Harris Hip Score Improvement Research Articles

Medium-term outcomes of total hip arthroplasty in juvenile patients

BackgroundJuvenile hip osteoarthritis is often the end result of congenital conditions or acquired hip ailments occurred during the paediatric age. This study evaluated the middle term results of total hip arthroplasty for end-stage juvenile hip osteoarthritis.Materials and methodsThis is a retrospective analysis of prospectively collected data on a cohort of 10 consecutive patients (12 hips), aged between 14 and 20 at operation, who underwent cementless total hip arthroplasty for end-stage juvenile secondary hip osteoarthritis in two orthopaedic tertiary referral centres between 2009 and 2018.ResultsJuvenile hip osteoarthritis occurred as a consequence of developmental dysplasia of the hip, Legg-Calvé-Perthes disease, femoral head necrosis or slipped capital femoral epiphysis. All patients showed a significant improvement in Harris Hip Score (p < 0.01) at 3.3 years average follow-up (range 0.7–10.1 years).ConclusionThe management of juvenile hip osteoarthritis following developmental dysplasia of the hip, Legg-Calvé-Perthes disease, femoral head necrosis or slipped capital femoral epiphysis is still challenging. Careful preoperative planning is essential to achieve good outcomes and improve the Harris Hip Score in these young patients. Total hip arthroplasty is a suitable option for end-stage secondary juvenile hip osteoarthritis, when proximal femoral osteotomies and conservative treatments fail to improve patients’ symptoms and quality of life.Level of evidenceIV

Bone marrow lesion on magneticresonance imaging indicates the last chance for hip osteonecrosis treated with vascularized fibular grafting before collapse.

Timing of surgery is the most critical prognostic factor for hip osteonecrosis treated with free vascularized fibular grafting (FVFG). Bone marrow lesion (BML) on MRI usually occurs immediately before femoral head collapse. We conducted a retrospective cohort study to evaluate whether the noncollapsed hips with BML can benefit from FVFG. Consecutive patients undergoing modified FVFG were identified from our clinical repository between January 2014 and December 2014. Based on whether BML was pre-operatively detected, the four year radiographic and clinical outcomes were compared. In the BML cohort, 22 of 53 hips (42%) showed radiographic signs of osteonecrosis progression, which was significantly higher than that in the control cohort (8 of 49, 16%; P = 0.005). The BML hips showed a significantly lower pre-operative Harris Hip Score (HHS) than those without BML (77.8 vs. 85.5, P = 0.046), whereas no such difference was observed in the final HHS or its post-operative improvement (HHS 90 vs. 94, P = 0.397; HHS improvement 12 vs. 8, P = 0.067). In the subgroup of patients with a pre-operative HHS lower than 80, BML hips were associated with a slightly lower final HHS than hips without BML. Four of 5 (80%) failed hips with BML had a poor pre-operative hip function. BML indicates the last chance for a reproducible improvement in the treatment of hip osteonecrosis with FVFG before collapse. However, the concomitant lower pre-operative HHS (< 80) is a poor prognostic factor for BML-positive hips.

Long-Term Results of Revision Total Hip Arthroplasty Using a Modern Extensively Porous-Coated Femoral Stem

BackgroundThe use of an extensively porous-coated uncemented cobalt-chrome monoblock femoral stem for revision total hip arthroplasty (THA) is well established with excellent mid-term results. The aim of this study is to report the long-term survivorship of these implants in femoral stem revisions. MethodsThis is a long-term retrospective review of prospectively collected data of 55 femoral stem revisions in 55 patients using a contemporary, cementless extensively porous-coated cobalt-chrome monoblock stem. All patients between 2001 and 2006 who underwent first time femoral stem revision with a contemporary, cementless extensively porous-coated cobalt-chrome monoblock stem were included. Harris Hip Score, Western Ontario and McMaster Universities Index, and University of California Los Angeles activity scores were recorded preoperatively and at latest follow-up. Radiographs were analyzed for evidence of loosening, subsidence, osteolysis, and bony union. This study included 55 patients, comprising of 36 females (66%) and 19 males (34%) with a mean age of 66.4 ± 9.3 years at the time of surgery. The mean time interval from index procedure was 9.8 ± 2.9 years. Mean time from revision THA to final follow-up was 13.2 ± 2.17 years with a minimum of 10 years of follow-up. ResultsIndications for revision included aseptic loosening (33), prosthetic joint infection (13), and periprosthetic fracture (10). Significant improvement in Harris Hip Score (85.1 ± 1.77 vs 51.8 ± 2.3, P < .001), Western Ontario and McMaster Universities Index (17.6 ± 0.77 vs 33.3 ± 0.8, P < .001), and University of California Los Angeles (5.25 ± 0.2 vs 2.7 ± 0.36, P < .001) scores were found at latest follow-up compared to preoperative. Fifty-four patients (98%) achieved stable bony ingrowth on radiographic analysis. All 10 patients treated for periprosthetic fractures achieved bony union of their fractures. Two patients suffered intraoperative periprosthetic fractures and were treated with a cable-plating system. There were no mechanical failures and no femoral stem re-revisions. One patient was diagnosed with a deep infection and was treated with chronic suppressive antibiotic therapy due to significant medical comorbidities. ConclusionRevision of the femoral component with a contemporary extensively porous-coated cobalt-chrome femoral stem has excellent functional outcomes, radiographic outcomes, and long-term survivorship with minimal complications.

Systematic review of primary total hip arthroplasty using titanium-titanium modular-neck prostheses: the true risk of revision.

Modular-neck femoral implants are used to enable more variability in femoral neck version, offset and length. It has been reported that these implants carry a higher rate of revision. The aim of this review was to assess the overall and cause-specific revision rate of titanium-titanium alloy modular-neck implants in primary total hip arthroplasty (THA). A systematic review was conducted following PRISMA guidelines and utilising multiple databases. All results were screened for eligibility. Studies published from 2000 onwards, using a current-generation, titanium-titanium, modular-neck implant were included. Overall and cause-specific revision rates were analysed, comparing to fixed-neck prostheses where applicable. 920 studies were screened. After applying exclusion criteria, 23 were assessed in full and 14 included. These consisted of 12 case series and 2 joint registry analyses. 21,841 patients underwent a modular-neck implant with a weighted mean follow-up of 5.7 years, mean age of 62.4 years, and average body mass index (BMI) of 28.4kg/m2. The overall revision rate was 3.95% and 2.98% for modular and fixed-neck prostheses, respectively. For studies with >5 years follow-up the mean revision rate was 3.08%. There was no difference in cause-specific revision rates by implant design. Mean improvement in Harris Hip Score was 41.9. At medium-term, revision rates for titanium-titanium primary modular-neck THA are acceptable. These prostheses are a sensible management option in patients with considerable anatomical hip deformity not amenable to correction with standard fixed-neck implants. Patients of male gender, high BMI and requiring prostheses with a larger neck, offset or head are at higher risk of implant failure.

Reconstruction for pelvic discontinuity and massive acetabular defects

ObjectiveThe acetabular reconstruction with massive acetabular defects and pelvic discontinuity is a complex surgery with important difficulties for the orthopaedic surgeon. The objective of this study is to show the short and midterm results of the acetabular revision with the Cup-Cage construct in a consecutive series of cases. Material and methodsRetrospectively we reviewed 22 consecutive patients with massive acetabular defects (8 Paprosky IIIa and 9 IIIB); 5 pelvic discontinuities; 2 pelvic fractures during the implantation of primary arthroplasty, and one pelvic pseudoarthrosis. All were reoperated with a trabecular metal acetabular component and a Cup-Cage. We did clinical and radiological follow-up to detect mechanical failures and loosening of the implant. ResultsWith a middle follow-up of 45.06 months (12–73 months) we did not see any radiographic failure of the implant (component migration, osteolysis neither rupture of the implant or screws). The complications (13.63%) included one recurrent luxation, one infection and one recurrent subluxation. The Merle d’Aubigné-Postel score improved from 6.91 to 14.36 and the punctuation in the range of motion from 2.91 to 4.36 on average of the values preoperatively and postoperatively respectively and improvement in Harris Hip Score 30 (16–55) to 72 (40–90) in the latest follow up. ConclusionThe acetabular reconstruction with the Cup-Cage system is a valid alternative for the reconstruction of massive acetabular defects (Paprosky type IIIA and IIIB) and pelvic discontinuities offering good results at short and midterm follow-up.

Dual mobility total hip arthroplasty in patients at risk for dislocation

Background Total hip arthroplasty (THA) is one of the most successful surgeries in orthopedics. However, postoperative dislocation is one of the major complications. There are some patients with higher risk for dislocations. Dual mobility cup THA (DMC) may decrease the rate of dislocation and enhance functional outcome in those patients.Aim The aim was to retrospectively assess postoperative rate of dislocation and functional outcome in patients with preoperative risk factors for dislocation treated by DMC THA.Patients and methods A total of 26 DMC THAs were done for 25 patients with preoperative risk factors for dislocation. Functional outcome by Harris hip score and dislocation rates have been followed for a period of 12–48 months (mean: 31 months).Results There was 0% rate of dislocation till the last follow-up. There was marked improvement in Harris hip score, with good to excellent results in 74% of patients.Conclusion DMC THA is a good option for patients at risk for dislocations, with very low or no rate of dislocation, with good functional outcomes.

Reconstrucción acetabular con el sistema Cup-Cage para discontinuidades pélvicas y defectos acetabulares masivos

ObjectiveThe acetabular reconstruction with massive acetabular defects and pelvic discontinuity is a complex surgery with important difficulties for the orthopaedic surgeon. The objective of this study is to show the short and midterm results of the acetabular revision with the Cup-Cage construct in a consecutive serie of cases. Material and methodsRetrospectively we reviewed 22 consecutive patients with massive acetabular defects (8 Paprosky IIIa and 9 IIIB); 5 pelvic discontinuities; 2 pelvic fractures during the implantation of primary artroplasty, and one pelvic pseudoarthrosis. All were reoperated with a trabecular metal acetabular component and a Cup-Cage. We did clinical and radiological follow-up to detect machanical failures and loosening of the implant. ResultsWith a middle follow-up of 45.06 months (12-73 months) we did not see any radiographic failure of the implant (component migration, osteolysis neither rupture of the implant or screws). The complications (13,63%) included one recurrent luxation, one infection and one recurrent subluxation. The Merle d’Aubigné-Postel score improved from 6.91 to 14.36 and the punctuation in the range of motion from 2.91 to 4.36 on average of the values preoperatively and postoperatively respectively and improvement in Harris Hip Score 30 (16-55) to 72 (40-90) in the latest follow up. ConclusionThe acetabular reconstruction with the Cup-Cage system is a valid alternative for the reconstruction of massive acetabular defects (Paprosky type IIIA and IIIB) and pelvic discontinuities offering good results at short and midterm follow-up.

Hip abductor repair improves patient outcome, function, and satisfaction in patients without and with total hip arthroplasty

PurposeDetermine whether patient pain and function are similar following hip abductor repair in patients without and with total hip arthroplasty (THA). MethodsPatients who underwent hip abductor repair were categorized as to whether they had a THA or not. Pre- and postoperative pain and Harris Hip Score (HHS) were recorded and compared between groups. ResultsThere were no differences in improvement in pain level, improvement in HHS, satisfaction with surgery. ConclusionsHip abductor repair leads to similar pain, function, and satisfaction in patients without and with THA.

Midterm Clinical and Radiographic Outcomes of a Contemporary Monoblock Dual-Mobility Cup in Uncemented Total Hip Arthroplasty

BackgroundThe efficacy of contemporary monoblock dual-mobility (DM) cups to prevent dislocations in total hip arthroplasty (THA) is well reported, but there is little published data on their mid- to long-term outcomes. The authors aimed at reporting the 10-year survival of a contemporary DM cup as well as its clinical and radiographic outcomes. MethodsFrom a retrospective consecutive multicentric series of 516 patients (541 hips) that received uncemented THA between June 2007 and June 2010, 6 patients (6 hips) had cup and stem revisions, 5 patients (5 hips) had isolated stem revision, and 2 patients (2 hips) had isolated insert revision. A total of 103 patients (111 hips) died with their original implants, and 41 patients (42 hips) were lost to follow-up. This left 358 patients (375 hips) for clinical assessment at a median follow-up of 8.7 years (range, 6.8-10.5 years), including 279 patients (290 hips) with postoperative radiographs. Implant survival was calculated using the Kaplan-Meier method, and multivariable analyses were performed to determine whether clinical outcomes are associated with patient or surgical factors. ResultsThe 10-year survival considering revision for aseptic loosening as end point was 100% for the cup and 99.2% for the stem. No dislocations were observed, and radiographic assessment revealed 1 acetabular granuloma (0.3%), but no radiolucencies nor fractures. The Harris hip score improved from 49.6 ± 15.5 to 85.2 ± 14.5, and the postoperative Oxford hip score was 19.2 ± 7.6. Multivariable analyses revealed that improvement in Harris hip score increased with cup diameter (beta, 1.28; P = .039). ConclusionOur data confirmed satisfactory midterm outcomes of uncemented THA using a contemporary DM cup, with no dislocations nor cup revisions due to aseptic loosening. Level of EvidenceLevel IV, retrospective cohort study.

Study of functional outcome of core decompression with platelet rich plasma enhanced cancellous bone graft in avascular necrosis of femoral head grade I and II

Introduction: Avascular necrosis (AVN), most commonly affects femoral head. Etiology may be traumatic or non-traumatic. The goal of treatment is preservation of head of femur in early stages I and II by different hip preserving methods & to delay hip arthroplasty. Aims and Objectives: To evaluate and discuss the results of iliac crest cancellous bone graft enhanced with platelet rich plasma and core decompression in of AVN head of femur grade I and II.Method and Materials: This study was done in Deptt of Ortho., RNT MC & Hospital, Udaipur from 1 Oct. 2016 to 30 Sep. 2018. 25 Patients (38 hips) of both sex and aged between 25 to 50 years with AVN head of femur grade I and II were treated by core decompression with platelet rich plasma enhanced cancellous bone graft. Final results were graded according to Harris hip score. Results: Final Results were 10 hips (26.3%) had excellent, 17 hips (44.7%) good, 7 hips (18.4%) had fair and 4 hips (10.5%) had poor result. There was improvement in mean Harris Hip Scores by 10.1 points (73.1 to 83.2).Conclusion: Pain relief was achieved and probably due to decompression, and curettage of necrotic area. Improvement in Harris hip score and delay the need for THR.

Clinical outcomes and quality of life after total hip arthroplasty in adult patients with a history of infection of the hip in childhood: a mid-term follow-up study

BackgroundTotal hip arthroplasty for adult patients with a history of infection of the hip in childhood could be a more technically demanding procedure due to complicated anatomy and the possibility of reinfection. Here, we conducted a mid-term analysis of clinical outcomes in such patients after primary cementless total hip arthroplasty (THA).MethodsWe reviewed 101 patients (101 hips; 51 men; mean age, 52.3 years) who underwent cementless THA between 2008 and 2015, at a mean of 24 years (range, 11–43) since the resolution of childhood hip infection. Patients were followed up for a mean of 6.1 years (range, 2.1–9.6). Clinical outcomes and quality of life after THA were assessed at final follow-up.ResultsNo cases of infection were reported during the follow-up, and patients showed significant improvement in Harris Hip Score, for which the mean score increased from 48.5 to 90 points; the modified Merle d’Aubigne and Postel (MAP) Hip Score; the Hip Dysfunction and Osteoarthritis Outcome Score; the SF-12; and mean limb length discrepancy, which decreased from 3.4 to 1.1 cm. During follow-up, four cases of prosthesis dislocation, three of transient sciatic paralysis, seven of femoral fracture, five of heterotopic ossification, and 19 of osteolysis were recorded. Revision surgery was performed for two patients, one for isolated loosening of the acetabular component and another for loosening of the femoral stem.ConclusionCementless THA can effectively treat patients with a quiescent period of infection of the hip of more than 10 years, resulting in good functional outcomes and fewer complications. Risk of infection recurrence after THA in these patients seems extremely low.

Gait Analysis after Unilateral Total Hip Replacement Surgery

Total hip replacement (THR) is an elective surgical procedure with the primary indication being pain relief. The aim of this study is to analyze gait dynamics for patients after they underwent a unilateral THR surgery and compare it with normal parameters. To investigate the gait dynamics a gait analysis was performed on five patients after they underwent a unilateral THR surgery; only two of them were examined before the surgery. The gait analysis was performed using a digital video camera with two force plates. Kinematics data were obtained from 2D trajectories of seven passive markers using SkillSpector software. MATLAB software has been used for inverse dynamics computation. General gait parameters, Harris Hip Score, joints’ angles, forces, moments and powers were obtained during gait cycle. It was found that the average of improvement in Harris Hip Score (for four patients who were examined 1.5, 2.5, 3 and 9 months after surgery) is 61.8 points, which is an indication of pain relief. In the other hand, the general gait parameters were found slightly lower than normal after THR surgery. The average hip reaction force was found to be 2.988 N/BW, which is within normal range. Also, the average of maximum hip extension and maximum hip flexion angles were found to be 25.69 and -13.524 degree respectively, which both are within normal ranges. Furthermore, hip, knee and ankle moments and powers results showed some abnormality. Therefore as a conclusion, patient satisfaction and functional improvement are not related to general gait parameter. And it is not unusual that gait mechanics improvement would not reach normal after months of recovery. Also, the results of gait dynamics which are from the engineer’s perspective are compatible with Harris Hip Score, which is from the physician’s perspective, in quantifying surgical results and subsequent recovery progress.

Revision Total Hip Arthroplasty after Ceramic Bearing Fractures in Patients Under 60-years Old; Mid-term Results

PurposeAlthough advances in technology have reduced the risk of ceramic implant fractures in total hip arthroplasty, these injuries do occur and their treatment remains challenging. There is a lack of studies reporting on the effectiveness of ceramic components in revision hip arthroplasty after ceramic bearing fracture. The aim of this study is to evaluate clinical and radiologic outcomes of revision surgery with ceramic-on-ceramic components after ceramic bearing fractures in young (i.e., under 60 years old) and active patients.Materials and MethodsEight patients who, from May 2004 to November 2011, underwent ceramic-on-ceramic revision surgery following a ceramic component fracture and had more than 6 years follow up were enrolled in this study. All eight patients were male with mean ages at first and revision surgeries of 39 years (range, 31–50 years) and 43.8 years (range, 33–60 years), respectively. There were 6 and 2 cases of ceramic liner and ceramic head fractures, respectively. The average time from the first operation to revision surgery was 54.3 months (range, 9–120 months), and the average follow up period was 9.7 years (range, 6–13.3 years).ResultsAt the last follow up, all patients showed improvement in Harris hip score and pain relief and there were no cases of loosening or osteolysis.ConclusionRevision total hip arthroplasty using ceramic-on-ceramic components after ceramic component fracture is a feasible and appropriate surgical option in young and active patients.

Choice of implant in stable intertrochanteric fracture femur: PFNA vs DHS

Introduction: The best treatment for trochanteric fracture remains controversial Many methods have been recommended. Stable fixation that allows early mobilization is the treatment of choice. In this study, we aimed to compare the results of osteosynthesis using the PFNA and DHS system, in the treatment of stable intertrochanteric fractures including operative and postoperative complications, general complications and final outcome measurements. Method: We randomised 60 patients with low-energy extracapsular pertrochanteric stable femoral fractures (AO category 31-A1.1-31A.2.1)7 to be treated with the dynamic hip screw or the proximal femoral nail A2. All fractures were categorised according to the AO/ASIF classification. Follow-up reviews were undertaken at four weeks, three and six months post-operatively using Harris hip score. Results: From the first to the 6th month, there was a significant improvement in Harris hip score (p

Comparative study of simultaneous and staged bilateral non-cemented total hip replacement in young active adults in terms of cost effectiveness and improvements in Harris hip score

Objective: To compare the outcome of simultaneous versus two staged Non-cemented Total hip Arthroplasty (THA) in terms of cost effectiveness and improvement in Harris Hip Score (HHS)Material and methodology: This comparative prospective study was conducted from 2008 to 2012. Total 100 patients with 200 hips fulfilling the inclusion and exclusion criteria was included in this study. Non-cemented THA was performed in all these patients. Fifty patients each were placed in group A and B who were managed with simultaneous bilateral THA and staged bilateral non-cemented THA respectively. Patients in both the groups were matched. Duration of surgery, preoperative and postoperative HHS, duration of stay in hospital, time to return to work and complications were the main variables that were evaluated. Results: The mean preoperative and postoperative HHS in group A was 53.08±8.178 (36-69) and 92.62±2.26 (90-97) respectively with p-value

Outcome of 4 Surgical Treatments for Wear and Osteolysis of Cementless Acetabular Components

BackgroundLoosening and periprosthetic osteolysis are some of the most common long-term complications after hip arthroplasty. The decision-making process and surgical treatment options are controversial. MethodsWe retrospectively reviewed 96 acetabular revisions (91 patients) performed between 2002 and 2012, with a minimum of 2 years of follow-up and a mean of 5.7 years of follow-up. Clinical outcome was assessed using the Harris Hip Score. The size and location of osteolytic lesions were evaluated using the preoperative radiographs; healing of the defects was categorized using a standardized protocol. ResultsThirty-three (34.4%) hips had isolated liner exchanges (ILEs), 10 (10.4%) hips had cemented liners into well-fixed shells (CLS), 45 (46.9%) hips had full acetabular revisions (FARs), and 8 (8.3%) hips had revision with a roof ring/antiprotrusio cage (RWC). All procedures showed significant improvement in Harris Hip Score after revision (P ≤ .001). Fifteen patients had moderate residual pain (pain score ≤20): 8 (24%) ILE, 3 (30%) CLS, and 4 (9%) FAR. Complete bone defect healing after grafting was lower with acetabular component retention procedures (ILE and CLS; 27%) compared with full acetabular component revision procedures (FAR and RWC; 57%). Fifteen patients underwent reoperation: 3 ILE, 1 CLS, 8 FAR, and 3 RWC. ConclusionAcetabular component retention demonstrates a low risk of reoperation; however, residual pain and limited potential for bone graft incorporation are a concern. FAR is technically challenging and may have an elevated risk of reoperation; however, higher degrees of bone graft incorporation and satisfactory clinical outcome can be expected.

Total Hip Arthroplasty Improves Pain and Function but Not Physical Activity

BackgroundPeople with hip osteoarthritis are likely to limit physical activity (PA) engagement due to pain and lack of function. Total hip arthroplasty (THA) reduces pain and improves function, potentially allowing increased PA. PA of THA patients was quantified to 12 months postoperation. The hypothesis was that postoperatively levels of PA would increase. MethodsPA of 30 THA patients (67 ± 7 years) was objectively measured preoperatively and 3 and 12 months postoperation. Harris Hip Score (HHS), Oxford Hip Score (OHS), and 6-minute walk test (6MWT) were recorded. Mixed linear modelling was used to examine relationships of outcomes with time, baseline body mass index (BMI), age, gender, and baseline HHS. ResultsTime was not a significant factor in predicting volume measures of PA, including sit-to-stand transitions, upright time, and steps. Notably, baseline BMI was a significant predictor of upright time, steps, largest number of steps in an upright bout, HHS, and 6MWT. Baseline HHS helped predict longest upright bout, cadence of walking bouts longer than 60 seconds, and OHS. The significant effect of participant as a random intercept in the model for PA outcomes suggested habituation from presurgery to postsurgery. ConclusionVolume measures of PA did not change from presurgery to 12 months postsurgery despite improvement in HHS, OHS, and 6MWT. Baseline BMI was a more important predictor of upright activity and stepping than time. Preoperative and postoperative PA promotion could be used to modify apparently habitual low levels of PA to enable full health benefits of THA to be gained.

Enhanced recovery programmes after total hip arthroplasty can result in reduced length of hospital stay without compromising functional outcome.

The primary aim of this study was to investigate the effect of an enhanced recovery program (ERP) on the short-term functional outcome after total hip arthroplasty (THA). Secondary outcomes included its effect on rates of dislocation and mortality. Data were gathered on 1161 patients undergoing primary THA which included 611 patients treated with traditional rehabilitation and 550 treated with an ERP. The ERP was shown to be a significant independent factor which shortened length of stay (LOS) by a mean of 1.5 days (95% confidence interval (CI) 1.3 to 1.8, p < 0.001) after adjusting for confounding variables. The rates of dislocation (traditional 1.03% vs ERP 0.91%, p = 0.84) and mortality (1.5% vs 0.6%, p = 0.14) one year post-operatively were not significantly different. Both groups showed significant improvement in Harris Hip Score (42.8 vs 41.5) at 12 to 18 months post-operatively and there was no significant difference in the magnitude of improvement on univariate (p = 0.09) and multivariate analysis (p = 0.35). There was no significant difference in any of the eight domain scores of the Short-Form - 36 general health surveys post-operatively (p > 0.38). We conclude that an ERP after THA shortens LOS by a mean of 1.5 days and does not increase the rate of complications post-operatively. It gives equivalent functional outcomes to a traditional rehabilitation pathway. ERP reduces LOS after THA in comparison to traditional rehabilitation, without adversely affecting functional outcomes, dislocation rates or mortality.

Does Hip Arthroscopy Affect the Outcomes of a Subsequent Total Hip Arthroplasty?

BackgroundHip arthroscopy utilization is on the rise in the United States. Thus, determining the impact of prior hip arthroscopy on subsequent total hip arthroplasty (THA) is important to understand. MethodsA retrospective review of a high-volume orthopedic surgery practice’s billing database yielded 42 hip arthroscopies that underwent subsequent THA. An age-, sex-, and body mass index (2:1)–matched cohort of primary THAs was used for comparison. ResultsNo difference was observed in the postoperative Harris Hip Score between groups (92.1 ± 10.9 vs 90.1 ± 6.6, P = .20); however, there was greater overall improvement in Harris Hip Score in the control group (40.4 ± 18.4 vs 45.1 ± 8.7, P = .05). There were no differences observed in the complication (P = .5) or revision rates (P = .4). ConclusionWith the numbers available, prior hip arthroscopy does not appear to have an impact on the functional outcomes of a subsequent THA.

The use of bisphosphonate in the treatment of osteonecrosis of the femoral head: a meta-analysis of randomized control trials

This meta-analysis revealed that bisphosphonates could not provide a better clinical outcome in the treatment of osteonecrosis of the femoral head (ONFH) when compared with placebo. Bisphosphonates have been recommended to treat ONFH. However, the exact clinical outcomes after treatment are still controversial. A comprehensive search of PubMed, Embase, and Web of Science databases was undertaken, and only randomized control trials were included. The clinical outcomes consisted of progression to collapse, total hip arthroplasty (THA) incidence, and improvement of Harris hip score (HHS). The heterogeneities between the trials were assessed with the I (2) statistic, and random effects models were used for the meta-analysis. Five eligible trials were identified involving 329 subjects with 920.9 patient-years of follow-up. The clinical outcomes of patients with ONFH was not significantly improved by bisphosphonate therapy (progression to collapse: risk ratio = 0.71 (0.41, 1.24), p = 0.23; THA incidence: risk ratio = 0.61 (0.33, 1.15), p = 0.13; HHS improvement: mean difference = 3.26 (-5.12, 11.64), p = 0.45). The I (2) statistic showed the existence of considerable heterogeneity (all I (2) ≥ 50 %), which was explained by one trial where bisphosphonate alone was used with no additional therapy. However, when this trial was excluded, the clinical outcomes after bisphosphonate therapy were still not significantly improved compared with placebo. The current analysis does not support the use of bisphosphonates for ONFH. As potential serious adverse effects are associated with these drugs, only limited use can be recommended.