Aims. In previous studies, we identified multiple factors influencing the survivorship of hip resurfacing arthroplasties (HRAs), such as initial anatomical conditions and surgical technique. In addition, the University of California, Los Angeles (UCLA) activity score presents a ceiling effect, so a better quantification of activity is important to determine which activities may be advisable or detrimental to the recovered patient. We aimed to determine the effect of specific groups of sporting activities on the survivorship free of aseptic failure of a large series of HRA. Patients and Methods. A total of 661 patients (806 hips) representing 77% of a consecutive series of patients treated with metal-on-metal hybrid HRA answered a survey to determine the types and amounts of sporting activities they regularly participated in. There were 462 male patients (70%) and 199 female patients (30%). Their mean age at the time of surgery was 51.9 years (14 to 78). Their mean body mass index (BMI) was 26.5 kg/m. 2. (16.7 to 46.5). Activities were regrouped into 17 categories based on general analogies between these activities. Scores for typical frequency and duration of the sessions were used to quantify the patients’ overall time spent engaging in sporting activities. Impact and cycle scores were computed. Multivariable models were used. Results. We found no association between any category of activity and a decrease in survivorship. Impact and hip cycle scores also failed to show any association with revision for aseptic failure or wear. Conclusion. Return to sporting activities after surgery is safe for patients treated with well-designed and well-implanted HRA. Cite this article: Bone Joint J 2019;101-B:1186–1191

Aims. Young adults undergoing total hip arthroplasty (THA) largely have different indications for surgery, preoperative function, and postoperative goals compared to a standard patient group. The aim of our study was to describe young adult THA preoperative function and quality of life, and to assess postoperative satisfaction and compare this with functional outcome measures. Methods. A retrospective cohort analysis of young adults (aged < 50 years) undergoing THA between May 2018 and May 2023 in a single tertiary centre was undertaken. Median follow-up was 31 months (12 to 61). Oxford Hip Score (OHS) and focus group-designed questionnaires were distributed. Searches identified 244 cases in 225 patients. Those aged aged under 30 years represented 22.7% of the cohort. Developmental dysplasia of the hip (50; 45.5%) and Perthes’ disease (15; 13.6%) were the commonest indications for THA. Results. Preoperatively, of 110 patients, 19 (17.2%) were unable to work before THA, 57 (52%) required opioid analgesia, 51 (46.4%) were reliant upon walking aids, and 70 (63.6%) had sexual activity limited by their pathology. One patient required revision due to instability. Mean OHS was 39 (9 to 48). There was a significant difference between the OHS of cases where THA met expectation, compared with the OHS when it did not (satisfied: 86 (78.2%), OHS: 41.2 (36.1%) vs non-satisfied: 24 (21%), OHS: 31.6; p ≤ 0.001). Only one of the 83 patients (75.5%) who returned to premorbid levels of activity did so after 12 months. Conclusion. Satisfaction rates of THA in young adults is high, albeit lower than commonly quoted figures. Young adults awaiting THA have poor function with high requirements for mobility aids, analgesia, and difficulties in working and undertaking leisure activities. The OHS provided a useful insight into patient function and was predictive of satisfaction rates, although it did not address the specific demands of young adults undertaking THA. Function at one year postoperatively is a good indication of overall outcomes. Cite this article: Bone Jt Open 2024;5(4):304–311

Recently, some smart media devices including portable accelerometers have been used to measure objective physical activity (OPA) after total hip arthroplasty (THA). The aim of this study was to longitudinally assess OPA changes in patients who underwent THA using a compact triaxial accelerometer and to investigate the impact of this recovery process on patient-reported outcomes. This prospective cohort study involved 163 consecutive patients who had unilateral osteoarthritis of the hip and were followed up for 12 months after THA. There were 132 women and 31 men with average age of 66 years. OPA was measured using a compact triaxial accelerometer preoperatively and at 1, 3, 6, and 12 months postoperatively. This study investigated the recovery process of OPA in four patient groups classified by the median of age and preoperative activity levels (younger and higher activity (YH), younger and lower activity (YL), older and higher activity (OH), and older and lower activity (OL)), and examined its impact on patient-reported outcomes, including forgotten joint score-12 (FJS-12). The target period for regaining preoperative activity levels was approximately 3 months for patients with lower preoperative activity, and about 6 months for those with higher preoperative activity. The OPA at 12 months postoperatively was higher in the patients with higher preoperative activity levels than in those with lower preoperative activity levels. In patients with higher preoperative activity levels, FJS-12 scores significantly increased between 6 and 12 months postoperatively (p=0.018). FJS-12 at 12 months postoperatively was best in YH (81.7±18.9), followed by YL (73.5±22.9), OH (73.2±17.4), and OL (66.3±21.8). Differences in the recovery process of postoperative activity levels impacted the duration required for improvement in FJS-12 scores. These results can serve as indicators for setting activity goals in patients undergoing THA

In a recent phase 2 superiority clinical trial we demonstrated that a single dose of 60mg of the human monoclonal antibody denosumab inhibits osteolytic lesion activity in patients undergoing revision total hip arthroplasty (THA), demonstrating proof of biological efficacy for this clinical application. Here, we examined the effect that denosumab has on disease biology at the osteolysis tissue level. Osteolytic tissue taken from the prosthesis-bone lesion interface at revision surgery in patients with osteolysis (n=10 participants that had received a single 60 mg dose of denosumab 8 weeks prior to revision surgery and n=10 that had received placebo) was examined for total genetic message activity and protein levels using whole genome sequencing and mass spectrometry, respectively. The top five upregulated enriched pathways with denosumab treatment included inflammatory response, myeloid cell activation, myeloid leukocyte migration, neutrophil and granulocyte activation (p<6.26 × 10. −28. ). Cell morphogenesis was amongst the most downregulated pathways (p<3.42 ×10. −23. ). Finally, comparison of the trial mRNA and protein data versus mouse single cell RNA sequencing data of the same pathway blockade in mouse tibia showed the same direction of effect, suggesting that giving the drug causes then cells responsible for osteolysis to disperse into a more immature form (128 of 189 genes (z=4.87, P<0.0001) disease and functional pathways at the mRNA level and 10 of 11 (z=2.72, P=0.0065) at the protein level). In this first-in-man study we identify multiple genes and pathways within periprosthetic osteolysis tissue that are affected by denosumab treatment. The dominant pathways involved upregulation of innate inflammatory signaling and downregulation of cell morphogenesis. We also found enrichment of similar disease and functional pathways at both the mRNA and protein levels versus mRNA pathway enrichment found in mouse osteomorphs. These data provide the first human data of the mechanistic effect of denosumab treatment on inflammatory osteolytic lesion activity after joint replacement that is necessary to support its clinical application. ∗Winner of The Bone & Joint Journal prize∗

Background. The impact of a patient's activity level following total hip arthroplasty (THA) remains controversial, with some concerned about increased polyethylene wear, aseptic loosening and revisions. The purpose of this study is to report on implant survivorship and outcomes of high activity patients compared to low activity patients after THA with current polyethylene. Methods. A retrospective review identified 2002 patients (2532 hip) that underwent a primary THA with vitamin E infused highly crosslinked polyethylene liner and 2-year minimum follow-up or revision. Patients were divided in two 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, complications and reoperations. Multivariate nominal regression analysis was performed to evaluate the significance of postoperative activity level on survivorship while controlling for age, gender, preoperative pain, HHS and body mass index (BMI). Results. Mean follow-up was 4.5 years (range, 0.3 to 9.9 years). The LA group had significantly more female patients, were older, higher BMI and lower HHS pre-operatively (all with p<0.001). HA group had significantly higher improvements in HHS (p<0.001) and UCLA activity score (p<0.001). Aseptic revisions were performed in 2.1% of the LA group and in 0.4% hips of the HA group (p<0.001). Multivariate regression analysis found that a higher postoperative activity level remained a significant factor for improved aseptic survivorship with an OR of 4.9 (95% CI, 1.1 to 21.2, p=0.03). The aseptic 5-year survivorship was 99.6% for the HA group and 98% for the LA group (p<0.001). Conclusions. Higher activity level after primary THA did not increase the risk for midterm aseptic or all cause failure. Patient activity level after THA may not need to be limited with modern polyethylene

Aims. The purpose of this exploratory study was to investigate if the 24-hour activity profile (i.e. waking activities and sleep) objectively measured using wrist-worn accelerometry of patients scheduled for total hip arthroplasty (THA) improves postoperatively. Patients and Methods. A total of 51 THA patients with a mean age of 64 years (24 to 87) were recruited from a single public hospital. All patients underwent THA using the same surgical approach with the same prosthesis type. The 24-hour activity profiles were captured using wrist-worn accelerometers preoperatively and at 2, 6, 12, and 26 weeks postoperatively. Patient-reported outcomes (Hip Disability and Osteoarthritis Outcome Score (HOOS)) were collected at all timepoints except two weeks postoperatively. Accelerometry data were used to quantify the intensity (sedentary, light, moderate, and vigorous activities) and frequency (bouts) of activity during the day and sleep efficiency. The analysis investigated changes with time and differences between Charnley class. Results. Patients slept or were sedentary for a mean of 19.5 hours/day preoperatively and the 24-hour activity pattern did not improve significantly postoperatively. Outside of sleep, the patients spent their time in sedentary activities for a mean of 620 minutes/day (. sd. 143) preoperatively and 641 minutes/day (. sd. 133) six months postoperatively. No significant improvements were observed for light, moderate, and vigorous intensity activities (p = 0.140, p = 0.531, and p = 0.407, respectively). Sleep efficiency was poor (< 85%) at all timepoints. There was no postoperative improvement in sleep efficiency when adjusted for medications (p > 0.05). Patient-reported outcome measures showed a significant improvement with time in all domains when compared with preoperative levels. There were no differences with Charnley class at six months postoperatively. However, Charnley class C patients were more sedentary at two weeks postoperatively when compared with Charnley class A patients (p < 0.05). There were no further differences between Charnley classifications. Conclusion. This study describes the 24-hour activity profile of THA patients for the first time. Prior to THA, patients in this cohort were inactive and slept poorly. This cohort shows no improvement in 24-hour activity profiles at six months postoperative. Cite this article: Bone Joint J 2019;101-B:415–425

Aims. Total hip arthroplasty (THA) has well known subjective benefits, but little is known objectively about the recovery of mobility in the early post-operative period. Patients and Methods. A total of 33 patients aged > 60 years who underwent elective primary THA had their activity monitored for 30 days post-operatively using an at-home (Fitbit) ankle accelerometer. Their mean age was 70.7 years (61 to 86); 15 (45.5%) were female. The rate of compliance and the mean level of activity were determined. Comparisons between subgroups based on age, body mass index (BMI), surgical approach, and the destination of the patients when discharged were also performed. Results. The mean compliance over the 30 days was 26.7 days (16 to 30; 89%) of use. The mean number of steps increased from 235 (5 to 1152) to 2563 (87 to 7280) (p < 0.001) between the first and the 30th post-operative day. Age < 70 years and an anterior surgical approach were significantly associated with higher levels of activity (1600 to 2400 (p = 0.016 to 0.031) and 1000 to 1800 (p = 0.017 to 0.037) more steps per day, respectively) between the second and the fourth week post-operatively. There was also a trend towards higher levels of activity in those who were discharged to their home rather than to a nursing facility (a mean of 1500 more steps per day, p = 0.02). BMI greater or less than 30 kg/m. 2. was not predictive of activity (p = 0.45 to 0.98). Conclusion. At-home remote mobility monitoring using existing commercially available technology is feasible in patients who have undergone THA. It showed a clear trend towards increased activity with the passage of time. Additionally, the remote device was able to detect differences in levels of activity clearly between patients in relation to variables of interest including age, BMI, surgical approach, and the destination of the patient at the time of discharge from hospital. Such monitoring may allow for the early identification and targeted intervention in patients who recover slowly. Cite this article: Bone Joint J 2016;98-B:1450–4

The primary treatment goal for patients with femoroacetabular impingement syndrome, a common hip condition in athletes, is to improve pain and function. In selected patients, in the short term following intervention, arthroscopic hip surgery is superior to a pragmatic NHS- type physiotherapy programme. Here, we report the three-year follow-up results from the FemoroAcetabular Impingement Trial (FAIT), comparing arthroscopic hip surgery with physiotherapy in the management of patients with femoroacetabular impingement (FAI) syndrome. Two-group parallel, assessor-blinded, pragmatic randomised controlled study across seven NHS England sites. 222 participants aged 18 to 60 years with FAI syndrome confirmed clinically and radiologically were randomised (1:1) to receive arthroscopic hip surgery (n = 112) or physiotherapy and activity modification (n = 110). We previously reported on the hip outcome score at eight months. The primary outcome measure of this study was minimum Joint Space Width (mJSW) on Anteroposterior Radiograph at 38 months post randomisation. Secondary outcome measures included the Hip Outcome Score and Scoring Hip Osteoarthritis with MRI (SHOMRI) score. Minimum Joint Space Width data were available for 101 participants (45%) at 38 months post randomisation. Hip outcome score and MRI data were available for 77% and 62% of participants respectively. mJSW was higher in the arthroscopy group (mean (SD) 3.34mm (1.01)) compared to the physiotherapy group (2.99mm (1.33)) at 38 months, p=0.017, however this did not exceed the minimally clinically important difference of 0.48mm. SHOMRI score was significantly lower in the arthroscopy group (mean (SD) 9.22 (11.43)) compared to the physiotherapy group (22.76 (15.26)), p-value <0.001. Hip outcome score was higher in the arthroscopy group (mean (SD) 84.2 (17.4)) compared with the physiotherapy group (74.2 (21.9)), p-value < 0.001). Patients with FAI syndrome treated surgically may experience slowing of osteoarthritisprogression and superior pain and function compared with patients treated non- operatively

Introduction. Early functional recovery following total hip arthroplasty (THA) has the potential to increase patient satisfaction and reduce resource utilization. The direct anterior approach (DA) has been shown to provide earlier recovery compared to the direct lateral (DL) approach based on functional tests and outcome scores. There are limited studies that objectively evaluate functional recovery comparing the two approaches in the early post-operative period. Activity trackers have emerged as a valid tool to objectively quantify physical activity levels and potentially better assess functional status compared to commonly reported functional questionnaires. The purpose of this study is to measure physical activity levels in patients undergoing THA with the DA approach and compare these to THA with the direct lateral approach in the immediate postoperative period. Methods. In a tertiary academic center we prospectively enrolled patients with primary OA that were eligible for a primary THA undergoing either the DA or the DL approach using the same prosthesis. Patients with comorbidities precluding them from ambulation, diagnoses of AVN or RA or undergoing bilateral THA were excluded. The number of steps walked per day were measured using wristband activity tracking technology for one week preoperatively, the first 2 weeks postoperatively and for 1 week leading up to their 6-week follow-up appointment. The University of California, Los Angeles (UCLA) activity score was also collected at the same two time points. Demographics were analyzed with descriptive statistics. A non-parametric Mann Whitney U test was used to determine whether a difference in physical activity levels exist between the DA and DL approach groups in the first 2 weeks and 6 weeks postoperatively. Results. One hundred and thirty-nine patients with primary OA were enrolled. Seventeen were withdrawn prior to beginning the study (7 – patient requested, 5 – could not work the activity tracker, 5 – health issues). Following enrolment 29 patients were withdrawn due to lack of data available for analysis. There were 53 patients in the DA group and 40 patients in the DL group. Patient demographics including age and gender were similar in both groups. Body mass index was higher in the DL group (32.4 ± 6.9) compared to the DA group (28.2 ± 3.9) (p=0.001). There was no difference in the average steps taken per day or the UCLA score between the two groups preoperatively. The UCLA score and the overall average steps walked collected at 2 weeks postoperatively were significantly higher in the DA group compared to the DL group (median 4(1–6) vs. 3(2–6), p<0.001 and median 1641(329 – 8678) vs. 890(87 – 4347), p<0.001) respectively. When each postoperative day was evaluated individually, the DA group had a greater number of steps per day for the entire two weeks. At 6 weeks, the average number of steps taken by the DA group (median 4734 (1703 – 16605) () were greater than those taken by the DL group (median 3534 (462–8665) ± 2263) (p=0.007). A similar finding was demonstrated for the UCLA with the DA having greater self-reported activity levels (median 6 vs. 4, p<0.001). Discussion/Conclusions. The DA approach provided faster functional recovery in the immediate postoperative period compared to the DL approach as measured by a wristband activity tracker. DA approach patients walked a greater number of steps at both 2 weeks and 6 weeks. Further examination regarding the economic implications of the improved early function from the perspective of the patient, caregiver, and care payer is indicated

This study investigates the use of the Metabolic Equivalent of Task (MET) score in a hip arthroplasty population and its ability to capture additional benefit beyond the maximum Oxford Hip Score (OHS). OHS, EuroQol-5D index (EQ-5D), and the MET were prospectively recorded in 221 primary hip arthroplasty procedures pre-operatively and at 1-year. The distribution was examined reporting the presence of ceiling & floor effects. Validity was assessed correlating the MET with the other scores using Spearman's rank and determining responsiveness using the standardised response mean (SRM). A subgroup of 93 patients scoring 48/48 on the OHS were analysed by age group, sex, BMI and pre-operative MET using the other two metrics to determine if differences could be established despite all scoring identically on the OHS. 117 total hip and 104 hip resurfacing arthroplasty operations were included. Mean age was 59.4 ± 11.3. Post-operatively the OHS and EQ-5D demonstrate significant negatively skewed distributions with ceiling effects of 41% and 53%, respectively. The MET was normally distributed post-operatively with no ceiling effect. Weak-moderate but statistically significant correlations were found between the MET and the other two metrics both pre & post-operatively. Responsiveness was excellent, SRM for OHS: 2.01, EQ-5D: 1.06 and MET: 1.17. In the 48/48 scoring subgroup, no differences were found comparing groups with the EQ-5D, however significantly higher MET scores were demonstrated for patients aged <60 (12.7 vs 10.6, p=0.008), male patients (12.5 vs 10.8, p=0.024) and those with pre-operative MET scores >6 (12.6 vs 11.0, p=0.040). The MET is normally distributed in patients following hip arthroplasty, recording levels of activity which are undetectable using the OHS. As a simple, valid activity metric, it should be considered in addition to conventional PROMs in order to capture the entire benefit experienced following hip arthroplasty

To date there is no medical treatment alternative to surgery for osteolysis after THA. In this proof-of-concept clinical trial we examined the effect of a human monoclonal antibody against osteoclasts versus placebo on osteolytic lesion activity in patients undergoing revision surgery. Patients scheduled for revision for symptomatic osteolysis were randomised (1:1) to receive either denosumab 60mg or placebo subcutaneously eight weeks prior to operation. At surgery, biopsies from the osteolytic membrane-bone interface were taken for histomorphometric analysis of osteoclast number. Secondary outcome measures included systemic bone turnover markers. 22 subjects completed the study (10 denosumab). The denosumab group had 83% (−63 to −97), P=0.011 fewer osteoclasts at osteolytic lesion sites, 87% lower osteoclast surface (−65 to −95, P=0.009), and 72% lower eroded surface (−35 to −93, P=0.020) versus the placebo group. At surgery, serum CTX-I, TRAP5b and PINP were 80% (−65 to −95, p<0.001), 57% (−40 to −90, p<0.001), and 44% (−41 to −65, p<0.001) lower in the denosumab versus placebo groups, respectively. The rate of adverse events (denosumab 6, placebo 7) were similar between groups (P>0.05). These data provide a biological basis for a definitive clinical trial using pain, function and prosthesis survival as the study endpoints. As osteolysis/ aseptic loosening is the leading cause of prosthesis failure world-wide, the establishment of a non-surgical solution would reduce patient suffering and dramatically reducing the cost to healthcare economies

Subjective outcomes used in THA show outstanding improvements in patient-reported outcomes. However, recent evidence suggests that there may be a disconnect between patient-reported and objectively measured function. The aim of this study was to investigate if physical activity and sleep patterns change from pre- to six months post primary THA. 54 patients scheduled for THA were recruited. Patients were given a wrist-worn accelerometer (GeneActiv, UK) to wear continuously for one week pre-operatively and six weeks, three months and six months post-operatively. The device was also fitted to the patient immediately following surgery to capture data for the first two post-operative weeks. The following parameters were calculated: (1) sleep efficiency; (2) the amount of time (and length of each bout and fragmentation of the activity) spent in sedentary activity; and (3) time spent in light, moderate and vigorous physical activity. Sedentary activities showed no change in the number, duration or fragmentation (p= 0.382, 0.288, 0.382, respectively). Patients were sedentary for 5–6 bouts/day with each bout lasting 50–76 minutes/day. A significant main effect was identified for time spent in light intensity activities (p=0.049). Prior to surgery, patients spent 201 minutes/day in light intensity activity. This decreased significantly to 133 minutes/day (p=0.025) in the first two postoperative weeks before returning close to pre-operative levels (192 minutes/day) at six weeks (p=0.025). No further changes were observed in light intensity activities. A significant main effect was identified for time spent in moderate intensity activities (p=0.003). Prior to surgery, patients spent 45 minutes/day in moderate intensity activities. This dropped to 18 minutes/day in the first two postoperative weeks (p=0.190). By three months this had increased to 66 minutes/day (p=0.049). No further changes were seen. There were no significant differences in time spent in vigorous intensity activities (p=0.244). Patients spent <1minute/day in vigorous intensity activities. Sleep efficiency did not change significantly from pre- (82%) to six months post-operative (75%) (p=0.067) − 85% is typically considered good sleep efficiency. Patients discharged to a regional hospital had significantly poorer sleep efficiency than those discharged home (mean difference=14%, p=<0.001) or to a rehabilitation centre (mean difference=15%, p=0.001). This patient cohort didn't demonstrate an overall improvement in objectively measured physical activity patterns from pre- to six months post-operative. Sleep efficiency, did not improve and remained sub-optimal

Introduction. This analysis determined whether the type and level of physical activity changes during the initial 24 months post-total hip (THR) or total knee replacement (TKR) compared to pre-operative levels, and how this change compares to people without arthroplasty or osteoarthritis. Patients/Materials & Methods. Data from a prospective cohort dataset (Osteoarthritis Initiative dataset) of community-dwelling individuals who had undergone a primary THR or TKR were identified. These were compared to people who had not undergone an arthroplasty and who did not have a diagnosis of hip or knee osteoarthritis during the follow-up period (control). Data were analysed comparing between-group and within-group differences for physical activity (gardening, domestic activities, sports, employment, walking) within the first 24 months post-arthroplasty. Results. In total, 116 participants were analysed in the TKR group, 105 in the THR group. These cohorts were compared to 3441 (control) participants. Whilst physical activity largely increased from pre-operative levels during the first 12 months post-operatively, this change reverted at the 24 month assessment to pre-operative levels in people who underwent THR. There appeared limited change (increase nor decrease) in physical activity at 12 or 24 months post-operatively compared to pre-operative levels in people who underwent TKR. Compared to the non-arthroplasty cohorts, physical activity was consistently greater in the non-arthroplasty group at 12 and 24 months post-pre-operative/baseline measures. Discussion. There is limited change in the level or type of physical activity undertaken between people before or after THR or TKR in the first 24 post-operative months. Physical activity levels are lower in people following THR and TKR compared to people with similar characteristics who have not undergone arthroplasty or have osteoarthritis. Conclusion. Health strategies are warranted to address the limited increase in post-operative physical activity, to encourage this post-arthroplasty population to engage and maintain physical activity pursuits for wider health benefits

We conducted a longitudinal study including patients with the same type of primary hybrid total hip replacement and evaluated patient activity and femoral osteolysis at either five or ten years post-operatively. Activity was measured using the University of California, Los Angeles scale. The primary outcome was the radiological assessment of femoral osteolysis. Secondary outcomes were revision of the femoral component for aseptic loosening and the patients’ quality of life. Of 503 hip replacements in 433 patients with a mean age of 67.7 years (30 to 91), 241 (48%) were seen at five and 262 (52%) at ten years post-operatively. Osteolytic lesions were identified in nine of 166 total hip replacements (5.4%) in patients with low activity, 21 of 279 (7.5%) with moderate activity, and 14 of 58 (24.1%) patients with high activity. The risk of osteolysis increased with participation in a greater number of sporting activities. In multivariate logistic regression adjusting for age, gender, body mass index and the inclination angle of the acetabular component, the adjusted odds ratio for osteolysis comparing high vs moderate activity was 3.6 (95% confidence interval 1.6 to 8.3). Stratification for the cementing technique revealed that lower quality cementing increased the effect of high activity on osteolysis. Revision for aseptic loosening was most frequent with high activity. Patients with the highest activity had the best outcome and highest satisfaction. In conclusion, of patients engaged in high activity, 24% had developed femoral osteolysis five to ten years post-operatively

Introduction. Previous systematic reviews have shown that patients experience low physical activity levels following total hip replacement (THR). However no previous systematic reviews have examined the changes between pre- and post-operative physical activity levels. Methods. AMED, MEDLINE, EMBASE, CENTRAL, CINHAL, openSIGLE, . ClinicalTrials.gov. and UK Clinical Trials Gateway databases were searched to 19. th. May 2015. All study designs presenting data on physical activity at pre- and up to one-year post-operatively were included. Eligible studies were critically appraised using the Cochrane risk of bias tool (for randomised controlled trials (RCTs)) and the CASP tool (non-RCTs). Where possible, mean differences (MD) and 95% confidence intervals (CI) were calculated through meta-analyses. Results. From 3850 citations, 16 met the eligibility criteria; nine included in the meta-analysis. The quality of the evidence was graded low to moderate. There was no statistically significant difference in physical activity pre- to one year post-THR when assessed using: movement-related activity (MD: −0.08; 95% CI:- 1.60 to 1.44; I. 2. =0%; n=77), percentage of 24 hours spent walking (MD: −0.21; 95% CI: −1.36 to 0.93; I. 2. =12%; n=65), six minute walk test (MD: −60.85; 95% CI: −122.41 to 0.72; I. 2. =84%; n=113) or the cardiopulmonary exercise test (MD: −0.24; 95% CI: −1.36 to 0.87; I. 2. =0%; n=76). Discussion. There is no evidence to suggest that physical activity changes pre- compared to post-THR. The low methodological quality of the included papers means this finding should be viewed with caution. Further research is warranted to better understand the relationship between physical activity pre- and post-THR, as greater consideration may be needed to increase physical activity in this population post-operatively. Conclusion. Surprisingly, there is no significant change in physical activity following THR. Surgeons, physiotherapists and patients should consider how to increase and maintain physical activity levels to maximise the potential for wider-health benefits following THR

Dual Mobility (DM) Total Hip Replacements (THRs), are becoming widely used but function in-vivo is not fully understood. The aim of this study was to compare the incidence of impingement of a modular dual mobility with that of a standard cup. A geometrical model of one subject's bony anatomy \[1\] was developed, a THR was implanted with the cup at a range of inclination and anteversion positions (Corail® stem, Pinnacle® cup (DePuy Synthes)). Two DM variants and one STD acetabular cup were modelled. Joint motions were taken from kinematic data of activities of daily living associated with dislocation \[2\] and walking. The occurrence of impingement was assessed for each component combination, orientation and activity. Implant-implant impingement can occur between the femoral neck and the metal or PE liner (DM or STD constructs respectively) or neck-PE mobile liner (DM only). The results comprise a colour coded matrix which sums the number of impingement events for each cup position and activity and for each implant variant. Neck-PE mobile liner impingement, occurred for both DM sizes, for all activities, and most cup placement positions indicating that the PE mobile liner is likely to move at the start of all activities including walking. For all constructs no placement positions avoided neck-metal (DM) or neck-PE liner (STD) impingementevents in all activities. The least number of events occurred at higher inclination and anteversion component positions. In addition to implant-implant impingement, some instances of bone-bone and implant-bone impingement were also observed. Consistent with DM philosophy, neck-PE mobile liner impingement and liner motion occurred for all activities including walking. Neck-liner impingement frequency was comparable between both DM sizes (metal liner) and a standard cup (PE liner)

Aims. We assessed the long-term outcomes of a large cohort of patients who have undergone a periacetabular osteotomy (PAO), and sought to validate a patient satisfaction questionnaire for use in a PAO cohort. Methods. All patients who had undergone a PAO from July 1998 to February 2013 were surveyed, with several patient-reported outcome measures (PROMs) and radiological measurements of preoperative acetabular dysplasia and postoperative correction also recorded. Patients were asked to rate their level of satisfaction with their operation in achieving pain relief, restoration of activities of daily living, ability to perform recreational activity, and their overall level of satisfaction with the procedure. Results. A total of 143 PAOs were performed between 1998 and 2013. Of those, 90 postoperative surveys were returned. Only 65 patients (73 hips) had both pre- and postoperative radiographs available for measurement. The mean time to follow-up was 15 years (6.5 to 20). Most patients were female (91%), with a mean age of 26.4 years (14.9 to 48.3) at the time of their surgery. A statistically significant improvement in radiological correction was detected in all hips (p < 0.001). A total of 67 patients (92.3%) remained either very satisfied or satisfied with their PAO. The internal consistency of the patient satisfaction questionnaire, measured using Cronbach’s α, ranged from 0.89 to 0.94 indicating ‘good’ to ‘excellent’ reliability. Conclusion. Outcomes of importance to patients undergoing a PAO include several key domains: pain relief, improve activities of daily living, and improve recreational ability. Our study demonstrates high rates of long-term patient satisfaction in all domains, and found the patient satisfaction questionnaire to be a valid and reliable instrument for use in this cohort. Cite this article: Bone Jt Open 2023;4(12):964–969

Aims. The primary aim of our study was to assess the influence of age on hip-specific outcome following total hip arthroplasty (THA). Secondary aims were to assess health-related quality of life (HRQoL) and level of activity according to age. Methods. A prospective cohort study was conducted. All patients were fitted with an Exeter stem with a 32 mm head on highly cross-linked polyethylene (X3RimFit) cemented acetabulum. Patients were recruited into three age groups: < 65 years, 65 to 74 years, and ≥ 75 years, and assessed preoperatively and at three, 12, 24, and 60 months postoperatively. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Harris Hip Score (HHS), and Hip disability and Osteoarthritis Outcome Score (HOOS), were used to assess hip-specific outcome. EuroQol five-dimension five-level questionnaire (EQ-5D-5L) and 36-Item Short Form Survey (SF-36) scores were used to assess HRQoL. The Lower Extremity Activity Scale (LEAS) and Timed Up and Go (TUG) were used to assess level of activity. Results. There were no significant (p > 0.05) differences in the WOMAC scores, HSS, HOOS, or EQ-5D-5L at any postoperative timepoint between the age groups. Patients aged ≥ 75 years had significantly lower physical function (p ≤ 0.010) and physical role (p ≤ 0.047) SF-36 scores at 12, 24, and 60 months, but were equal to that expect of an age-matched population. No differences according to age were observed for the other six domains of the SF-36 (p > 0.060). The ≥ 75 years group had a lower LEAS (p < 0.001) and longer TUG test times (p ≤ 0.032) compared to the < 65 years group, but older age groups had significant (p < 0.001) improvement relative to their preoperative baseline measures. Conclusion. Age did not influence postoperative hip-specific outcome or HRQoL (according to the EQ-5D) following THA. Despite a significant improvement, older patients had lower postoperative activity levels compared to younger patients, but this may be reflective of the overall physical effect of ageing. Cite this article: Bone Jt Open 2022;3(9):692–700

We previously reported the five to ten-year results of the Birmingham Hip Resurfacing (BHR) implant. The purpose of this study was to evaluate the survivorship, radiographic results, and clinical outcomes of the BHR at long-term follow-up. We retrospectively reviewed 250 patients from the original cohort of 324 BHRs performed from 2006 to 2013 who met contemporary BHR indications. Of these, 4 patients died and 4 withdrew. From the 242 patients, 224 patients (93%) were available for analysis. Modified Harris hip score (mHHS) and University of California, Los Angeles (UCLA) scores were collected and compared to a matched total hip arthroplasty (THA) cohort. Mean follow-up was 14 years. Survivorship free of aseptic revision was 97.4% and survivorship free of any revision was 96.0% at 15 years. Revisions included 3 periprosthetic joint infections, 2 for elevated metal ions and symptomatic pseudotumor, 2 for aseptic femoral loosening, and 1 for unexplained pain. The mean mHHS was 93 in BHR patients at final follow-up, similar to the THA cohort (p=0.44). The UCLA score was significantly higher for BHR patients (p=0.02), however there were equal proportions of patients who remained highly active (UCLA 9 or 10) in both groups, 60.5% and 52.2% (p=0.45) for BHR and THA respectively. Metal ion levels at long term follow-up were low (mean serum cobalt 1.8±1.5 ppb and mean serum chromium 2.2±2.0 ppb). BHR demonstrated excellent survivorship in males less than 60 years of age at time of surgery. Clinical outcomes and activity levels were similar to THA patients. Failures related to the metal-on-metal bearing were rare and metal levels were low at long-term follow-up. Level of evidence: III. Keywords: survivorship; hip arthroplasty; activity; metal-on-metal. Surface Replacement Arthroplasty demonstrates low revision rates and similar activity level compared to total hip arthroplasty at long-term follow-up

Aims. In order to release the contracture band completely without damaging normal tissues (such as the sciatic nerve) in the surgical treatment of gluteal muscle contracture (GMC), we tried to display the relationship between normal tissue and contracture bands by magnetic resonance neurography (MRN) images, and to predesign a minimally invasive surgery based on the MRN images in advance. Methods. A total of 30 patients (60 hips) were included in this study. MRN scans of the pelvis were performed before surgery. The contracture band shape and external rotation angle (ERA) of the proximal femur were also analyzed. Then, the minimally invasive GMC releasing surgery was performed based on the images and measurements, and during the operation, incision lengths, surgery duration, intraoperative bleeding, and complications were recorded; the time of the first postoperative off-bed activity was also recorded. Furthermore, the patients’ clinical functions were evaluated by means of Hip Outcome Score (HOS) and Ye et al’s objective assessments, respectively. Results. The contracture bands exhibited three typical types of shape – feather-like, striped, and mixed shapes – in MR images. Guided by MRN images, we designed minimally invasive approaches directed to each hip. These approaches resulted in a shortened incision length in each hip (0.3 cm (SD 0.1)), shorter surgery duration (25.3 minutes (SD 5.8)), less intraoperative bleeding (8.0 ml (SD 3.6)), and shorter time between the end of the operation and the patient’s first off-bed activity (17.2 hours (SD 2.0)) in each patient. Meanwhile, no serious postoperative complications occurred in all patients. The mean HOS-Sports subscale of patients increased from 71.0 (SD 5.3) to 94.83 (SD 4.24) at six months postoperatively (p < 0.001). The follow-up outcomes from all patients were “good” and “excellent”, based on objective assessments. Conclusion. Preoperative MRN analysis can be used to facilitate the determination of the relationship between contracture band and normal tissues. The minimally invasive surgical design via MRN can avoid nerve damage and improve the release effect. Cite this article: Bone Jt Open 2024;5(9):776–784