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Robertson TS, Callary SA, Costi K, Clothier RJ, Venugopal K, Rickman M. The effect of weight compared to BMI on patient reported outcomes at long term follow up of primary total hip arthroplasty. J Orthop 2023; 41:14-22. [PMID: 37251725 PMCID: PMC10220309 DOI: 10.1016/j.jor.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 04/21/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Obesity has been linked to the development of osteoarthritis meaning that a large portion of arthroplasty patients are overweight or obese. Whilst the short-term complications associated with obesity are well described there is a paucity of evidence on the effect of weight compared to BMI for long term functional outcomes of total hip replacements (THR). The aim of this study was to investigate the influence of BMI and weight on long-term patient reported outcome measures following primary THR. Methods 846 patients who underwent primary THR at the Royal Adelaide Hospital between 2000 and 2009 had a pre-operative height and weight recorded. Patient reported outcome measures (PROMs) were completed at 1, 5 and greater than 10 years follow-up. Categorical comparison of PROMs was performed for patients in weight categories of 0-65 kg, 65-80 kg, 80-95 kg, 95-110 kg and >110 kg; and BMI categories as per the WHO Classifications. Results There was no difference in absolute or change in PROMs for any weight category. BMI did not have an effect on the change in (HHS), however there was a statistically significant decrease in absolute (HHS) values at 1 and 5 years with increasing obesity. 65 patients underwent revision within the first ten years. Conclusion The results from this study confirm for the first time that there was no impact of weight or BMI on the change in long-term PROMs of THR. There remains a need for larger registry studies to investigate the effect of weight and BMI on long-term patient outcomes and revision rate.
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Affiliation(s)
- Thomas S. Robertson
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, 5000, Australia
| | - Stuart Adam Callary
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, 5000, Australia
| | - Kerry Costi
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, 5000, Australia
| | - Robyn Janice Clothier
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, 5000, Australia
| | | | - Mark Rickman
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, 5000, Australia
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Robertson TS, Pijls BG, Munn Z, Solomon LB, Nelissen RGHH, Callary SA. Change in CT-measured acetabular bone density following total hip arthroplasty: a systematic review and meta-analysis. Acta Orthop 2023; 94:191-199. [PMID: 37114317 PMCID: PMC10140760 DOI: 10.2340/17453674.2023.11635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND AND PURPOSE Assessing peri-acetabular bone quality is valuable for optimizing the outcomes of primary total hip arthroplasty (THA) as preservation of good quality bone stock likely affects implant stability. The aim of this study was to perform a meta-analysis of peri-acetabular bone mineral density (BMD) changes over time measured using quantitative computer tomography (CT) and, second, to investigate the influence of age, sex, and fixation on the change in BMD over time. METHODS A systematic search of Embase, Scopus, Web of Science, and PubMed databases identified 19 studies that measured BMD using CT following THA. The regions of interest (ROI), reporting of BMD results, and scan protocols were extracted. A meta-analysis of BMD was performed on 12 studies that reported measurements immediately postoperatively and at follow-up. RESULTS The meta-analysis determined that periacetabular BMD around both cemented and uncemented components decreases over time. The amount of BMD loss increased relative to proximity of the acetabular component. There was a greater decrease in cortical BMD over time in females and cancellous BMD for young patients of any sex. CONCLUSION Peri-acetabular BMD decreases at different rates relative to its proximity to the acetabular component. Cancellous BMD decreases more in young patients and cortical bone decreases more in females. Standardized reporting parameters and suggested ROI to measure peri-acetabular BMD are proposed, to enable comparison between implant and patient variables in the future.
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Affiliation(s)
- Thomas S Robertson
- Department of Orthopaedics and Trauma Royal Adelaide Hospital, Adelaide, SA, Australia; Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia.
| | - Bart G Pijls
- Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands
| | - Zachary Munn
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA Australia
| | - L Bogdan Solomon
- Department of Orthopaedics and Trauma Royal Adelaide Hospital, Adelaide, SA, Australia; Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands
| | - Stuart A Callary
- Department of Orthopaedics and Trauma Royal Adelaide Hospital, Adelaide, SA, Australia; Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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Howie DW, Holubowycz OT, Callary SA, Robertson TS, Solomon LB. Highly Porous Tantalum Acetabular Components Without Ancillary Screws Have Similar Migration to Porous Titanium Acetabular Components With Screws at 2 Years: A Randomized Controlled Trial. J Arthroplasty 2020; 35:2931-2937. [PMID: 32593487 DOI: 10.1016/j.arth.2020.05.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 05/17/2020] [Accepted: 05/20/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND It is proposed that highly porous coatings on acetabular components, such as a porous tantalum coating, provide adequate fixation without ancillary screw fixation in primary total hip arthroplasty (THA). However, tantalum acetabular components have been associated with higher rates of revision than other uncemented components in national registries. The aim of this randomized controlled trial is to determine whether the early migration of a solid-backed tantalum acetabular component was no greater than that of a titanium acetabular component with ancillary screw fixation that has proven good clinical results. METHODS Sixty-six patients aged 40 to 64 years, with osteoarthritis and Charnley grade A or B activity grade and who underwent primary THA, were recruited into the trial. Patients were randomized intraoperatively to receive either the tantalum or titanium acetabular component. All patients received the same cemented polished tapered femoral stem, 28-mm cobalt-chromium femoral head, and highly cross-linked polyethylene liner. Acetabular component migration was measured using radiostereometric analysis at 4-6 days postoperatively and at 6 weeks, 3 months, 1 and 2 years following THA. RESULTS The mean proximal migration at 2 years for the tantalum cohort was 0.17 mm (95% confidence interval, 0.09-0.24) which was no greater than that of the titanium cohort which was 0.19 mm (0.07-0.32). Harris hip scores and functional activity scores were similar between groups. CONCLUSION These results demonstrate that early stability can be achieved without ancillary screw fixation through the use of a highly porous high friction coating on a solid-backed modular acetabular component. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Donald W Howie
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Oksana T Holubowycz
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Stuart A Callary
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Thomas S Robertson
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Lucian B Solomon
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
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Sharma DK, Sawyer RK, Robertson TS, Stamenkov R, Solomon LB, Atkins GJ, Clifton PM, Morris HA, Anderson PH. Elevated Serum 25-Hydroxyvitamin D Levels Are Associated with Improved Bone Formation and Micro-Structural Measures in Elderly Hip Fracture Patients. J Clin Med 2019; 8:jcm8111988. [PMID: 31731695 PMCID: PMC6912246 DOI: 10.3390/jcm8111988] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/11/2019] [Accepted: 11/13/2019] [Indexed: 12/17/2022] Open
Abstract
Vitamin D, along with calcium, is generally considered necessary for bone health and reduction of fractures. However, he effects of improving vitamin D status have not always been observed to improve bone mineral density (BMD). We have investigated whether varying vitamin D status in humans, as measured by serum 25(OH)D levels, relate to micro-structural and histomorphetric measures of bone quality and quantity, rather than density. Intertrochanteric trabecular bone biopsies and serum samples were collected from patients undergoing hip arthroplasty (65 females, 38 males, mean age 84.8 ± 8.3 years) at Royal Adelaide Hospital. Estimated GFR, serum ionized calcium, alkaline phosphatase, albumin, supplement and medication intake prior to surgery were taken from patient case records. Serum 25(OH)D, 1,25(OH)2D, and parathyroid hormone (PTH) levels were measured by immunoassays. Trabecular bone structural indices were determined by high-resolution micro-CT. Mean wall thickness (MWT) was measured on toluidine blue-stained histological sections. Bone mRNA levels for vitamin D metabolising enzymes CYP27B1 and CYP24A1 were measured by qRT-PCR. While serum 25(OH)D levels did not associate with bone volume/tissue volume (BV/TV%), serum 25(OH)D levels were strongly and independently associated with MWT (r = 0.81 p < 0.0001) with values significantly greater in patients with higher serum 25(OH)D levels. Furthermore, serum 25(OH)D levels were negatively associated with Bone Surface/Bone Volume (BS/BV) (r = −0.206, p < 0.05) and together with bone CYP27B1 and CYP24A1 mRNA accounted for 10% of the variability of BS/BV (p = 0.001). These data demonstrate that serum 25(OH)D is an independent positive predictor of micro-structural and bone formation measures and may be dependent, in part, on its metabolism within the bone.
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Affiliation(s)
- Deepti K. Sharma
- Health and Biomedical Innovation, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide 5001, Australia (R.K.S.); (G.J.A.); (P.M.C.)
| | - Rebecca K. Sawyer
- Health and Biomedical Innovation, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide 5001, Australia (R.K.S.); (G.J.A.); (P.M.C.)
| | - Thomas S. Robertson
- Royal Adelaide Hospital, Adelaide 5001, Australia (R.S.); (L.B.S.)
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide 5001, Australia
| | - Roumen Stamenkov
- Royal Adelaide Hospital, Adelaide 5001, Australia (R.S.); (L.B.S.)
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide 5001, Australia
| | - Lucian B. Solomon
- Royal Adelaide Hospital, Adelaide 5001, Australia (R.S.); (L.B.S.)
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide 5001, Australia
| | - Gerald J. Atkins
- Health and Biomedical Innovation, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide 5001, Australia (R.K.S.); (G.J.A.); (P.M.C.)
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide 5001, Australia
| | - Peter M. Clifton
- Health and Biomedical Innovation, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide 5001, Australia (R.K.S.); (G.J.A.); (P.M.C.)
| | - Howard A. Morris
- Health and Biomedical Innovation, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide 5001, Australia (R.K.S.); (G.J.A.); (P.M.C.)
| | - Paul H. Anderson
- Health and Biomedical Innovation, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide 5001, Australia (R.K.S.); (G.J.A.); (P.M.C.)
- Correspondence:
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Rossiter JR, Robertson TS. Canonical Analysis of Developmental, Social, and Experiential Factors in Children's Comprehension of Television Advertising. The Journal of Genetic Psychology 2012. [DOI: 10.1080/00221325.1976.10534043] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- John R. Rossiter
- a Department of Marketing CC , The Wharton School University of Pennsylvania , Philadelphia , Pennsylvania , 19174 , USA
| | - Thomas S. Robertson
- a Department of Marketing CC , The Wharton School University of Pennsylvania , Philadelphia , Pennsylvania , 19174 , USA
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Moore G, Robertson TS, Monsour HP. Clinical case conference, UNMC. Case 11-1986. Nebr Med J 1987; 72:344-53. [PMID: 3499576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Robertson TS, Wind Y. Organizational cosmopolitanism and innovativeness. Acad Manage J 1983; 26:332-338. [PMID: 10263065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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