Aims. Social media is a popular resource for patients seeking medical information and sharing experiences. periacetabular osteotomy (PAO) is the gold-standard treatment for symptomatic acetabular dysplasia with good long-term outcomes. However, little is known regarding the perceived outcomes of PAO on social media. The aims of this study were to describe the perceived outcomes following PAO using three social media platforms: Facebook, Instagram, and X (formerly known as Twitter). Methods. Facebook, Instagram, and X posts were retrospectively collected from 1 February 2023. Facebook posts were collected from the two most populated interest groups: “periacetabular osteotomy” and “PAO Australia.” Instagram and X posts were queried using the most popular hashtags: #PAOwarrior, #periacetabularosteotomy, #periacetabularosteotomyrecovery, #PAOsurgery, and #PAOrecovery. Posts were assessed for demographic data (sex, race, location), perspective (patient, physician, professional organization, industry), timing (preoperative vs postoperative), and perceived outcome (positive, negative, neutral). Results. A total of 1,054 Facebook posts, 1,003 Instagram posts, and 502 X posts were consecutively assessed from 887 unique authors. The majority (63.3%) of these posts were from patients in the postoperative period, with a median of 84 days postoperatively (interquartile range 20 to 275). The longest follow-up timeframe postoperatively was 20 years. Regarding perceived outcomes, 52.8% expressed satisfaction, 39.7% held neutral opinions, and 7.5% were dissatisfied. Most dissatisfied patients (50.9%) reported pain (chronic or uncontrolled acute) as an attributing factor. Conclusion. Most PAO-perceived surgical outcomes on social media had a positive tone. Findings also indicate that a small percentage of patients reported negative perceived outcomes. However, dissatisfaction with PAO primarily stemmed from postoperative pain. Social media posts from other sources (physicians, hospitals, professional organizations, etc.) trend towards neutrality. Healthcare providers must consider the social media narratives of patients following PAO, as they may reveal additional outcome expectations and help improve patient-centred care, create informed decision-making, and optimize treatment outcomes. Cite this article: Bone Jt Open 2024;5(1):53–59

The Paprosky acetabular bone defect classification system and related algorithms for acetabular reconstruction cannot properly guide cementless acetabular reconstruction in the presence of porous metal augments. We aimed to introduce a rim, points, and column (RPC)-oriented cementless acetabular reconstruction algorithm and its clinical and radiographic outcomes. A total of 123 patients (128 hips) were enrolled. A minimum 5-year radiographic follow-up was available for 96 (75.8%) hips. The mean clinical and radiographic follow-up durations were 6.8±0.9 (range: 5.2–9.2) and 6.3±1.9 (range: 5.0–9.2) years, respectively. Harris hip score (HHS) improved significantly from 35.39±9.91 preoperatively to 85.98±12.81 postoperatively (P<0.001). Among the fixation modes, 42 (32.8%) hips were reconstructed with rim fixation, 42 (32.8%) with three-point fixation without point reconstruction, 40 (31.3%) with three-point fixation combined with point reconstruction, and 4 (3.1%) with three-point fixation combined with pelvic distraction. Complementary medial wall reconstruction was performed in 20 (15.6%) patients. All acetabular components were radiographically stable. Nine-year cumulative Kaplan–Meier survival rates for 123 patients with the endpoint defined as periprosthetic joint infection, any reoperation, and dissatisfaction were 96.91% (confidence interval [CI]: 86.26%, 99.34%), 97.66% (CI: 92.91%, 99.24%), and 96.06% (CI: 86.4%, 98.89%), respectively. Cup stability in cementless acetabular reconstruction depends on rim or three-point fixation. The continuity of the anterior and posterior columns determines whether the points provide adequate stability to the cup. Medial wall reconstruction is an important complementary fixation method for rim or three-point fixation. The patients who underwent cementless acetabular reconstruction guided by the RPC decision-making algorithm demonstrated satisfactory mid-term clinical function, satisfaction levels, radiographic results, and complication rates

It is anecdotally thought that a good outcome from the first of staged total hip arthroplasties (THAs) is predictive of benefit on the contralateral side. The objective was to determine whether outcome from the first THA could be used to predict outcome from the second, contralateral THA. A retrospective cohort study of consecutive patients undergoing staged THAs at a UK arthroplasty centre over 25-years (1995–2020). A control THA group was identified and matched for age, gender, BMI, implant and diagnosis. One-year patient-reported outcome data was available for 91% 1543/1700. 1700 patients who underwent staged THA were compared to 1700 matched controls. Preoperative status was comparable for pain, function, and modified Harris hip score (mHHS, mean 41 SD 13 for both groups). At one year, there was a 2% dissatisfaction rate in all groups (first of staged THAs, second of staged THAs and controls). Groups were similar in terms of pain, function and mHHS (mean 88 SD 11 for all groups). For every 100 patients undergoing staged THAs, 87 had a bilateral good outcome (mHHS >70 both), 11 had unilateral poor outcome (mHHS >70 one, <70 other) and 2 had bilateral poor outcome (mHHS <70 both). If the first THA had a good outcome, the relative risk of a bad outcome was 20% less than for controls (RR 0.8 95% CI 0.6–1.1). If the first THA had a poor outcome, the risk of a second poor outcome was 4.5 times higher (RR 4.5 95% CI 3.2–6.4), increasing from 6% to 29% (absolute risk). Patients undergoing staged THAs with a good outcome from the first THA were less likely to have a bad outcome with the second. Risk of a poor outcome after a previous successful THA was 6% but rose to almost 30% with a previous poor outcome. This remained after correcting for patient variables including gender, age, BMI and diagnosis, indicating a potentially novel independent risk factor for poor outcome from staged THA

Over 62,000 total hip arthroplasty (THA) cases are performed each year in Canada, with an estimated annual healthcare system cost of $1.4 billion and resulting in 4 billion tonnes of waste annually (6,600 tonnes per day). The aims of this study were 1) Assess satisfaction of current/standard set-up amongst different stakeholders. 2) Assess energy, economic and waste cost of current set up and apply lean methodology to improve efficiency 3. Design and test SLIM setup based on lean principles and its ability to be safely implemented into everyday practice. A Needs Assessment Survey was circulated to OR nursing staff to assess the need for change in the current THA OR setup at an academic tertiary referral hospital. Through feedback, surgeon input, and careful analysis of current instrumentation, the “SLIM setup” was created. Standard instrument tray numbers for elective THA were reduced from 9 to 3 trays. Eighty patients were then randomised to either the standard or SLIM setup. Four staff arthroplasty surgeons each randomised 20 patients to either standard or SLIM setup. OR time, blood loss, 90-day complication rates, cost/case, instrument weight (kg/case), total waste in kg/case (non-recyclable), case set-up time, and number of times and number of extra trays required were compared between groups. The majority of nursing staff demonstrated dissatisfaction with the current THA setup and felt current processes lacked efficiency. Use of the SLIM setup, was associated with the following savings in comparison to standard (Trays = −6 (720kg/case); Waste = −1.5 kg/case; Cost = − $560 ($50.00 × 6 trays + 10min saved × $26.00 /min OR setup time)). OR time, blood loss and 90-day complication rate were not statistically different (p >0.05); however, set up time was significantly shorter in comparison to standard. Extra instrumentation was opened in < 10% of cases. A more minimalist approach to THA can be undertaken using the SLIM setup, potentially resulting in cost, energy and waste savings. Estimate savings of $560,000 and 1.65 tonnes reduction in waste per 1,000 THAs performed may be realised

Clinical decision-making is often based on evidence of outcome after a specific treatment. Surgeons and patients may, have different perceptions and expectations of what to achieve following a Total Hip Replacement (THR). Several studies have shown that unfulfilled expectations are a principal source of patient dissatisfaction and patients are typically overly optimistic with regards to expected outcomes following surgery. Published data on clinical and functional outcomes show that persistence of symptoms, such as pain, and failure to return to preoperative levels of function are normal. To measure patient's expectations we undertook prospective study reviewing patients' expectations in 1800 THRs over a 21-year period (1997–2018). Of the whole cohort, 48.98% patients reported they wanted a THR to overcome unbearable pain. 11.75 % wanted a THR to be able to walk without a limp. 9.69% wanted to a THR to increase walk endurance. 61.97% reported it was extremely important to decrease pain following a THR. In 2001, the most important reason for a THR reported by patients was to relieve unbearable pain and this remained the same most important reason in 2018. This result was also statistically significant with a p-value of 0.001. 80.36% reported they anticipated ‘no pain’ after recovery from a THR, 16.75% reported they anticipated ‘some pain’ and 2.89% reported they anticipated ‘extreme pain’ following a THR. 74.71% reported it was extremely important to increase their ability to undertake normal activities. 22.06% reported it was very important, 2.40% reported it was moderately important, 0.55% slightly important and 0.28% reported it was not all to important to increase their ability to undertake normal activity. In conclusion patients' want to reduce their pain, walk normally and increase their level activities. Differences in expectation fulfilment may be due to unrealistic expectations. To achieve optimal outcome managing patient expectations is vital

Background. Thigh pain following a well-fixed total hip arthroplasty (THA) remains problematic and a source of patient dissatisfaction. The purpose of this study is to evaluate if the development of distal femoral cortical hypertrophy (DFCH) is associated with chronic postoperative thigh pain after THA with a short stem implant. Methods. All patients who underwent an uncomplicated primary THA via a direct anterior approach with the short stem Taperloc Microplasty® (Zimmer Biomet, Warsaw, IN) implant between 2011 and 2015 were mailed a pain drawing questionnaire. Radiographs were reviewed at 1-year minimum to determine cortical thickness change from immediate post-op. Thigh pain was compared to DFCH as well as patient demographics and femoral stem size. 293 patients were included in the study. Results. Mean follow-up was 3.2 years. A total of 218 hips (74%) had cortical hypertrophy in Gruen zone 3 and 165 hips (56%) had cortical hypertrophy in Gruen zone 5. Fifty-two hips (18%) had ≥25% cortical hypertrophy in zone 3 and 91 hips (31%) had ≥25% cortical hypertrophy in zone 5. A total of 44 patients (15%) reported anterior thigh pain and 43 patients (15%) reported lateral thigh pain. Development of DFCH in either Gruen zone 3 or 5 was not associated with anterior or lateral thigh pain. Stem size was positively correlated with zone 3 hypertrophy and inversely related to zone 5 hypertrophy. Thigh pain was not associated with patient age, gender, activity level or stem size. Conclusion. The development of distal femoral cortical hypertrophy after THA with a short stem implant was high, but not associated with patient reported anterior or lateral thigh pain. For any tables or figures, please contact the authors directly

Aims

Achieving accurate implant positioning and restoring native hip biomechanics are key surgeon-controlled technical objectives in total hip arthroplasty (THA). The primary objective of this study was to compare the reproducibility of the planned preoperative centre of hip rotation (COR) in patients undergoing robotic arm-assisted THA versus conventional THA.

Introduction. Depression is a common co-morbidity in Total Hip Arthroplasty (THA). Chronic pain and depression influence one another. Postoperative outcomes and satisfaction rates are affected by depression. Objectives. The aim of the study was to determine the impact of pre-operative depression on patient functional outcomes and satisfaction rates after THA. A secondary objective was to assess potential change in the incidence of depression at mid-term post-operative follow-up. Study Design & Methods. We retrospectively reviewed 200 patients undergoing THA from 2015–2016 at a single academic institution.150 (75%) of patients were followed up at a minimum of 24 months. Patients pre-operative depression symptoms were assessed according to the Zung Self-reported depression score and the PHQ-9 scores. Functional scores, satisfaction rates, expectation rates and 30- and 90-day readmission rates were correlated with pre-operative and 2-year follow-up depression scores. Results. There were 103 females and 47 males with an average age of 60.1 years (22–89 years old). The Patient Health Questionnaire (PHQ-9) correlated with the Zung Self-reported depression scores. Overall, 73 patients (48.7%) were classified as being depressed pre-operatively. There were 48 (32.2%) with mild depression and 19 (12.8%) with marked depression. Females, HIV-infected and morbidly obese patients were more likely to be depressed. The mean pre-operative Harris Hip Score (HHS) was 35.95 (24–66) and Oxford Hip Score (OHS) 17.11 (0–48). The 30-day readmission rate was 2% and all patients were pre-operatively severely depressed. At a minimum of 2 years there was an improvement in Zung Self-Rating Depression Scale and PHQ-9 scores. Only 29 (18.8%) patients were depressed. There were 55 patients who progressed from depressed to non-depressed (p=0.00), while 11 patients (7.4%) became depressed after THA (p=0.00). The least improvement in both OHS and HHS was in the severely depressed group (p<0.05). The overall satisfaction rate was 89.7%. Depressed patient satisfaction rate was 86.9% with only 70.27% of the severely depressed group satisfied post-operatively. Age (>70) and BMI >40 correlated with dissatisfaction (p<0.05). Conclusions. There is a high prevalence of depression in THA. Incorporation of psychological management strategies may improve satisfaction rates and functional outcomes post-THA

Dislocation is one of the most common causes of patient and surgeon dissatisfaction following hip replacement and to treat it, the causes must first be understood. Patient factors include age greater than 70 years, medical comorbidities, female gender, ligamentous laxity, revision surgery, issues with the abductors, and patient education. Surgeon factors include the annual quantity of procedures and experience, the surgical approach, adequate restoration of femoral offset and leg length, component position, and soft-tissue or bony impingement. Implant factors include the design of the head and neck region, and so-called skirts on longer neck lengths. There should be offset choices available in order to restore soft-tissue tension. Lipped liners aid in gaining stability, yet if improperly placed may result in impingement and dislocation. Late dislocation may result from polyethylene wear, soft-tissue destruction, trochanteric or abductor disruption and weakness, or infection. Understanding the causes of hip dislocation facilitates prevention in a majority of instances. Proper pre-operative planning includes the identification of patients with a high offset in whom inadequate restoration of offset will reduce soft-tissue tension and abductor efficiency. Component position must be accurate to achieve stability without impingement. Finally, patient education cannot be over-emphasised, as most dislocations occur early, and are preventable with proper instructions. Cite this article: Bone Joint J 2013;95-B, Supple A:67–9

Aims

Leg length discrepancy (LLD) is a common pre- and postoperative issue in total hip arthroplasty (THA) patients. The conventional technique for measuring LLD has historically been on a non-weightbearing anteroposterior pelvic radiograph; however, this does not capture many potential sources of LLD. The aim of this study was to determine if long-limb EOS radiology can provide a more reproducible and holistic measurement of LLD.

Aims

Iliopsoas impingement occurs in 4% to 30% of patients after undergoing total hip arthroplasty (THA). Despite a relatively high incidence, there are few attempts at modelling impingement between the iliopsoas and acetabular component, and no attempts at modelling this in a representative cohort of subjects. The purpose of this study was to develop a novel computational model for quantifying the impingement between the iliopsoas and acetabular component and validate its utility in a case-controlled investigation.

Aims

The aim of this study was to evaluate the suitability of the tapered cone stem in total hip arthroplasty (THA) in patients with excessive femoral anteversion and after femoral osteotomy.

Introduction. Iliopsoas tendonitis after total hip arthroplasty (THA) can be a considerable cause of pain and patient dissatisfaction. The optimal cup position to avoid iliopsoas tendonitis has not been clearly established. Implant designs have also been developed with an anterior recess to avoid iliopsoas impingement. The purpose of this cadaveric study was to determine the effect of cup position and implant design on iliopsoas impingement. Materials. Bilateral THA was performed on three fresh frozen cadavers using oversized (jumbo) offset head center revision acetabular cups with an anterior recess (60, 62 and 66 mm diameter) and tapered wedge primary stems through a posterior approach. The relatively large shell sizes were chosen to simulate THA revision cases. At least one fixation screw was used with each shell. A 2mm diameter flexible stainless steel cable was inserted into the psoas tendon sheath between the muscle and the surrounding membrane to identify the location of the psoas muscle radiographically. Following the procedure, CT scans were performed on each cadaver. The CT images were imported in an imaging software for further analysis. The acetabular shells, cables as well as pelvis were segmented to create separate solid models of each. To compare the offset head center shell to a conventional hemispherical shell in the same orientation, the offset head center shell was virtually replaced with an equivalent diameter hemispherical shell by overlaying the outer shell surfaces of both designs and keeping the faces of shells parallel. enabled us to assess the relationship between the conventional shells and the cable. The shortest distance between each shell and cable was measured. To determine the influence of cup inclination and anteversion on psoas impingement, we virtually varied the inclination (30°/40°/50°) and anteversion (10°/20°/30°) angles for both shell designs. Results. The CT analysis revealed that the original orientation (inclination/anteversion) of the shells implanted in 3 cadavers were as follows: Left1: 44.7°/23.3°; Right1: 41.7°/33.8°; Left2: 40.0/17; Right2: 31.7/23.5; Left3: 33.0/2908; Right3: 46.7/6.3. For the offset center shells, the shell to cable distance in all the above cases were positive indicating that there was clearance between the shells and psoas. For the hemispherical shells, in 3 out of 6 cases, the distance was negative indicating impingement of psoas. With the virtual implantation of both shell designs at orientations 40°/10°, 40°/20°, 40°/30° we found that greater anteversion helped decrease psoas impingement in both shell designs. When we analyzed the influence of inclination angle on psoas impingement by comparing wire distances for three orientations (30°/20°, 40°/20°, 50°/20°), we found that the effect was less pronounced. Further analysis comparing the offset head center shell to the conventional hemispherical shell revealed that the offset design was favored (greater clearance between the shell and the wire) in 17 out of 18 cases when the effect of anteversion was considered and in 15 out of 18 cases when the effect of inclinations was considered. Discussion. Our results indicate that psoas impingement is related to both cup position and implant geometry. For an oversized jumbo cup, psoas impingement is reduced by greater anteversion while cup inclination has little effect. An offset head center cup with an anterior recess was effective in reducing psoas impingement in comparison to a conventional hemispherical geometry. In conclusion, adequate anteversion is important to avoid psoas impingement with jumbo acetabular shells and an implant with an anterior recess may further mitigate the risk of psoas impingement

Aims

This study investigates the use of the metabolic equivalent of task (MET) score in a young hip arthroplasty population, and its ability to capture additional benefit beyond the ceiling effect of conventional patient-reported outcome measures.

Discrepancy in leg length after total hip replacement has been associated with patient dissatisfaction. We prospectively studied 200 consecutive patients undergoing unilateral Charnley hip replacements to identify whether there is a demonstrable association between such disparity and postoperative function. Radiological measurements between defined points on the pelvis and femur of the operated hip were compared with the same points on the contralateral joint. A lengthening index was derived and statistical analysis used to compare this with validated functional outcome scores (Harris hip score and the SF36 Health Survey) and patient satisfaction. Our results showed no statistical association between leg-length discrepancy after hip arthroplasty and functional outcome or patient satisfaction

We compared patient satisfaction with surgeon satisfaction after total hip arthroplasty (THA) in a group of 193 patients (200 THAs, mean follow-up six years) using a visual analogue scale (VAS), and two objective and two subjective scoring systems. We also determined the survival rate with different endpoints. For the 121 hips available for clinical follow-up, we did not find a significant difference in satisfaction between patient and surgeon. In a subgroup with low patient satisfaction, the surgeon was more satisfied than the patient (p = 0.04). The correlation between the patient satisfaction VAS and the different subjective and objective scoring systems suggests that pain during activity is the most important factor for the patient. The survivorship at six years decreased from 96.6% to 83.7% if dissatisfaction (VAS > 20) was added to revision as an endpoint in the survival analysis. The patient satisfaction VAS provides additional information to evaluate the outcome of THA. We recommend the use of both subjective and objective scoring systems to evaluate the outcome of THA

Aims

Due to the opioid epidemic in the USA, our service progressively decreased the number of opioid tablets prescribed at discharge after primary hip (THA) and knee (TKA) arthroplasty. The goal of this study was to analyze the effect on total morphine milligram equivalents (MMEs) prescribed and post-discharge opioid repeat prescriptions.

Aims

Routine surveillance of primary hip and knee arthroplasties has traditionally been performed with office follow-up visits at one year postoperatively. The value of these visits is unclear. The present study aims to determine the utility and burden of routine clinical follow-up at one year after primary arthroplasty to patients and providers.

Aims

The primary aim of this study was to compare the hip-specific functional outcome of robotic assisted total hip arthroplasty (rTHA) with manual total hip arthroplasty (mTHA) in patients with osteoarthritis (OA). Secondary aims were to compare general health improvement, patient satisfaction, and radiological component position and restoration of leg length between rTHA and mTHA.

Aims

Despite few good-quality studies on the subject, total hip arthroplasty (THA) is increasingly being performed for displaced intracapsular fractures of the neck of femur. We compared outcomes of all patients with displacement of these fractures treated surgically over a ten-year period in one institution.