Hip Pain Scores Research Articles

The Uncemented Primary Bicontact Stem in Revision Total Hip Arthroplasty in Young Patients

The purpose of this study was to evaluate the uncemented primary Bicontact stem (B.Braun-Aesculap, Tuttlingen, Germany) as a possible adequate alternative to other revision systems in revision total hip arthroplasty. Twenty patients aged up to 58 years (34-58 years, mean age 5.7 +/- 5.8 years) with minor bone defects underwent a revision total hip arthroplasty with the uncemented primary Bicontact stem. The patients were assessed clinically and radiologically at follow-up (follow-up: 8.0 +/- 3. years). The postoperative Harris Hip Score, Motion and Pain Score improved significantly. There was only one further revision in these patients because of infection and only one case with mild stress shielding. The uncemented primary Bicontact stem seems to be a good alternative to other revision systems in total hip revision arthroplasty in young patients.

Metal-on-Metal Hip Resurfacing Compares Favorably with THA at 2 Years Followup

Metal-on-metal total hip resurfacing is a bone-conserving reconstructive option for patients with advanced articular damage. While intended to address several problems with conventional THA, the safety and efficacy is not well established. We therefore retrospectively compared the outcomes of 52 patients (57 hips) with resurfacing arthroplasty to 84 patients (93 hips) with cementless primary THAs. The patients had a minimum 2-year followup (mean 3 years). The patients with resurfacing arthroplasty had a mean age of 47 years (range, 22-64) while those with cementless primary THA had a mean age of 57 years (range, 17-92). After controlling for age, gender, and preoperative differences, the total Harris Hip Scores (HHS), function scores, and pain scores were similar between the two groups. However, the resurfacing group had higher activity scores (14 versus 13, p < 0.001) and range of motion (ROM) scores (5.0 versus 4.8, p < 0.001). The complication rates (5.3% for resurfacing versus 14.0% for THA) and reoperation rates (3.5% for resurfacing versus 4.3% for THA) were similar. The total hip arthroplasty and metal-on-metal resurfacing groups both showed improvement in HHS, pain, activity, and ROM and had similar early complication and reoperation rates.

Hydroxyapatite-coated Titanium Porous Plasma Spray Tapered Stem

Advocates of hydroxyapatite in primary total hip arthroplasty report enhanced fixation and early improvements in pain and function. Others report no difference in long-term outcomes with hydroxyapatite application to an already proven fixation surface. We previously reported more rapid clinical improvement with a proximally porous, plasma-sprayed titanium, tapered geometry stem. We now report the long-term followup data on 191 consecutive total hip arthroplasties in which a standard (130 hips) or the hydroxyapatite-coated stem (61 hips) was implanted. At average 12.7 years followup, one stem (noncoated) was revised for aseptic loosening. The Harris hip total and pain scores were similar. Survivorship of the femoral component with aseptic loosening as the endpoint was 99.2% for noncoated stems and 100% for hydroxyapatite stems. The long-term survivorship of plasma-sprayed titanium tapered stems was excellent regardless of hydroxyapatite application, with neither benefit nor detriment observed.

A Clinical, Radiographic, and Cost Comparison of Cerclage Techniques: Wires vs Cables

The cerclage technique is used to secure femoral fractures, allografts, and plates. It is not clear whether wires or cables are better suited for this technique. A retrospective radiographic review of the 6460 total hip arthroplasties done between 1986 and 2003 was performed. Wires/cables were used in 249 hips. It was found that one cable was broken (0.92%) compared with 11 wires (1.72%) ( P < .5373). It was found that there was no statistical difference in Harris hip function or pain scores between patients with wires and those with cables or between those with broken wires/cables and those without broken wires/cables. The Luque wires, which cost $29.79 each, performed equally to the cables, which cost $275.40 each, suggesting that wiring may be the preferred cerclage technique.

Stepwise introduction of a bone-conserving osseointegrated hip arthroplasty using RSA and a randomized study: I. Preliminary investigations—52 patients followed for 3 years

Background We developed a total hip system using osseointegration guidelines, a metaphyseal-loading proximal femoral replacement in the retained neck and a dual-geometry titanium shell in the acetabulum.Patients and methods A randomized controlled clinical trial was undertaken in 52 patients (53 hips), using the cemented Spectron stem and cementless Harris-Galante II cup as control implants (24 patients in experimental group, 29 control patients). Clinical measures of Harris Hip Score (HHS), pain score and radiostereometric analysis (RSA) at regular intervals for up to three years were used to monitor progress.Results No statistically significant differences were found in HHS and pain score; the stability of the cementless experimental implant was also comparable to that of the cemented controls by RSA. 3 revisions were required for migration in the experimental group and 1 was required for component dislocation in the control group.Interpretation Our findings indicate the practicality of osseointegration of titanium implants, but suggest that current performance is inadequate for clinical introduction. However, the stable fixation achieved in the retained neck in the majority of patients is indicative of osseointegration. This finding will encourage technical and design improvements for enhancement of clinical osseointegration and should also encourage further study. Periprosthetic osteolysis might be avoided by the establishment and maintenance of direct implant-bone connection: “osseointegration”.

Stepwise introduction of a bone-conserving osseointegrated hip arthroplasty using RSA and a randomized study: II. Clinical proof of concept—40 patients followed for 2 years

Background We have developed a bone-conserving commercially pure titanium hip replacement system using osseointegration principles: a metaphyseal loading proximal femoral component affixing into the retained neck and metaphysis only, leaving the femoral canal untouched. The acetabular cup closely fits a dual-geometry cavity, avoiding stress protection at the dome.Patients and methods After extensive laboratory and clinical pilot trial investigations, the surface-engineered implants were submitted to a prospective randomized controlled clinical trial involving 40 patients (40 hips), in which they were compared to the cemented Spectron femoral component and cementless Trilogy cup as control implant. The following clinical measures were used to monitor progress at regular intervals for the first 2 postoperative years: radiostereometric analysis (RSA), Harris Hip Score, pain score, WOMAC, and SF-36.Results After 2 years of follow-up, no statistically significant differences were seen between the groups concerning rotation or translation along the cardinal axes. The patients receiving the Gothenburg osseointegrated titanium (GOT) system had significantly higher Harris Hip Score at 6 months, suggesting more rapid recovery. WOMAC, SF-36 and pain analysis were similar for the first 2 postoperative years.Interpretation Our RSA data suggest that osseointegration was achieved for all patients receiving the GOT hip system. This bone-conserving prosthesis may provide a good alternative, especially for young and active patients.

Failure of Femoral Surface Replacement for Femoral Head Avascular Necrosis

The appropriate treatment for the young patient with post-collapse avascular necrosis (AVN) of the femoral head continues to be controversial. Femoral surface replacement (FSR) has emerged as a potential strategy to delay total hip arthroplasty in these patients. Between 1997 and 2003, 37 FSR procedures were performed. Success was defined as patients not requiring revision surgery or having a Harris hip pain score of 30 or greater. Failure was defined as patients having revision surgery or a Harris hip pain score of 20 or less. The overall failure rate based on Harris hip pain scores and revision surgery was 64.8% (24/37 procedures). Fifteen (40.5%) procedures required revision surgery, whereas 9 (24.3%) patients were considered failures based on their pain scores. The purpose of this study was to determine if FSR is a viable option for post-collapse AVN. We conclude that hemiresurfacing for AVN is an unpredictable procedure. This procedure is no longer offered as a treatment option for post-collapse AVN at our institution.

Total Femoral Arthroplasty for Salvage of End-stage Prosthetic Disease

The complications and outcomes in patients who had total femoral arthroplasty for salvage of a severely compromised femur were studied. The clinical scenarios included numerous revision total hip or knee arthroplasties, failed periprosthetic fractures, or recurrent infection treated with multiple radical debridement surgeries. Fifty-nine patients (average age, 73.7 years) were identified. At an average 4.8 years followup, adequate pain relief was achieved and Harris hip pain scores averaged 33.8 of 44 points, and knee pain scores averaged 42.8 of 50 points. Good function was achieved with 98% of patients able to ambulate and 43% using no assistive device or a cane only. There were 18 complications or subsequent surgeries. Infection and dislocation occurred in eight patients and seven patients, respectively. Total femoral arthroplasty for salvage of a severely compromised femur provides acceptable results even in the most difficult of cases.

Outcome of Hip and Knee Arthroplasty in Persons Aged 80 Years and Older

Recent studies have established the cost effectiveness and safety of total joint arthroplasties. As the population ages, it is important to determine whether these procedures are equally beneficial in the elderly. The short term safety and efficacy of total hip and knee arthroplasties in subjects 80 years of age and older was evaluated. Between 1988 and 1993, preoperative and postoperative physical and functional information was collected on 99 consecutive elective hip and knee arthroplasties in subjects 80 years of age or older. These data were compared with those derived from a younger otherwise matched control group. Data collected included subject demographics and characteristics, information concerning the acute and postacute hospital stay, comorbid conditions, postoperative complications, discharge disposition, Hospital for Special Surgery knee and Harris hip scores, pain scores, and functional capacity. The average age of the subjects was 83 years; osteoarthritis was the most common diagnosis; and the average followup was 25 months. Complication rates and length of stay in acute care facilities were not significantly different than for the control group. Mean preoperative Hospital for Special Surgery knee and Harris hip scores were 58 and 60, respectively, with postoperative scores of 77 and 88, respectively. Pain dramatically improved with 98% of total knee arthroplasty and 100% of total hip arthroplasty subjects reporting mild or no pain at followup. Preoperatively, none of the knee or hip subjects could walk unlimited distances. Postoperatively 51% of the total knee arthroplasty and 54% of the total hip arthroplasty subjects could walk more than five blocks; 71% of the total knee arthroplasty and 86% of the total hip arthroplasty subjects walked with a cane or no assistive device. The most dramatic postoperative functional gains were seen in the most disabled subjects. Total charges of care for patients 80 years of age and older was slightly greater than for a younger group. It was established that total joint arthroplasty can be performed safely in patients 80 years of age and older, promising excellent pain relief and improved functional outcome.

ACETABULAR BONE DESTRUCTION RELATED TO NON-STEROIDAL ANTI-INFLAMMATORY DRUGS

In a retrospective investigation of the relation between use of non-steroidal anti-inflammatory drugs (NSAIDs) and acetabular destruction in primary osteoarthritis of the hip, 70 hips were studied in 64 patients. Cranial acetabular migration, a measure of acetabular destruction, was present in 37 hips and absent in 33. Migrators and non-migrators did not differ in age, sex, hip pain score, walking ability score, femoral neck-shaft angle, or distribution of atrophic and hypertrophic types of osteoarthritis. Regular intake of NSAIDs was noted for 31 of the 37 migrating hips and irregular intake for a further 3. Among the 33 non-migrating hips, the corresponding numbers were 7 and 5, respectively. This highly significant association between NSAID use and acetabular destruction gives cause for concern, not least because of the difficulty in achieving satisfactory hip replacements in patients with severely damaged acetabula.