Hip Dysfunction And Osteoarthritis Outcome Score Research Articles

PATIENT-REPORTED OUTCOMES AND GAIT FOLLOWING PRIMARY AND REVISION TOTAL HIP ARTHROPLASTY

This study aimed to quantify self-reported outcomes and walking gait biomechanics in patients following primary and revision THA. The specific goals of this study were to investigate: (i) if primary and revision THA patients have comparable preoperative outcomes; and (2) if revision THA patients have worse postoperative outcomes than primary THA patients.Forty-three patients undergoing primary THA for osteoarthritis and 23 patients undergoing revision THA were recruited and followed longitudinally for their first 12 postoperative months. Reasons for revision were loosening (73%), dislocation (9%), and infection (18%). Patients completed the Hip dysfunction and Osteoarthritis Outcome Score (HOOS), and underwent gait analysis preoperatively, and at 3 and 12 months postoperatively. A 10 camera motion analysis system (V5 Vantage, Vicon, UK) recorded marker trajectories (100 Hz) during walking at self- selected speeds. A generic lower-body musculoskeletal model (Gait2392) was scaled using principal component analysis [1] and the inverse kinematics tool in Opensim 3.3 was used to compute joint angles for the lower limbs in the sagittal plane. Independent samples t-test were used to compare patient reported outcomes between the primary and revision groups at each timepoint. Statistical parametric mapping was used to compare gait patterns between the two groups at each timepoint.Preoperatively, patients undergoing primary THA reported significantly worse pain (p<0.001), symptoms (p<0.001), function (p<0.001), and quality of life (p=0.004). No differences were observed at 3 and 12 months postoperatively between patients who had received a primary or revision THA. The only observed difference in gait pattern was that patients with a revision THA had reduced hip extension at 3 months, but no differences were observed preoperatively and 12 months.Despite the suggestions in the literature that revision THA is bound to have worse outcomes compared to primary THA, we found no differences in in patient-reported outcomes and gait patterns at 12 months postoperatively. This suggests that it may be possible, in some circumstances, for patients following revision THA to achieve similar outcomes to their peers undergoing primary THA.

Effect of Combined Intraosseous and Intraarticular Infiltrations of Autologous Platelet-Rich Plasma on Subchondral Bone Marrow Mesenchymal Stromal Cells from Patients with Hip Osteoarthritis.

Osteoarthritis (OA) is a debilitating condition that significantly impacts its patients and is closely associated with advancing age and senescence. Treatment with autologous platelet rich plasma (PRP) is a novel approach that is increasingly being researched for its effects. Subchondral bone mesenchymal stromal cells (MSCs) are key progenitors that form bone and cartilage lineages that are affected in OA. This study investigated the changes in subchondral bone MSCs before and after combined intraosseous (IO) and intraarticular (IA) PRP infiltration. Patient bone marrow aspirates were collected from 12 patients (four male, eight female) aged 40–86 years old (median 59.5). MSCs were expanded in standard media containing human serum to passage 1 and analysed for their colony-forming potential, senescence status, and gene expression. Hip dysfunction and Osteoarthritis Outcome Score (HOOS) at baseline and 6 months post second infiltration were used to assess the clinical outcomes; seven patients were considered responders and five non-responders. The number of colony-forming MSCs did not increase in the post treatment group, however, they demonstrated significantly higher colony areas (14.5% higher compared to Pre) indicative of enhanced proliferative capacity, especially in older donors (28.2% higher). Senescence assays also suggest that older patients and responders had a higher resistance to senescent cell accumulation. Responder and non-responder MSCs tended to differ in the expression of genes associated with bone formation and cartilage turnover including osteoblast markers, matrix metalloproteinases, and their inhibitors. Taken together, our data show that in hip OA patients, combined IO and IA PRP infiltrations enhanced subchondral MSC proliferative and stress-resistance capacities, particularly in older patients. Future investigation of the potential anti-ageing effect of PRP infiltrations and the use of next-generation sequencing would contribute towards better understanding of the molecular mechanisms associated with OA in MSCs.

Is the Femoral-Epiphyseal Acetabular Roof (FEAR) index associated with hip pain in patients with hip dysplasia?

Micro instability of the hip joint has been suggested to cause pain in patients with hip dysplasia. Recently, the Femoral-Epiphyseal Acetabular Roof (FEAR) index has been developed to evaluate hip instability in patients with dysplasia. To investigate associations between the FEAR index and patient-reported outcomes before and six months after periacetabular osteotomy (PAO). Radiographs of patients with hip dysplasia who underwent PAO between 2018 and 2020 were retrospectively assessed by a radiologist and an orthopedic surgeon. Radiographic measurements indicative of hip instability (Shenton's line, FEAR index, center-edge angle of Wiberg, acetabular index of Tönnis, and the femoral neck-shaft angle) were measured. Data on hip pain, function, and quality of life were collected prospectively using the Hip dysfunction and Osteoarthritis Outcome Score (HOOS). A total of 222 patients were included in the study. All radiographic measurements and patient-reported outcomes improved significantly from preoperative to six months postoperative (P < 0.001). There were no differences in the change score of patient-reported outcomes between patients with a FEAR index >2° (indicative of hip instability) and patients with a FEAR index ≤2°. The FEAR index was not associated with hip pain, function, and quality of life among patients with hip dysplasia. This study did not find evidence supporting that instability defined by the FEAR index caused pain in patients with hip dysplasia.

Long-Term Clinical Outcomes and Survivorship of Total Hip Arthroplasty for Pyogenic Arthritis: A Retrospective Cohort Study of 168 Hips.

ObjectiveThe aim of the present study was to evaluate the 10‐year outcomes of cementless total hip arthroplasty (THA) in adult patients with the late sequelae of septic arthritis of the hip.MethodsWe followed 166 consecutive patients (168 hips) who underwent cementless THA between March 2001 and December 2011. There were 79 men and 87 women, with a mean age of 50.4 years (range 21–76 years) at the time of index THA, all of whom had hip osteoarthritis secondary to hip pyogenic infection. The average duration of follow up was 10.6 years (range 6.9–17.2 years). Preoperative and postoperative clinical ratings were evaluated, including the hip dysfunction and osteoarthritis outcome score (HOOS), the Harris hip score (HHS), range of motion, a 100‐point visual analog scale for hip pain, and the severity of limp and limb length discrepancy (LLD). The anteroposterior and lateral radiographs of the hip and full‐length view of the lower extremities were obtained to assess the position of the components, radiolucent lines, osteolysis, loosening of components, and heterotopic ossification. The intraoperative and postoperative complications were also recorded.ResultsThe mean HSS and hip pain score were 44.2 points (range 29–66 points) and 42.5 points (range 32–64 points), respectively, before the index surgery and significantly improved to 88.1 points (range 78–96 points) and 15.1 points (range 10–26 points), respectively, at final follow‐up examination. The HOOS and range of motion also improved significantly. The mean limb length discrepancy was reduced from 2.6 to 0.8 cm. The limp at last follow‐up examination was moderate in 3 cases because of hip osteoarthritis in the other limb, slight in 26, and absent in 137. A radiolucent line was observed in 12 hips (7.1%) around the acetabular or femoral components. A progressive radiolucent line around the undersized femoral stem in all zones was seen in 1 hip, resulting in aseptic loosening and breakage of the femoral component. There were 8 cases of intraoperative fracture, 7 cases of dislocation, and 7 cases of transient nerve palsy. Recurrence of infection occurred in 2 hips. Revision surgery was conducted in 2 hips because of isolated loosening of the acetabular cup and the femoral stem, respectively. Kaplan–Meier survival was 97% at 10 years, with revision for any reason with any component as an end‐point.ConclusionImproved surgical techniques and development of components with various sizes provided favorable results for cementless THA conducted for late sequelae of sepsis in these young and active patients. Although the incidence of complications was relatively high, the complications were treated successfully.

Pain and quality of life are impaired in adults with hip dysplasia undergoing periacetabular osteotomy: a systematic review and meta-analysis

Purpose: In adults with hip dysplasia (i) evaluate pre to post- operative changes in pain, function and quality of life following Periacetabular Osteotomy (PAO); (ii) evaluate differences in pain, function and quality of life in those undertaking PAO and healthy controls; and (iii) evaluate differences in pain, function and quality of life in those with mild versus severe dysplasia, as defined by the Lateral Centre Edge Angle (LCEA) LCEA. Methods: A comprehensive, reproducible search strategy was performed on the following databases MEDLINE CINAHL, EMBASE, Sports Discuss, and PsychINFO from inception until 11th July 2019. Studies were eligible for inclusion if they used a hip-specific patient-reported outcome measure (PROM) and reported Level IV evidence or above. Participants: People aged 15 years and older with hip dysplasia undertaking PAO. Intervention: Studies utilising PAO surgery as primary intervention for Hip Dysplasia. The terms “Bernese Osteotomy” and “Ganz Osteotomy” were considered interchangeable with ‘Periacetabular Osteotomy’. Studies were ineligible if the PAO was reported to be a ‘rotational’ or ‘”curved” procedure. Comparator: Studies using sham treatment, no treatment or other treatment as the comparator/control treatment were included. We also included studies where no control group was present. Outcomes: Primary outcomes of interest were pain, function and quality of life. The hip-specific PROMs included: Hip Dysfunction and Osteoarthritis Outcome Score (HOOS), Western Ontario and McMaster universities osteoarthritis Index (WOMAC), the International Hip Outcome Tool (iHOT), the Copenhagen Hip and Groin Outcome Score (HAGOS), NAHS (Non-arthritic Hip Score), and the Oxford Hip Score (OHS). A modified version of the Downs and Black checklist was used to assess the quality of included studies. Quality Evaluation and Data Extraction was performed by two independent reviewers with any disagreements discussed in a consensus meeting and an independent arbitrator was employed when consensus could not be met. A hierarchy of PROMs was decided on between authors to prioritise data extraction where more than one had been used. The order of the hierarchy was based on the established level of validity and reliability of the PROM for young people with hip pain, and applicability to people with hip dysplasia undergoing PAO. In order of selection the hierarchy was HOOS, WOMAC, IHOT, HAGOS, NAHS, OHS. Results: The search yielded 4065 titles and abstracts for screening, with 51 studies included in the final analyses. The methodological quality scores ranged from 50% to 94%, with an overall mean (SD) rating of 71% (11.6%). Sample sizes of the PAO groups ranged from 16 patients to 391 patients. The ages for patients in the included studies ranged from 20 years to 45 years. All included studies used a PROM. Seventeen studies used the HOOS, 34 studies used the WOMAC, five studies used the iHOT, 4 studies used the HAGOS and 3 studies used the NAHS.Two studies, one prospective cohort study and a retrospective cohort study, compared subscale scores (pain, symptoms, activities of daily living (ADL), sport & recreation, and quality of life) pre-operatively versus post-operatively. For the pain subscale (Fig. 1) a significant improvement was found between pre-surgery and the one-year timepoint (SMC (95% CI): 1.50; 1.33 to 1.67) and this improvement was maintained at the two-year timepoint (1.43; 1.16 to 1.70). This also occurred in the symptoms subscale at one-year (1.21; 1.06 to 1.36) and two-years (1.08; 0.82 to 1.34); ADL at one-year (1.21; 1.06 to 1.36) and two-years (1.11; 0.98 to 1.23); sport & recreation at one-year (1.41; 1.25 to 1.57) and two-years (1.32; 0.88 to 1.75); and quality of life at one-year (1.38; 1.22 to 1.54) and two-years (1.31; 1.04 to 1.57). These results provide low-level evidence that patients experience clinical improvements across all subgroups at one year after PAO, compared to pre-surgery, and this is maintained at the two-year timepoint. Two studies compared outcomes between PAO patients and healthy participants, one high-quality prospective cohort study and one high quality cross-sectional study. Meta-analysis of the pre-operative time point showed significantly worse outcomes in the PAO group with large effect sizes across all subgroups. This included pain (Fig. 2) (SMD (95% CI): -3.84; -4.73 to -2.95), symptoms (-3.84; -4.36 to -3.29), ADL (-2.81, -3.89 to -1.74), sport & recreation (-3.47; -3.79 to -3.16), and quality of life (-4.10; -4.43 to -3.77). This result provides low-level evidence that PAO patients have significantly worse outcomes across all subgroups when compared to healthy participants. This occurs both pre-operatively and postoperatively and 6, 12 and 32 months. Conclusions: Before undergoing PAO surgery, adults with hip dysplasia have worse levels of pain, symptoms, ADL, sport and recreation and quality of life compared to healthy participants. These levels improve over two years following PAO, but do not reach the same level as their asymptomatic peersView Large Image Figure ViewerDownload Hi-res image Download (PPT)

Long-term results of combined porous tantalum augments and titanium-coated cups for Paprosky type III bone defects in acetabular revision.

The use of porous tantalum augments and titanium-coated cups in primary total hip arthroplasty (THA) with acetabular defects has shown satisfactory outcomes in our centre. The aim of this study was to report the long-term radiological and clinical outcomes of using this combination for Paprosky type III acetabular bone defects in acetabular revision. Between January 2007 and January 2015, 45 patients with Paprosky type III acetabular defects underwent acetabular revision using a combination of porous tantalum augments and titanium-coated cups. Among these, 41 patients (41 hips) had complete follow-up. Thirty-one patients had a Paprosky type IIIA defect, and ten patients had a Paprosky type IIIB defect. No patients had pelvic discontinuity. There were 20 males and 21 females with an average age of 63.2years (range 35-80) at the time of revision surgery. The mean follow-up was 122.8months (range 69-165). The Harris Hip Score (HHS) improved significantly from 32.1 points (range 17-58) pre-operatively to 85.3 points (63-98) at the last follow-up. The Short Form-12 (SF-12) and Hip Dysfunction and Osteoarthritis Outcome Score (HOOS) improved significantly for each item at the last follow-up. Two patients had a high hip centre post-operatively. One patient had recurrent dislocation but did not require re-revision. No further revision of the acetabular components was required, and all hips remained stable at the last follow-up with bony ingrowth of the acetabular components according to the criteria of Moore et al. CONCLUSION: The combination of tantalum augments and conventional titanium-coated cups achieved satisfactory long-term radiographic and clinical outcomes for Paprosky type III acetabular bone defects without pelvic discontinuity.

Immediate outcomes following the GLA:D® program in Denmark, Canada and Australia. A longitudinal analysis including 28,370 patients with symptomatic knee or hip osteoarthritis

To report outcomes across three countries for patients with symptomatic knee or hip OA attending the evidence-based education and exercise therapy program Good Life with osteoArthritis from Denmark (GLA:D®). GLA:D® is a structured treatment program including 2-3 patient education sessions and 12 supervised exercise sessions delivered over 8 weeks by certified health care practitioners. The program was introduced in Denmark in 2013, in Canada 2015 and in Australia 2016. Absolute mean change in pain intensity, number of chair stands in 30s, 40m walk test time and Knee injury and Osteoarthritis Outcome Score (KOOS)/Hip dysfunction and Osteoarthritis Outcome Score (HOOS) QOL subscale scores from baseline to immediately after treatment were reported as means and 95 % CIs and proportion of responders for each country. Patients from the three countries improved 26-33% in mean pain intensity, 8-12% in walking speed, 18-30% in chair stand ability and 12-26% in joint-related quality of life from baseline to immediately after treatment, with no clinically relevant differences between patients with hip and knee OA. These improvements correspond with moderate to large within-group effect sizes and 43-47 % of the patients experienced clinically relevant pain reductions. About half or more of patients across the three countries were categorized as responders for pain and objective function following the implementation of GLA:D®. These findings indicate positive patient outcomes associated with GLA:D® participation across varying health care systems from implementation of guideline-based patient education and exercise therapy for knee and hip OA.

Does the Femoral Head Size in Hip Arthroplasty Influence Lower Body Movements during Squats, Gait and Stair Walking? A Clinical Pilot Study Based on Wearable Motion Sensors.

A hip prosthesis design with larger femoral head size may improve functional outcomes compared to the conventional total hip arthroplasty (THA) design. Our aim was to compare the range of motion (RoM) in lower body joints during squats, gait and stair walking using a wearable movement analysis system based on inertial measurement units (IMUs) in three age-matched male groups: 6 males with a conventional THA (THAC), 9 with a large femoral head (LFH) design, and 8 hip- and knee-asymptomatic controls (CTRL). We hypothesized that the LFH design would allow a greater hip RoM, providing movement patterns more like CTRL, and a larger side difference in hip RoM in THAC when compared to LFH and controls. IMUs were attached to the pelvis, thighs and shanks during five trials of squats, gait, and stair ascending/descending performed at self-selected speed. THAC and LFH participants completed the Hip dysfunction and Osteoarthritis Outcome Score (HOOS). The results showed a larger hip RoM during squats in LFH compared to THAC. Side differences in LFH and THAC groups (operated vs. non-operated side) indicated that movement function was not fully recovered in either group, further corroborated by non-maximal mean HOOS scores (LFH: 83 ± 13, THAC: 84 ± 19 groups, vs. normal function 100). The IMU system may have the potential to enhance clinical movement evaluations as an adjunct to clinical scales.

Gluteal Loading Versus Sham Exercises to Improve Pain and Dysfunction in Postmenopausal Women with Greater Trochanteric Pain Syndrome: A Randomized Controlled Trial.

The aim of the current study was to determine the effects of education with targeted or sham exercise on pain and function in postmenopausal women with greater trochanteric pain syndrome (GTPS). Conservative management of GTPS is poorly described, and to date, there have been no studies on education with exercise as an intervention for GTPS. Ninety-four postmenopausal women with GTPS were recruited to participate in this study. Participants were randomized to receive one of two 12-week exercise programs (GLoBE vs. sham). Participants received education on avoiding tendon compression with appropriate activity modification. The Victorian Institute of Sport Assessment-Gluteal tendon (VISA-G) was examined at baseline, 12, and 52 weeks. Secondary outcomes included hip pain and function questionnaires (Hip dysfunction and Osteoarthritis Outcome Score (HOOS), Oxford Hip Score (OHS), and Lateral Hip Pain questionnaire), a global rating of change in symptom questionnaire, and a quality of life measure (Assessment of Quality of Life [AQoL]-8D). Differences between groups were analyzed using intention to treat with analysis of covariance, per-protocol analysis, and responder analysis. Responders to the GLoBE intervention had significantly better VISA-G, HOOS, OHS, and lateral hip pain questionnaire scores compared to responders in the sham group. However, intention to treat analyses showed no between-group differences for the GLoBE intervention and sham exercise groups. Significant improvement in VISA-G score was found for both programs at 12- and 52-weeks time points (p < 0.001). Lack of treatment effect was found with the addition of an exercise program to a comprehensive education on GTPS management. The improved outcomes of the responders in the GLoBE group indicate that there may be a subgroup of patients with a GTPS diagnosis that benefit from a GLoBE intervention program.

Assessment of reliability, validity, responsiveness and minimally important change of the German Hip dysfunction and osteoarthritis outcome score (HOOS) in patients with osteoarthritis of the hip.

Patient-reported outcome measures are a critical tool in evaluating the efficacy of orthopedic procedures. The intention of this study was to evaluate reliability, validity, responsiveness and minimally important change of the German version of the Hip dysfunction and osteoarthritis outcome score (HOOS). The German HOOS was investigated in 251 consecutive patients before and 6months after total hip arthroplasty. All patients completed HOOS, Oxford-Hip Score, Short-Form (SF-36) and numeric scales for pain and disability. Test-retest reliability, internal consistency, floor and ceiling effects, construct validity and minimal important change were analyzed. The German HOOS demonstrated excellent test-retest reliability with intraclass correlation coefficient values>0.7. Cronbach´s alpha values demonstrated strong internal consistency. As hypothesized, HOOS subscales strongly correlated with corresponding OHS and SF-36 domains. All subscales showed excellent (effect size/standardized response means>0.8) responsiveness between preoperative assessment and postoperative follow-up. The HOOS and all subdomains showed higher changes than the minimal detectable change which indicates true changes. The German version of the HOOS demonstrated good psychometric properties. It proved to be valid, reliable and responsive to the changes instrument for use in patients with hip osteoarthritis undergoing total hip replacement.

Local infiltration analgesia: a 2-year follow-up of patients undergoing total hip arthroplasty

PurposeLocal infiltration analgesia (LIA) is commonly used for postoperative pain management following total hip arthroplasty (THA). However, the long-term effects of the component drugs are unclear. The aim of our study was to investigate functional outcome, quality of life, chronic post-surgical pain, and adverse events in patients within 2 years of undergoing THA.MethodsThe study was a secondary analysis of data from a previous larger study. Eighty patients were randomized to receive either intrathecal morphine (Group ITM) or local infiltration analgesia (Group LIA) for pain management in a double-blind study. The parameters measured were patient-assessed functional outcome [using the Hip dysfunction and Osteo-arthritis Outcome Score (HOOS) questionnaire], health-related quality of life [using the European Quality of Life–5 dimensions (EQ-5D) questionnaire and the 36-Item Short Form Health Survey (SF-36) score], and pain using the numeric rating score (NRS), with persistent post-surgical pain having a NRS of > 3 or a HOOS pain sub-score of > 30. All complications and adverse events were investigated during the first 2 years after primary surgery.ResultsPain intensity and rescue analgesic consumption were similar between the groups after hospital discharge. No differences were found in HOOS or SF-36 score between the groups up to 6 months after surgery. A significant group × time interaction was seen in the EQ 5D form in favor of the LIA group. No between-group difference in persistent post-surgical pain was found at 3 or 6 months, or in adverse events up to 2 years after surgery.ConclusionAnalysis of functional outcome, quality of life, and post-discharge surgical pain did not reveal significant differences between patients receiving LIA and those receiving ITM. LIA was found to be a safe technique for THA during the long-term follow-up. However, it should be noted that these conclusions are based on a limited number of patients.

Mid-term migration of a cementless, porous acetabular cup: A 5 year Radiostereometric analysis

PurposeThe aim of the study was to determine the 5 year migratory and wear patterns, adverse events and clinical outcomes of a cementless, porous acetabular cup. MethodsRSA imaging of a cohort of 11 patients was retrospective analysed at 5 years post Total Hip Arthroplasty (THA). Changes in pain, function and symptoms of the hip at 5 years post-THA were compared to preoperative and 2 year postoperative assessments on the Harris Hip Score (HHS) and Hip dysfunction and Osteoarthritis Outcome Score (HOOS). ResultsThe majority of cup migration occurred up to 6 months and stabilised thereafter (6 months to 5 years, p=0.091–0.866, Wilcoxon Signed Rank test). The direction of rotation around the 3 axes was evenly distributed among the cups between anterior-posterior rotation, internal-external rotation and increased-decreased inclination. The majority of the cups translated proximally, at an average migration of 0.36mm (±95%CI 0.17) at 5-years post-THA. Following initial bedding in, up to 6 months, there was no detectable polyethylene wear between 6 months and 5 years. At 5 years postoperatively, a statistically significant difference was observed across all HOOS subscales in comparison to preoperative values, with higher means reported at 5 years (p<0.001). The total mean HHS displayed a statistically significant improvement, increasing from ‘poor’ preoperatively to ‘good’ at 5 years post-THA. ConclusionFollowing initial migration between discharge and 6 months, the cementless porous acetabular cup demonstrated a tendency for stabilisation from 6 months up to 5 years post-THA, suggesting good mid-term fixation. Additionally, improvements in clinical outcome measures of pain, function and quality-of-life remained high following THA at 5 years post-surgery.

Preoperative Symptoms in Femoroacetabular Impingement Patients Are More Related to Mental Health Scores Than the Severity of Labral Tear or Magnitude of Bony Deformity

BackgroundThe purpose of this study was to determine the relationships between patient factors, mental health status, the condition of the local tissue, magnitude of bony deformity, and preoperative symptoms in a series of femoroacetabular impingement (FAI) patients. MethodsFrom our prospective outcomes registry, we identified 64 patients with arthroscopically-treated labral tears and cam deformities. We assessed the correlations between patient factors (age, sex, body mass index, level of education), surgical findings (size of labral tear, presence of chondral lesions), mental health factors (VR-12 mental component score [MCS], depression, and preoperative use of psychotropic and/or opioid drugs), magnitude of FAI deformity (alpha and lateral center edge angles), and preoperative hip dysfunction and osteoarthritis outcome score (HOOS) subscales. Patient factors, surgical and radiographic findings, and preoperative HOOS scores were compared between patients with low and high MCS. ResultsNeither hip pathology nor patient-related factors significantly correlated with HOOS scores. On the contrary, MCS significantly correlated with HOOS symptom (ρ = 0.45, P < .001) and pain scores (ρ = 0.52, P < .001). Low MCS patients had significantly lower preoperative scores for all 5 HOOS subscales (P ≤ .002) and more frequent chondral lesions and comorbid depression (P ≤ .01). ConclusionSymptom severity was significantly more related to mental health status than either the size of labral tear or FAI deformity. Patients with low MCS had significantly worse preoperative pain and self-reported function, and a greater prevalence of concomitant chondral lesions. Future studies are necessary to determine if earlier surgical treatment or preoperative psychological and/or pain coping interventions may improve outcomes for those with low MCS.

Physical Functioning and Prediction of Physical Activity After Total Hip Arthroplasty: Five‐Year Followup of a Randomized Controlled Trial

To examine whether the 1-year effects from a previous walking skill training program on walking and stair climbing still persist 5 years following total hip arthroplasty (THA), to examine recovery of physical functioning from before to 5 years after surgery, and to identify predictors of physical activity 5 years after THA from preoperative measures. We performed a 5-year followup of a randomized controlled trial and a longitudinal study. Sixty participants with a mean age of 70 years (range 50-87 years; 95% confidence interval 68, 72 years) were assessed. Outcome measures were the 6-minute walk test, the stair climbing test (SCT), active hip range of motion (ROM), self-efficacy, Hip Dysfunction and Osteoarthritis Outcome Score (HOOS), and University of California, Los Angeles (UCLA) activity scale. Data were analyzed by Student's t-tests, generalized linear model, and multivariate regression analyses. The training and control groups were approximately equal on outcome measures of physical functioning, pain, and self-efficacy at 5 years (P > 0.05). In the total group, the recovery course was unchanged from 1 to 5 years (P > 0.05), except for 9% improvement in ROM (P < 0.001) and an increase in time on SCT of 18% (P = 0.004). Preoperative HOOS pain (P = 0.022) and HOOS sport (P = 0.019) predicted UCLA activity scale 5 years after THA. At 5 years after THA, the control group had caught up with the training group on physical functioning, and the participants led an active lifestyle. Those with worse preoperative scores on pain and physical functioning in sport were at risk of being less physically active in the long term following THA.

Effectiveness of Lower Energy Density Extracorporeal Shock Wave Therapy in the Early Stage of Avascular Necrosis of the Femoral Head.

ObjectiveTo evaluate the effectiveness of lower energy flux density (EFD) extracorporeal shock wave therapy (ESWT) in the early stage of avascular necrosis (AVN) of the femoral head.MethodsNineteen patients and 30 hips were enrolled. All subjects received 4 weekly sessions of ESWT, at different energy levels; group A (n=15; 1,000 shocks/session, EFD per shock 0.12 mJ/mm2) and group B (n=15; 1,000 shocks/session, EFD per shock 0.32 mJ/mm2). We measured pain by using the visual analog scale (VAS), and disability by using the Harris hip score, Hip dysfunction and Osteoarthritis Outcome Score (HOOS), and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC). To determine the effect of the lower EFD ESWT, we assessed the VAS, Harris hip score, HOOS, WOMAC of the subjects before and at 1, 3, and 6 months.ResultsIn both groups, the VAS, Harris hip score, HOOS, and WOMAC scores improved over time (p<0.05).ConclusionLower EFD ESWT may be an effective method to improve the function and to relieve pain in the early stage of AVN.

Early surgical and functional outcomes comparison of the supercapsular percutaneously-assisted total hip and traditional posterior surgical techniques for total hip arthroplasty: protocol for a randomized, controlled study.

Total hip arthroplasty (THA) is one of the most commonly performed and successful orthopaedic surgeries. While the long-term success of THA is well documented, there is still significant room for improving patient speed of recovery and return to activities. The surgical technique used during THA has the potential to affect these early outcomes. The described design is a single center, prospective, randomized, controlled study. Subjects will be randomized to receive THA using either the supercapsular percutaneously-assisted total hip (SuperPath) or traditional posterior surgical techniques. Subjects will be evaluated using Timed Up and Go (TUG), Timed Stair Climb (TSC), Hip Dysfunction and Osteoarthritis Outcome Score (HOOS), and Visual Analog Scale (VAS) for pain level estimation preoperatively, during the hospital stay, and at 2, 6 weeks, and 100 days post-discharge. Other endpoints to be evaluated include: length of stay (LOS); discharge status; transfusion rates; readmission rates; complication rates; operative time; date returned to work; and acetabular component anteversion and inclination angles. The described study will determine the effect of a tissue-sparing surgical technique on short term subject recovery following THA in comparison to the most commonly used technique in clinical practice.

Minimal clinically important improvement (MCII) and patient-acceptable symptom state (PASS) in total hip arthroplasty (THA) patients 1 year postoperatively

Background and purpose — The increased use of patient-reported outcomes (PROs) in orthopedics requires data on estimated minimal clinically important improvements (MCIIs) and patient-acceptable symptom states (PASSs). We wanted to find cut-points corresponding to minimal clinically important PRO change score and the acceptable postoperative PRO score, by estimating MCII and PASS 1 year after total hip arthroplasty (THA) for the Hip Dysfunction and Osteoarthritis Outcome Score (HOOS) and the EQ-5D.Patients and methods — THA patients from 16 different departments received 2 PROs and additional questions preoperatively and 1 year postoperatively. The PROs included were the HOOS subscales pain (HOOS Pain), physical function short form (HOOS-PS), and hip-related quality of life (HOOS QoL), and the EQ-5D. MCII and PASS were estimated using multiple anchor-based approaches.Results — Of 1,837 patients available, 1,335 answered the preoperative PROs, and 1,288 of them answered the 1-year follow-up. The MCIIs and PASSs were estimated to be: 24 and 91 (HOOS Pain), 23 and 88 (HOOS-PS), 17 and 83 (HOOS QoL), 0.31 and 0.92 (EQ-5D Index), and 23 and 85 (EQ-VAS), respectively. MCIIs corresponded to a 38–55% improvement from mean baseline PRO score and PASSs corresponded to absolute follow-up scores of 57–91% of the maximum score in THA patients 1 year after surgery.Interpretation — This study improves the interpretability of PRO scores. The different estimation approaches presented may serve as a guide for future MCII and PASS estimations in other contexts. The cutoff points may serve as reference values in registry settings.

Clinical results of the Metha short hip stem: a perspective for younger patients?

In recent years, various uncemented proximal metaphyseal hip stems were introduced for younger patients as a bone preserving strategy. Initial osteodensitometric analyses of the surrounding bone of short stems indicate an increase of bone mass with secondary bone ingrowth fixation as a predictor of long-term survival of these types of implants. We report the outcome of 151 modular Metha short hip stem implants in 148 patients between March 2005 and October 2007. The mean follow-up was 5.8±0.7 years and the mean age of the patients was 55.7±9.8 years. Along with demographic data and co-morbidities, the Harris Hip Score (HHS), the Hip dysfunction and Osteoarthritis Outcome Score (HOOS), and also the results of a patient-administered questionnaire were recorded pre-operatively and at follow-up. The mean HHS increased from 46±17 pre-operatively to 90±5 the HOOS improved from 55±16 pre-operatively to 89±10 at the final follow-up. A total of three patients have been revised, two for subsidence with femoral revision and one for infection without femoral revision (Kaplan Meier survival estimate 98%). The radiological findings showed no radiolucent lines in any of the patients. The modular Metha short hip stem was implanted in younger patients, who reported an overall high level of satisfaction. The clinical and radiographic results give support to the principle of using short stems with metaphyseal anchorage. However, long-term results are necessary to confirm the success of this concept in the years to come.

Association of cartilage defects, and other MRI findings with pain and function in individuals with mild–moderate radiographic hip osteoarthritis and controls

To evaluate the relationship of hip radiographic osteoarthritis (ROA) and MRI findings of cartilage lesions, labral tears, bone marrow edema-like lesions (BMELs) and subchondral cysts with self-reported and physical function. Eighty five subjects were classified as controls (n=55, Kellgren-Lawrence (KL) 0, 1) or having mild-moderate ROA (n=30, KL 2, 3). T2 weighted MRI images at 3-Twere graded for presence of cartilage lesions, labral tears, BMELs and subchondral cysts. Posterior wall sign, cross-over sign, center-edge angle and alpha angle were also recorded. Function was assessed using Hip dysfunction and Osteoarthritis Outcome Score (HOOS), Timed-Up and Go (TUG) test and Y-Balance Test (YBT). Analysis compared function between subjects with and without ROA and those with and without femoral or acetabular cartilage lesions, adjusted for age. Non-parametric correlations were used to assess the relationship between radiographic scores, MRI scores and function. Subjects with acetabular cartilage lesions had worse HOOS (Difference=5-10%, P=0.036-0.004), but not TUG or YBT, scores. Acetabular cartilage lesions, BMELs and subchondral cysts were associated with worse HOOS scores (ρ=0.23-0.37, P=0.041-0.001). Differences in function between subjects with and without ROA or femoral cartilage lesions were not significant. Other radiologic findings were not associated with function. Acetabular cartilage defects, but not femoral cartilage defects or ROA, were associated with greater self-reported pain and disability. BMELs and subchondral cysts were related to greater hip related self-reported pain and disability. None of the radiographic or MRI features was related to physical function.

Feasibility of 4 patient-reported outcome measures in a registry setting

Background and purpose Feasibility is an important parameter when choosing which patient-reported outcomes (PRO) to use in a study. We assessed the feasibility of PROs in a hip registry setting.Methods Primary total hip arthroplasty (THA) patients (n = 5,747) who had been operated on 1–2, 5–6, or 10–11 years previously were randomly selected from the Danish Hip Arthroplasty Register and sent 2 PRO questionnaires: 1 generic (EuroQoL-5D or SF-12 health survey) and 1 disease-specific (hip dysfunction and osteoarthritis outcome score (HOOS) or Oxford 12-item hip score). We compared response rates, floor and ceiling effects, missing items, and the need for manual validation of forms.Results 4,784 patients (mean age 71 years, 57% females) were included (83%). The response rates ranged from 82–84%. Statistically significantly different floor and ceiling effects ranged from 0% to 0.5% and from 6.1% to 46%, respectively. Missing items ranged from 1.2% to 3.4%, and 0.8–4.3% required manual validation (p < 0.009). A hypothetical repeat study found that group sizes from 51 to 1,566 are needed for subgroup analysis, depending on descriptive factor and choice of PRO.Interpretation All 4 PROs fulfilled a priori set criteria, with the exception of ceiling effects. The high ceiling effects were attributed to postoperative administration and good outcome for THA. We conclude that all 4 PROs are appropriate for administration in a hip registry.