University Of California, Los Angeles Activity Score Research Articles

Use of a fluoroscopy‐based robotic‐assisted total hip arthroplasty system resulted in greater improvements in hip‐specific outcome measures at one‐year compared to a CT‐based robotic‐assisted system

AbstractBackgroundThe purpose of this study was to compare one‐year patient reported outcome measures between a novel fluoroscopy‐based robotic‐assisted (FL‐RTHA) system and an existing computerised tomography‐based robotic assisted (CT‐RTHA) system.MethodsA review of 85 consecutive FL‐RTHA and 125 consecutive CT‐RTHA was conducted. Outcomes included one‐year post‐operative Veterans RAND‐12 (VR‐12) Physical (PCS)/Mental (MCS), Hip Disability and Osteoarthritis Outcome (HOOS) Pain/Physical Function (PS)/Joint replacement, and University of California Los Angeles (UCLA) Activity scores.ResultsThe FL‐RTHA cohort had lower pre‐operative VR‐12 PCS, HOOS Pain, HOOS‐PS, HOOS‐JR, and UCLA Activity scores compared with patients in the CT‐RTHA cohort. The FL‐RTHA cohort reported greater improvements in HOOS‐PS scores (−41.54 vs. −36.55; p = 0.028) than the CT‐RTHA cohort. Both cohorts experienced similar rates of major post‐operative complications, and had similar radiographic outcomes.ConclusionsUse of the fluoroscopy‐based robotic system resulted in greater improvements in HOOS‐PS in one‐year relative to the CT‐based robotic technique.

Patients Undergoing Postless Hip Arthroscopy Demonstrate Significantly Better Patient-Reported Outcomes and Clinically Significant Outcomes Compared to Conventional Post-Assisted Hip Arthroscopy at Short-Term Follow-Up

PurposeTo prospectively compare the short-term clinical outcomes of patients undergoing hip arthroscopy with versus without the use of a perineal post. MethodsA prospective, single-surgeon cohort study was performed on a subset of patients undergoing hip arthroscopy between 2020 and 2022. A post-free hip distraction system was used at one center at which the senior author operates, and a perineal post was used at another surgical location. An electronic survey of Patient-Reported Outcome Measures (PROMs) was completed by each patient at a minimum of 1 year postoperatively. PROMs included a Visual Analogue Scale (VAS) for pain, University of California Los Angeles (UCLA) Activity Scale, modified Harris Hip Score (mHHS), Hip Outcome Score-Sports-Specific Subscale (HOS-SSS), and a Single Assessment Numeric Evaluation (SANE). Postoperative scores and clinically significant outcomes including the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptom state (PASS) for each PROM were compared between groups. ResultsSixty-nine patients were reached for follow-up (41 post, 28 postless) of 87 patients eligible for the study (79%). No significant differences were found between groups in terms of sex (post: 61% female, postless: 54% female, p = 0.54), age (post: 34 years, postless: 29 years, p = 0.11), body mass index (post: 26 kg/m2, postless: 24 kg/m2, p = 0.23) or follow-up duration (post: 24.4 months, postless: 21.3 months, p = 0.16). There was a significantly higher VAS (3.1 vs 1.4, p = 0.01), significantly lower UCLA Activity Score (7.0 vs 8.4, p = 0.02), and significantly lower mHHS (73.7 vs. 82.2, p = 0.03) in the post-assisted group. A significantly higher proportion of patients in the postless group achieved a PASS for the UCLA (89.3% vs. 68.3%, p = 0.04), mHHS (84.6% vs. 61.0%, p = 0.04), and HOS-SSS (84.0% vs. 61.0%, p = 0.048), and a SCB for HOS-SSS (72.0% vs. 41.5%, p = 0.02). One patient (2.6%) in the post group underwent revision hip arthroscopy and another was indicated for total hip arthroplasty by the time of follow-up. ConclusionPostless hip arthroscopy may result in better clinical outcomes compared to post-assisted hip arthroscopy. Level of EvidenceIII, retrospective cohort study

Lateral Unicompartmental Knee Arthroplasty for Osteoarthritis Secondary to Lateral Meniscectomy: High Functional Results and Survivorship and Low Osteoarthritis Progression at a Mean 10 Years of Follow-up.

Meniscectomy, whether partial or total, is a common knee surgery, but it considerably increases the risk of knee osteoarthritis (OA). Lateral meniscectomy has more severe consequences than medial meniscectomy, leading to faster OA progression and worse clinical outcomes. Unicompartmental knee arthroplasty (UKA) is a suitable treatment option for lateral OA and has demonstrated better outcomes than total knee arthroplasty (TKA). The aims of this study were to evaluate the clinical and functional results, OA progression in the medial compartment, and implant survivorship following lateral UKA in patients with OA secondary to lateral meniscectomy and to compare these outcomes with those of patients who underwent lateral UKA for primary lateral OA. Between 2001 and 2017, 214 lateral UKAs were performed. Of these, 42 were performed for OA secondary to lateral meniscectomy. The control group was composed of patients who underwent lateral UKA for primary lateral OA and was formed through a 1:1 case-control matching process based on sex, age, body mass index, and operation date. The outcomes that were studied included range of motion, Knee Society Score, University of California Los Angeles (UCLA) Activity Score, Tegner Activity Scale, Forgotten Joint Score, visual analog scale for pain, OA progression in the medial compartment, and implant survivorship. At a mean follow-up of 10.2 years, both groups demonstrated significant improvements (p < 0.01) after lateral UKA in all clinical and functional scores except the UCLA Activity Score and Tegner Activity Scale. No significant differences in clinical and functional scores were found between the groups. However, patients with OA secondary to meniscectomy exhibited significantly less OA progression in the medial compartment (p = 0.035) and higher 10-year implant survival (97.6% versus 83.3%). Lateral UKA is an effective treatment option for OA secondary to lateral meniscectomy, providing excellent functional outcomes and survivorship. Patients with post-meniscectomy OA exhibited less OA progression in the medial compartment than patients with primary OA and, consequently, had better 10-year implant survivorship. Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

Use of a fluoroscopy-based robotic-assisted total hip arthroplasty system produced greater improvements in patient-reported outcomes at one year compared to manual, fluoroscopic-assisted technique

IntroductionThe adoption of new technology should be supported by improvements in patient-reported outcomes (PROMs). The purpose of this study was to assess the one-year PROMs of patients who underwent total hip arthroplasty (THA) using a novel, fluoroscopy-based, robotic-assisted (RA-THA) system when compared to a manual, fluoroscopic-assisted technique (mTHA).Materials and methodsA review of 91 consecutive mTHA and 85 consecutive RA-THA via a direct anterior approach was conducted. All cases were performed by the same surgeon at the same institution, for a pre-operative diagnosis of osteoarthritis, avascular necrosis, or rheumatoid arthritis. Outcomes included one-year Veterans RAND-12 (VR-12) Physical/Mental, Hip Disability and Osteoarthritis Outcome (HOOS) Pain/Physical Function/Joint Replacement, and University of California Los Angeles (UCLA) Activity scores, as well as the difference between pre-operative and one-year post-operative PROMs.ResultsPatients in the RA-THA cohort had lower pre-operative HOOS-JR scores compared to patients in the mTHA cohort (37.0 vs. 43.1; p = 0.031). Cohorts experienced similar one-year post-operative VR-12, HOOS, and UCLA Activity scores. Patients in the RA-THA cohort experienced greater improvements across all pre- and post-operative HOOS scores compared to patients in the mTHA cohort: Pain (+ 54.7 vs. +42.1; p = 0.009), Physical Function (-41.6 vs. -28.7; p = 0.007), and Joint Replacement (+ 46.6 vs. +33.0; p = 0.002). These differences exceeded minimum clinically important difference (MCID).ConclusionsBoth manual and robotic cohorts experienced benefit from THA at one-year post-operative. Importantly, the use of a novel, fluoroscopy-based robotic assistance system for primary THA resulted in greater improvements in PROMs at one-year relative to manual technique.

Outcomes and Return-to-Sports Rates in Patients With Borderline Hip Dysplasia After Periacetabular Osteotomy: A Case Series With 5-Year Follow-up

Background: The optimal surgical approach in patients with borderline hip dysplasia (BHD) remains controversial. Both hip arthroscopy and periacetabular osteotomy (PAO) are commonly employed in this patient population. Those who participate in sports want to resume and maintain sports activities after surgery, and the ability to do so plays an important role in the choice of a treatment method. To our knowledge, no previous study has assessed return-to-sports rates and activity levels in patients with BHD after PAO. Purpose: To assess return-to-sports rates and postoperative activity levels as measured by the University of California, Los Angeles (UCLA), activity scale as well as patient-reported outcome measures. Also to assess changes in sports activity both qualitatively and quantitatively as well as underlying reasons for these changes. Study Design: Case series; Level of evidence, 4. Methods: We conducted a retrospective analysis of prospectively collected data from 55 hips in 52 patients with BHD who underwent PAO between January 2015 and June 2017. Return-to-sports rates, UCLA activity scores, International Hip Outcome Tool–12 scores, Subjective Hip Value scores, Hip disability and Osteoarthritis Outcome Score subscores, sports practiced, frequency and duration of sports activity, and postoperative changes as well as underlying reasons were recorded. Results: The mean follow-up was 62.8 ± 9.0 months. The return-to-sports rate among preoperatively active patients was 92.5%. Most patients resumed sports activity after 6 months (50%) or after 3 to 6 months (37.5%). The UCLA activity score improved significantly (from 5.2 ± 2.4 to 7.0 ± 1.8; P < .001). The International Hip Outcome Tool-12, Subjective Hip Value, and Hip disability and Osteoarthritis Outcome Score scores also improved significantly (all, P < .001). Changes in sports activity occurred in 34.5% of cases after PAO. Significantly more patients engaged in low-impact sports postoperatively. Participation in high-impact sports did not decrease significantly. Reasons for changes were both hip related and non–hip related. Quantitatively, patients were able to significantly increase both the frequency (P = .007) and duration (P = .007) of sports activity. Conclusion: The return-to-sports rate in patients with BHD after PAO was high at over 92%. Most patients returned to sports after a period of 6 months or 3 to 6 months. Overall, activity levels and hip function improved after PAO. A number of patients adjusted their sports activity after PAO. Although more patients engaged in low-impact sports, participation in high-impact sports was maintained postoperatively. The results of this study may help both patients and orthopaedic surgeons in deciding on the best surgical procedure in the setting of BHD.

DOES SOCIOECONOMIC DEPRIVATION INFLUENCE PATIENT OUTCOMES AFTER PERIACETABULAR OSTEOTOMY?

Higher levels of socioeconomic deprivation have been associated with worse health outcomes. The influence of socioeconomic deprivation on patients undergoing periacetabular osteotomy (PAO) has not previously been investigated.A total of 217 patients (171 female, 46 male; median age 23.4 years) who underwent PAO by a single surgeon were identified. Patients were categorised into three groups according to their New Zealand Deprivation (NZDep) Index: minimal deprivation (NZDep Index 1–3, n=89), moderate deprivation (NZDep Index 4-6, n=94), and maximal deprivation (NZDep Index 7-10, n=34). The three groups were compared with respect to baseline variables, surgical details, complications, and pre-operative and two-year post-operative functional scores (including International Hip Outcome Tool (iHOT-12), EQ-5D quality of life score, and University of California Los Angeles (UCLA) activity score). Multivariate regression was undertaken to assess for the effect of NZDep Index on patient outcomes.Patients in the maximal deprivation group were more likely to be Māori (p&lt;0.001) and have surgery in a public rather than a private hospital (p=0.004), while the minimal deprivation group demonstrated a lower BMI (p=0.005). There were otherwise no other significant differences in baseline variables, surgical details, complications, nor pre-operative or two-year post-operative functional scores between the three groups (all p&gt;0.05). Multivariate analysis identified a higher NZDep Index to be independently predictive of a lower pre-operative UCLA activity score (p=0.014) and a higher two-year iHOT-12 score (p&lt;0.001).Our results demonstrate an inequality in access to PAO, with patients exposed to higher levels of socioeconomic deprivation under-represented in our study population. When provided access to PAO, these vulnerable patients achieve significant functional improvement at least as great as patients with less socioeconomic deprivation. Initiatives to improve access to hip preservation care in socioeconomically deprived populations appear warranted.

Changes in Sports Activity After Periacetabular Osteotomy: A Qualitative and Quantitative Analysis

Background: Patients undergoing periacetabular osteotomy (PAO) for symptomatic developmental dysplasia of the hip are usually young and active with high functional demands. Those who participate in sports seek surgical therapy to resume or maintain sports activities. There is little evidence regarding the postoperative level of activity and the extent to which sports activity changes after PAO both qualitatively and quantitatively. Purpose: The aim of this study was to determine the change in activity level as measured using the University of California Los Angeles (UCLA) activity score and the changes in qualitative and quantitative sports activity. Study Design: Case series; Level of evidence, 4. Methods: This was a retrospective analysis of prospectively collected data of 123 hips in 111 patients who underwent PAO for developmental dysplasia of the hip between January 2015 and June 2017. UCLA activity score, International Hip Outcome Tool 12, and Subjective Hip Value, as well as practiced sports, frequency and duration of sports activity, and time to return to sports, were assessed. Eventual changes in practiced sports and reasons for those changes were recorded. Results: Of the participating patients, 85% were female and 15% were male. The mean patient age at the time of surgery was 27.7 ± 7.3 years. Mean follow-up was 63 ± 10 months. UCLA score (5.08 ± 2.44 vs 6.95 ± 1.74; P < .001), International Hip Outcome Tool 12 (41.4 ± 22.2 vs 72.6 ± 22.9; P < .001), and Subjective Hip Value (42.8 ± 24.3 vs 80.4 ± 17.8; P < .001) increased significantly from pre- to postoperatively. Significantly more patients participated in low-impact sports postoperatively (31.7% vs 52%; P = .001). Participation in high-impact sports decreased (42.3% vs 36.6%; P = .361). The overall sports activity rate increased significantly (78.8% vs 90.8%; P = .008). Quantitatively, sports frequency in times per week (P < .001) as well as length of exercise per time (P = .007) increased significantly. A total of 52 patients (42%) changed sports activities postoperatively. Of these, 35 (28.4%) reported having stopped previously practiced sports after surgery, while 17 (13.8%) reported having started new sports. Reasons for starting and stopping certain sports varied and included hip- and non–hip related ones. In only 2 cases was physician’s advice given as a reason for changing the sport. Conclusion: Patients can improve their sports activity both qualitatively and quantitatively after PAO. However, a relevant proportion of patients adjusts their sports activities for a variety of hip-related and non–hip related reasons.

Sports activity participation and subjective health status of patients after total hip arthroplasty via the anterolateral-supine approach: a case series study

BackgroundNo reports have been published about participation in sports activity and subjective health status after total hip arthroplasty via the anterolateral approach in the supine position (ALS-THA) in Japanese patients. This study assessed sports activity participation and subjective health status, as well as factors potential associated with these variables, in patients who underwent ALS-THA.MethodsOf 698 patients who underwent total hip arthroplasty at our institution between 2013 and 2018, questionnaires were sent to 355 patients under 80 years old who had undergone ALS-THA and 242 responded. Patients were asked about their subjective health status, participation in sports activity, the EuroQol 5-dimensions 5-level (EQ-5D-5L), the University of California Los Angeles (UCLA) activity scale score and the Forgotten Joint Score (FJS). Patient characteristics and hospitalization information were also collected. Patients’ subjective health status was categorized as “healthy” or “unhealthy”. Univariate and multivariate logistic regression analyses were performed to determine factors associated with participation in sports activity after ALS-THA and a “healthy” status.ResultsThe pre- and postoperative sports activity participation rates were 54.0% and 57.8%, respectively. Most patients (76.8%, n = 182) were considered “healthy”. Age (P = .019) and UCLA activity score (P < .001) were significantly associated with sports activity after ALS-THA. FJS (P = .002) and EQ-5D-5L (P = .004) were significantly associated with a “healthy” status.ConclusionPatients participating in sports activity after ALS-THA are older and have higher UCLA activity scores and patients considered “healthy” have higher FJS and EQ-5D-5L scores.

Factors Associated With Disease Progression in the Contralateral Hip of Patients With Symptomatic Femoroacetabular Impingement: A Minimum 5-Year Analysis

Background: Femoroacetabular impingement (FAI) is one of the most common causes of hip osteoarthritis, yet the factors controlling disease progression are poorly understood. Purpose: To investigate rates of initial and subsequent symptoms in the contralateral hip of patients with FAI, and identify predictors of disease progression (symptom development and surgical intervention) in the contralateral hip. Study Design: Cohort study; Level of evidence, 2. Methods: This prospective study included a minimum 5-year follow-up of the contralateral hip in 179 patients undergoing FAI surgery. Symptoms (moderate pain) and surgical progression were monitored. Univariate and multivariate analyses compared patient-specific and imaging characteristics of symptomatic patients with those who remained asymptomatic to identify factors associated with disease progression. Results: A total of 150 patients (84% follow-up) were followed for a mean of 7.1 years (range, 5-11 years). Thirty-nine of these patients (26% [39/150]) had contralateral hip symptoms at initial evaluation. Of those without contralateral hip symptoms at initial evaluation, 32% (36/111) had developed contralateral hip symptoms by latest follow-up. Those who developed symptoms during the study period had a lower anteroposterior head-neck offset ratio (0.153 vs 0.165; P = .005), decreased total arc of rotation in 90° of flexion (39.9° vs 51.1°; P = .005), and decreased external rotation in 90° of flexion (28.6° vs 37.1°; P = .003) compared with those who never developed symptoms. Age, sex, body mass index, alpha angle, lateral center-edge angle, internal rotation in flexion, and University of California, Los Angeles (UCLA), activity score were similar between these groups. Those with contralateral symptoms at initial evaluation progressed to contralateral surgery at a rate of 41% (16/39) and those who developed contralateral symptoms during the study period progressed to contralateral surgery at a rate of 28% (10/36). Among those with contalateral hip symptoms (either present initially or developed during study period)), younger age (24.6 vs 34.1 years; P < .001) and baseline UCLA activity score ≥9 (P = .003) were associated with progression to surgery. By Kaplan-Meier analysis, 64%, 54%, and 48% of patients remained free of contralateral hip symptoms at 2, 5, and 10 years. Conclusion: At a mean follow-up of 7.1 years, significant symptoms in the contralateral hip of patients with FAI were present in approximately 50% of patients. FAI disease progression (symptom development and surgical intervention) was associated with decreased hip rotation arc, decreased external rotation, and decreased head-neck offset ratio. In symptomatic patients, younger age and UCLA activity score ≥9 were associated with progression to surgery. These findings represent important factors for patient counseling and risk modeling in FAI.

The Desired Oxford Knee Score Obtained Before Total Knee Arthroplasty is Predictive of the Postoperative Oxford Knee Score: A Prospective Study

BackgroundThe relationship between patient expectations and patient-reported outcome measures (PROMs) after total knee arthroplasty (TKA) is not well understood. The purpose of the study was to test the influence of desired knee function on postoperative perceived knee function 1 year after TKA. MethodsA total of 102 patients undergoing primary TKA were available for data analyses. Preoperatively, patients completed the Oxford Knee Score (OKS) twice, one representing preoperative function (preoperative OKS); the second representing desired function after TKA (desired OKS). Western Ontario and McMaster Universities Arthritis Index (WOMAC), University of California, Los Angeles (UCLA) Activity score, Hospital for Special Surgery Knee Replacement Expectations Survey (HSS-KRES), Patient Health Questionnaire-9, and EuroQol-visual analogue scales were obtained preoperatively. One year after surgery, all surveys besides the UCLA activity score and HSS-KRES were repeated. The associations between postoperative OKS and WOMAC versus desired OKS and HSS-KRES were assessed using multivariable linear regression models, wherein linear regression coefficients represent the additive effect on the mean postoperative PROM. ResultsThe desired OKS was independently associated with the postoperative OKS (linear regression coefficient = 0.43; P = .011), that is, each point increase in desired OKS yielded a 0.43 increase in postoperative OKS. The preoperative OKS showed no association with postoperative PROMs. Desired OKS was correlated with postoperative WOMAC (coefficient = −0.67; P = .014). The HSS-KRES was not associated with the postoperative OKS (coefficient = −0.005; P = .965) or WOMAC (coefficient = 0.18; P = .288). ConclusionIn TKA patients, higher preoperative desired function predict greater postoperative PROMs. Effects of preoperative expectations on outcomes are independent of patient demographics or preoperative function.

Quels niveaux d’activité sportive peut-on atteindre à long terme après une amputation majeure des membres inférieurs pour tumeur maligne ? Une analyse avec un recul minimum de vingt ans

BackgroundIt is well-known that exercise through sports and physical activity has beneficial effects on health. After lower extremity amputation, low rates of participation in sports activities have been shown. So far, there is only limited scientific long-term information concerning sports activity and feasible types of sports in patients with lower extremity amputations due to malignant tumors. This study sought to provide very long-term information about the following questions: (1) What sports activity levels can be achieved after lower extremity amputation due to a malignant tumor? (2) What are feasible types of sports? (3) Is the University of California Los Angeles (UCLA) Activity Score influenced by patient's age, the age at the time of surgery and the amount of prosthesis sockets used to date? HypothesisPatients with lower extremity amputation due to a malignant tumor cannot regularly participate in moderate sports activities (UCLA Activity Score≥6) in the very long term. Materials and methodsIn a retrospective questionnaire survey, 21 former patients (seven females, 14 males; median age: 60.5 years [range, 33–74]) who underwent an amputation of the lower extremity (14 transfemoral, four knee disarticulations, three transtibial) from 1961 to 1993 due to a malignant tumor were interviewed. The median follow-up was 41.1 years (range, 23–55). The patients were interviewed about types of sports, frequencies and durations of sports sessions at the time of the last follow-up, as well as retrospectively. Sports activity levels were then assessed based on the UCLA Activity Score. Demographic background, data on amputation level, histological results, prosthetic devices and revision surgeries were collected. ResultsSeven patients (33%) were still regularly exercising at least moderate sports activities at the last follow-up, including one patient regularly participating in impact sports. The preoperative median UCLA Activity Score of 9 (range, 2–10) decreased to 5 (range, 2–10) at the last follow-up (p<0.001). Swimming (13 patients, seven on a regular basis), cycling (seven), downhill skiing (five) and hiking (four) were among the most common feasible types of sports. Increasing age had a negative influence on the UCLA Activity Score (95% CI (−0.034, −0.006); RB=−0.020; SD=0.0074; p=0.007). ConclusionAfter a major amputation in the lower extremity due to a malignant tumor, high activity levels by practicing types of sports such as downhill skiing, are achievable. In the very long term, a regular participation in at least moderate activities, such as swimming, is possible. Programs for physical and sports activities, based on recommendations drawn from long-term experience, are necessary and should be individually tailored to amputees and their limitations. Level of evidenceIV.

Birmingham Hip Resurfacing for osteoarthritis — a Canadian retrospective cohort study with a minimum 10-year follow-up

Background:Young men with osteoarthritis of the hip are a growing segment of the population requiring arthroplasty, and there is compelling evidence that the Birmingham Hip Resurfacing (BHR) system provides good functional outcomes and durability in young, active men. We reviewed the survivorship and clinical outcomes of patients who underwent BHR with a minimum follow-up of 10 years.Methods:We analyzed survivorship using the Kaplan–Meier method. Functional scoring was performed using the Harris Hip Score (HHS), the University of California, Los Angeles (UCLA) Activity Score, and a visual analogue scale (VAS).Results:In total, 211 patients (243 hips) were included in the study. Of these, 107 patients (127 hips) were available for long-term clinical follow-up, with a mean duration of 12.4 ± 1.4 years. The proportion of male participants with BHRs surviving past 13 years was 93.8% (95% confidence interval [CI] 87.9%–100%) compared with 87% (95% CI 77.8%–97.3%) of female patients. Eleven patients (11 hips) underwent BHR revision. Upon final follow-up, the median HHS was 93.9 in males and 93.6 in females (p = 0.27); median UCLA Activity Score was 8.2 in males and 7.2 in females (p < 0.001), and the median VAS score was 81.9 in males and 81.3 in females (p = 0.35). The median acetabular component inclination was 45.5° ± 6.0° (range 34.6°–57.2°) in males and 44.6° ± 5.9° (range 29°–58.9°) in females. The most common femoral head size was 50 mm with a 56 mm or 58 mm cup (36.3%).Conclusion:This study confirms that BHR provides good to excellent functional outcomes, lasting functional improvements, and acceptable durability beyond 10 years in men. Survivorship following BHR is inferior in women; however, HHS and VAS scores were similar in women and men.

Development of a Clinical Prediction Rule to Identify Physical Activity After Total Hip Arthroplasty

ObjectiveTo develop clinical prediction rule (CPR) of physical activity 1 year after total hip arthroplasty (THA). DesignRetrospective cohort study. SettingUniversity hospital with orthopedic surgery. ParticipantsThe study group included 321 patients (56 men) who underwent primary THA (N=321). InterventionNot applicable. Main Outcomes MeasuresThe data collected included age, body mass index, clinical score from the questionnaires, hip pain, range of motion, muscle strength, and Physical functions (10-meter walk test [10MWT], timed Up and Go test, sit-to-stand test). Patients were classified into sufficient and insufficient activity groups based on their University of California, Los Angeles (UCLA) activity score 1 year after THA. Variables measured preoperatively and 3 weeks postoperatively were analyzed using univariate and multivariate methods to derive CPR for physical activity. ResultsA CPR was developed using the following 5 factors and cutoffs: age 70.5 years or younger, preoperative UCLA activity score ≥3.5, preoperative hip abduction strength ≥0.54 Nm/kg, preoperative knee extension strength ≥1.04 Nm/kg, and 10MWT ≤8.49 seconds 3 weeks after surgery. The presence of 4 of the 5 factors predicted a sufficient physical activity level at 1 year, with a positive likelihood ratio of 5.94 and probability of 85.4%. The presence of 5 predictor variables increased the probability of sufficient physical activity after THA to 94.7%. ConclusionsThis study developed a CPR for physical activity 1 year after THA. Having 4 or more of the 5 measurements were useful indicators for predicting of physical activity 1 year postoperatively.

Patellofemoral arthroplasty: obesity linked to high risk of revision and progression of medial tibiofemoral osteoarthritis.

The purpose of this study was to determine the effect of obesity on patient outcome, procedure failure rate and osteoarthritis (OA) progression in the tibiofemoral compartments in a series of isolated patellofemoral arthroplasty (PFA) performed with a third-generation implant. The study population was patients who had undergone third-generation PFA at a specialized orthopedic center between 2007 and 2017. Patients were categorized by body-mass index (BMI) as obese (O, BMI > 30kg/m2) or nonobese (NO, BMI < 30kg/m2). Preoperative and postoperative clinical and functional assessment included knee range of motion, Knee Society Score (KSS), University of California Los Angeles (UCLA) Activity Score, Tegner Activity Level Scale, and visual analogue scale (VAS) for pain. Preoperative and postoperative radiographs were evaluated for progression of tibiofemoral compartment OA, changes in patellar height and in knee coronal alignment. Multiple logistic regression models were used to assess the effect of BMI on outcomes together with other covariates. A total of 120 PFAs with a mean follow-up of 6.9 ± 2.5years were included: 25 in the O group and 95 in the NO group. Significant improvement was noted in in knee range of motion (P < 0.001), clinical and functional KSS (P < 0.001), UCLA Activity Score (P < 0.001), Tegner score (P < 0.001) and VAS pain (P < 0.001) without inter-groups differences. Worsening of the medial Kellgren-Lawrence (KL) grade (but not the lateral KL grade) was more frequent in the O than the NO group during the follow-up period (P = 0.014). Failure occurred in 4.2% of NO and in 20% of O group patients; the difference was solely due to failure because of OA progression in the tibiofemoral compartment (16% in the O group). There were no between group differences in the failure rate for any cause other than OA progression (4.2% in the NO group, 4.0% in the O group). An equal improvement in function after PFA was noted in both obese and nonobese patients; however, the high failure rate due to OA progression in the medial tibiofemoral compartment warrants caution when considering PFA in obese patients.

Clinical Performance of an Ultrashort, Proximally Porous-Coated and Tapered Metaphyseal-Fitting Cementless Femoral Stem Among Octogenarians.

Total hip arthroplasty (THA) among octogenarians presents greater challenges than among the younger patient population because of the high risk of perioperative morbidity and mortality and poor bone quality. We determined the clinical performance and radiographic results of an ultrashort, proximally porous-coated and tapered metaphyseal-fitting cementless femoral stem for octogenarians. A total of 100 unselected octogenarians (112 hips) were included in this retrospective study. All patients received the ultrashort, proximally porous-coated and tapered cementless stem during the study period, but patients who could not walk preoperatively were excluded from the analysis. Their mean age was 82.3±12.1 years (range, 80-92 years). Assessment was performed with the Harris Hip Score; Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score; thigh pain; University of California, Los Angeles (UCLA) activity score; and radiographic results. The mean duration of follow-up was 7.6 years (range, 6-9 years). At the final follow-up, the mean Harris Hip Score was 87±13 points, the mean WOMAC score was 26±8 points, and the mean UCLA activity score was 4.5 points. Osseointegration was obtained for 105 (94%) acetabular components and 110 (98%) femoral components. Kaplan-Meier survivorship analysis at 9 years showed that the survival rate for the acetabular component was 94% (95% CI, 91-98) and that of the femoral component was 98% (95% CI, 91-100), with aseptic loosening or revision as the end point. The ultrashort cementless femoral component provides stable fixation without the need for diaphyseal fixation among octogenarians. [Orthopedics. 2022;45(3):181-186.].

What sports activity levels can be achieved in the long-term after major lower extremity amputation for malignant tumors? – A minimum follow-up of twenty years

BackgroundIt is well-known that exercise through sports and physical activity has beneficial effects on health. After lower extremity amputation, low rates of participation in sports activities have been shown. So far, there is only limited scientific long-term information concerning sports activity and feasible types of sports in patients with lower extremity amputations due to malignant tumors. This study sought to provide very long-term information about the following questions: (1) What sports activity levels can be achieved after lower extremity amputation due to a malignant tumor? (2) What are feasible types of sports? (3) Is the University of California Los Angeles (UCLA) Activity Score influenced by patient's age, the age at the time of surgery and the amount of prosthesis sockets used to date? HypothesisPatients with lower extremity amputation due to a malignant tumor cannot regularly participate in moderate sports activities (UCLA Activity Score≥6) in the very long-term. Materials and methodsIn a retrospective questionnaire survey, 21 former patients (seven females, 14 males; median age: 60.5years [range: 33–74]) who underwent an amputation of the lower extremity (14 transfemoral, four knee disarticulations, three transtibial) from 1961 to 1993 due to a malignant tumor were interviewed. The median follow-up was 41.1years (range: 23–55). The patients were interviewed about types of sports, frequencies and durations of sports sessions at the time of the last follow-up, as well as retrospectively. Sports activity levels were then assessed based on the UCLA Activity Score. Demographic background, data on amputation level, histological results, prosthetic devices and revision surgeries were collected. ResultsSeven patients (33%) were still regularly exercising at least moderate sports activities at the last follow-up, including one patient regularly participating in impact sports. The preoperative median UCLA Activity Score of 9 (range: 2–10) decreased to 5 (range: 2–10) at the last follow-up (p<0.001). Swimming (13 patients, seven on a regular basis), cycling (seven), downhill skiing (five) and hiking (four) were among the most common feasible types of sports. Increasing age had a negative influence on the UCLA Activity Score [95% CI (−0.034, −0.006); RB=−0.020; SD=0.0074; p=0.007]. ConclusionAfter a major amputation in the lower extremity due to a malignant tumor, high activity levels by practicing types of sports such as downhill skiing, are achievable. In the very long-term, a regular participation in at least moderate activities, such as swimming, is possible. Programs for physical and sports activities, based on recommendations drawn from long-term experience, are necessary and should be individually tailored to amputees and their limitations. Level of evidenceIV.

Investigating sagittal spinal alignment, low back pain, and clinical outcomes after total hip arthroplasty for lumbar hyperlordosis: a retrospective study.

Hip-spine syndrome, wherein flexion deformity of the hip might exaggerate normal lumbar lordosis (LL), was first described in 1983. It could result in subluxation of the posterior facets and cause low back pain (LBP). However, the clinical outcomes of total hip arthroplasty (THA) and spinal alignment changes in patients with lumbar hyperlordosis (hyper LL) remain unknown. We aimed to clarify the proportion of patients with hyper LL before THA and compare pre- and post-operative sagittal spinal alignment, LBP, and clinical outcomes between patients with hyper LL and those with normal LL. We investigated 278 patients who underwent primary THA between December 2015 and December 2019. Spine radiographs in the standing position were examined preoperatively and 1year postoperatively. Patients with hyper LL were defined as having a pelvic incidence (PI) minus LL of < - 9° preoperatively. The control group included age- and sex-matched patients with normal LL, defined by a PI minus LL of - 9° to 9°. Clinical outcomes were evaluated using the visual analogue scale (VAS) for LBP, Harris hip score (HHS), Oxford hip score (OHS), and University of California, Los Angeles (UCLA) activity score. Thirty-eight patients (13.7%) had hyper LL, and they exhibited a lower pelvic tilt, lower sagittal vertical axis, and greater sigmoid curvature than did the controls. Evaluation of changes in the spinal alignment after surgery showed that the pelvis tilted more posteriorly, and LL decreased more in the hyper LL group than in the control group. Pre- and post-operative VAS for LBP, HHS, OHS, and UCLA activity scores were not significantly different between the two groups. Hyper LL in patients with hip osteoarthritis had no adverse effects on LBP and the clinical outcomes of THA. Hyper LL may partially result from a flexible and adaptable lumbo-pelvic structure.

Outcomes of dual mobility articulation total hip arthroplasty in ipsilateral residual poliomyelitis.

Patients with poliomyelitis underwent total hip arthroplasty (THA) are known to be at higher risk of dislocation on account of muscular atrophy. This study aimed to investigate clinical outcomes, radiographic outcomes, complication rates, and survivorship of dual mobility THA in displaced femoral neck fractures of elderly with poliomyelitis. We retrospectively included 17 patients (17 hips) with residual poliomyelitis who underwent THA with dual mobility articulation. Clinical outcomes were assessed with the visual analog scale (VAS) pain score, Oxford hip score, and University of California Los Angeles activity (UCLA) score. Radiographic outcomes were examined by radiographs. Complications and re-operations following THA were recorded. The mean follow-up period was 77.05months. The mean VAS, Oxford hip score, and UCLA score were improved significantly. In all but one patient, no complications were occurred. Re-operation was carried out in one patient due to posterior dislocation. The Kaplan-Meier survivorship with an end point of re-operation for any reason was 94.1%. THA with dual mobility system is proved to be effective in strengthening stability and reducing the risk of dislocation, which is suitable for patients with neuromuscular disease. Hence, in elderly with residual poliomyelitis, dual mobility THA is a valid choice as a treatment for displaced femoral neck fractures.

Does Activity Level After Primary Total Hip Arthroplasty Affect Aseptic Survival?

BackgroundThe purpose of this study is to evaluate survivorship and outcomes of high-activity patients compared to low-activity patients after total hip arthroplasty.MethodsA retrospective review identified 2002 patients (2532 hip) that underwent a primary total hip arthroplasty with vitamin E–infused highly crosslinked polyethylene liner. Patients were divided into 2 groups based on their University of California Los Angeles (UCLA) activity level: low activity (LA) (UCLA ≤5) and high activity (HA) (UCLA ≥6). Outcomes included Harris Hip Score, UCLA activity score, and reoperations. A multivariate nominal regression analysis was performed to evaluate the significance of postoperative activity level on survivorship.ResultsThe mean follow-up duration was 4.5 years (range, 0.3 to 9.9 years). HA group had significantly higher improvements in Harris Hip Score (HHS) (P < .001) and UCLA activity score (P < .001). Aseptic revisions were performed in 2.1% of the LA group and in 0.4% hips of the HA group (P < .001). After controlling for age, gender, preoperative pain, HHS, and body mass index, a higher postoperative activity level remained a significant factor for improved aseptic survivorship with an odds ratio of 4.9 (95% confidence interval, 1.1 to 21.2, P = .03). The all-cause 5-year survivorship was 99% for the HA group and 96% to for the LA group (P < .001). The aseptic 5-year survivorship was 99.6% for the HA group and 98% for the LA group (P < .001).ConclusionsThis study found that a higher activity level after primary THA was not deleterious to survivorship at short to midterm follow-up with modern implants.

Patient-reported outcomes after primary or revision total hip arthroplasty: A propensity score-matched Asian cohort study.

BackgroundFew studies have compared patient-reported outcome measures (PROMs) between primary and revision total hip arthroplasty (THA). We investigated and compared PROMs between propensity score-matched primary and revision THA in an Asian cohort.MethodsThe Oxford Hip Score (OHS) and University of California-Los Angeles (UCLA) activity score, satisfaction score, and Short Form-12 Health Survey (SF-12) were compared between 110 primary and 110 revision THAs after propensity score matching. Multivariate analyses were performed to determine which factors, including patients’ demographics, indication for revision, and pre-operative PROMs, were associated with post-operative PROMs in the revision THA cohort.ResultsThe revision THA cohort demonstrated significantly lower post-operative OHS, UCLA activity score, and satisfaction score (10% decrease on average) than those in the primary THA cohort (P < .05). The difference in SF-12 mental component summary measure (MCS) between the two cohorts was statistically insignificant (P = .24). In multivariate analysis for the revision THA cohort, lower post-operative UCLA activity score was significantly associated with higher BMI and lower pre-operative UCLA activity score (P < .05).ConclusionRevision THA was associated with a modest but significant decrease in physical PROMs as compared with primary THA. Pre-operative UCLA activity score significantly affected the post-operative physical outcome measures in the revision THA cohort. However, post-operative SF-12 MCS was comparable between the primary and revision THA cohorts.