Hip Osteoarthritis Research Articles

Hip joint motion amplitude control based on exponential product formula

Background: Handball is a team sport, and during a game, there is a lot of direct squabbling and close contact between the players. Objective: The goal of the research is to determine how handball training affected several aspects of physical fitness. The study also investigates the relationship between playing handball, passive hip range of motion (ROM), and the development of radiologically detectable hip osteoarthritis (OA) in formerly elite handball players. The research employed the exponential product algorithm for evaluating bilateral radiographs to classify and diagnose hip OA. This technique most likely evaluated subchondral sclerosis, osteophyte formation, joint space narrowing, and other radiological signs of OA in the individuals’ hip joints. Methods: The relationship among the risk of hip OA in long-term top handball players is explored, as well as the connections among hip ROM, OA, and pain. The research was conducted using a sample size of 20 ex-professional handball players and 39 control subjects. Information on demographics, loading patterns during exercise, and history of lower limb joint injury were gathered via a questionnaire. The inclusion criteria for individuals consisted former professional handball players with significant elite-level competitive experience, as well as control subjects with no background of high-impact sports. Confounding characteristics such as age, gender, and previous lower limb joint injuries were carefully controlled for using extensive demographic and injury history evaluations. To identify and categorize hip OA, bilateral radiographs were analyzed using the exponential product algorithm. The goniometer was used to assess the bilateral passive hip ROM. Long-term participation in elite handball at a high level was found to have a strong correlation with the hip development of osteoarthritis (OA). Sixty percent of handball players had been identified with OA in at least one hip joint, compared to only thirteen percent of control patients. Results: Hip flexion and medial rotation in the handball players were significantly decreased, whereas abduction, extension, and lateral rotation were increased considerably compared to the control values. When doing daily activities, the hip joints of the handball players with OA were less painful than those of the OA-afflicted control participants. Retired handball players seem to be at a much higher risk than the general population for developing early hip OA. Conclusion: The repetitive nature of handball-specific movements may result in anomalies that are seldom seen in the general population, which makes diagnosing pain and discomfort a challenging diagnostic challenge for sports physicians.

FUNCTIONAL OUTCOME OF DUAL MOBILITY ARTICULATIONS: IS THERE A COMPROMISE?

Dislocation is still one of the more common reasons for revision of THR.Registry and large institutional data has demonstrated the effectiveness of Dual Mobility articulations in reducing revision for dislocation after THR. There is little data about whether the use of dual mobility is associated with a comprised clinical functional outcome.This study aimed to ascertain whether the use of Dual Mobility articulations (DM cups) comes within a compromise to the functional of the THR procedure as measured by the Hip disability and Osteoarthritis Outcome Score (HOOS).Utilising a retrospective design, patients were grouped into those with DM cups with 12 PROMs (Cohort 1) or a large data base of all THR procedures also with a complete set of 12 month PROMs (Cohort 2). The 2 groups were matched for age and gender through propensity score matching. The comparison focused on five domains of the HOOS: Pain, Symptoms, Activities of Daily Living (ADL), Sports and Recreation, and Quality of Life (QOL) at 6- and 12-months post-operation.12 month PROM data suggested a convergence in scores for several domains, no uniform superiority of one articulation type over the other was found across all domains. These results suggest that both DM cup and standard articulations can effectively improve patient-reported outcomes in THR surgeries, but there are variations in recovery within each cohort that are potentially influenced by factors beyond the articulation type.This study contributes to the ongoing dialogue on optimising prosthetic selection to enhance recovery trajectories and quality of life for THR patients, emphasising the critical role of evidence-based decision-making in orthopaedic surgery.

A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL COMPARING THE DIRECT SUPERIOR APPROACH WITH THE POSTERIOR APPROACH FOR TOTAL HIP ARTHROPLASTY

The direct superior approach (DSA) is a modification of the posterior approach (PA) that preserves the iliotibial band and short external rotators except for the piriformis or conjoined tendon during total hip arthroplasty (THA). The objective of this study was to compare postoperative pain, early functional rehabilitation, functional outcomes, implant positioning, implant migration, and complications in patients undergoing the DSA versus PA for THA.This study included 80 patients with symptomatic hip arthritis undergoing primary THA. Patients were prospectively randomised to receive either the DSA or PA for THA, surgery was undertaken using identical implant designs in both groups, and all patients received a standardized postoperative rehabilitation programme. Predefined study outcomes were recorded by blinded observers at regular intervals for two-years after THA. Radiosteriometric analysis (RSA) was used to assess implant migration.There were no statistical differences between the DSA and PA in postoperative pain scores (p=0.312), opiate analgesia consumption (p=0.067), and time to hospital discharge (p=0.416). At two years follow-up, both groups had comparable Oxford hip scores (p=0.476); Harris hip scores (p=0.293); Hip disability and osteoarthritis outcome scores (p=0.543); University of California at Los Angeles scores (p=0.609); Western Ontario and McMaster Universities Arthritis Index (p=0.833); and European Quality of Life questionnaire with 5 dimensions scores (p=0.418). Radiographic analysis revealed no difference between the two treatment groups for overall accuracy of acetabular cup positioning (p=0.687) and femoral stem alignment (p=0.564). RSA revealed no difference in femoral component migration (p=0.145) between the groups at two years follow-up.There were no differences between patients undergoing the DSA versus PA for THA with respect to postoperative pain scores, functional rehabilitation, patient-reported outcome measurements, accuracy of implant positioning, and implant migration at two years follow-up. Both treatment groups had excellent outcomes that remained comparable at all follow-up intervals.

The Impact of Physiotherapy on a patient with Ankylosing Spondylitis Following Bilateral Total Hip Replacement: A Case Study

Ankylosing spondylitis (AS) is a chronic, progressive inflammatory disorder primarily affecting the axial skeleton, with a prevalence of approximately 0.25% in India, predominantly in males. This case study explores the physiotherapeutic management of a 35-year-old male patient underwent bilateral Total Hip Replacement and presented with primary complaint of progressive stiffness in the back and neck region along with pain in his right hip joint. Outcome measures included Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Visual Analog Scale (VAS), and Hip disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS, JR) with significant improvements observed over 12 weeks: BASFI improved from 7 to 2, BASDAI from 8.1 to 3.8, VAS pain from 8 to 3, and HOOS, JR score from 40 to 60. The results demonstrate that AS-specific exercises combined with a home-based exercise protocol can significantly enhance pain management, functional capacity, disease activity and hip disability in AS patients.

DOES TOTAL HIP ARTHROPLASTY BENEFIT PATIENTS WITH MINIMAL RADIOLOGICAL OSTEOARTHRITIS?

There is some evidence to suggest that outcomes of THA in patients with minimal radiographic osteoarthritis may not be associated with predictable outcomes. The aim of this study was to:Assess the outcome of patients with hip pain who underwent THA with no or minimal radiographic signs of osteoarthritis,Identify patient comorbidities and multiplanar imaging findings which are predictive of outcome,Compare the outcome in these patients to the expected outcome of THA in hip OA.A retrospective review of 107 hips (102 patients, 90F:12M, median age 40.6, IQR 35.1–45.8 years, range 18–73) were included for analysis. Plain radiographs were evaluated using the Tonnis grading scale of hip OA. Outcome measures were all-cause revision; iHOT12; EQ-5D; Oxford Hip Score; UCLA Activity Scale; and whether THA had resulted in the patient's hip pain and function being Better/Same/Worse.The median Oxford Hip Score was 33.3 (IQR 13.9, range 13–48), and 36/107 (33.6%) hips achieved an OHS≥42. There was no association between primary hip diagnosis and post-operative PROMs. A total of 91 of the 102 patients (89.2%, 93 hips) reported that their hip pain and function was Better than prior to THA and would have the surgery again, 7 patients (6.8%, 10 hips) felt the Same, and 4 patients (3.9%, 4 hips) felt Worse and would not have the surgery again.Younger patients undergoing total hip arthroplasty with no or minimal radiographic osteoarthritis had lower postoperative Oxford Hip Scores than the general population; though most felt symptomatically better and knowing what they know now, would have surgery again. Those with chronic pain syndrome or hypermobility were likely to benefit less. Those with subchondral cysts or joint space narrowing on CT imaging were more likely to achieve higher functional scores and satisfaction.

Genetic polymorphisms of LMX1B and MLXIP are associated with hip osteoarthritis in the Chinese population.

Aims: A large genome-wide analyses of UK Biobank data reported 15 novel loci associated with the susceptibility of hip osteoarthritis (HOA). We aimed to replicate the association of these loci with HOA in the Chinese population.Methods: A total of 13 Single Nucleotide Polymorphismswere genotyped in 892 HOA patients and 1123 healthy controls.Results: The risk allele frequency of rs62578127 and rs11059094 was significantly higher in the patients than in the controls. The mRNA expression of LMX1B (p=0.01) and MLXIP (p=0.001) were significantly increased in HOA tissues.Conclusion: We successfully replicated two novel susceptible loci of HOA and further characterized two potential causative genes.

P223. A comparison of surgical outcome and equitable access for hip, knee and lumbar spine surgery for endstage osteoarthritis

P223. A comparison of surgical outcome and equitable access for hip, knee and lumbar spine surgery for endstage osteoarthritis

P168. Severe hip and knee osteoarthritis worsens patient-reported disability in adult spinal deformity patients

P168. Severe hip and knee osteoarthritis worsens patient-reported disability in adult spinal deformity patients

Uncovering sociodemographic disparities in temporal trends of osteoarthritis incidence and age-at-diagnosis, 2006-2019.

To describe sociodemographic disparities in temporal trends of incidence and age distributions of first registered osteoarthritis (OA) diagnosis in southern Sweden. We identified all Skåne residents aged 35+ who had lived in the region at any point during the period 2006-2019 with no previous OA diagnosis (ICD-10 codes M15-M19) for 8 years prior to inclusion in the study (n = 849,061). We calculated person-years from inclusion until OA diagnosis, death, emigration, or 31 December 2019, whichever occurred first. Combining sex (female, male), education (low, medium, high) and nativity (Swedish, immigrant), we created a variable with 12 strata. Average annual percent changes in age-standardized incidence rates were estimated using joinpoint regression. Changes in the median age-at-diagnosis (year of diagnosis minus birth year), weighted to the mid-2005 Swedish population, were explored. Cumulative age-standardized incidence rates ranged from 116 (95% CI: 111, 121) per 10,000 person-years for immigrant males with low education to 205 (95% CI: 200, 210) for immigrant females with medium education. The estimated average annual percent changes (ranging from 3.4% to 6.1%) were generally similar, with slightly greater variations among immigrants than Swedes. The weighted median age-at-diagnosis was higher for Swedes and low educated people. Immigrant females with low education were the only stratum with a reduction (3 years) in the weighted median age-at-diagnosis over time. Sociodemographic patterns in knee OA incidence were different from patterns for hip OA. There were few sociodemographic disparities in temporal trends of OA incidence and age-at-diagnosis, suggesting persistent sociodemographic disparities in OA burden in southern Sweden.

Causal link between metabolic related factors and osteoarthritis: a Mendelian randomization investigation.

Metabolic syndrome (MetS) is significantly associated with osteoarthritis (OA), especially in MetS patients with blood glucose abnormalities, such as elevated fasting blood glucose (FG), which may increase OA risk. Dietary modifications, especially the intake of polyunsaturated fatty acids (PUFAs), are regarded as a potential means of preventing MetS and its complications. However, regarding the effects of FG, Omega-3s, and Omega-6s on OA, the research conclusions are conflicting, which is attributed to the complexity of the pathogenesis of OA. Therefore, it is imperative to thoroughly evaluate multiple factors to fully understand their role in OA, which needs further exploration and clarification. Two-sample univariable Mendelian randomization (UVMR) and multivariable Mendelian randomization (MVMR) were employed to examine the causal effect of metabolic related factors on hip OA (HOA) or knee OA (KOA). The exposure and outcome datasets were obtained from Open GWAS IEU. All cases were independent European ancestry data. Three MR methods were performed to estimate the causal effect: inverse-variance weighting (IVW), weighted median method (WMM), and MR-Egger regression. Additionally, the intercept analysis in MR-Egger regression is used to estimate pleiotropy, and the IVW method and MR-Egger regression are used to test the heterogeneity. The UVMR analysis revealed a causal relationship between FG and HOA. By MVMR analysis, the study discovered a significant link between FG (OR = 0.79, 95%CI: 0.64∼0.99, p = 0.036) and KOA after accounting for body mass index (BMI), age, and sex hormone-binding globulin (SHBG). However, no causal effects of FG on HOA were seen. Omega-3s and Omega-6s did not have a causal influence on HOA or KOA. No significant evidence of pleiotropy was identified. The MR investigation showed a protective effect of FG on KOA development but no causal relationship between FG and HOA. No causal effect of Omega-3s and Omega-6s on HOA and KOA was observed. Shared genetic overlaps might also exist between BMI and age, SHBG and PUFAs for OA development. This finding offers a novel insight into the treatment and prevention of KOA from glucose metabolism perspective. The FG cutoff value should be explored in the future, and consideration should be given to demonstrating the study in populations other than Europeans.

Pre-operative gluteus medius tendon degeneration and its impact on strength and functional ability one year after total hip replacement

Objective Hip osteoarthritis is a common cause of disability and surgery is often unavoidable. Patient satisfaction is high and functional ability improves after surgery. However, residual impairment and pain are common. Degenerative changes in tendons and muscles are probable causes. The aim of this study is to investigate gluteus medius (GMED) tendon degeneration in relation to muscle strength, physical function and walking distance before and one year after total hip replacement. Material and methods In total, 18 patients were examined pre- and post-operatively, of whom 15 were available in the final analysis. Muscle strength, physical function and walking distance were assessed. Tendon biopsies were assessed microscopically, and the total degeneration score (TDS) was calculated. Results A correlation between the TDS and muscle strength was found for the hamstrings, GMED and quadriceps pre- or post-operatively. No correlations were found between the TDS and functional ability. Functional ability and muscle strength improved significantly after surgery. Conclusion Our results indicate a correlation between tendon degeneration and the muscle strength of the hip and knee in patients with hip OA and one year after THR. To minimise post-operative residual discomfort, rehabilitation programs should probably be modified over time to match the pre- and post-operative needs. Further studies are needed. This study was registered at https://www.researchweb.org/is/vgr/project/279039 (in Swedish).

Prefabricated contoured foot orthoses to reduce pain and increase physical activity in people with hip osteoarthritis: A randomised feasibility trial.

Hip osteoarthritis (OA) is a prevalent and burdensome condition that leads to impaired quality of life and a substantial economic burden. Encouraging physical activity, particularly walking, is crucial for OA management, but many individuals with hip OA fail to meet recommended activity levels. Prefabricated contoured foot orthoses have shown promise in improving hip muscle efficiency during walking in laboratory settings, but their real-world feasibility and efficacy remain uncertain. The aim of this study was to assess the feasibility of conducting a fully powered randomised controlled trial (RCT) to evaluate the effectiveness of prefabricated contoured foot orthoses, prescribed via telehealth, in people with hip OA. This feasibility trial randomised 27 participants with hip OA into two groups: prefabricated contoured foot orthoses or flat shoe inserts. Feasibility outcomes were assessed, including recruitment rate, adherence, logbook completion, and dropout rate. Patient-reported outcomes and accelerometer-measured physical activity were collected as secondary outcomes. While the recruitment rate was low (0.88 people/week), adherence to the intervention (59%), logbook completion (93%), and dropout rates (7%) met or exceeded our predefined feasibility parameters. Participants found the intervention acceptable, and practicality was demonstrated with minor adverse events. Preliminary efficacy testing indicated that prefabricated contoured foot orthoses positively affected physical activity (adjusted mean difference=2590 [260 to 4920] steps/day), with comparable outcomes for hip-related quality of life and pain. This trial supports proceeding to a fully powered RCT to assess the effect of teleheath prescribed prefabricated contoured foot orthoses on physical activity in people with hip OA. National Institutes of Health Trial Registry (NCT05138380).

The indication for total hip arthroplasty and its durability

The most frequent indication for total hip arthroplasty (THA) is hip osteoarthritis. THA is inserted to improve function, reduce pain, and improve quality of life. Results are generally good, and 90-95% of the patients are satisfied. However, there are risks associated with THA, and patients must be well informed. Before THA is considered, non-surgical treatment must be completed, as the need for surgery often is postponed. Patients can expect rapid mobilisation and a return to a near-habitual level of physical activity within a year. In Denmark, 95% have their THA after five years and 76% after 25 years.

Functional patient-reported outcome measures after hip or knee arthroplasty: A systematic review and content analysis using the International Classification of Functioning, Disability and Health (ICF).

This systematic review aimed to identify the existing patient-reported outcome measures (PROMs) used in hip or knee arthroplasty for adults with osteoarthritis and assess their content validity using the modified International Classification of Functioning, Disability and Health (ICF) core set for osteoarthritis (OA). Four databases were systematically searched to identify disease or joint-specific PROMs evaluating function after hip or knee arthroplasty. Two reviewers independently evaluated the content of PROMs based on established ICF linking rules. From 449 studies included in this review, 50 PROMs were identified. The mobility chapter of activities and participation was the most common component, followed by sensory function and pain chapter of body function and structure. The most frequent ICF activity and participation categories were d451:going up and down stairs, d4701:using private motorized transportation, d4104:standing, and d4154:maintaining a standing position. However, 11 ICF categories of the modified OA coreset were not captured in any PROMs. This ICF-based content analysis of PROMs revealed that included activity and participation categories vary widely, with little overlap between PROMs. The Knee injury and Osteoarthritis Outcome Score and Hip disability and Osteoarthritis Outcome Score had the most coverage for activity and participation (36.7%). Even though our search identified 50 specific PROMs, there remain gaps in content related to activity and participation coverage. By providing a content analysis of the PROMs used after hip or knee arthroplasty, this study may help clinicians select PROMs based on covered categories and relevant clinical objectives.

The Impact of Preoperative Intra-articular Injections on Postoperative Outcomes in Hip Arthroscopy

Introduction: Hip arthroscopy is a minimally invasive procedure commonly performed to treat various hip conditions. Preoperative intra-articular injections, such as local anesthetics and corticosteroids, are frequently used to alleviate pain and as a diagnostic tool before hip arthroscopy. However, studies have shown conflicting information; some demonstrate better patient outcomes, while others have found an increased risk of complications and negative effects on postoperative recovery. This retrospective study evaluated the association between preoperative injections and postoperative outcomes in hip arthroscopy patients. Materials and Methods: A retrospective review of 1400 patients who underwent hip arthroscopy between 2014 and 2021 at our institution was performed. The patients were allocated into two cohorts based on whether they received a cortisone injection with local anesthetic within 1 year before the surgery. Outcomes during the study follow-up period (average: 437 days, max: 3018 days) were compared. Further analysis looked at subgroups at 30-day increments. Results: The results showed that 35.5% of the patients had received a preoperative injection. Although patients who received injections were more likely to be female (68.3% injected vs. 60.8% not injected, P = 0.019) and have asthma (12.5% injected vs. 7.3% not injected, P = 0.008), there were no significant differences in 90-day complications, 90-day emergency department visits, 90-day readmissions, any complications (wound infection, re-injury, recurrent pain or weakness, deep vein thrombosis, or pulmonary embolism), prolonged pain or recovery, reoperation, total hip arthroplasty, 6-month Patient-Reported Outcomes Measurement Information System Physical Function, 6-month Hip Dysfunction and Osteoarthritis Outcome Score Joint Replacement, or follow-up time between the injection and noninjection groups. There were no other differences in demographics, comorbidities, or physical function between the groups. Conclusion: Our study suggests that preoperative corticosteroid injections with local anesthetics do not significantly affect postoperative outcomes in hip arthroscopy patients or increase the risk of adverse effects. Careful evaluation of these risks and benefits is crucial to minimize potential adverse effects and maximize patient outcomes.

Characteristics of pelvic obliquity in dysplastic hip osteoarthritis.

Factors affecting direction of pelvic obliquity (PO) in dysplastic hip osteoarthritis (DHOA) remains unclear. This retrospective cohort study evaluates morphological characteristics, spinal alignment, and hip function in patients with unilateral DHOA. Between 2018 and 2022, 104 patients with unilateral DHA were enrolled. Patients were categorized into flat PO (F-PO group; PO < 2°), affected side PO (A-PO group; PO downward by ≥ 2°), and unaffected side PO (U-PO group; PO upward by ≥ 2°). Demographics, radiographic hip and lower limb parameters, spinal parameters, and functional scores were compared between the groups. There were 39, 44, and 21 patients in the F-PO, A-PO, and U-PO group, respectively. The subluxation percentage of Crowe classification showed a significant difference among the three groups. The femoral head lateralization distance was significantly greater in the U-PO group than in the F-PO and A-PO groups. Furthermore, the hip adduction angle was significantly lower in the A-PO group than in the F-PO and U-PO groups. The lumbar scoliosis angle was significantly different between the groups. In multivariate analysis, hip adduction angle was extracted as an independent factor associated with the A-PO. Age, subluxation percentage, and hip adduction angle were identified as independent factors associated with the U-PO. Harris hip score was significantly poorer in U-PO group than in F-PO group. Hip adduction angle influenced A-PO, while age, subluxation percentage, and hip adduction angle influenced U-PO; lumbar scoliosis angle was associated with PO direction. U-PO patients had poorer functional scores, indicating the impact of hip contracture and subluxation on PO direction in DHOA.

Are hip joint imaging findings associated with symptoms and early hip osteoarthritis features in elite male Australian Football League draftees?

ABSTRACT 1) describe intra-articular features (prevalence and severity) and bony hip morphology (prevalence and size) in elite male Australia Football League (AFL) draftees; 2) examine the relationship between bony hip morphology (cam and pincer morphology) and intra-articular features (cartilage defects and labral tears); and 3) examine the relationship between intra-articular features, bony hip morphology, and the Copenhagen Hip and Groin Outcome Score (HAGOS). Cross-sectional study. 58 male AFL draftees underwent 3-tesla hip MRI. Alpha angle determined cam morphology and acetabular depth defined pincer morphology. For each hip, intra-articular features were scored semi-quantitatively. All players completed the HAGOS to determine hip/groin symptoms and sports function. Logistic regression determined whether bony hip morphology was associated with labral tears and cartilage defects. Mann-Whitney U tests evaluated the difference in HAGOS subscale scores between football players with and without intra-articular features and bony hip morphology. Cam and pincer morphology were evident in 20% and 19% of hips, respectively. Nearly half of hips (41%) had a labral tear, with only 14% having a cartilage defect. Greater alpha angle was associated with the presence of labral tears (OR 1.14, 95%CI 1.07 to 1.21, p < 0.001) but not cartilage defects. Hip imaging findings were not associated with lower (worse) HAGOS scores. Hip joint imaging findings were common in elite male AFL draftees but not associated with worse pain, symptoms, or sport function. Cam morphology may contribute to the development of labral tears in male AFL draftees.

Enhancing the Tribological Properties of Bearing Surfaces in Hip Arthroplasty by Shot-Peening the Metal Surface

Total hip arthroplasty (THA) is a surgical procedure for patients with pain and difficulty walking due to hip osteoarthritis. In primary THA, the acetabulum and femoral head are replaced by a prosthesis where the modular femoral head and inner liner of the acetabulum form the bearing surface. The most popular bearing surface used in the United States, metal-on-polyethylene, consists of a cobalt–chromium molybdenum (CoCrMo) alloy femoral head that articulates with a polyethylene acetabular liner, typically made of highly cross-linked polyethylene. While successful in most cases, THA sometimes fails, commonly from aseptic loosening due to the wear debris of polyethylene. Fine-particle shot peening (FPSP) is a simple method for enhancing the mechanical properties and surface properties of metal, including reducing friction and enhancing the lubrication properties of the metal surface. In this study, we applied FPSP to the CoCr in the femoral head of a hip prosthesis to improve its surface properties and conducted experiments with pin-on-disc tribometers using CoCr as a pin and highly cross-linked polyethylene as a disc to mimic the THA implant. The results show that FPSP significantly enhances the tribological properties of the CoCr surface, including lubrication; decreases the friction coefficient; and decreases the polyethylene wear volume.

Best timing of bilateral total hip arthroplasty – an analysis of revision and mortality rates from the German Arthroplasty Registry (EPRD)

BackgroundThe burden of osteoarthritis (OA) in multiple joints is high and for patients with bilateral OA of the hip there is no clear recommendation about the indication for simultaneous (one-stage) bilateral total hip arthroplasty (THA) versus two-staged procedures. The purpose of this study was therefore to compare revision and mortality rates after different strategies of surgical timing in bilateral hip OA from the German Arthroplasty Registry (EPRD).MethodsSince 2012 22,500 patients with bilateral THA (including 767 patients with one-staged bilateral surgery and 11,796 patients with another separate procedures within one year after first THA) are documented in the registry. The patients who underwent simultaneous bilateral THA were matched with a cohort of 767 patients who underwent the second THA between 1 and 90 days postoperatively (short interval) and another cohort of 4,602 patients with THA between 91 and 365 days postoperatively (intermediate interval). Revision for all reasons and mortality rates were recorded. Cox regression was performed to evaluate the influence of different patient characteristics.ResultsThe cumulative 5-year revision rate for patients with simultaneous bilateral THA was 1.8% (95% CI 0.9–2.6), for patients with two-staged THA 2.3% (95% CI 1.0-3.6) in the short interval and 2.5% (95% CI 2.1–2.9) in the intermediate interval, respectively. In all three groups, patients who underwent THA in a high-volume center (≥ 500 THA per year) had a significant lower risk for revision (HR 0.687; 95% CI 0.501–0.942) compared to surgeries in a low-volume center (< 250 THA per year). There was no significant difference regarding cumulative mortality rates in the three cohorts. Higher age (HR 1.060; 95% CI 1.042–1.078) and severe comorbidities as reflected in the Elixhauser Score (HR 1.046; 95% CI 1.014–1.079) were associated with higher mortality rates after simultaneous THA.ConclusionSimultaneous bilateral THA seems to be a safe procedure for younger patients with limited comorbidities who have bilateral end-stage hip OA, especially if performed in high-volume centers.Level of evidenceIII.

New Insights on the Therapeutic Potential of Runt-Related Transcription Factor2 for Osteoarthritis: Evidence from Mendelian Randomization.

Research has highlighted the role of runt-related transcription factor2 (Runx2) in the development of osteoarthritis (OA); however, its causal association remains unclear. This study aimed to explore whether Runx2 expression is causally associated with OA and assess its therapeutic potential for OA. Genetic proxy instruments for Runx2 expression were obtained from gene expression quantitative trait locus (eQTLs) study of eQTLGen Consortium (n = 31,684). Aggregated genome-wide association study (GWAS) data for OA (including all OA [177,517 cases and 649,173 controls], knee OA (KOA) [62,497 cases and 333,557 controls], and hip OA (HOA) [36,445 cases and 316,943 controls]) were extracted from the Genetics of Osteoarthritis Consortium. We integrated eQTLs data with OA GWAS data to estimate their causal association and to estimate the potential of Runx2 as a drug target in the treatment of OA using summary data-based Mendelian randomization (SMR) analysis. Furthermore, different OA GWAS data (including all OA [77,052 cases and 378,169 controls], KOA [24,955 cases and 378,169 controls], and HOA [15,704 cases and 378,169 controls]) derived from the GWAS Catalog database were used for replication study. SMR analysis showed that high expression levels of Runx2 were associated with an increased risk of all OA [odds ratio (OR) 1.044, 95% confidence interval (CI) 1.023-1.067; P = 5.03 × 10-5], KOA (OR1.040, 95%CI 1.006-1.075; P = 0.021), and HOA (OR1.067, 95%CI 1.022-1.113; P = 0.003). This suggests that Runx2 inhibitors may have promising potential for the treatment of OA. Notably, the causal effects of Runx2 with all OA (OR1.053, 95%CI 1.027-1.079; P = 3.95 × 10-5) and KOA (OR1.043, 95%CI 1.001-1.087; P = 0.045) were repeated in the replication study, but limited evidence supported the association of Runx2 expression levels with HOA (OR1.045, 95%CI 0.993-1.101; P = 0.094). Our analyses indicate a positive correlation between Runx2 expression and OA risk across all three phenotypes, suggesting the potential of Runx2 inhibitors in the treatment of OA and providing evidence from a genetic perspective.