considerable heterogeneity. This study aimed to investigate whether patients follow distinct pain trajectories following THA and identify the patient characteristics linked to suboptimal trajectories. Methods This retrospective cohort study analyzed THA patients at a large academic centre (NYU Langone Orthopedic Hospital, New York, USA) from January 2018 to January 2023, who completed the Patient-Reported Outcomes Measurement Information System (PROMIS) pain intensity questionnaires, collected preoperatively at one-, three-, six-, 12-, and 24-month follow-up times. Growth mixture modelling (GMM) was used to model the trajectories. Optimal model fit was determined by Bayesian information criterion (BIC), Vuong-Lo-Mendell-Rubin likelihood ratio test (VLMR-LRT), posterior probabilities, and entropy values. Association between trajectory groups and patient characteristics were measured by multinomial logistic regression using the three-step approach. Results Among the 1,249 patients, a piecewise GMM model revealed three distinct pain trajectory groups: 56 patients (4.5%) in group 1; 1,144 patients (91.6%) in group 2; and 49 patients (3.9%) in group 3. Patients in group 2 experienced swift recovery post-THA and minimal preoperative pain. In contrast, groups 1 and 3 initiated with pronounced preoperative pain; however, only group 3 exhibited persistent long-term pain. Multinomial regression indicated African Americans were exceedingly likely to follow trajectory groups 1 (odds ratio (OR) 2.73) and 3 (OR 3.18). Additionally, odds of membership to group 3 increased by 12% for each BMI unit rise, by 19% for each added postoperative day, and by over four if discharged to rehabilitation services (OR 4.07). Conclusion This study identified three distinct pain trajectories following THA, highlighting the role of individual patient factors in postoperative recovery. This emphasizes the importance of preoperatively addressing modifiable risk factors associated with suboptimal pain trajectories, particularly in at-risk patients.
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Affiliation(s)
- Kareem Omran
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Daniel Waren
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
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Harada S, Hamai S, Shiomoto K, Kawahara S, Hara D, Harada T, Nakashima Y. Predictors of physical activity recovery after total hip arthroplasty: a prospective observational study. INTERNATIONAL ORTHOPAEDICS 2024; 48:753-760. [PMID: 37923880 DOI: 10.1007/s00264-023-06022-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/23/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE Little is known about the changes and the factors in physical activity as following total hip arthroplasty (THA). There are potential discrepancies between subjective and objective measurements of physical activity. Thus, our porpose is to compare objective and subjective measurements of activity levels in patients undergoing THA preoperatively, three months and one year following surgery, and investigated the factors that predicts the objective activity level after THA. METHODS This prospective observational study included 42 patients with unilateral symptomatic hip osteoarthritis who underwent THA. The objective activity level (step counts, sit-to-stands, and upright time) by using a tri-axial accelerometer, PRO (Oxford hip score; OHS and University of California, Los Angeles activity score; UCLA score), and muscle volume around the hip joint by using preoperative computed tomography were measured. RESULTS The number of steps, OHS, and UCLA score before, at three months, and one year after THA averaged 5092, 6532, and 6545 steps, 30.3, 43.0, and 44.2 points, and 3.4, 4.8, and 4.6 points, respectively, with significant postoperative increases (P < 0.05). No significant difference was found between three months and one year postoperatively. In multivariate analysis, younger age and higher preoperative contralateral gluteal medius volume were the predictors of higher postoperative step counts (P < 0.05). CONCLUSIONS Physical activity, including step counts, OHS, and UCLA score increased significantly until three months after unilateral THA. Early surgical intervention before contralateral muscle declines and preoperative rehabilitation including contralateral side may additionally improve postoperative activity levels.
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Affiliation(s)
- Satoru Harada
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
- Department of Medical-Engineering Collaboration for Healthy Longevity, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Kyohei Shiomoto
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shinya Kawahara
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Daisuke Hara
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Tetsunari Harada
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Spranz D, Skrobek D, Randoll J, Kinkel S, Merle C, Walker T, Renkawitz T, Reiner T. Femoral revision in total hip arthroplasty using a cementless modular stem: clinical and radiological results with a 8-year follow-up. Arch Orthop Trauma Surg 2024; 144:1369-1377. [PMID: 37872437 PMCID: PMC10896780 DOI: 10.1007/s00402-023-05066-8] [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: 06/20/2023] [Accepted: 09/03/2023] [Indexed: 10/25/2023]
Abstract
INTRODUCTION Modular femoral components allow for patient-specific restoration of hip joint geometry and the reconstruction of extensive bone defects in revision total hip arthroplasty (THA); however, potential problems of modular implants such as taper corrosion and the risk of implant fracture continue to be of concern. The aim of the present study was to evaluate the clinical and radiological results of a cementless modular revision stem following revision surgery due to aseptic loosening and periprosthetic fracture and to assess patient-reported outcome measures (PROMs) in these patients at mid-term follow-up. MATERIALS AND METHODS In this study, a consecutive cohort of 75 patients who underwent primary revision THA at our institution using a modular cementless stem design (MRP-TITAN stem) was retrospectively evaluated at a mean follow-up of 7.7 years. Kaplan-Meier survivorship analyses were performed with revision of the femoral component for any reason as the end point. The Harris-Hip Score, the UCLA Activity Score, the Forgotten Joint Score and the SF-12 Score were used for clinical assessment. We used the Wilcoxon signed rank test to compare pre- and postoperative clinical scores. RESULTS Overall stem survival with the endpoint stem re-revision for any reason was 85.4% at a mean follow-up of 7.7 years (range 2.4-14 years). Stem survival was 89.5% in the aseptic loosening group and 78.3% in the periprosthetic fracture group with no statistically significant difference between both groups (p = 0.107). One patient had to be revised due to taper fracture. PROMs improved significantly up to the latest follow-up, and radiographic evaluation showed full osseointegration of all stems in this cohort. CONCLUSIONS Revision THA using a modular cementless titanium revision stem demonstrated adequate clinical and radiological results at mid- to long-term follow-up in this cohort. Cementless revision stems are a useful treatment option to restore the anatomy, especially in deformed hips and in complex revision hip arthroplasty. However, there are some significant disadvantages related to an increased risk of mechanical failure such as corrosion/fretting damage and implant fracture. Future high-quality prospective studies with longer follow-up are necessary to confirm the supposed advantages.
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Affiliation(s)
- David Spranz
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstraße 200 a, 69118, Heidelberg, Germany
| | - David Skrobek
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstraße 200 a, 69118, Heidelberg, Germany
| | - Jannis Randoll
- Orthopaedicum Darmstadt, Rheinstraße 19, 64283, Darmstadt, Germany
| | - Stefan Kinkel
- ARCUS Sportklinik Pforzheim, Rastatterstraße 17-19, 75179, Pforzheim, Germany
| | - Christian Merle
- Department of Orthopedic and Trauma Surgery, Paulinenhilfe, Diakonieklinikum Stuttgart, Rosenbergstraße 38, 70192, Stuttgart, Germany
| | - Tilman Walker
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstraße 200 a, 69118, Heidelberg, Germany
| | - Tobias Renkawitz
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstraße 200 a, 69118, Heidelberg, Germany
| | - Tobias Reiner
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstraße 200 a, 69118, Heidelberg, Germany.
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Brown L, Swiontkowski M, Odland K, Polly DW, Haselhuhn J. Effect of revision sacroiliac joint fusion on unresolved pain and disability: a retrospective cohort study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:533-542. [PMID: 38193936 DOI: 10.1007/s00586-023-08104-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/05/2023] [Accepted: 12/11/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE The sacroiliac (SI) joint is recognized as a source of low back pain in 15-30% of patients. Though randomized controlled trials have shown clinical improvement following SI joint fusion in 83.1% of patients, revision rates of 2.9% within 2 years have been reported. There is a paucity of literature reviewing this small yet significant population of patients requiring revision surgery. METHODS Following IRB approval, retrospective review of patients, who underwent a revision SI joint fusion from 2009 to 2021 was completed. Patient-reported outcomes were measured before and at each clinic visit after surgery with visual analoge scale (VAS) for back pain and Oswestry Disability Index (ODI). Patient characteristics (chronic opiate use and prior lumbar fusion) and surgical factors (operative approach, type/number of implants and use of bone graft) were recorded. Patient-reported outcomes were evaluated with Paired t and Wilcoxon signed rank tests. Univariate and multivariate logistic regression determined if patients met the minimally clinical important differences (MCID) for VAS-back pain and ODI scores at 1 year. RESULTS Fifty-two patients (77% female) with an average age of 49.1 (SD ± 11.1) years met inclusion criteria. Forty-four had single sided revisions and eight bilateral revisions. At 1 year follow-up there was no significant improvement in VAS-Back (p = 0.06) or ODI (p = 0.06). Patients with chronic opioid use were 8.5 times less likely to achieve the MDC for ODI scores (OR 0.118, p = 0.029). There was no difference in outcomes when comparing the different surgical approaches (p = 0.41). CONCLUSION Our study demonstrates patients undergoing revision surgery have moderate improvement in low back pain, however, few have complete resolution of their symptoms. Specific patient factors, such as chronic opiate use and female sex may decrease the expected improvement in patient-reported outcomes following surgery. Failure to obtain relief may be due to incorrect indications, lack of biologic fusion and/or presence of co-pathologies. Further clinical examination and consistent long-term follow-up, clarify the role revision surgery plays in long-term patient outcomes.
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Affiliation(s)
- Levi Brown
- The Department of Orthopedic Surgery, University of Minnesota, 2512 Riverside Avenue South, Suite R200, Minneapolis, MN, 55454, USA
| | - Marc Swiontkowski
- The Department of Orthopedic Surgery, University of Minnesota, 2512 Riverside Avenue South, Suite R200, Minneapolis, MN, 55454, USA
| | - Kari Odland
- The Department of Orthopedic Surgery, University of Minnesota, 2512 Riverside Avenue South, Suite R200, Minneapolis, MN, 55454, USA.
| | - David W Polly
- The Department of Orthopedic Surgery, University of Minnesota, 2512 Riverside Avenue South, Suite R200, Minneapolis, MN, 55454, USA
| | - Jason Haselhuhn
- The Department of Orthopedic Surgery, University of Minnesota, 2512 Riverside Avenue South, Suite R200, Minneapolis, MN, 55454, USA
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Salimy MS, Paschalidis A, Dunahoe JA, Bedair HS, Melnic CM. Patient-Reported Outcomes Following Revision Total Hip Arthroplasty Demonstrate Less Improvement and Significantly Higher Rates of Worsening Compared to Primaries. J Arthroplasty 2023; 38:2410-2414. [PMID: 37271232 DOI: 10.1016/j.arth.2023.05.053] [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: 02/20/2023] [Revised: 05/17/2023] [Accepted: 05/20/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) provide the patient's perspective following total hip arthroplasty (THA), although differences between primary THA (pTHA) and revision THA (rTHA) remain unclear. Thus, we compared the Minimal Clinically Important Difference for Improvement (MCID-I) and Worsening (MCID-W) in pTHA and rTHA patients. METHODS Data from 2,159 patients (1,995 pTHAs/164 rTHAs) who had completed Hip Disability and Osteoarthritis Outcome Score-Physical Function Short Form (HOOS-PS), Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Short Form 10a (PF10a), PROMIS Global-Mental, or PROMIS Global-Physical questionnaires were analyzed. The PROMs and MCID-I/MCID-W rates were compared using statistical tests and multivariate logistic regressions. RESULTS Compared to the pTHA group, the rTHA group had lower rates of improvement and higher rates of worsening for almost all PROMs, including HOOS-PS (MCID-I: 54 versus 84%, P < .001; MCID-W: 24 versus 4.4%, P < .001), PF10a (MCID-I: 44 versus 73%, P < .001; MCID-W: 22 versus 5.9%, P < .001), PROMIS Global-Mental (MCID-W: 42 versus 28%, P < .001), and PROMIS Global-Physical (MCID-I: 41 versus 68%, P < .001; MCID-W: 26 versus 11%, P < .001). Odds ratios supported rates of worsening following revision for the HOOS-PS (Odds Ratio (OR): 8.25, 95% Confidence Interval (CI): 5.62 to 12.4, P < .001), PF10a (OR: 8.34, 95% CI: 5.63 to 12.6, P < .001), PROMIS Global-Mental (OR: 2.16, 95% CI: 1.41 to 3.34, P < .001), and PROMIS Global-Physical (OR: 3.69, 95% CI: 2.46 to 5.62, P < .001). CONCLUSION Patients reported higher rates of worsening and lower rates of improvement following rTHA than pTHA, with significantly less score improvement and lower postoperative scores for all PROMs after revision. Most patients reported improvements following pTHA, with few worsening postoperatively. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Mehdi S Salimy
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Aris Paschalidis
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jacquelyn A Dunahoe
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hany S Bedair
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Christopher M Melnic
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
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Matsunaga-Myoji Y, Fujita K, Tabuchi Y, Mawatari M. Propensity score-matched comparison of physical activity and quality of life between revision total hip arthroplasty and primary total hip arthroplasty. J Orthop 2023; 40:23-28. [PMID: 37168616 PMCID: PMC10164750 DOI: 10.1016/j.jor.2023.04.012] [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: 01/28/2023] [Revised: 04/10/2023] [Accepted: 04/17/2023] [Indexed: 05/13/2023] Open
Abstract
Purpose Studies on physical activity (PA) after revision total hip arthroplasty (THA) are limited. It is important to assess PA levels as well as improvements in physical function and pain after revision THA. The purpose of the study was to compare accelerometer-measured PA and health-related quality of life (HR-QoL) in patients 1-3 years after revision or primary THA. We also clarified the relationship between measured PA and HR-QoL. Methods This cross-sectional study included 64 patients who underwent revision THA and 188 who underwent primary THA 1-3 years earlier. Outcome measures were accelerometer-measured light PA, moderate-to-vigorous intensity PA, number of steps, questionnaire-based Oxford hip score, SF-8 physical and mental component scores. We conducted propensity-score matching for age, sex, comorbidities, body mass index, and postoperative follow-up duration and compared PA levels and HR-QoL scores between patients after revision THA and primary THA of each 50 patients. Results Based on propensity scores in the revision THA (68.3 years) and primary THA (67.8 years) groups, light PA, number of steps, and HR-QoL scores 1-3 years after revision THA were significantly lower than those after primary THA (P < 0.05). Moderate-to-vigorous intensity PA did not different between groups (P = 0.204). Measured light PA, moderate-to-vigorous intensity PA, and number of steps after re-THA were moderately correlated with HR-QoL scores. Conclusion Increasing the time and frequency spent on light PA to the levels after primary THA may lead to an increase in overall PA levels after revision THA. A detailed understanding of PA, including light PA, in daily life and an approach that promotes activity levels are necessary.
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Affiliation(s)
- Yuriko Matsunaga-Myoji
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Fukuoka, Japan
| | - Kimie Fujita
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Fukuoka, Japan
| | - Yasuko Tabuchi
- Division of Nursing, Saga University, 5-1-1 Nabeshima, Saga, Japan
| | - Masaaki Mawatari
- Orthopaedic Surgery, Saga University, 5-1-1 Nabeshima, Saga, Japan
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Kahhaleh E, Charles T, Collard X, Jayankura M. A low dislocation rate after revision total hip arthroplasty performed through the anterior approach. ARTHROPLASTY (LONDON, ENGLAND) 2023; 5:4. [PMID: 36600292 PMCID: PMC9814313 DOI: 10.1186/s42836-022-00159-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 12/12/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Dislocation is a major complication in revision total hip arthroplasties. This study aimed to evaluate the dislocation rate, complications, and functional scores of revision total hip arthroplasty performed through the direct anterior approach. METHODS Between January 2014 and March 2020, 84 patients undergoing revision total hip arthroplasty were retrospectively reviewed. All operations were performed through the direct anterior approach. At the final follow-up, incidences of dislocation, reoperation, acute deep infections, periprosthetic fractures and psoas impingement were assessed. The median postoperative Oxford Hip Score was also calculated. RESULTS At revision surgery, the mean age was 66 ± 12 years (range, 28-91). During an average follow-up of 4.2 ± 1.2 years, reoperation rate for major complications in the non-infected revisions was 15% (n = 11), including five acute deep infections (7%), four periprosthetic fractures (5%), one dislocation and one psoas impingement (1%). The median postoperative Oxford Hip Score was 39 (interquartile range = 14). CONCLUSION In our series, revision total hip arthroplasty through direct anterior approach was associated with a very low dislocation rate, acceptable complication rates and good functional results. Our results suggest that this procedure is safe and reliable. TRIAL REGISTRATION Ethical approval for this study was obtained, before enrollment of the first participant, by CUB Erasme's research ethics committee (P2020/323) and C.H.U Ambroise Paré's research ethics committee.
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Affiliation(s)
- Edward Kahhaleh
- grid.412157.40000 0000 8571 829XDepartment of Orthopaedic Surgery and Traumatology, C.U.B Erasme, Route de Lennik 808, 1070 Brussels, Belgium ,grid.492608.1Department of Orthopaedic Surgery and Traumatology, C.H.U Ambroise Paré, Boulevard John Fitzgerald Kennedy 2, 7000 Mons, Belgium
| | - Tatiana Charles
- grid.412157.40000 0000 8571 829XDepartment of Orthopaedic Surgery and Traumatology, C.U.B Erasme, Route de Lennik 808, 1070 Brussels, Belgium
| | - Xavier Collard
- grid.492608.1Department of Orthopaedic Surgery and Traumatology, C.H.U Ambroise Paré, Boulevard John Fitzgerald Kennedy 2, 7000 Mons, Belgium
| | - Marc Jayankura
- grid.412157.40000 0000 8571 829XDepartment of Orthopaedic Surgery and Traumatology, C.U.B Erasme, Route de Lennik 808, 1070 Brussels, Belgium
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12
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Harada S, Hamai S, Ikebe S, Hara D, Higaki H, Gondo H, Kawahara S, Shiomoto K, Harada T, Nakashima Y. Elucidation of target implant orientations with the safety range of hip rotation with adduction or abduction during squatting: Simulation based on in vivo replaced hip kinematics. Front Bioeng Biotechnol 2022; 10:1023721. [DOI: 10.3389/fbioe.2022.1023721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 10/24/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives: The study aimed to elucidate target cup orientation and stem anteversions to avoid impingement between the liner and stem neck even at hip rotation with adduction during the deeply flexed posture.Methods: A computer simulation analysis was performed on 32 total hip arthroplasty patients applying patient-specific orientation of the components and in vivo hip kinematics obtained from three-dimensional analysis of the squatting motion. The anterior/posterior liner-to-neck distance and impingement were evaluated based on a virtual change in internal/external rotation (0°–60°) and adduction/abduction (0°–20°) at actual maximum flexion/extension during squatting. Cutoff values of cup orientations, stem anteversion, and combined anteversion to avoid liner-to-neck impingements were determined.Results: The anterior liner-to-neck distance decreased as internal rotation or adduction increased, and the posterior liner-to-neck distance decreased as external rotation or adduction increased. Negative correlations were found between anterior/posterior liner-to-neck distances at maximum flexion/extension and internal/external rotation. Anterior/posterior liner-to-neck impingements were observed in 6/18 hips (18/56%) at 45° internal/external rotation with 20° adduction. The range of target cup anteversion, stem anteversion, and combined anteversion to avoid both anterior and posterior liner-to-neck impingements during squatting were 15°–18°, 19°–34°, and 41°–56°, respectively.Conclusion: Simulated hip rotations caused prosthetic impingement during squatting. Surgeons could gain valuable insights into target cup orientations and stem anteversion based on postoperative simulations during the deeply flexed posture.
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13
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Golinelli D, Grassi A, Tedesco D, Sanmarchi F, Rosa S, Rucci P, Amabile M, Cosentino M, Bordini B, Fantini MP, Zaffagnini S. Patient reported outcomes measures (PROMs) trajectories after elective hip arthroplasty: a latent class and growth mixture analysis. J Patient Rep Outcomes 2022; 6:95. [PMID: 36085337 PMCID: PMC9462642 DOI: 10.1186/s41687-022-00503-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 09/02/2022] [Indexed: 12/02/2022] Open
Abstract
Background Patient-reported outcome measures (PROMs) are an extensively used tool to assess and improve the quality of healthcare services. PROMs can be related to individual demographic and clinical characteristics in patients undergoing hip arthroplasty (HA). The aim of this study is to identify distinct subgroups of patients with unique trajectories of PROMS scores and to determine patients’ features associated with these subgroups.
Methods We conducted a prospective, cohort study in which PROMs questionnaires (Euro Quality 5 Dimensions 3L, EQ-5D-3L, Euro-Quality-Visual-Analytic-Score, EQ-VAS, Hip disability and Osteoarthritis Outcome Score, HOOS-PS) were administered to patients undergoing elective HA pre-operatively, and at 6 and 12 months after surgery. For each measure, latent class growth analysis and growth mixture models were used to identify subgroups of patients with distinct trajectories of scores. Demografic and clinical predictors of the latent classes in growth mixture model were identified using a 3-step approach.
Results We found three distinct trajectories for each PROM score. These trajectories indicated a response heterogeneity to the HA among the patients (n = 991). Patient’s gender, ASA score, and obesity were significantly associated with different PROMs trajectories. Conclusions We identified three distinct trajectories for each of the three PROMs indicators. Several demographic and clinical characteristics are associated with the different trajectories of PROMs at 6 and 12 months after HA and could be used to identify groups of patients with different outcomes following HA surgery. These findings underline the importance of patient-centered care, supporting the usefulness of integrating PROMs data alongside routinely collected healthcare records for guiding clinical care and maximizing patients’ positive outcomes. Trial registration: Protocol version (1.0) and trial registration data are available on the platform www.clinicaltrial.gov with the identifier NCT03790267, posted on December 31, 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-022-00503-5.
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14
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Riddle DL, Ghomrawi HMK. Comment on the Paper by George and Colleagues and Entitled Chronic Pain Prevalence and Factors Associated With High Impact Chronic Pain Following Total Joint Arthroplasty: An Observational Study. THE JOURNAL OF PAIN 2022; 23:1092-1093. [PMID: 35101625 DOI: 10.1016/j.jpain.2021.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 12/08/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Daniel L Riddle
- Departments of Physical Therapy, Orthopaedic Surgery and Rheumatology, Virginia Commonwealth University, Richmond, Virginia.
| | - Hassan M K Ghomrawi
- Departments of Surgery, Medicine (Rheumatology) and Pediatrics, Northwestern University, Chicago, Illinois
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15
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Harada S, Hamai S, Gondo H, Higaki H, Ikebe S, Nakashima Y. Squatting After Total Hip Arthroplasty: Patient-Reported Outcomes and In Vivo Three-Dimensional Kinematic Study. J Arthroplasty 2022; 37:734-741. [PMID: 34968648 DOI: 10.1016/j.arth.2021.12.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/12/2021] [Accepted: 12/20/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Squatting is an important function for many daily activities, but has not been well documented after total hip arthroplasty (THA). This study investigated the participation rate of squatting and in vivo kinematics during squatting. METHODS A survey questionnaire about squatting was mailed to patients who underwent primary THA and 328 patients returned acceptable responses. Additionally, 32 hips were evaluated for dynamic 3-dimensional kinematics of squatting using density-based image-matching techniques. Multivariate analyses were applied to determine which factors were associated with anterior liner-to-neck distance at maximum hip flexion. RESULTS Patients who could easily squat significantly increased this ability postoperatively (23.5% vs 46%, P < .01). In 29.5% of the patients there was still no ability to squat after THA; the main reason was anxiety of dislocation (34.2%). Kinematic analysis revealed that maximum hip flexion averaged 80.7° ± 12.3° with 12.8° ± 10.7° of posterior pelvic tilt and 9.7 ± 3.0 mm of anterior liner-to-neck distance. Neither liner-to-neck, bone-to-bone, nor bone-to-implant contact was observed in any of the hips. Larger hip flexion and smaller cup anteversion were negatively associated with the anterior liner-to-neck distance at maximum hip flexion (P < .05). CONCLUSION Postoperatively, approximately 70% of patients squatted easily or with support. Anxiety of dislocation made patients avoid squatting after THA. In vivo squatting kinematics suggest no danger of impingement or subsequent dislocation, but excessively large hip flexion and small cup anteversion remain as risks.
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Affiliation(s)
- Satoru Harada
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Medical-Engineering Collaboration for Healthy Longevity, Kyushu University, Fukuoka, Japan
| | - Hirotaka Gondo
- Department of Biorobotics, Faculty of Engineering, Kyushu Sangyo University, Fukuoka, Japan
| | - Hidehiko Higaki
- Department of Biorobotics, Faculty of Engineering, Kyushu Sangyo University, Fukuoka, Japan
| | - Satoru Ikebe
- Department of Creative Engineering, National Institute of Technology, Kitakyushu College, Fukuoka, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
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Fujita T, Hamai S, Shiomoto K, Okazawa K, Nasu YK, Hara D, Harada S, Motomura G, Ikemura S, Fujii M, Kawahara S, Kawaguchi KI, Nakashima Y. Analysis of factors influencing patient satisfaction after total hip arthroplasty in a Japanese cohort: the significant effect of postoperative physical activity. J Phys Ther Sci 2022; 34:76-84. [PMID: 35221508 PMCID: PMC8860695 DOI: 10.1589/jpts.34.76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 11/11/2021] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To determine patient satisfaction after total hip arthroplasty in a Japanese
cohort and to identify factors that significantly influence patient satisfaction.
[Participants and Methods] This study included 285 patients who underwent primary total
hip arthroplasty for osteoarthritis. Postoperative satisfaction, Oxford hip score, short
form-12 mental component summary score, and University of California Los Angeles activity
score were investigated. Muscle strength and daily step counts were determined using a
hand-held dynamometer (μ-Tas F1) and activity monitor (ActivPAL) in 89 and 26 patients,
respectively. Factors associated with postoperative satisfaction, Oxford hip
score-activities of daily living, and University of California Los Angeles activity score
were identified. The relationship between the Oxford hip score-activities of daily living
and daily step counts was examined. [Results] Overall, 94.7% of the patients reported
satisfaction with total hip arthroplasty. The Oxford hip score-activities of daily living
and University of California Los Angeles activity score were significantly associated with
patient satisfaction. Younger age and hip abductor strength were significantly associated
with a higher Oxford hip score-activities of daily living and University of California Los
Angeles activity score. The average daily step count was significantly correlated with the
Oxford hip score-activities of daily living. [Conclusion] Self-reported physical activity
levels significantly influenced patient satisfaction and were correlated with objective
muscle strength and daily step count measurements. These findings can guide total hip
arthroplasty patient counseling on the importance of muscle strength and activity
levels.
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Affiliation(s)
- Tsutomu Fujita
- Department of Rehabilitation, Kyushu University Hospital, Japan
| | - Satoshi Hamai
- Department of Medical-Engineering Collaboration for Healthy Longevity, Faculty of Medical Sciences, Kyushu University: 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Kyohei Shiomoto
- Department of Orthopedic Surgery, Faculty of Medical Sciences, Kyushu University, Japan
| | - Kazuya Okazawa
- Department of Rehabilitation, Kyushu University Hospital, Japan
| | - Yu-Ki Nasu
- Department of Rehabilitation, Kyushu University Hospital, Japan
| | - Daisuke Hara
- Department of Orthopedic Surgery, Faculty of Medical Sciences, Kyushu University, Japan
| | - Satoru Harada
- Department of Orthopedic Surgery, Faculty of Medical Sciences, Kyushu University, Japan
| | - Goro Motomura
- Department of Orthopedic Surgery, Faculty of Medical Sciences, Kyushu University, Japan
| | - Satoshi Ikemura
- Department of Orthopedic Surgery, Faculty of Medical Sciences, Kyushu University, Japan
| | - Masanori Fujii
- Department of Orthopedic Surgery, Faculty of Medical Sciences, Kyushu University, Japan
| | - Shinya Kawahara
- Department of Orthopedic Surgery, Faculty of Medical Sciences, Kyushu University, Japan
| | - Ken-Ichi Kawaguchi
- Department of Orthopedic Surgery, Faculty of Medical Sciences, Kyushu University, Japan
| | - Yasuharu Nakashima
- Department of Orthopedic Surgery, Faculty of Medical Sciences, Kyushu University, Japan
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Fujiwara T, Kondo M, Yamada H, Haraguchi A, Fujimura K, Sakuraba K, Kamura S, Fukushi JI, Miyahara H, Inoue Y, Tsuru T, Shuto T, Yoshizawa S, Suematsu E, Miyamura T, Ayano M, Mitoma H, Arinobu Y, Niiro H, Ohishi M, Hirata A, Tokunaga S, Takada A, Hara D, Tsushima H, Akasaki Y, Ikemura S, Sueishi T, Toya M, Sakuragi T, Tsutsui T, Kai K, Arisumi S, Nakashima Y. Factors affecting patient satisfaction related to cost and treatment effectiveness in rheumatoid arthritis: results from the multicenter observational cohort study, FRANK Registry. Arthritis Res Ther 2022; 24:53. [PMID: 35193646 PMCID: PMC8862466 DOI: 10.1186/s13075-022-02746-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 02/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background To further improve rheumatoid arthritis (RA) treatment, it is necessary to understand each RA patient’s satisfaction and to identify the factors affecting their satisfaction. Despite the rise in medical costs for RA, little is known about the factors that influence patient satisfaction with the cost of treatment in RA patients. Methods This is a multicenter observational study of Japanese RA patients from the FRANK Registry with data analyzed from March 2017 to August 2020. We collected data on demographic characteristics, clinical data, quality of life which was evaluated using the EuroQol 5-dimensional questionnaire (EQ5D), and patient satisfaction. The four categories of patient satisfaction were evaluated individually (i.e., cost, treatment efficacy, activities of daily living [ADL], and global treatment satisfaction). We analyzed the factors that affected each patient’s satisfaction, such as age, sex, EQ5D, disease duration, disease activity, and treatment. Results This study included 2235 RA outpatients (406 males, 1829 females). In RA patients, “very satisfied” and “satisfied” were given for nearly half of each satisfaction aspect (cost 49%; efficacy 72%; ADL 58%; global treatment 66%) at the time of the initial registration. To investigate the factors influencing each satisfaction, multivariate analysis has revealed that the use of b/tsDMARDs increased satisfaction of treatment effect (odds ratio [OR] 0.66) and ADL (OR 0.78) but decreased cost satisfaction (OR 2.21). Age (50–64 years; OR 0.91; 65–74 years, 0.55: ≥ 75 years, 0.35), female (OR 0.81), and history of musculoskeletal surgery (OR 0.60) all increased cost satisfaction. Patients with lower disease activity and higher EQ5D scores had higher levels of satisfaction in all areas. Conclusions In this study, patient satisfaction in terms of cost, treatment effect, ADL, and overall treatment was generally higher, but some patients were dissatisfied. The cost of satisfaction increased with age and a history of musculoskeletal surgery, while it decreased with a lower EQ5D score and the use of b/tsDMARDs. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-022-02746-5.
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Affiliation(s)
- Toshifumi Fujiwara
- Department of Orthopaedic Surgery, Kyushu University Graduate School of Medical Sciences, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Masakazu Kondo
- Kondo Clinic of Rheumatology and Orthopaedic Surgery, Fukuoka, Japan
| | - Hisakata Yamada
- Department of Orthopaedic Surgery, Kyushu University Graduate School of Medical Sciences, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.,Kondo Clinic of Rheumatology and Orthopaedic Surgery, Fukuoka, Japan
| | - Akihisa Haraguchi
- Department of Orthopedics Surgery and Rheumatology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Kenjiro Fujimura
- Department of Orthopedics Surgery and Rheumatology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Koji Sakuraba
- Department of Orthopedics Surgery and Rheumatology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Satoshi Kamura
- Department of Orthopedics Surgery and Rheumatology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Jun-Ichi Fukushi
- Department of Orthopedics Surgery and Rheumatology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Hisaaki Miyahara
- Department of Orthopedics Surgery and Rheumatology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Yasushi Inoue
- Department of Rheumatology, Fukuoka Red Cross Hospital, Fukuoka, Japan
| | | | - Toshihide Shuto
- Department of Orthopedics Surgery, Chiyoda Hospital, Miyazaki, Japan
| | - Seiji Yoshizawa
- Department of Rheumatology, Hamanomachi Hospital, Fukuoka, Japan
| | - Eiichi Suematsu
- Department of Internal Medicine and Rheumatology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Tomoya Miyamura
- Department of Internal Medicine and Rheumatology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Masahiro Ayano
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Hiroki Mitoma
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Yojiro Arinobu
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Hiroaki Niiro
- Department of Medical Education, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Masanobu Ohishi
- Department of Orthopaedic Surgery, Chihaya Hospital, Fukuoka, Japan
| | - Akie Hirata
- Medical Information Center, Kyushu University Hospital, Fukuoka, Japan
| | - Shoji Tokunaga
- Medical Information Center, Kyushu University Hospital, Fukuoka, Japan
| | - Atsushi Takada
- Medical Information Center, Kyushu University Hospital, Fukuoka, Japan
| | - Daisuke Hara
- Department of Orthopaedic Surgery, Kyushu University Graduate School of Medical Sciences, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hidetoshi Tsushima
- Department of Orthopaedic Surgery, Kyushu University Graduate School of Medical Sciences, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yukio Akasaki
- Department of Orthopaedic Surgery, Kyushu University Graduate School of Medical Sciences, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Ikemura
- Department of Orthopaedic Surgery, Kyushu University Graduate School of Medical Sciences, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Takuya Sueishi
- Department of Orthopaedic Surgery, Kyushu University Graduate School of Medical Sciences, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Masakazu Toya
- Department of Orthopaedic Surgery, Kyushu University Graduate School of Medical Sciences, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Takahide Sakuragi
- Department of Orthopaedic Surgery, Kyushu University Graduate School of Medical Sciences, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Tomoko Tsutsui
- Department of Orthopaedic Surgery, Kyushu University Graduate School of Medical Sciences, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kazuhiro Kai
- Department of Orthopaedic Surgery, Kyushu University Graduate School of Medical Sciences, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shinkichi Arisumi
- Department of Orthopaedic Surgery, Kyushu University Graduate School of Medical Sciences, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Kyushu University Graduate School of Medical Sciences, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Evaluation of optimal implant alignment in total hip arthroplasty based on postoperative range of motion simulation. Clin Biomech (Bristol, Avon) 2022; 92:105555. [PMID: 35026659 DOI: 10.1016/j.clinbiomech.2021.105555] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dislocation after total hip arthroplasty is a frequent cause of revision surgery. This study was performed to determine the optimal implant alignment in total hip arthroplasty by simulating the postoperative range of motion. METHODS All operations were performed via posterolateral approach using combined anteversion of the stem and cup technique. Maximum range of motion without implant impingement was simulated in 79 replaced hips using postoperative computed tomography and the achievement of the required range of motion defined by previous studies was assessed. Optimal cup and stem alignment for impingement-free range of motion were statistically determined using the receiver operator coefficient curve. FINDINGS Cup inclination and anteversion, stem anteversion, and combined anteversion were 37.6°, 20.1°, 26.2°, and 46.3°, respectively. Maximum range of motion in flexion, extension, internal rotation at 90° of flexion, and external rotation were 131.8°, 42.3°, 56.4°, and 64.5°, respectively. Flexion >110°, extension >30°, internal rotation >30° at 90° of flexion, and external rotation >30° were fulfilled by 96%, 86%, 92%, and 96% of all replaced hips, respectively. Optimal implant alignment for impingement-free range of motion was 34°-43° of cup inclination, 18°-26° of cup anteversion, 17°-29° of stem anteversion, and 35°-56° of combined anteversion. Both cup and stem anteversion showed significant relationship with postoperative range of motion. INTERPRETATION Surgeons could gain valuable insights into optimal cup and stem alignment to perform postoperative range of motion simulations.
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