UCLA Activity Score Research Articles

SMARTPHONE-BASED STEP-COUNT MEASURES CORRELATE WITH KOOS-12 FUNCTION AND UCLA ACTIVITY PROMS DURING EARLY TKA RECOVERY

Passive smartphone-based apps are becoming more common for measuring patient progress after total knee arthroplasty (TKA). Optimum activity levels during early TKA recovery haven't been well documented. This study investigated correlations between step-count and patient reported outcome measures (PROMs) and how demographics impact step-count preoperatively and during early post-operative recovery.Smartphone capture step-count data from 357 TKA patients was retrospectively reviewed. Mean age was 68±8years. 61% were female. Mean BMI was 31±6kg/m2. Mean daily step count was calculated over three time-windows: 60 days prior to surgery (preop), 5-6 weeks postop (6wk), and 11-12 weeks postop (12wk).Linear correlations between step-count and KOOS12-function and UCLA activity scores were performed. Patients were separated into three step-count levels: low (<1500steps/day), medium (1500-4000steps/day), and high (>4000steps/day). Age >65years, BMI >30kg/m2, and sex were used for demographic comparisons.Student's t-tests determined significant differences in mean step-counts between demographic groups, and in mean PROMs between step-count groups.UCLA correlated with step-count at all time-windows (p<0.01). KOOS12-Function correlated with step-count at 6wk and 12wk (p<0.05). High step-count individuals had improved PROMs compared to low step-count individuals preoperatively (UCLA: ∆1.4 [p<0.001], KOOS12-Function: ∆7.3 [p<0.05]), at 6wk (UCLA: ∆1 [p<0.01], KOOS12-Function: ∆7 [p<0.05]), and at 12wk (UCLA: ∆0.8 [p<0.05], KOOS12-Function: ∆6.5 [p<0.05]).Younger patients had greater step-count preoperatively (3.8±3.0k vs. 2.5±2.3k, p<0.01), at 6wk (3.1±2.9k vs. 2.2±2.3k, p<0.05) and at 12wk (3.9±2.6k vs. 2.8±2.6k, p<0.01). Males had greater step-count preoperatively (3.7±2.6k vs. 2.5±2.6k, p<0.001), at 6wk (3.6±2.6k vs. 1.9±2.4k, p<0.001), and at 12wk (3.9±2.3 vs. 2.8±2.8k, p<0.01). No differences in step-count were observed between low and high BMI patients at any timepoint.High step count led to improved PROMs scores compared to low step-count. Early post-operative step-count was significantly impacted by age and sex. Generic recovery profiles may not be appropriate across a diverse population.

SMARTPHONE-BASED STEP-COUNT MEASURES CORRELATE WITH HOOS-12 FUNCTION AND UCLA ACTIVITY PROMS DURING EARLY THA RECOVERY

Smartphone-based apps that measure step-count and patient reported outcomes (PROMs) are being increasingly used to quantify recovery in total hip arthroplasty (THA). However, optimum patient-specific activity level before and during THA early-recovery is not well characterised. This study investigated 1) correlations between step-count and PROMs and 2) how patient demographics impact step-count preoperatively and during early postoperative recovery.Smartphone step-count and PROM data from 554 THA patients was retrospectively reviewed. Mean age was 64±10yr, BMI was 29±13kg/m2, 56% were female. Mean daily step count was calculated over three time-windows: 60 days prior to surgery (preop), 5-6 weeks postop (6wk), and 11-12 weeks postop (12wk).Linear correlations between step-count and HOOS12 Function and UCLA activity scores were performed. Patients were separated into three step-count levels: low (<2500steps/day), medium (2500-5500steps/day), and high (>5500steps/day). Age >65years, BMI >30, and sex were used for demographic comparisons.Student's t-tests determined significant differences in mean step-counts between demographic groups and in mean PROMs between step-count groups.UCLA correlated with step-count at all time-windows (p<0.01). HOOS12 Function correlated with step-count preoperatively and at 6wk (p<0.01). High vs low step count individuals had improved UCLA scores preoperatively (∆1.8,p<0.001), at 6wk (∆1.1,p<0.05), and 12wk (∆1.6,p<0.01), and improved HOOS12 Function scores preoperatively (∆8.4,p<0.05) and at 6wk (∆8.8,p<0.001).Younger patients had greater step-count preoperatively (4.1±3.0k vs 3.0±2.5k, p<0.01) and at 12wk (5.1±3.3k vs 3.6±2.9k, p<0.01). Males had greater step-count preoperatively (4.1±3.0k vs. 3.0±2.7k, p<0.001), at 6wk (4.5±3.2k vs 2.6±2.5k, p<0.001), and at 12wk (5.2±3.6k vs. 3.4±2.5k, p<0.001). Low BMI patients had greater step-count at 6wk (4.3±3.3k vs. 2.6±2.7k, p<0.01) and 12wk (5.0±3.6k vs. 3.6±2.6k, p<0.05).Daily step-count is significantly impacted by patient demographics and correlates with PROMs, where patients with high step count exhibit improved PROMs. Generic recovery profiles may therefore not be appropriate for benchmarking across diverse populations.

Impacted bone allograft personalised by a novel 3D printed customization kit produces high surgical accuracy in medial opening wedge high tibial osteotomy: a pilot study

PurposeContemporary medial opening wedge high tibial osteotomy (MOWHTO) still seems to struggle with inconsistent accuracy outcomes. Our objective was to assess surgical accuracy and short-term clinical outcomes when using 3D planning and a patient-specific instrumentation (PSI) kit to prepare customized bone allografts.MethodsThirty subjects (age 48y ± 13) were included in a double-center prospective case series. A low-dose CT-scan was performed to generate 3D bone models, a MOWHTO was simulated, and PSI was designed and 3D printed based on the complementary negative of the planned osteotomy gap. Clinical outcome was assessed at two, four, 12 weeks and one year using NRS, KOOS, UCLA activity score, EQ-5D and anchor questions. A linear-mixed model approach was implemented for data analysis.ResultsPreoperative 3D values were 175.0° ± 2.2 mechanical tibiofemoral angle (mTFA), 85.0° ± 3.0 medial proximal tibial angle (MPTA), and 94.1° ± 3.4 medial posterior tibial slope (MPTS). Target planning ranged from slight varus to the lateral tibial spine (slight valgus). Postoperative 3D analysis showed an accuracy of 1.1° ± 0.7 ΔMPTA (p = 0.04) and 1.2° ± 1.2 ΔMPTS (p = 0.11). NRS decreased from baseline 6.1 ± 1.9 to 2.7 ± 1.9 at four weeks (p < 0.001) and 1.7 ± 1.9 at one year (p < 0.001). KOOS increased from 31.4 ± 17.6 to 50.6 ± 20.6 at 12 weeks (p < 0.001) and to 71.8 ± 15.6 at one year (p < 0.001).ConclusionThe study suggests that 3D printed instrumentation to personalize structural bone allograft is a viable alternative method in MOWHTO that has the benefit of optimizing surgical accuracy while providing early and consistent pain relief after surgery.

Comparison of the Journey II bicruciate stabilised (JII-BCS) and GENESIS II total knee arthroplasty for functional ability and motor impairment: the CAPAbility, blinded, randomised controlled trial

ObjectivesTo determine if a newer design of total knee replacement (TKR) (Journey II BCS) produces superior patient-reported outcomes scores and biomechanical outcomes than the older, more established design (Genesis II).SettingPatients...

Running Following Hip Arthroplasty: A Systematic Review

With improved implants and younger patients undergoing total hip arthroplasty (THA) and hip resurfacing arthroplasty (HRA), there are increased expectations to return to high-impact activities. Recommendations regarding return to running following hip arthroplasty remain unclear. A search of the PubMed database was conducted, and all publications referencing running following THA or HRA published between January 1, 2000, and September 1, 2020, were included in the systematic review. Patient demographics, surgical variables, activity measures, and revision rates were recorded for each study. A total of 225 unique citations were identified, of which four manuscripts met the eligibility criteria. Eighty-nine of 121 (73.6%) preoperative runners returned to running postoperatively. All four studies reported mean postoperative UCLA activity scores of at least nine. More patients returned to running following HRA than THA with lower rates of revision. Further research with longer postoperative follow-up is necessary to provide definitive recommendations for running following arthroplasty procedures. (Journal of Surgical Orthopaedic Advances 32(1):001-004, 2023).

Early return to activity of daily living after total hip arthroplasty: a systematic review and meta-analysis.

Total hip arthroplasty (THA) is an orthopaedic procedure that improves the quality of life in patients suffering from hip pain related to osteoarthritis, fractures, and avascular osteonecrosis of the femoral head. Different surgical approaches can be used for THA leading to different recovery times. Because of the lowering medium age of people undergoing THA, it is important to focus on the earlier return of physiological activity after surgery. To evaluate the best approach for THA in terms of earlier return to activity. Studies comparing the postoperative outcomes in patients who underwent THA through different approaches were analysed focusing on patients' self-reported outcomes, ADL score and UCLA activity score with a short follow-up. A total of 1990 articles were identified in the search, and 14 met the inclusion criteria. The Review Manager software version 5.4 was used to conduct a meta-analysis to compare the direct anterior (DAA) and posterior (PA) approaches, which are the most adopted approaches. An earlier return to walk without aids and to independent ADLs were reported with DAA, but without statistical significance (respectively p = 0.06 and p = 0.10). The time to return to drive was similar among the 2 groups (p = 0.88). The return to work was faster with PA, but no statistical significance was reported (p = 0.47). Further studies are needed with a larger number of patients, that present homogeneous outcomes, follow-ups and rehabilitation programmes, and that compare similar surgical approaches to assess the early return to activity of daily living after THA.

Revision Hip Arthroplasty Using a Modular, Cementless Femoral Stem: Long-Term Follow-Up

BackgroundAs the number of primary total hip arthroplasty (THA) cases increase, so does the demand for revision operations. However, long-term follow-up data for revision THA is lacking. MethodsA retrospective review was completed of patients who underwent revision THA at a single institution between January 2002 and October 2007 using a cementless modular stem. Patient demographic, clinical, and radiographic data was collected. Preoperative and postoperative patient-reported outcome scores were compared at a minimum of fourteen-year follow-up. ResultsEighty-four patients (89 hips) with a median age of 69 years (range, 28 to 88) at operation were included. Indications for revision included aseptic loosening (84.2%), infection (12.4%), and periprosthetic fracture (3.4%). Twenty-two hips sustained at least 1 complication: intraoperative fracture (7.9%), dislocation (6.7%), prosthetic joint infection (4.5%), deep venous thrombosis (3.4%), and late periprosthetic fracture (2.2%). There were no modular junction complications. Eight patients underwent reoperations; only three involved the stem. Thirty-eight patients (45%) were deceased prior to final follow-up without known reoperations. Twenty-seven patients (32%) were lost to follow-up. Twenty-one patients (23%) were alive at minimum fourteen-year follow-up. Complete patient-reported outcomes were available for nineteen patients (range, 14 to 18.5 years of follow-up). Significant improvement was seen in UCLA activity, VR-12 physical, hip disability and osteoarthritis outcome score, joint replacement., and Harris Hip score pain and function scores. ConclusionChallenges of long-term follow-up include patient migration, an unwillingness to travel for re-examination, medical comorbidities, advanced age, and death. The cementless modular revision stem demonstrated long-term clinical success and remains a safe and reliable option for complex revision operations.

Clinical and Radiologic Outcomes after Anatomical Total Shoulder Replacement Using a Modular Metal-Backed Glenoid after a Mean Follow-Up of 5.7 Years.

Background: Glenoid wear is a common complication of anatomical total shoulder arthroplasty (aTSA) with a metal-backed glenoid (MBG), and the clinical and radiological results of historical implants are poor. The aim of this work was to evaluate the clinical and radiological results of 25 participants as well as the longevity after implantation of an anatomic shoulder prosthesis with a recent, modular cementless flat metal-backed glenoid component after a mean follow-up of 5.7 years. Methods: Clinically, the Simple Shoulder Test (SST), UCLA Activity Score (UCLA), and Constant Murley Score (CMS) were evaluated. Radiographically, the radiolucent lines (RLs), humeral head migration (HHM), and lateral glenohumeral offset (LGHO) were assessed. Survival was calculated with Kaplan–Meier curves and life-table analysis. Results: The mean CMS at follow-up was 46.2 points (range: 14–77; SD: 19.5). In terms of the SST score, the average value was 6.5 points (range: 1–10; SD: 3.5). The UCLA activity score showed a mean value of 5.9 points (range: 1–9; SD: 2.1). There were 17 revisions after a mean follow-up of 68.2 months (range: 1.8–119.6; SD: 27.9). HHM occurred in every patient, with a mean measurement of 6.4 mm (range: 0.5–13.4; SD: 3.9; p < 0.0001). The mean LGHO between the initial postoperative and follow-up images was 2.6 mm (range: 0–4.0; SD: 1.5; p < 0.0001). RLs were found in 22 patients (88%) around the glenoid and in 21 patients (84%) around the humeral head prosthesis. Conclusion: The clinical and radiographic outcomes after metal-backed glenoids were poor at 2.2 to 8.4 years of follow-up. We determined devastating survival in the majority of cases (68%), with mostly inlay wear (71%) as the main reason that led to revision surgery. The use of metalback genoids cannot be recommended based on the data of this study.

Double level osteotomy for genu varum: Is a return to sport possible?

IntroductionA double level osteotomy (DLO) may be indicated in patients with genu varum when the deformity involves both the tibia and femur. These patients, who are often young and active, have a high functional demand and hope for a rapid return to sport. The purpose of our study was to assess return to sport and functional outcomes following DLO for symptomatic genu varum. Materials and methodsA total of 40 patients (mean age 45.5±2 years) who underwent a DLO between 2018 and 2020, performed in 2 different hospitals, were reviewed after a minimum follow-up of 1-year. The mean initial varus was 11±2°. The type of sport and frequency of participation (UCLA activity score) as well as time to return to sport and level of activity recovered were defined as the primary endpoints. Functional scores were also assessed with the knee injury and osteoarthritis outcome score (KOOS). ResultsAt the last follow-up, 87.5% (n=35) of patients reported that they had returned to sport. The mean time to return to sport was 6±1 months with a significant difference (p<0.001) between the pre- and postoperative UCLA activity scores. There was a strong correlation between the presence of a joint line obliquity >3° and decreased functional outcomes (p<0.0001). The overall KOOS score improved (p<0.001) by a mean of 38.6 points after the correction. The 8 lateral cortical fractures (Takeuchi type I and II) and the 2 medial cortical fractures (Nakayama type 1) that were found had no impact on functional outcomes (p>0.05). ConclusionOur findings demonstrated that DLO provided rapid return to sport, thus making it possible to meet the functional demands and expectations of patients. Level of evidenceIV; Retrospective study.

Clinical outcomes of hybrid closed wedge high tibial osteotomy for advanced osteoarthritis of the knee compared with total knee arthroplasty.

To evaluate clinical outcomes between hybrid closed wedge high tibial osteotomy (HCWHTO) and total knee arthroplasty (TKA) for advanced medial compartmental osteoarthritis of the knee (advanced knee OA). In more than grade 3 OA based on the Kellgren-Lawrence classification, when patients' age was less than 60years or activity level was more than level 5 based on the UCLA activity score, 22 knees (18 patients) underwent HCWHTO. The other 22 knees (18 patients) that underwent TKA were evaluated retrospectively. Muscle strength was evaluated preoperatively and at 1 year postoperatively. The visual analogue scale (VAS) and Japanese version of the Knee injury and Osteoarthritis Outcome Score (J-KOOS) were used to evaluate clinical outcomes preoperatively and at a mean 66-months follow-up. All postoperative muscle strength measures improved to preoperative equivalent levels in the HCWHTO group; they were significantly higher in the HCWHTO group than in the TKA group (p < .05). The VAS score and total J-KOOS significantly improved in both groups (HCWHTO, p = .001; TKA, p = .040); there were no significant differences in the scores between the groups at the final follow-up. Hybrid closed wedge HTO significantly improved the activities of daily living and sport/recreation scores, whereas TKA did not at the final follow-up. In advanced knee OA, HCWHTO led to improved muscle strength, and its midterm clinical outcomes were equivalent to those of TKA. To postpone or even to avoid TKA, HCWHTO is considered an appropriate treatment for young and high-activity patients with advanced knee OA. Therapeutic Level III.

Combined treatment with medial unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction is effective on long-term follow-up

PurposeThe purpose of the present study was to evaluate the long-term outcome of combined medial unicompartmental knee arthroplasty (UKA) and anterior cruciate ligament reconstruction (ACLR). The authors hypothesized that the combined procedure leads to good long-term outcome in patients with isolated medial knee osteoarthritis (OA) and anterior cruciate ligament (ACL) deficiency.MethodsTwenty-three patients with ACL deficiency and concomitant medial knee OA were treated from 2008 to 2016 with a combined UKA (Oxford Partial Knee) and ACLR using a hamstring tendon autograft. The follow-up assessment included VAS pain score, Lysholm score, Oxford Knee Score (OKS), American Knee Society scores (AKSS), International Knee Documentation Committee (IKDC 2000), Tegner and UCLA activity scores. Instrumented laxity test was done using the KT-1000 arthrometer. Survivorship analysis was performed using the Kaplan–Meier method. Implant loosening and disease progression was assessed by conventional radiography.ResultsAverage follow-up duration was 10 years (6–14.5). VAS, Lysholm, Tegner and UCLA scores improved significantly. OKS, AKSS and IKDC 2000 showed excellent results on follow-up. Implant survivorship was 91.4% at 14.5 years. There were 2 revisions with conversion to total knee arthroplasty at 6 and 12 years postoperatively due to trauma and disease progression, respectively. There were no radiological or clinical signs of instability or disease progression in any of the remaining knees. The side-to-side difference using the KT-1000 arthrometer was insignificant.ConclusionsUKA combined with ACLR is an effective therapeutic option with good outcome and return to sport rate on the long-term.Level of evidenceIV.

Comparison of modern periacetabular osteotomy for hip dysplasia with total hip arthroplasty for hip osteoarthritis-10-year outcomes are comparable in young adult patients.

ABSTRACTYoung adult patients with symptomatic acetabular dysplasia and marginal secondary osteoarthritis can be faced with the decision to either undergo periacetabular osteotomy (PAO) to relieve symptoms and slow osteoarthritis progression or wait until progression to more advanced disease and undergo total hip arthroplasty (THA). The decision can be difficult, and contemporary literature to guide these decisions is sparse. Therefore, we retrospectively assessed complication rate, survivorship and patient-reported clinical outcomes [modified Harris Hip score (mHHS), UCLA Activity score] in two, consecutive cohorts of patients aged 18–40 years that underwent either PAO for symptomatic acetabular dysplasia (mean age 28.9 years) or THA for advanced secondary osteoarthritis (32.5 years). PAO patients were followed for a mean of 10.5 years (8–19) and THA patients for 11.9 (8–17) years. Between PAO and THA groups, there were no differences in overall complication rate (4.7% versus 4.7%), non-revision reoperation rate (5.9% versus 2.3%, P = 0.37) or end-revision rate [7 (8.2%) PAOs converted to THA at mean 10.8 years versus 3 (7.0%) THAs revised at 6.2 years, P = 0.80]. Latest scores remained significantly improved from baseline in both the PAO (mHHS 86.1 versus 63.3, P < 0.001; UCLA 7.5 versus 6.9, P < 0.05) and THA (mHHS 82.6 versus 48.4, P < 0.001; UCLA 7.2 versus 4.6, P < 0.001) cohorts. Final scores were similar between groups (mHHS 86.1 versus 82.6, P = 0.46; UCLA 7.5 versus 7.2, P = 0.37). Clinical success [mHHS minimal clinically important difference (8) OR PASS (>70) at latest follow-up without end-revision] was achieved in 81.2% of PAO hips and 83.7% of THA hips (P = 0.72).

Primary constrained-condylar-knee designs outperform posterior-stabilized and cruciate-retaining designs in high-grade varus osteoarthritic knees during short-term follow-up: a pilot study.

High-grade varus osteoarthrosis (OA) is characterized by a pronounced intra-articular varus deformity and associated insufficiency of the lateral ligamentous complex. When performing a total knee arthroplasty (TKA) in such a knee, traditionally the alignment is restored to neutral, and the medial soft tissue structures are released to compensate for the lateral laxity and balance the joint. However, another option would be to leave the medial soft tissues untouched and accept the lateral laxity but to compensate for it using an ML-stabilized constrained-condylar knee (CCK) design. Our aim was to prove our hypothesis that such knees would demonstrate better clinical stability and better functionality as well as subjective outcome scores. We searched our bicenter database of 912 primary TKAs (from 2016 to 2019) for primary TKA patients with a preoperative varus alignment of > 8°. After inclusion, 60 patients were divided into three groups by implant design: CCK (n = 21), posterior-stabilized (PS) (n = 20) and cruciate-retaining (CR) (n = 19). Oxford Knee Score (OKS), Forgotten Joint Score (FJS), Knee Society Score (KSS), UCLA-activity score, ML instability scores and both radiographic and clinical data were compared between groups. ML stability was significantly better in CCK designs (86% grade 0) compared to CR (37% grade 0) (p = 0.004) but not PS (70% grade 0) designs. No grade II instability was present in CCK and PS implants compared to 16% of CR implants. KSS and UCLA-activity score were higher in CCK designs compared to PS (p = 0.027, p = 0.041) and CR designs (p < 0.001, p = 0.007). OKS and FJS were higher in CCK designs compared to CR (p = 0.025, p = 0.008) but not to PS. The use of a CCK design to compensate for the lateral laxity in high-grade varus OA knees allowed to refrain from a medial release. CCK designs displayed improved clinical stability and better functionality as well as subjective outcome scores compared to less-constrained designs.

Functional Outcomes of Non-operative Treatment in Proximal Humeral Fracture of Adults

Background: The functional outcomes after non-operative treatment of proximal humeral fractures in adults required detailed understanding for improved health outcomes. Objective: To identify the functional outcomes of non-operative treatment in proximal humeral fracture of adults. Study Design: Prospective cohort study Place and Duration of Study: Department of Orthopaedic, KMC Civil Hospital, Khairpur Mirs from 1st October 2020 to 30th September 2021. Methodology: Fifty patients with proximal humeral fracture &gt;45 years were treated with non-operative treatment protocol including 1 year follow-up. Patient’s radiological imaging was continued till one year and they were given a sling to wear for three week’s time. The treatment primary functional outcomes were assessed by Oxford Shoulder Score and EuroQol-5 Dimensions-3 Levels, while secondary functional outcomes were assessed by visual analog scale and university of California Los-Angeles scoring method. Results: Mean age was 65.6±4.2 years with females as 74% and 26% males. Improvement in OSS was up to 48 points. One-year scores for OSS were mean 33.1 with 95% confidence of interval while it was 0.59 for EQ-5D-3L. Mean VAS pain score was 32.1 with 59.2 as VAS satisfaction score and UCLA activity score as 20.4. Conclusion: Non-operative treatment for proximal humeral fracture in adults’ results in significant changes in shoulder-specific as well as improved health outcomes after one year. Key words: Proximal humeral fractures, Non-operative, Bone health

Prolonged Application of Continuous Passive Movement Improves the Postoperative Recovery of Tibial Head Fractures: A Prospective Randomized Controlled Study

Methods 60 patients with THFs were randomly and equally divided into the CPM group and non-CPM group. Both groups immediately received CPM and conventional physical therapies during hospitalization. After discharge, the non-CPM group was treated with conventional physical therapy alone, while the CPM group received conventional physical training in combination with CPM treatment. At 6 weeks and 6 months postoperatively, the primary outcome which was knee ROM and the secondary outcome which was knee functionality and quality of life were evaluated. Results The CPM group had a significantly increased ROM at both follow-up time points. The Knee Society Score, UCLA activity score, and the EuroQoL as well as the pain analysis showed significantly better results of the CPM group than the non-CPM group. Conclusions The prolonged application of CPM therapy is an effective method to improve the postoperative rehabilitation of THFs.

Cementless Hip Arthroplasty in Patients with Subchondral Insufficiency Fracture of the Femoral Head.

Subchondral insufficiency fracture of the femoral head (SIFFH) occurs in elderly patients and might be confused with osteonecrosis of the femoral head (ONFH). Subchondral insufficiency fracture of the femoral head is an insufficiency fracture at the dome of the femoral head and has been known to be associated with osteoporosis, hip dysplasia, and posterior pelvic tilt. This study's aims were to evaluate (1) surgical complications, (2) radiological changes, (3) clinical results, and (4) survivorship of THA in patients with SIFFH. From November 2010 to June 2017, 21 patients (23 hips); 5 men (5 hips) and 16 women (18 hips) underwent cementless THA due to SIFFH at our institution. Their mean age was 71.9 years (range, 57 to 86) at the time of surgery, and mean T-score was -2.2 (range, -4.2 to 0.2). The mean lateral center-edge angle, abduction, and anteversion of the acetabulum were 29.9° (range, 14.8° to 47.5°), 38.5° (range, 31° to 45°), and 20.0° (range, 12° to 25°), respectively. The mean pelvic incidence, lumbar kyphotic angle and posterior pelvic tilt were 56.4° (range, 39° to 79°), 14.7° (range, -34° to 43°), and 13.0° (range, 3° to 34°), respectively. An intraoperative calcar crack occurred in 1 hip. The mean anteversion and abduction of cup were 29.0° (range, 17° to 43°) and 43.3° (range, 37° to 50°), respectively. One patient sustained a traumatic posterior hip dislocation 2 weeks after the procedure, and was treated with open reduction. At a mean follow-up of 35.4 months (range, 24 to 79 months), no hip had prosthetic loosening or focal osteolysis. At the latest follow-up, the mean modified Harris hip score was 79.1 (range, 60 to 100) points, and mean UCLA activity score was 4.2 (range, 2 to 7) points. The survivorship was 95.7% (95% CI, 94.9% to 100%) at 6 years. Cementless THA is a favorable treatment option for SIFFH in elderly patients. 3.

Do cobalt and chromium blood metal ion levels normalize after revision of failed metal-on-metal total hip replacements?

Increased cobalt (Co) and chromium (Cr) serum levels are one reason for revision surgery in metal on metal (MoM) total hip arthroplasty (THA) patients. Dual mobility liners are a simple revision option; however, they preserve the metal shell and stem and it is thereforenot clear if metal ion levels will fully normalize after revision surgery. Between April 2013 and December 2017 25 hips (24 patients) underwent revision from a MoM THA to an off-label dual mobility liner. Five patients were lost to follow-up and one patient refused leaving 18 patients (11 men, 7 female, average age 63.9years) for pre- and postoperative metal ion level blood tests at a minimum follow-up of 2years. Fourteen patients were revised for osteolysis, two for elevated metal ion levels and two for fluid or cysts around the femoral or acetabular component. The average preoperative Co and Cr levels were 8.3µg/l and 5.0µg/l, respectively. At a minimum follow-up of 2years (30-95months), metal ions dropped to 0.8µg/l. Harris Hip Score (HHS), Hip Osteoarthritis Outcome Score (HOOS), Visual Analog Scale (VAS) and the UCLA activity score improved non-significantly from pre- to postoperative. There was one postoperative complication in the study cohort. One patient with persisting pain required revision surgery to a standard acetabular component during the follow-up period. The off-label use of a dual-mobility liner in the current study resulted in normalization of the metal ion levels suggesting that preserving the cobalt-chromium acetabular component has little impact on ion levels. In addition, dual mobility liners have a low complication and revision rate.

Identification of Factors Associated with Disease Progression in the Contralateral Hip of Patients with Symptomatic Femoroacetabular Impingement. (139)

Objectives:Femoroacetabular Impingement (FAI) is one of the most common causes of hip osteoarthritis. Nevertheless, the factors contributing to symptom development and FAI disease progression are poorly understood. The purpose of this study was to (1) investigate rates of symptom development in the contralateral hip of patients with FAI at mid-term follow-up, and (2) identify predictors of disease progression (symptom development) in the contralateral hip.Methods:This prospective study included 179 patients undergoing ipsilateral FAI surgery with no history of previous contralateral hip surgery. In the current study, the contralateral hip was assessed at minimum 5 year follow-up. Symptoms (defined as moderate pain) and the need for surgery were monitored over the study course. Statistical analysis compared patient and FAI imaging characteristics of patients developing symptoms to those who remained asymptomatic.Results:A total of 146 hips (81.5%) were included at a mean 6.7 years of follow-up. Thirty-nine (26.7%) presented with symptoms in the contralateral hip, while an additional 35 (23.9%) developed symptoms during the follow-up period. Twenty-Six (17.8%) progressed to surgery for their contralateral hip. Head-neck offset ratio (HNOR) on AP pelvis radiographs was significantly lower among hips that developed symptoms (0.16 vs. 0.15 p=0.03). Maximum alpha angle (p=0.41), lateral center edge angle (p=0.70), and crossover sign (p=0.12) were not predictive of symptoms. Patients with a UCLA activity score greater than 9 were less likely to develop symptoms (14% vs. 46%, p=0.081), but this was not statistically significant. The total arc of rotation in 90° of flexion (40.0° vs 50.8°, p=0.01) as well as external rotation at 900 of flexion (28.9° vs 36.6°, p=0.02) were decreased in hips developing symptoms. Internal rotation in flexion was not significantly decreased in symptomatic patients (11.1° vs 14.2°, p=0.11). Kaplan Meier survival analysis demonstrated 53% and 45% of patients remaining asymptomatic at 5 and 8 year time points (Figure).Conclusions:At a mean follow-up of 6.7 years, significant symptoms in the contralateral hip of patients with FAI are present in 50.7% of patients, while 49.3% remain asymptomatic or minimally symptomatic. We identified unique radiographic and physical exam findings that are associated with symptom development in patients with FAI. Specifically, decreased hip rotation arc and decreased HNOR were strongly associated with disease progression and may represent important factors for future risk modeling in FAI patients.

French hip resurfacing registry: A study of 1650 cases

BackgroundHip resurfacing has been the focus of many evaluations based on international registries but, to date, no prospective studies have evaluated this procedure in France. In 2015, the French Society for Orthopaedics and Traumatology (SoFCOT) and the French Hip and Knee Society concluded an agreement with the French Medicines Agency (ANSM) and French National Health Authority (HAS) to establish an exhaustive observational hip resurfacing registry. The primary objective of this study was to evaluate the hip resurfacing survival rate since the creation of the registry 5 years ago. The secondary objectives were to evaluate the clinical, functional, and radiological outcomes of hip resurfacing and to check the absence of specific complications related to this implant. HypothesisThe hypothesis was that the registry survival rate was below 0.5% per year. MethodsSince 2015, data from all patients undergoing hip resurfacing were collected into a monitored database using the software suite OrthoWave. The following were collected for each patient: demographics, anthropometric characteristics, clinical parameters (Postel Merle d’Aubigné score, Harris Hip Score, Oxford Hip Score, and UCLA Activity Score), and radiological findings. Completeness of data collection was checked once a year. ResultsIn total, 1650 hip resurfacings in 1506 patients (1409 males and 97 females) with a mean age of 50.7 years (range, 17–70 years) were included. Mean follow-up was 3.8 years (range, 2–4.8 years). Mean completeness of data recording was 98.2%. All clinical scores improved significantly. Hip revision was required for 7 (0.4%) complications including 4 femoral neck fractures, 1 aseptic lymphocyte-dominant vasculitis-associated lesion with a large joint effusion, 1 femoral component loosening, and 1 delayed sepsis requiring bipolar removal. At 5 years, the survival rate without hip revision for any cause was 99.6% (95% confidence interval, 99.3–100%). DiscussionThe short-term outcomes of patients in the French registry are encouraging in terms of complication and surgical revision rates. The near absence of complications related to metal-on-metal bearing surfaces demonstrates that the criteria used in France (at least 48mm head diameter, use of implants for which long-term data are available, and specific training of surgeons) ensure successful long-term outcomes. Level of evidenceII.

CORR Insights®: No Difference in Functional, Radiographic, and Survivorship Outcomes Between Direct Anterior or Posterior Approach THA: 5-Year Results of a Randomized Trial.

CORR Insights®: No Difference in Functional, Radiographic, and Survivorship Outcomes Between Direct Anterior or Posterior Approach THA: 5-Year Results of a Randomized Trial.