Preoperative Harris Hip Score Research Articles

Evaluating functional outcome of patients with limb length discrepancy after total hip replacement: a clinical prospective study

Background: Total hip arthroplasty is a reliable procedure for relief of pain in patients with avascular necrosis of head of femur and osteoarthritis of hip joint. In order to optimize function, hip mechanics should be restored to as near normal as possible. This includes restoration of limb length as well as femoral offset after total hip arthoplasty. There are two types of limb length discrepancies-apparent and true. Apparent Limb length discrepancy is due to pelvic obliquity. True limb length discrepancy is actual discrepancy caused due to under or oversized implants or due to contracture of tissues not allowing bones to achieve their anatomical position. Methods: Surgeries were performed at Dayanand medical hospital. Preoperative templating was performed in all cases. Patients were examined before surgery and six months after surgery. In order to compare the outcomes of patients with different degrees of leg length discrepancy, patients were divided into four groups. The limb length discrepancy was measured both clinically and radiologically. Results: Leg length discrepancies were there in postoperative patients. 3 have shortening of more than 5 mm, 8 have lengthening between 5-10 mm, 7 patients have lengthening more than 10 mm, 28 have discrepancy within 5mm. Functional outcome of patients was measured by using Harris hip score at a follow up of six months. In our series mean preoperative Harris hip score was 45.59 and mean Harris hip score at follow up was 89.70 (97–84), of which 52.2% graded as excellent and 47.8% as good. Conclusions: In our study we found no correlation between leg length discrepancy and functional outcome following total hip arthroplasty was found.

Short-term functional outcome of total hip arthroplasty for avascular necrosis of femoral head and influence of patient-related factors

Introduction Avascular necrosis of the femoral head (ANFH) is a phenomenon vascular supply disruption lead to death of bone cells around the femoral head. The disease is a severe health issue all over the world. Within 2 years about 80 % to 85 % of symptomatic cases will result in collapse of the femoral head. Recovery of hip function after total hip arthroplasty (THA) may be influenced by many factors that vary among different racial/ethnic groups. Most findings in this field have been from Western developed nations, and not much information from developing Asian countries is available.This study aimed to determine the six-month functional outcome and patient–related factors that predict functional recovery in patients with avascular necrosis of the femoral head (ANFH) undertaking total hip arthroplasty (THA).Methods Between January 2022 and December 2023 there were 143 patients participating in this prospective study. Demographic, medical history and clinical findings were collected from their medical records. The six-month functional outcome was evaluated using the Harris hip score (HHS). The mean age of the participants was 55.90 ± 11.49 years, and the majority (86.7 %) were male. Most patients had excellent (43.4 %) or good outcome (51.7 %).Discussion Our study had some limitations: the length of the follow-up after surgery is short (6 months), that hospital-related factors like the type and volume of the hospital have not been analyzed. Nonetheless, previous observations suggest that most of the improvement in physical function occurs during the first six months following surgery and remains the same for a long time. However, our sample has typical demographic and clinical characteristics of patients with THA for ANFH, suggesting that determinants of the 6-month functional outcome in the current study could apply to other patients undergoing this surgery.Results The determinants of excellent outcome were a higher preoperative HHS (odds ratio (OR): 4.369, 95 % confidence interval (CI) =1.854 – 10.299; p < 0.001) and absence of comorbidity (OR: 2.440, 95 % CI = 1.071 – 5.557, p = 0.034). No demographic (age, gender, body mass index), medical history (using of steroids, alcohol consumption or smoking), or any other clinical parameter (stage or side of the affected hip, time until surgery) had a significant influence on functional outcome.Conclusion Earlier surgery during functional decline and better management of comorbidity may help improve THA outcomes for patients with avascular necrosis of the femoral head.

Treatment Outcomes of Total Hip Arthroplasty Following Hip Joint Gunshot and Shell Fragment Injuries: Insights From a Single-Center Retrospective Study in Yemen.

Background Gunshot injuries to the hip joint are uncommon extremity injuries. The management outcomes of total hip arthroplasty for such injuries are inadequately documented and lack comprehensive treatment protocols. The purpose of this study was to evaluate the outcomes and complications associated with total hip arthroplasty following gunshot and shell fragment injury incidents in a resource-limited setting. Materials and methods A retrospective study of 10 patients diagnosed with hip joint gunshot and shell fragment injuries and who underwent total hip arthroplasty was conducted between November 2020 and November 2023 at the 48 Model Hospital in Sana'a, Yemen. Clinical demographic data, hip joint injury characteristics, management, complications, and outcomes were collected and analyzed. The primary end measure was the Harris Hip Score (HHS), which was calculated both before and after surgery, and the secondary outcome was the variables associated with complications. Result The mean age was 30.2 ± 10.7 years (range: 20-49 years). The mechanism of injury was bullets in six (60.0%) patients and shell fragments in four (40.0%). The most common previous surgery was wound debridement in eight (80.0%) patients. The mean time between fracture and total hip arthroplasty was 16.7 ± 7.5 months. The mean preoperative and postoperative HHS was 32.1 ± 8 and 69.2 ± 16.7 points, respectively. The postoperative HHS improved significantly, with a mean difference of 37.08 points (95% CI: 24.30-49.85, p = 0.002). Complications occurred in two patients (20.0%), including heterotopic ossification in one patient and surgical site infection in one. Within a mean follow-up time of 31.9 ± 11.8 months, the functional result showed poor functional outcomes in four (40.0%) patients, fair in three (30.0%), excellent in two (20.0%), and good in one (10.0%). Factors associated with postoperative complications were older age (p = 0.049), previous abdominal surgery with intestinal repair (p = 0.022), and shorter time to arthroplasty (p = 0.029). Conclusion In this study, total hip arthroplasty was a highly effective therapy for posttraumatic arthritis induced by bullets or shell fragments, lowering discomfort and increasing function, allowing younger patients to lead normal lives. Moreover, post-arthroplasty complications were found to be more common in patients aged older, who had previous abdominal surgery with intestinal repair, and those who underwent arthroplasty earlier.

Post-operative short-term clinical evaluation of direct lateral (Harding) approach in primary total hip replacement.

To evaluate patients' functional outcomes after total hip arthroplasty through a direct lateral approach. The prospective, observational, descriptive study was conducted at Al-Yarmouk Teaching Hospital, Baghdad, Iraq, from May 2019 to June 2020, and comprised patients aged 28-81 years having advanced osteoarthritis and avascular necrosis who underwent cementless total hip arthroplasty. The patients were followed up for 6 months. Outcome was assessed using the Harris hip score, Trendelenburg sign, post-operative hip dislocation, post-operative infection, and heterotopic ossifications. Data was analysed using Excel version 2019. Of the 30 patients, 14(47%) were males and 16(53%) were females. The overall mean age was 49.8±15.28 years. The mean pre-operative Harris hip score was 43.166±8.27, while it was 83.566±3.83 post-operatively (p<0.001). There was 1(3.33%) case of heterotopic ossification, 3(10%) had Trendelenburg sign. There was no case of postoperative hip dislocation or infection. The lateral hip approach was found to be associated with good post-operative hip stability and good post-operative functional outcome with low post-operative risk of infection.

A comprehensive predictive model for postoperative joint function in robot-assisted total hip arthroplasty patients: combining radiomics and clinical indicators.

Total hip arthroplasty (THA) effectively treats various end-stage hip conditions, offering pain relief and improved joint function. However, surgical outcomes are influenced by multifaceted factors. This research aims to create a predictive model, incorporating radiomic and clinical information, to forecast post-surgery joint function in robot-assisted THA (RA-THA) patients. The study set comprised 136 patients who underwent unilateral RA-THA, which were subsequently partitioned into a training set (n = 95) and a test set (n = 41) for analysis. Preoperative CT imaging was employed to derive 851 radiomic characteristics, selecting those with an intra-class correlation coefficient > 0.75 for analysis. Least absolute shrinkage and selection operator regression reduced redundancy to six significant radiomic features. Clinical data including preoperative Visual Analog Scale (VAS), Harris Hip Score (HHS), and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score were collected. Logistic regression identified significant predictors, and three models were developed. Receiver operating characteristic and decision curves evaluated the models. Preoperative VAS, HHS, WOMAC score, and radiomics feature scores were significant predictors. In the training set, the AUCs were 0.835 (clinical model), 0.757 (radiomic model), and 0.891 (combined model). In the test set, the AUCs were 0.777 (clinical model), 0.824 (radiomic model), and 0.881 (combined model). The constructed nomogram prediction model combines radiological features with relevant clinical data to accurately predict functional outcomes 3years after RA-THA. This model has significant prediction accuracy and broad clinical application prospects and can provide a valuable reference for formulating personalized treatment plans and optimizing patient management strategies.

The medullary cavity morphology of the proximal femur influences the fixation pattern of the rectangular tapered short stem in total hip arthroplasty.

This study aimed to evaluate differences in the pattern of fixation with a rectangular tapered short stem (Fitmore stem) due to proximal femoral medullary cavity morphology based on periprosthetic bone mineral density (BMD) and radiological findings. We analyzed 105 consecutive patients (Dorr type A, 18; Dorr type B, 66; Dorr type C, 21) who underwent total hip arthroplasty using a Fitmore stem. Periprosthetic BMD was measured using dual-energy X-ray absorptiometry from 1 to 24months postoperatively and radiological analysis was performed. Clinical outcomes were evaluated using the Harris hip score (HHS) and the University of California Los Angeles (UCLA) activity score preoperatively and 24months postoperatively. At 24months postoperatively, Dorr type C had significantly decreased BMD changes in Gruen zones 2, 6, and 7 compared to Dorr types A and B, and conversely, significantly increased BMD changes in zone 4 (p < 0.05). Dorr type C had significantly greater subsidence than the other types (p < 0.01) and significantly higher cortical hypertrophy in zone 3 (p < 0.01). Stress shielding was not significantly different between Dorr types. The preoperative and postoperative HHS and UCLA activity scores showed no significant differences between the Dorr types. In Dorr type C, BMD significantly decreased in the proximal femur with a rectangular tapered short stem, suggesting that the stem was fixed at the distal part. Careful observation of this prosthesis over time is needed in patients with Dorr type C.

Effects of Ward Noise Management on Mental Health and Hip Function in Elderly Patients Undergoing Total Hip Arthroplasty.

The aim of this study was to explore the influence of ward noise management on the mental health and hip joint function of elderly patients post-total hip arthroplasty. The retrospective analysis involved the medical records of 160 elderly patients who underwent total hip arthroplasty at Nanchang First Hospital from March 2021 to January 2023. The observation group received ward noise management (n = 75) and the control group received perioperative routine management (n = 85). The noise level, Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS), the Generic Quality of Life Inventory-74 (GQOLI-74), Harris Hip Score (HHS) system, and satisfaction scale were used to evaluate patients. T test and chi-square tests were used for statistical analysis. The observation group exhibited a significantly lower noise level compared to the control group (P < 0.05). No significant differences were observed in the general information and preoperative SDS, SAS, HHS, and GQOLI-74 scores between the two groups (P > 0.05). No significant differences were observed in the SDS and HHS between the two groups 7 days after the operation (P > 0.05). The observation group presented a significantly lower SAS score than the control group 7 days after the operation (P < 0.05). The score of the observation group 7 days after the operation was lower than that before the operation (P < 0.05). At 7 days after the operation, the observation group showed a higher score in the "social function" dimension of GQOLI-74 compared to the control group (P < 0.05), and the satisfaction of the observation group was significantly higher than that of the control group (94.67 vs. 77.65%, P < 0.05). Ward noise management can help reduce anxiety among elderly patients after total hip arthroplasty, improve their quality of life and social function, and obtain higher satisfaction.

Total Hip Arthroplasty Combined with Proximal Femoral Reconstruction Effectively Treats Severe Hip Deformities: A Novel Osteotomy Technique.

Total hip arthroplasty (THA) combined with proximal femoral reconstruction is a novel osteotomy technique developed to address severe hip deformities. There is a paucity of robust clinical and radiological evidence regarding the outcomes of this novel osteotomy technique. This study aimed to evaluate the clinical and radiological outcomes of THA combined with proximal femoral reconstruction during the early follow-up. This is a retrospective case series of 63 hips who underwent THA combined with proximal femoral reconstruction at a single institution between January 2020 and July 2023. The mean age of patients was 39.6 ± 12.6 years. The mean follow-up was 25.6 ± 3.8 months. Surgical characteristics and perioperative variables were evaluated to assess the efficacy of this technique. Harris hip score (HHS) was utilized to evaluate hip function. Leg length discrepancy (LLD) was evaluated in X-ray. The incidence of major adverse events including deep vein thrombosis (DVT), osteolysis, nonunion of the osteotomy, intraoperative femoral fracture, and infection was also evaluated. Paired-samples t-test was used to compare preoperative and postoperative HHS and LLD. The mean operative time was 125.1 min. The mean size of the acetabular components used was 45.2 mm, and the stem size was 7.5. The primary friction interface was ceramic-on-ceramic, accounting for 92.1% of cases. The average length of hospital stay was 8.5 days. The mean cost of treatment was 46,296.0 Yuan. There was a significant improvement in postoperative HHS (p < 0.001) and LLD (p < 0.001) compared to preoperative values. The incidence of deep venous thrombosis was 4.8%; osteolysis rates for the cup and stem were 4.8% and 6.4%, respectively. The non-union and dislocation rates were 1.6% and 3.2%, respectively. There was no incidence of postoperative infection. The novel osteotomy surgical procedure yields reliable and impressive clinical and radiological outcomes, with minimal complications. We advocate for its use in complex primary THA cases involving severe proximal femoral deformities.

FUNCTIONAL OUTCOME OF UNCEMENTED TOTAL HIP ARTHROPLASTY IN POST-TRAUMATIC AVASCULAR NECROSIS OF FEMORAL HEAD IN YOUNG PATIENTS

Objective: To determine the frequency of different outcomes of uncemented total hip replacement in young patients with avascular necrosis due to traumatic cause Materials and Methods: This study was done in Khyber Teaching Hospital Peshawar, Pakistan from March 2022 to January 2024. 96 patients of the younger age group (20-45 years) consisting of both genders with uncemented total hip arthroplasty for AVN femoral head due to traumatic cause, were studied. Age, gender, side of hip affected by AVN, and pre-operative Harris Hip Score were noted. Functional outcomes of uncemented THA were determined in terms of improvement in postoperative Harris hip score was documented at 3 months postoperatively. Results: A total of 96 patients, 80 (83.33%) men and 16 (16.67%) women underwent uncemented total hip arthroplasty. The age ranged from 20 to 45 years, with a mean of 40±7.02 years. Reasons for osteonecrosis included femoral neck fracture (50%), hip dislocation (36.46%), and acetabular fracture (13.54%). After 3 months of surgery, the Harris hip score improved and was excellent in 86.46% of patients, good in 8.33% of patients, fair in 5.2% of patients and none of the patients had poor scores. Conclusion: The cementless hip prosthesis for the treatment of post-traumatic avascular necrosis of the femoral head in active and young individuals is a very good option. The results of cementless hip arthroplasties are good and encouraging in terms of functional outcome postoperatively. Keyword: Harris Hip Score; Uncemented Total Hip Arthroplasty; Avascular Necrosis Hip

Total hip arthroplasty in patients with ankylosing spondylitis: challenges and midterm results

Purpose To assess the effectiveness of total hip arthroplasty (THA) in patients with ankylosing spondylitis (AS). Introduction The prevalence of hip disease in AS ranges from 19 to 36%, with 90% of patients affected bilaterally. Hip involvement in AS patients represents a substantial clinical challenge. While THA using cemented and cementless implants offers a valid treatment option, the complexities of AS-related osteoporosis, diminished spinopelvic mobility, reduced bone union, and femoral deformities necessitate tailored surgical strategies. Patients and methods This retrospective case series study involved 11 patients (equating to 20 hip joints). These patients were diagnosed with AS that affected their hips and underwent THA. The study spans from 2012 to 2018, with a minimum follow-up 5 years. The mean age at the time of operation was 25.2 ± 4.6 years and the mean duration of follow-up was 5.6 ± 0.6 yrs. Follow-up was assessed using Harris Hip Score (HHS) preoperatively, 6 months, 1 year, and at last follow-up postoperatively with a mean period of 6.4 (5–8) years. Results The mean preoperative HHS was 15.3 ± 6.6, while in the last follow-up, the mean HHS was 76.3 ± 4.2. The comparison between preoperative mean HHS and the last follow-up was highly significant. There were no postoperative complications except an iatrogenic fracture of the acetabulum. Conclusion AS is a painful and debilitating disease. THA in patients with AS causes a significant improvement in patient’s pain and function. THA is a definitive solution for the crippling fate of these patients with advanced hip OA.

Short-term results of hip prosthesis with shortening osteotomy in patients with crowe type iv dysplastic coxarthrosis

Developmental hip dysplasia describes developmental abnormalities affecting the acetabulum, proximal femur, and capsule. Various surgical options, including pelvic and femoral osteotomies, are available yet degeneration and osteoarthritis may persist despite these interventions. Total hip arthroplasty with shortening osteotomy has yielded highly satisfactory results patients experiencing pain and reduced quality of life due to osteoarthritis. Crowe type 4 patients who were operated on by the same surgeon between 2010 and 2014 were included in the study. The study evaluated 14 hips from 9 female patients, aged between 42 and 52 years (mean age: 46.57±3.15 years). Each operated hip was followed up for at least 12 months. Preoperative, six-month, and one-year postoperative assessments included Harris Hip Scores, Oswestry Scale, VAS Hip and Lumbar, and SF-36 Quality of Life Indexes. Preoperative Harris hip scores (41.86±8.63) increased to 85.46±2.51 at six-months and 89.97±1.52 at one year. The mean preoperative VAS hip measurement was 8.50±0.76, while the mean postoperative six-month VAS hip measurement was 2.64±0.50 and the mean postoperative one-year VAS hip measurement was 2.14±0.36. The increase in the SF-36 quality of life index is statistically significant. The mean preoperative Oswestry measurement was 32.86±2.93, which decreased to 6.78±1.62 postoperatively and further decreased to 2.21±0.97 at one-year. The outcomes of shortening osteotomy combined with cementless total hip arthroplasty (THA) for treating pain and loss of function in patients with developmental dysplasia of the hip who do not respond to conservative treatments are highly favorable.

Long-Term Results in the Treatment of Avascular Necrosis of Femoral Head with Free Vascularized Fibular Graft

Objective: to evaluate outcomes of vascularized fibula flap used for Avascular necrosis of femoral head. Outcomes were recorded by post-operative Harris hip and radiological improvement of the femoral head. Study Design: Retrospective longitudinal study. Place and Duration of Study: Department of Plastic Surgery, Shifa International Hospital, Islamabad Pakistan, from Jan 2019 to Jan 2020. Methodology: Cases were recruited from 2005-2018 (SIH) performed by the same Orthopaedic and Plastic Surgeon. Data from 30 patients was reviewed. Ethical approval and consent of the patient were taken before the utilization of their data. Results: A total of 30 patients were included, comprising 27(90%) males and 3(10%) females. The mean age was 28.3± years. Pre-operative Harris Hip scores were fair in 17(56.7%) and poor in 13(43.3%) patients. Post operatively these scores improvedv and were noted to be excellent in 10(33.3%), good in 18(60%) and fair in 2(6,7%) patients. Radiological improvement was seen in 20(80%) patients, 8(23.3%) showed no change and 2(6.7%) went into progression. The radiological improvement was significantly associated with aetiology (p=0.004) and Avascular necrosis of HIP (p=0.007). Conclusion: A vascularized fibular graft is an effective treatment option for avascular necrosis of the femoral head in terms of improved radiological outcomes and post-operative Harris Hip scores.

The invasiveness of robot-assisted total hip replacement is similar to that of conventional surgery.

Robot-assisted total hip arthroplasty (R-THA) is increasingly being performed throughout the world. The invasiveness of this operation is unknown. We retrospectively reviewed the cohort of consecutive osteonecrosis of the femoral head (ONFH) patients who received primary R-THA or manual THA (M-THA) from January 2020 to January 2022 in our institution. One experienced surgeon performed all procedures. We calculated the propensity score to match similar patients in different groups by multivariate logistic regression analysis for each patient. We included confounders consisting of age, sex, body mass index (BMI), and operation time. Preoperative serum markers and Harris hip scores (HHS), postoperative serum markers at first day and third day, complications rate, postoperative HHS and Forgotten Joint Score (FJS) at 6months after surgery of different cohorts were compared. We analyzed 218 ONFH patients treated with THA (98 R-THA patients, and 120M-THA patients). After propensity score matching, we generated cohorts of 95 patients in R-THA and M-THA groups. We found no significant difference in preoperative serum markers and HHS. In the R-THA cohort, the PLT count was significantly lower on the postoperative day 1 (192.36 ± 41.72 × 109/L Vs 210.47 ± 72.85 × 109/L, p < 0.05). The Hb level was significantly lower on the postoperative third day in the R-THA cohort (98.52 ± 12.99g/L Vs 104.74 ± 13.15g/L, p < 0.05). There was no significant difference in the other serum markers between the cohorts on postoperative day 1 and 3 (p > 0.05). The FJS was significantly higher in the R-THA than M-THA group (p = 0.01). There was no significant difference in the postoperative HHS or complication rate between the groups (p > 0.05). The R-THA is not associated with a serious invasiveness compared to M-THA. Patients who underwent R-THA had a better early function compared to those who underwent M-THA.

Long-term effectiveness of uncemented allograft-prosthesis composite for reconstruction of bone defects after proximal femur tumor resection

To investigate the long-term effectiveness of uncemented allograft-prosthesis composite (APC) for reconstruction of bone defects after proximal femur tumor resection. Between June 2007 and March 2014, 21 patients who underwent uncemented APC reconstruction of proximal femur after tumor resection were retrospectively evaluated. There were 9 males and 12 females with an average age of 33.2 years (range, 19-54 years). There were 9 cases of giant cell tumor of bone, 5 cases of osteosarcoma, 4 cases of osteoblastic osteosarcoma, 2 cases of chondrosarcoma, and 1 case of undifferentiated pleomorphic sarcoma. Thirteen cases of benign bone tumors were all classified as stage 3 by Enneking staging; and 8 cases of malignant bone tumors were classified as grade ⅡB in 7 cases and grade ⅡA in 1 case according to the American Joint Committee on Cancer (AJCC) staging system. Among them, 7 patients underwent reoperation after recurrence, and the rest were primary operations; 8 patients presented with pathological fractures. The preoperative Harris hip score (HHS) and American Musculoskeletal Tumor Society (MSTS) score was 40 (30, 49) and 9.1±3.5, respectively. The length of osteotomy was 80-154 mm, with an average of 110 mm. At 1 year after operation and last follow-up, HHS and MSTS scores were utilized to evaluate the function of hip joint; the gluteus medius strength score was used to evaluation of the hip abduction function. Image examinations were taken at 1, 3, 6, 9, and 12 months after operation and every year thereafter to assess the union of allograft-host bone interfaces. Intra- and post-operative complications were also recorded. All patients were followed up 84-163 months (mean, 123.5 months). At 1 year after operation and last follow-up, the HHS and MSTS scores significantly improved when compared with the preoperative scores ( P<0.05). However, there was no significant difference in the HHS score, MSTS score, and gluteus medius strength score between the two time points after operation ( P>0.05). Image examination showed that all allograft-host bone interfaces achieved union after 5-10 months (mean, 7.6 months). At last follow-up, all patients had bone resorption, including 11 severe cases, 4 moderate cases, and 6 mild cases; the bone resorption sites included Gruen 1, 2, and 7 regions. Complications included 10 fractures and 1 prosthetic fracture. Local recurrence occurred in 3 patients and pulmonary metastasis in 3 patients. Uncemented APC is a reliable method for the reconstruction of bone defects after proximal femur tumor resection. It has the good long-term effectiveness and possesses obvious advantages in the union at the bone-bone surface.

Risk factors for liner wear and head migration in total hip arthroplasty: a systematic review

Total hip arthroplasty (THA) is a successful orthopaedic surgical procedure, and its longevity depends on bearing components and implant fixation. Optimizing polyethylene and ceramics has led to improved wear parameters and contributed to improved long-term outcomes. The present systematic review investigated whether time span from implantation, patient characteristics and performance status exert an influence on liner wear and head migration in THA. This study was conducted in conformity to the 2020 PRISMA guidelines. All the clinical investigations which reported quantitative data on the amount of liner wear and head migration in THA were considered. Only studies which reported quantitative data at least on one of the following patient characteristics were suitable: mean age, mean BMI (kg/m2), sex, side, time span between the index THA and the last follow-up (months) were eligible. A multiple linear model regression analysis was employed to verify the association between patient characteristics and the amount of liner wear and/or head migration. The Pearson Product-Moment Correlation Coefficient was used to assess the association between variables. Data from 12,629 patients were considered. The mean length of the follow-up was 90.5 ± 50.9 months. The mean age of patients at surgery was 58.4 ± 9.4 years, and the mean BMI was 27.2 ± 2.5 kg/m2. 57% (7199 of 12,629 patients) were women, and in 44% (5557 of 12,629 patients) THAs were performed on the left. The mean pre-operative Harris hip score was 46.5 ± 6.0 points. There was evidence of a moderate positive association between the amount of liner wear and the time elapsed between the index surgery to the follow-up (P = 0.02). There was evidence of a moderate positive association between the amount of head migration and the time elapsed between the index surgery to the follow-up (P = 0.01). No further statistically significant association was found. The time elapsed between the index surgery to the follow-up was the most important factor which influence the head migration and liner wear in THA. Patients’ characteristics and preoperative physical activity did not influence the amount of head migration and liner wear.

Total hip arthroplasty in patients with coxarthrosis due to developmental dysplasia of the hip: Is fixation of the subtrochanteric osteotomy necessary?

This study aims to analyze the clinical, functional, and radiographic results of patients with Crowe type IV developmental dysplasia of the hip (DDH) sequelae undergoing cementless total hip arthroplasty (THA) with transverse subtrochanteric shortening osteotomy without fixation at the osteotomy site. Between March 2013 and February 2020, a total of 42 hips of 34 patients (8 males, 26 females; mean age: 50.7±11.7 years; range, 27 to 76 years) with Crowe type IV DDH treated with subtrochanteric shortening osteotomy combined with primary cementless THA were retrospectively analyzed. Each case was evaluated to the Harris Hip Score (HHS). Crowe classification, location of the rotation center of hip, loosening of the implants, and union at the osteotomy line were evaluated radiologically. The mean follow-up was 57.9±31.5 (range, 24 to 192) months. The mean interval to complete bone union in 40 hips (95%) after surgery was 3.5±0.9 (range, 2 to 6) months. The mean preoperative HHS scores of the patients was 35.6±6.86, while the scores increased to 91.53±5.41 at the final follow-up (p<0.001). Our study results suggest that excellent clinical and radiological results can be obtained in Crowe type IV dysplastic hips in patients undergoing THA with the rectangular femoral component and transverse shortening osteotomy technique, without fixation at the osteotomy site.

The Role of Global Femoral Offset in Total Hip Arthroplasty with High Hip Center Technique.

The high hip center (HHC) technique has been proposed for the treatment of patients with developmental dysplaisa of the hip (DDH) who have an acetabular bone defect. However, the importance of global femoral offset (FO) in the application of this technique has not been sufficiently appreciated. Our goals were to confirm that the HHC technique is feasible in the treatment of patients with DDH and to assess the function of global FO in this procedure. We retrospectively analyzed 73 patients who underwent total hip arthroplasty using high hip center technique for unilateral DDH at our hospital between January 2014 and June 2019. According to global FO, the patients were split into three groups: increased FO group (increment greater than 5 mm), restored FO group (restoration within 5 mm) and decreased FO group (reduction greater than 5 mm). Patients' medical records and plain radiographs were reviewed. One-way ANOVA was used to compare radiographic outcomes and Harris hip score (HHS). Paired t-test was used to assess preoperative and postoperative HHS and leg length discrepancy. Trochanteric pain syndrome, Trendelenburg sign and postoperative limp was evaluated with Fisher's exact test. The average follow-up time was 7.5 ± 1.4 years. The patients' HHS and leg length discrepancy were significantly improved (p < 0.05). In terms of vertical acetabular height, abductor arm, postoperative leg length difference, and acetabular cup inclination, there was no statistically significant difference between the three groups. At the last follow-up, HHS was significantly higher in the restored FO group than in the decreased FO and increased FO groups. Trochanteric pain syndrome occurred in 15.0% and Trendelenburg sign and postoperative limp in 8.2% of all patients, respectively. Trochanteric pain syndrome, Trendelenburg sign and postoperative limp did not differ significantly across the three groups. One patient in increased FO group underwent revision for dislocation 6 years after surgery. The HHC technique is an alternative technique for total hip arthroplasty in patients with acetabular bone abnormalities, according to the results of the mid-term follow-up. Also, controlling the correction of the global femoral offset to within 5 mm may lead to better clinical outcomes.

Facteurs influençant la reprise du sport après ostéotomie acétabulaire rotationnelle excentrique

BackgroundAlthough eccentric acetabular rotation osteotomy (ERAO) is an effective treatment for developmental dysplasia of the hip (DDH), there is little information about return to sports after ERAO. This study aimed to investigate 1) the patient factors that influence the return to sports after ERAO, 2) whether postoperative sports participation will affect future osteoarthritis progression. HypothesisSome factors affect the return to sports after ERAO. Patients and methodsOf 503 patients who underwent ERAO from 1990 to 2010, 124 who had been continuously participating in sports preoperatively (average 13.2 years after surgery) were included. Patient demographics of sex, age, body mass index, unilateral to bilateral case ratio, history of treatment for childhood DDH, preoperative Kellgren-Lawrence (KL) grade, center edge angle, joint congruency, Harris hip score, complications and the survival rate were compared between the S group (patients who participated in the same sports preoperatively) and N group (patients who could not participate in sports postoperatively). ResultsSeventy-two (58%) and 52 patients (42%) in the S and N groups, respectively, had an overall return to sports rate of 64% (79 patients). The most common sports that patients participated in were swimming (30 patients [24%]), jogging (12 [10%]), and golf (10 [8%]) preoperatively, and swimming (14 patients [11%]), golf (8 [6%]), and jogging (8 [6%]) postoperatively. There were no significant differences between both groups in terms of sex, age, body mass index, unilateral to bilateral case ratio, history of treatment for childhood DDH, preoperative KL grade, and joint congruency. There was a significant difference in patient factors between the S (11 joints [14%]) and N (20 joints [38%]) groups only when the preoperative center edge angle was <0°. There was no significant difference in the preoperative Harris hip score and the final survey between the S (73.2±4.6 and 93.4±7.2) and N (72.5±4.8 and 92.1±7.4) groups. Complications showed no significant differences between the five patients (7%) in the S group and six patients (13%) in the N group. The KL grade progressed in 10 cases (grade II to III in 2 cases and grade III to IV in 8) in the S group and 8 cases (grade II to III in 1 case and grade III to IV in 7 cases) in the N group. The 10-year and 20-year joint survival rates with THA conversion as the endpoint were 98.1% (95% CI: 87.4%–99.7%) and 83.7% (95% CI: 62.6%–93.4%) in the S group and 100% (95% CI: 70.7%–99.3%) and 95.2% (95% CI: 12.6%–92.6%) in the N group, respectively. In the evaluation of factors affecting sports return by logistic regression analysis, only one significant factor (odds ratio 3.42, 95% confidence interval: 1.58–7.42, p<0.01) was the preoperative center edge angle <0°. DiscussionThe chief factor affecting the return to sports after surgery was a preoperative center edge angle <0°; moreover, the continuation of sports did not affect the subsequent progression of osteoarthritis or THA conversion. Level of evidenceLevel III, cohort study.

Patient-Reported Outcomes and Factors Impacting Success of the Periacetabular Osteotomy.

Hip dysplasia is a condition affecting both infants and adults, characterized by a shallow acetabulum that does not sufficiently cover the head of the femur. This leads to instability of the hip and elevated levels of mechanical stress around the acetabular rim. A popular procedure for the correction of hip dysplasia is the periacetabular osteotomy (PAO), in which fluoroscopically guided osteotomies around the pelvis are made to allow for repositioning of the acetabulum to fit properly on the femoral head. This systematic review aims to analyze patient factors that impact outcomes, as well as patient-reported outcomes such as the Harris Hip Score (HHS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC). The patients in this review did not undergo any prior intervention for acetabular hip dysplasia, allowing for an unbiased reporting of outcomes from all included studies. Of studies reporting HHS, the mean preoperative HHS was 68.92 and the mean postoperative HHS was 89.1. Of the study that reported mHHS, the mean preoperative mHHS was 70, and the mean postoperative mHHS was 91. Of the studies reporting WOMAC, the mean preoperative WOMAC was 66, and the mean postoperative WOMAC was 63. Key findings of this review are that of the seven included studies, six achieved a minimally important clinical difference (MCID) based on patient-reported outcomes, and factors impacting outcome are preoperative Tönnis osteoarthritis (OA) grade, pre and postoperative lateral-center edge angle (LCEA), preoperative hip joint congruency, postoperative Tönnis angle, and age. In patients with no prior intervention for hip dysplasia, the PAO is a successful procedure with significant improvement in postoperative patient-reported outcomes. Despite the reported success of the PAO, proper patient selection is vital to avoid early conversions to total hip arthroplasty (THA) and prolonged pain. However, further investigation is prompted regarding the long-term survivorship of the PAO in patients with no prior intervention for hip dysplasia.

FUNCTIONAL OUTCOME OF BILATERAL CEMENTLESS TOTAL HIP ARTHROPLASTY IN DEGENERATIVE ARTHRITIS

Introduction : Bilateral hip degenerative arthritis is a frequent nding in 42% population with osteoarthritis. Unbearable pain restrict daily activities of living to a great extent. Bilateral total hip arthroplasty is an well established reconstructive procedure for advanced arthritis. The objective of this study was to evaluate functional outcome of bilateral cementless total hip arthroplasty using Harris Hip Score. A prospective study conducted in 20 patients with 40 hips w Materials And Methods : ere analyzed for clinical and functional outcome. Age, sex , operative indication and preoperative Harris Hip Score were documented. Operative time and complications were noted. Patients were evaluated immediate post operative period ,3 month and at 6 months . Harris Hip Score , Visual Analogue score , range of movement evaluation was done and documented. Mean preoperative Harris hip score w Results : as 38.6 on left side and 39.3 on right side . This score improved to 88.04 on left and 86.03 on right side immediate post operative period and 94 on left and 93 on right side on 6 month followup. A signicant improvement in Visual analogue score (VAS ) and range of movements were observed in post operative follow up. The outcome after bilateral total hip replacement was excellent in 95% and good in 5% of cases. Current generation of prosthesis used in cement less Conclusion : bilateral total hip arthroplasty for degenerative arthritis of hip, provides satisfactory functional and radiological outcomes . It is an effective and safe procedure and improves the quality of life by relieving pain and improving functional disability